Schizophrenia

Question 1

What is schizophrenia?

Answer 1

Schizophrenia is a profound disruption of cognition and emotion, which affects a person’s language, thought, perceptions and sense of self.

Question 2

What is meant by ‘positive’ symptoms of schizophrenia?

Answer 2

Positive symptoms: behaviours that have no psychological counterpart - they are in addition to a person’s ‘normal behaviour’.

Question 3

What is meant by ‘negative’ symptoms of schizophrenia?

Answer 3

Negative symptoms: Behaviours that are a reduction in ‘normal functioning’ - they take away from a person’s ‘normal’ behaviour

Question 4

What are the positive symptoms of schizophrenia?

Answer 4

Hallucinations, delusions and disorganised thinking

Question 5

What are hallucinations? What are the most common hallucinations?

Answer 5

Hallucinations are unusual sensory experiences.
-Can be related to environmental stimuli or completely random
-Hallucinations can occur in any of the senses
-Auditory hallucinations are the most common, e.g. hearing voices
-Visual hallucinations involve seeing things that aren’t there or seeing distorted facial expressions for example
-Hallucinations can also be olfactory (sense of smell) or tactile (touch)

Question 6

What are delusions? What are the most common delusions seen in people with SZ?

Answer 6

Delusions are strongly held false beliefs that are persistent even when there is evidence against them.

-Persecutory delusions: the belief that one is going to be harmed, harassed, etc by an individual or organisation i.e. believing that the police are after them, or that family members are special officers out to kill them (most common)

-Referential delusions: the belief that certain gestures, comments and environmental cues are directed at oneself i.e. believing that people are laughing at them (also common)

-Grandiose delusions: the belief that one has excessive fame, wealth or special powers.

Question 7

What is disorganised thinking? What are some examples of disorganised thinking common in those with SZ?

Answer 7

Disorganised thinking is the result of abnormal thought processes.

-Patient has trouble organising thought processes, which then manifests in speech. This can be quickly switching between topics (derailment), sometimes mid-sentence or speaking gibberish (word salad).

-People with SZ often report that their thoughts are not their own (thought insertion) and are believed to have been inserted by a third party.

-Answers to questions may be indirectly related or completely unrelated (tangentiality).

Question 8

What are the negative symptoms of schizophrenia?

Answer 8

Flat affect, avolition, alogia, anhedonia and catatonic behaviour

Question 9

What is the flat effect? (SZ)

Answer 9

-Reduction in range and expression of emotion, e.g. facial expression, eye contact, body language.
-Lack of prosody (intonation and tempo) in speech.

Question 10

What is avolition? (SZ)

Answer 10

-Difficulty beginning or keeping up with goal-directed activity

-Loss of motivation to carry out day to day tasks

-Andreason (1982) identified 3 signs of avolition: poor hygiene, lack of energy, lack of persistence in work or education

Question 11

What is alogia? (SZ)

Answer 11

-The focus is on the reduction in amount and quality of speech.

-“Name as many animals as you can in 1 minute” - patients with speech poverty would struggle with this task, not through lack of knowledge, but just struggling to spontaneously produce the words.

Question 12

What is anhedonia? (SZ)

Answer 12

Loss of pleasure from all activity. This can include eating, social contact or activities the patient used to find pleasure in.

Question 13

What is catatonic behaviour? (SZ)

Answer 13

-Can range from fast, repetitive movements to no movement at all
-Unexpected gestures and loud utterances
-Echopraxia: mimicking the movement of those around them
-Rigid and unnatural postures - immobile for long periods of time

Question 14

What are some prodromal symptoms of schizophrenia? (Symptoms that indicate the onset of SZ).

Answer 14

-A loss of interest in usual activities
-Avoiding the company of others
-Staying away from work or school
-Being irritable and oversensitive
-Lack of interest in personal appearance and hygiene
-Generalised anxiety
-Mild degrees of depression

Question 15

What are the requirements for a schizophrenia diagnosis through DSM-V?

Answer 15

Symptoms occur over at least a 1 month period

6 months of deterioration of functioning

Two or more of the following have to be present for a diagnosis:

Delusions
Hallucinations
Disorganised speech
Disorganised/ catatonic behaviour
Negative symptoms

Question 16

What are the requirements for a schizophrenia diagnosis through ICD-10?

Answer 16

At least 1 month of symptoms being present to diagnose SZ

At least 1 symptom from category 1 (thought echo/broadcasting and delusions/hallucinations) OR at least 2 category 2 (persistent hallucinations and fleeting delusions, disorganised speech, catatonic behaviour or negative symptoms).

Question 17

A typical exam question is:
Q) Describe the characteristics of behaviour that lead to a diagnosis of schizophrenia [10]

How would you answer this?

Answer 17

-Outline the difference between positive and negative symptoms
-Explain 2 positive symptoms MINIMUM with detailed examples of each
-Explain 3-4 negative symptoms with detailed examples of each

Question 18

Another example of a typical exam question:
Q) Ronald has not been feeling the same lately. He told his friend Rory what he has been experiencing. Rory suggested that the behaviours Ronald is showing could be characteristics of schizophrenia.

Describe the characteristics of schizophrenia that Ronald may have told Rory he was experiencing. [15]

How would you answer this?

Answer 18

To get marks for AO1 (description -10 marks):
-Outline the difference between positive and negative symptoms
-Explain 2 positive symptoms MINIMUM with detailed examples of each
-Explain 3-4 negative symptoms with detailed examples of each

To get marks for AO2 (linking to question - 5 marks)
-Reference Ronald or Rory as the characteristics are described, e.g. “Ronald may have told Rory that he is hearing voices that he doesn’t recognise. Rory could believe that Ronald is experiencing auditory hallucinations”

Question 19

What are the two biological explanations of schizophrenia?

Answer 19

The genetic explanation and the dopamine hypothesis

Question 20

Explain the main idea of the genetic explanation of schizophrenia.

Answer 20

This explanation believes that schizophrenia is inherited through genes passed down through families. This is investigated through twin, family and adoption studies.

Question 21

What are some examples of supporting research for family studies of schizophrenia?

Answer 21

Kendler et al (1985) found that first degree relatives of those with schizophrenia are 18 more times at risk than the general population.

Kety et al (1962) The Copenhagen high risk study:
207 children whose mothers had schizophrenia (high risk group) and 104 children with healthy mothers (low risk group) aged between 10-18 years old were matched based on age, gender, their parent’s socio-economic status, and whether they lived in an urban or rural setting. Schizophrenia was found in 16.2% of the high risk group and only 1.9% of the low risk group.

Question 22

What are some examples of supporting research for twin studies of schizophrenia?

Answer 22

Gottesman and Shields (1972) found a concordance rate of 42% for MZ (identical twins) and 9% concordance rates for DZ (fraternal twins).

Torey (1992) argued that twin studies were inadequate. He found from re-assessing eight previous studies that the concordance rate for the MZ twins was 26% compared with only 6% for DZ.

Cardno et al (1999) found a 40% concordance rate in MZ twins compared with 5.3% in DZ twins.

Question 23

What are some examples of supporting research for adoption studies of schizophrenia?

Answer 23

Heston (1966) compared 47 children of schizophrenic mothers, who were adopted into non-SZ families, before the age of one month with a control group of 47 children (with no biological SZ mother) raised by non-SZ families. 10% of the children with schizophrenic mothers developed it themselves whereas none of the children from the control group did.

Tienari et al (1987) compared 112 cases of adopted children who had biological mothers who had been diagnosed with schizophrenia with 135 adopted children who had non-schizophrenic biological mothers. 7% of the 112 children whose biological mothers had SZ developed schizophrenia compared to 1.5% of the control group.

Question 24

A typical exam question for the genetic explanation of schizophrenia is:
Q) Briefly describe one biological explanation for schizophrenia [5]

How would you answer this?

Answer 24

-Introduce the explanation, i.e. “This explanation believes that schizophrenia is inherited through genes passed down through families.”
-Explain that SZ is explored through family studies, twin studies and adoption studies
-Give examples of research (you only have to remember one or two from each), what they did, what they found and why this suggests SZ is genetic

Question 25

Another typical exam question for the biological explanations of schizophrenia is:
Q) Evaluate one biological explanation of schizophrenia [10]

How would you evaluate the genetic explanation of SZ?

Answer 25

+ve Supporting evidence
P: One strength of the genetic explanation of SZ is that there is research on families that supports the influence of genes on the onset of SZ.
E: For example, Gottesman (1991) found that the closer the genetic relationship to someone with SZ, the higher the likelihood of SZ developing. For example, the occurrence of SZ in the general population is approximately 1%, but if you have a parent with SZ, this jumps to 6%.
C: However, research has shown that 63% of people diagnosed with schizophrenia do not have any family history of schizophrenia in first-degree (parents and siblings) or second-degree (grandparents, aunts, and uncles) relatives.
L: Therefore, even though Gottesman’s research suggests that there is a genetic influence on the development of SZ, the findings across studies are inconsistent, leading us to question the reliability of the genetic explanation of SZ.

-ve Hard to separate nature and nurture
P: One weakness of the genetic explanation of SZ is that it is hard to separate nature and nurture.
E: Family studies/twin studies - participants share similar or the same environment as they live together
E: Therefore it is hard to know whether the development of SZ is down to shared genetics or a shared environment
L: This is a weakness of the genetic explanation as…

-ve Concordance rates are not 100%
P: One weakness of the genetic explanation is that the concordance rates within twin studies are not 100%.
E: Cardno et al (1999) - concordance rate of less than 50%
E: This means that there must be another influence of the development of SZ, not just genetics.
L: This is a weakness of the genetic explanation of SZ, as it fails to provide a full explanation of the cause of SZ, as clearly genetics only play a part in the onset of SZ and other factors must be considered.

Conclusion:
State whether or not the genetic explanation is a useful explanation of the development of SZ. Why/why not? How could it be improved?

Question 26

Explain the initial hypothesis of the dopamine explanation of schizophrenia.

Answer 26

The brains of schizophrenic patients produce more dopamine than normal brains. It is this increased dopamine that is believed to be responsible for some of the symptoms of the disorder.

Question 27

What supporting evidence is there for the initial dopamine hypothesis of SZ?

Answer 27

Falkai et al (1988) Autopsies found that people with schizophrenia have a larger than usual number of dopamine receptors. They found an excess of dopamine in the left amygdala. Concluded that dopamine production is abnormal for schizophrenia compared to “normal controls”.

People suffering from Parkinson’s disease were given the drug L-Dopa. L-Dopa raises dopamine activity in the brain, reducing Parkinsonian symptoms. Patients began to develop schizophrenic symptoms.

PET scans: Lindstroem et al (1999) L-Dopa was administered to 10 patients with schizophrenia and 10 controls. L-Dopa stayed in the brain of schizophrenic patients for longer (their synapses didn’t absorb it because the D2 receptors inhibited the transmission). This suggests that schizophrenics have excess levels of dopamine because they have more dopamine receptors.

Drug use: LSD/Amphetamines (chemically similar to dopamine) increase the effects of dopamine in the brain. Large quantities lead to delusions and hallucinations - characteristics associated with SZ. If drugs are taken by SZ patients, their symptoms get worse.

Question 28

What is the revised dopamine hypothesis of the dopamine explanation of schizophrenia?

Answer 28

Two pathways connecting the limbic system to the cortex and other structures have been found to be implicated in the development of positive and negative symptoms of SZ.

Question 29

What are the two pathways in the dopamine hypothesis that have been linked to the onset of SZ?

Answer 29

Mesolimbic pathway - positive symptoms
Mesocortical pathway - negative symptoms

The mesolimbic pathway runs from the VTA –> NTA. Too much dopamine in this pathway causes overstimulation, leading to positive symptoms like hallucinations and delusions. Antipsychotic drugs that reduce dopamine transmission (D2 receptors) target this pathway, reducing positive symptoms.

The mesocortical pathway runs from the VTA –> frontal lobe. This pathway is important for emotional response and motivation. Not enough dopamine in this pathway (D1 receptors) leads to the negative symptoms of SZ.

Question 30

How can the dopamine hypothesis be applied to methods of modifying schizophrenia?

Answer 30

Dopamine hypothesis = Antipsychotics

Antipsychotics are drugs developed to treat disorders like SZ by targeting the release of neurotransmitters at the synapse. Typical antipsychotics were developed based on the dopamine hypothesis and work by blocking the transmission of dopamine on the postsynaptic neuron, which leads to a reduction in neural activity. This then leads to a reduction in positive symptoms like hallucinations and delusions.

Question 31

A typical exam question for the dopamine explanation of SZ is:
Q) Describe one biological explanation for schizophrenia [10]

How would you answer this?

Answer 31

-One explanation for schizophrenia is the dopamine hypothesis.
-Initially it was believed… (briefly explain the initial dopamine hypothesis - the idea of too much dopamine). Give one piece of evidence to support this e.g. Falkai (1988) Autopsies.
-However, the dopamine hypothesis has advanced in recent years.
-Two pathways have been found to be implicated in the development of positive and negative symptoms of SZ
-Explain what the two pathways are and the difference in dopamine transmission.

Question 32

Another typical exam question for the dopamine explanation of SZ is:
Q) Evaluate one biological explanation of schizophrenia [10]

How would you answer this?

Answer 32

+ve Supporting evidence
P: One strength of the dopamine hypothesis as an explanation for SZ is that there is evidence to support it.
E: Choose one of the studies, e.g. Falkai’s autopsies, drug use, Parkinson’s
C: How can you critique this study? (only explains positive symptoms of SZ and not negative, there are issues with post mortems, etc)
L: Therefore, even though there is research supporting the link between high dopamine levels and the onset of SZ… (summarise your point - is this explanation useful? why/why not?)

-ve Reductionist
P: One weakness of the dopamine hypothesis is that it could be said to be reductionist.
E: Why is the DA hypothesis reductionist? Is it too simple to suggest that SZ is caused only by dopamine? (doesn’t take into account environmental factors, could mention the Diathesis Stress Model, biased towards nature)
C: Why could reductionism be a strength? (allows for scientific study, easier to study one part)
L: Therefore, even though it can be argued that the dopamine hypothesis as an explanation of SZ is too simplistic, reductionism can be a benefit, as it allows us to understand a potential cause of SZ from a scientific viewpoint.

+ve Practical applications
P: Another strength of the dopamine hypothesis is that it influenced the development of drug therapy for SZ.
E: For example, first generation antipsychotics were developed as dopamine antagonists, which target the overproduction of dopamine. These were found to be effective against positive symptoms. Second generation antipsychotics were developed later with a focus on tackling the negative symptoms as well as the positive symptoms.
E: This means that drugs were developed based on the dopamine hypothesis, as they tackle both high and low levels of dopamine in the different pathways of the brain.
L: This is a strength, because it means that the dopamine hypothesis is a useful explanation of SZ, as it has led to a successful therapy.

Conclusion
-State whether or not you believe the dopamine hypothesis is a useful explanation of SZ and why.

Question 33

What are the two individual differences explanations of schizophrenia?

Answer 33

Psychodynamic approach and cognitive approach.

Question 34

Explain the main ideas of the psychodynamic explanation of schizophrenia.

Answer 34

This explanation is based on Freud’s psychodynamic principles of the unconscious mind and the tripartite personality. It explores fixation, regression, losing touch with reality and the schizophrenogenic mother.

Question 35

Explain the idea of fixation in the psychodynamic explanation of SZ.

Answer 35

During the oral stage, the libido receives satisfaction from stimulation of the lips and mouth. Most of the time, the libido’s urges are satisfied by breastfeeding. If an infant receives too much or too little oral stimulation during this phase, they may become fixated. Freud proposed that schizophrenic individuals are fixated in the first one to two months of the oral stage in psychosexual development.

Question 36

Explain the idea of regression in the psychodynamic explanation of SZ.

Answer 36

Regression - an ego defence mechanism that involves the movement back in psychological time when we are faced with anxiety to an earlier stage (specifically the oral stage for schizophrenia)

If as an adult an individual experiences excessive amounts of stress, they may regress back to to the oral stage. This may just be temporary or may continue over the longterm.

Question 37

Explain the idea of losing touch with reality in the psychodynamic explanation of SZ.

Answer 37

In the oral stage, the ego isn’t well developed. The role of the ego is to control the id’s impulses and to balance the id’s demands with the morality of the superego.

If an individual regresses back to the oral stage where the ego doesn’t effectively exist, then there is nothing stopping the id from running free. Symptoms of SZ, such as hallucinations and delusions, supposedly represent the activities of the unchecked id. The person loses touch with reality, being unable to distinguish between reality and their desires and fantasies.

Question 38

Explain the idea of the schizophrenogenic mother in the psychodynamic explanation of SZ.

Answer 38

Schizophrenogenic mother - a mother who is not capable of drawing a clear boundary between herself and her child or differentiating between her own needs and the needs and emotions of her child.

Characteristics of SZ mother:
-Cold and distant
-Overprotective
-Rejecting
-Fearful of intimacy

Fromm-Reichmann (1948) The overprotectiveness in contrast with the emotional distance creates confusion in the child. This stifles their emotional development and the distrust and resentment towards the mother leads to the development of psychotic symptoms.

Question 39

What evidence is there for/against the idea of the schizophrenogenic mother?

Answer 39

Mednick (1984) Identified 207 children considered to be at a high risk of developing SZ due to being raised by mothers who were cold, rejecting and emotionally aggressive. The high risk participants were compared to a control group of 107 children. None of the participants or their mothers had a diagnosis of SZ at the start of the study. Within 10 years, 17 of the high risk group were diagnosed with SZ, and only 1 in the control group.

Mischler (1968) observations during family therapy found that mothers talking to daughters with schizophrenia were aloof and unresponsive, but the same mothers were normal and responsive when talking to healthy children.

Question 40

A typical exam question for the psychodynamic explanation of SZ is:
Q) Briefly describe one individual differences explanation of schizophrenia [5]

How would you answer this?

Answer 40

-Brief intro: how this explanation of SZ stems from Freuds psychodynamic principles of the unconscious mind and the tripartite personality
-Explain process of fixation in the oral stage, leads to regression in adulthood in face of stress, which leads to the loss of touch with reality and SZ symptoms
-IF TIME: Explain schizophrenogenic mother idea (Fromm-Reichmann) and how the characteristics of the SZ mother lead to onset of symptoms.

Question 41

Another typical exam question for the psychodynamic explanation of SZ is:
Q) Evaluate one individual differences explanation of schizophrenia [10]

How would you answer this?

Answer 41

+ve Supporting evidence
P: One strength of the psychodynamic explanation of SZ is that there is supporting evidence.
E: Brief outline of Mednick’s (1984) research - what he did and what he found
C: However, research by Mischler showed that… (what did Mischler find?)
L: Therefore, even though there is some research to suggest that growing up in the presence of a schizophrenogenic mother could lead to the onset of SZ in her children, the evidence is inconsistent and suggests that having a child with SZ could lead to changes in the mother’s personality, making it unclear what the role of the schizophrenogenic mother is in the onset of SZ.

-ve Socially sensitive
P: One weakness of the psychodynamic explanation of SZ is that it is socially sensitive.
E: Fromm-Reichmann’s theory of the ‘schizophrenogenic mother’ puts the blame of an individuals development of SZ entirely on the mother.
E: This could cause harm to the mother, as she would feel guilty for causing her child’s illness. Already a difficult situation having a child with SZ.
L: Ethical issues - stress of guilt could be a trigger for SZ for the mother or other mental health disorders, such as depression.

-ve Unfalsifiable
P: Another weakness of the psychodynamic explanation of SZ is that it is unfalsifiable.
E: The explanation cannot provide any scientific evidence as the hypotheses are not testable.
E: Can we say for certain that SZ is being caused by a dominant id (oral fixation)?
L: Cannot demonstrate the concepts scientifically - causes a lack of trust in the explanation, as it cannot explain something complex like SZ.

Question 42

Explain the main ideas of the cognitive explanation of schizophrenia.

Answer 42

For people with schizophrenia, the cognitive processes that we use to interpret the environment around us are faulty.
-Attention
-Perception
-Connections to schemas

This leads to an output of SZ symptoms:
-Halluciations
-Delusions
-Disorganised thinking

Question 43

How does the cognitive explanation of SZ explain hallucinations?

Answer 43

People with SZ fail to activate their schemas, which is an important process that helps us to identify what information is important in our environment based on past experiences. Internal thoughts are often not recognised as coming from within (memory/‘inner voice’) and are thought to be from an external source, which can explain auditory hallucinations.

Question 44

How does the cognitive explanation of SZ explain delusions?

Answer 44

People with schizophrenia have an unusual ‘attentional bias’ - this means that they interpret stimuli in their environment as being threatening or dangerous, even when they may not be.
-I.e. paranoid delusions may be caused by an individual misinterpreting an event as threatening due to the excessive amount of processing it receives.

Question 45

How does the cognitive explanation of SZ explain disorganised thinking?

Answer 45

People with schizophrenia struggle to focus their attention selectively. This inability to filter the incoming information means that they attempt to process too much irrelevant information. They are overwhelmed with external stimuli that they are unable to process effectively. This could explain symptoms like disorganised thinking, where the SZ seems to jump from one idea to the next with no clear connection.

Question 46

How does the cognitive explanation of SZ explain negative symptoms?

Answer 46

Beck et al (2008) used the cognitive triad to explain the development of negative symptoms of SZ, which the cognitive approach had struggled to explain up to this point.

Negative views about one’s self - dysfunctional beliefs around their performance and ability to experience pleasure
Negative views about the future - people with SZ hold cynical and gloomy views of the future

The dysfunctional filters mentioned earlier only allow negative messages to to be perceived, which perpetuate the negative views mentioned above. This leads to symptoms like flat affect, avolition and anhedonia.

Question 47

What evidence is there to support the idea of attention deficits in people with SZ?

Answer 47

Barch et al (1999) Two groups of participants (people with SZ vs people without SZ) completed the Stroop test. It was found that people with SZ were slower and made more mistakes on the Stroop test compared to controls.

Difficulties with the Stroop test can be used as evidence of people with SZ having defective attentional filters (find it difficult to switch attention between colour and letters of the word).

Frith (1979) Attention Deficit Theory:
Schizophrenia is the result of a faulty attention system. Preconscious thought contains a huge amount of information from our senses that would usually be filtered. If this filtering process doesn’t happen, it leads to a sensory overload. Frith says that this accounts for the positive symptoms of SZ, such as hallucinations, delusions and disorganised speech.

Question 48

How can the cognitive factors explanation be applied to methods of modifying schizophrenia?

Answer 48

Cognitive explanation = CBTp

CBTp aims to change the maladaptive thought patterns of people with SZ to help reduce symptoms and help them to organise their thoughts in a more rational way. For example, CBT uses the ABC model to help rationalise thoughts. Activating events lead to irrational beliefs that then create undesirable consequences (SZ symptoms).

Question 49

A typical exam question for the cognitive explanation of SZ is:
Q) Evaluate one individual differences explanation of schizophrenia [10]

How would you answer this?

Answer 49

-ve Reductionist
P: One weakness of the cognitive explanation of SZ is that it is reductionist.
E: Reduces complex disorder like SZ down to cognitive processes - e.g. explains symptoms as a product of faulty processes, fails to consider other processes (biological/social)
C: However, reductionism makes SZ easier to study scientifically, e.g. lab experiments like the Stroop test, which support the explanation
L: Therefore, although the cognitive explanation could be considered too simple, being reductionist helps provide objective evidence for SZ and makes it easier to study.

+ve Practical applications
P: One strength of the cognitive explanation of SZ is that it has practical applications.
E: CBT has been found to be successful in the management of SZ symptoms.
E: Patients are taught to rationalise their faulty processes, e.g if they have delusions, they are helped to see the evidence against them. Helps with living with the symptoms, but not a cure.
L: This is a strength, because it shows that the explanation is useful and strengthens the validity of the explanation.

-ve Incomplete explanation
P: Another weakness of the cognitive explanation of SZ is that it is an incomplete explanation of SZ.
E: Alone, the cognitive explanation struggles to explain SZ entirely. It can explain the onset of positive and negative symptoms, but struggles to identify the origin of the disorder.
C: However, if combined with a biological explanation of SZ, it could provide a more complete explanation - e.g. genes/dopamine could lead to cognitive deficits, which lead to the symptoms.
L: Therefore, even though the cognitive explanation alone cannot provide a full explanation, when it is paired with a biological explanation, it provides a more holistic view of SZ.

Conclusion:
Is the cognitive explanation useful? Why/why not? How can it be improved?

Question 50

What are the two social psychological explanations of SZ?

Answer 50

Dysfunctional families and sociocultural factors.

Question 51

What are the main ideas behind the dysfunctional families explanation of schziophrenia?

Answer 51

The idea that family relationships could be a casual factor in the development of SZ. A development on psychodynamic theories like the schizophrenogenic mother BUT still credible. Not based on unconscious concepts, but looking at the dynamic of family relationships = social psychological.

There are two key concepts: the double bind theory and expressed emotion (EE).

Question 52

What is the double bind theory? (SZ)

Answer 52

Bateson (1956) proposed that the symptoms seen in individuals with schizophrenia were the result of communication difficulties within the family, especially between parents and their children. These communication difficulties are caused by ‘conflicting messages’.

Question 53

What are conflicting messages? (SZ)

Answer 53

Conflicting messages are when a person’s words do not match their behaviour/actions. For example, if a father tells his child, “I’d love to hear what you did at school today” while at the same time focusing on the television and not properly listening to what his child is saying, the child receives conflicting messages. These communication contradictions incapacitate the child’s ability to respond effectively, as the verbal and nonverbal messages cancel each other out.

Question 54

How do conflicting messages link to the symptoms of schizophrenia?

Answer 54

Bateson believed that long-term exposure to these sort of communication contradictions means that the child develops some sort of internal conflict, as they internalise the double bind situation and can’t differentiate between the conflicting messages.

Bateson believed that this internal conflict eventually led to the manifestation of symptoms of schizophrenia, such as hallucinations and delusions, as a means to escaping the demands of the double bind situation.

Question 55

What is expressed emotion (EE)? (SZ)

Answer 55

EE is how you convey your feelings and thoughts toward a loved one living with schizophrenia.

Brown (1959) interviewed wives and parents of schizophrenic patients and found a relationship between EE and the likelihood of relapse. There are three key components of EE: critical comments, hostility and emotional over-indulgence.

Question 56

Describe the three key components of expressed emotion (EE)? (SZ)

Answer 56

-Critical comments - High EE caregivers tended to make critical comments about the behaviour of individuals with schizophrenia (e.g. ‘they are lazy’, ‘they don’t help around the house’), whereas low EE caregivers acknowledged behaviours were due to their illness.
-Hostility - this was noted during interviews with high EE caregivers. Hostility was thought to be due to the anger and rejection of the patient.

-Emotional over-involvement (EOI) - high EE caregivers often reported feelings of excessive self-sacrifice and overprotectiveness of the patient. They also reported feelings of guilt and this led to reparative efforts of emotional overinvolvement.

Question 57

What evidence is there to support EE? (SZ)

Answer 57

-Vaughn and Leff (1976) found 53% of those with schizophrenia who had high EE relatives relapsed within 9 months, whereas 12% of those with low EE relatives relapsed.

-Kavanagh (1992) found that schizophrenics in families with high EE were 4x more likely to release compared with those who live in families with low expressed emotion.

-McCreadie and Phillips (1999) failed to find higher 6 and 12 month relapse rates among individuals living in high EE homes.

Question 58

How can the dysfunctional families explanation be applied to methods of modifying schizophrenia?

Answer 58

Dysfunctional family = family therapy

Family therapy for SZ typically includes education, stress reduction, emotional processing and regulating as well as structured problem solving. The group will work together to improve their knowledge of the illness and its management. This helps to promote empathy and affective support, while also changing any unhelpful communication patterns that exist. This effectively reduces EE in the family home and lessens the chance of double bind experiences.

Question 59

A typical exam question for the dysfunctional families explanation is:
Q) Briefly describe one social psychological explanation of schizophrenia [5]

How would you answer this?

Answer 59

-Brief intro to dysfunctional families: family relationships could be a casual factor of SZ. One of the concepts within this is double bind/EE (choose either double bind or EE)
-Double bind:
-Explain the concept of conflicting messages and provide an example.
-The child doesn’t know how to respond
-This causes internal conflict
-This leads to the manifestation of positive SZ symptoms

-EE:
-High EE leads to relapse in people with SZ
-Explain the characteristics of a high EE household (critical comments, hostility, emotional over-involvement).
-Use an example of research, e.g. Vaughn and Leff (1976)

Question 60

Another typical exam question for the dysfunctional families explanation is:
Q) Evaluate one social psychological explanation of SZ [10]

How would you answer this?

Answer 60

+ve Practical application
P: A strength of the dysfunctional families explanation of schizophrenia is that it has practical applications.
E: Family therapy was developed from dysfunctional family explanation.
E: Family therapy improves communication in the family, this reduces double bind and EE, which also reduced relapse rates.
L: This is a strength because…

-ve Lack of scientific evidence
P: A weakness of the dysfunctional families explanation of schizophrenia is that there is a lack of scientific evidence.
E: When looking into dysfunctional families, Bateson used interviews as his main method of conducting research. This meant that any information obtained from participants was via self-reports.
E: The use of self-reports is an issue, because this leaves the research open to social desirability bias. This means that the findings may not be entirely accurate or valid, as the participants may have altered their behaviour to appear more likeable.
L: This is a weakness because…

-ve Cannot explain why SZ is diagnosed in adolescence
P: A weakness of the dysfunctional families explanation of schizophrenia is that it cannot explain why schizophrenia can also be diagnosed in adolescence.
E: Double bind and EE would occur in childhood (provide an example)
E: But symptoms of SZ don’t show until much later
L: Why is this a weakness? Question validity of explanation as would expect symptoms earlier?

Conclusion:
Is this explanation useful? Why/why not?

Question 61

What are the main ideas behind the sociocultural factors explanation of schizophrenia?

Answer 61

The sociocultural factors explanation of schizophrenia looks at how the sociocultural environment may be implicated in the development and maintenance of schizophrenia. (In simple terms, looking at how schizophrenia is caused by your environment). There are three factors: life events, urbanicity, social isolation.

Question 62

Explain the concept of life events. (SZ)

Answer 62

A life event is a major stress factor that has been associated with a higher risk of schizophrenic episodes.

The occurrence of a stressful life event, e.g. the death of a relative, job loss or the break up of an intimate relationship could trigger the illness. It is not known how stress triggers schizophrenia, although high levels of physiological arousal associated with neurotransmitter changes are thought to be involved (link to dopamine hypothesis).

Question 63

What evidence is there to support the idea that life events are linked to schizophrenic episodes?

Answer 63

Brown and Birley (1968) found that approximately 50% of people experienced a major life event in the 3 weeks prior to a schizophrenic episode. 12% of people reported one in 9 weeks prior to the episode.

Hirsch et al (1996) followed 71 schizophrenic patients over a 48 week period. Life events made a significant collective contribution in the 12 months preceding relapse rather than having a more concentrated effect in the period just prior to the schizophrenic episode.

Question 64

Explain the concept of urbanicity. (SZ)

Answer 64

Through most of history, the human population has lived a rural lifestyle, dependent on agriculture and hunting for survival. The world has experienced unprecedented urban growth in recent decades. Humans did not evolve to live in densely populated urban areas. It may be possible that urban living could account for some of the mental illnesses that we observe. One key finding is that the rate of schizophrenia in urban areas is much higher than in rural areas.

Question 65

What evidence is there to support the link between urbanicity and schizophrenia?

Answer 65

Krabbendam and Van Os (2005) Identified factors such as greater socioeconomic (occupation, education, income, wealth) difficulties for those living in urban areas, as well as environmental pollution, overcrowding, drug abuse and exposure to toxins.

A significant issue of living in a densely populated area is the greater amount of social stress, suggesting that poor social conditions creates stress that triggers SZ in some people.

Faris and Dunham (1939) reported a greater incidence of schizophrenia when comparing densely populated inner city areas with less populated outskirts of the city.

Van Os et al (2010) research shows a higher incidence of schizophrenia in people born and raised in urban areas.

Question 66

Explain the concept of social isolation. (SZ)

Answer 66

Social interaction is vital for healthy emotional and psychological development. Schizophrenics are often very socially isolated from others. They may have a few friends, be estranged from family and are more likely to live alone.

It has been suggested that those with schizophrenia find contact with others to be stressful, so they withdraw.
-Urbanicity and overcrowding can lead to social isolation
-This self-imposed social isolation may actually be implicated in the cause of symptoms or worsening of symptoms, as it means the individual does not get feedback about inappropriate thoughts and behaviours they have
-This lack of corrective feedback allows that individual to nurture these inappropriate ways of thinking and behaving, and so the strange behaviour can flourish unchecked.
-A lack of social interaction in some people may also mean that symptoms of SZ go unnoticed for a long time.

Question 67

What evidence is there to support the link between social isolation and schizophrenia?

Answer 67

Jones et al (1994) did a longitudinal study of 5362 people born in a specific week in March 1946. Between the ages of 16 and 43 years, 30 cases of schizophrenia were diagnosed. Those individuals diagnosed with schizophrenia were more likely to show solitary play preferences at ages 4 and 6 years old and at 13 years old were more likely to rate themselves at less socially confident.

Question 68

A typical exam question for the sociocultural factors explanation of SZ is:
Q) Describe one social psychological explanation of schizophrenia [10]

How would you answer this?

Answer 68

-Brief intro: Sociocultural factors are factors from the social environment that can increase the risk of development of SZ. Seen to be a trigger and work in a combination with other explanations (could mention Diathesis Stress)
-Outline all factors for depth and range of points
-Explain the three key concepts and go into detail for each, providing research examples.

Question 69

Another typical exam question for the sociocultural factors explanation of SZ is:
Q) Evaluate one of the social psychological explanations of schizophrenia [10]

How would you answer this?

Answer 69

+ve Supporting evidence
P: One strength of the sociocultural factors explanation of schizophrenia is that there is supporting evidence.
E: Choose one of the examples to use, e.g. Brown and Birley for life events or Faris and Dunham for urbanicity.
E: This suggests that urbanicity/life events plays a role in the development of SZ.
L: This is a strength because…

-ve No cause and effect
P: One weakness of the sociocultural factors explanation of schizophrenia is that a cause and effect relationship cannot be established.
E: CHOOSE EITHER:
-People with SZ often have small social circles as they find it difficult to make friends.
-Social drift hypothesis - people diagnosed with mental health disorders (like SZ) often find it difficult to maintain employment, so they may have to move into the inner city areas where it is cheaper to live.
E: CHOOSE EITHER:
-So, does social isolation cause SZ, or does having SZ make an individual isolated?
-So, does urbanicity cause SZ, or does having SZ lead to living in an urban environment?
L: This is a weakness because…

+ve Potential practical applications
P: Another strength of the sociocultural factors explanation of schizophrenia is that there are potential practical applications.
E: Jones et al (1994) found that individuals diagnosed with schizophrenia were more likely to show solitary play preferences at ages 4 and 6 years old and at 13 years old were more likely to rate themselves at less socially confident.
E: This suggests that to avoid the development of SZ in later life, we must reduce social isolation in children by encouraging them to play with others, or incorporating interventions in schools for those who seem to be struggling to engage with their peers.
L: This is a strength because…

Conclusion:
Is this explanation useful? Why/why not? How could it be improved?

Question 70

What are the two methods of modifying for schizophrenia?

Answer 70

Antipsychotics and CBTp

Question 71

What are antipsychotics? (SZ)

Answer 71

Antipsychotics - drugs used to reduce symptoms, particularly positive symptoms.

There are two types: typical and atypical.

Question 72

What are typical antipsychotics? How do they work? (SZ)

Answer 72

Typical (conventional) antipsychotics: The first generation of antipsychotic drugs. Introduced in the 1950’s, they were the first drug treatment for schizophrenia. They are dopamine antagonists (reduce the action of dopamine at the synapse).

Bind mainly to D2 receptors in the brain.

Strong affinity to D2 receptors - blocks dopamine by binding to receptor sites for a long period of time. Reduces the activity of the post-synaptic neuron.

This leads to the increase of DA released from the pre-synaptic neuron to begin with, until the DA levels in the vesicles are depleted, and there is a reduction in DA in the synapse.

Question 73

What are atypical antipsychotics? How do they work? (SZ)

Answer 73

Atypical antipsychotics: The second generation of antipsychotic drugs developed around the 1970’s. They were developed to improve the effects of reducing positive symptoms and to reduce side effects. Work on dopamine receptors as well as other neurotransmitters (mainly serotonin).

Atypical antipsychotics also target the D2 receptors but with a weaker affinity. This allows dopamine to bind to the post-synaptic receptors but at a slower rate.

The difference is that they also bind to serotonin receptors, which can help to reduce the negative symptoms through the reduction of the activity of serotonin in the mesocortical pathway.

Question 74

What three key areas can be used to evaluate antipsychotics as a treatment of schizophrenia?

Answer 74

Effectiveness, ethical implications and social implications.

Question 75

What evidence is there for/against the effectiveness of typical antipsychotics?

Answer 75

FOR:
-Cole et al (1964) - 75% of patients given typical antipsychotics were considered ‘much improved’ in comparison to 25% of those that received the placebo.
-Davis et al (1989) - typical antipsychotics had a short-term (first 6 months) beneficial effect in 75% of patients.
-Davis et al (1993) - typical drugs have long-term beneficial effects in 55-60% of patients.

AGAINST:
-Typical antipsychotics take several weeks to start reducing the positive symptoms and tend to have little impact on reducing negative symptoms.

Question 76

What evidence is there for/against the effectiveness of atypical antipsychotics?

Answer 76

FOR:
-Awad (1999) - atypical antipsychotics are effective with 85% of patients in comparison to 60% for typical antipsychotics.
-Bilder et al (2002) - atypical antipsychotics are as effective as typical for positive symptoms and MORE effective for reduction of negative symptoms.
-De Nayar et al (2003) - atypical antipsychotics are effective in over 1/3 of patients that didn’t respond to typical antipsychotics.

AGAINST:
Clozapine carries the risk of the development of a blood disorder called agranulocytosis (life threatening drop in white blood cells). Patents taking this must have regular blood tests to monitor for white blood cell problems. This could be a difficulty for the patient to adhere to (may lead to non-compliance due to effort required).

Question 77

What ethical implications do antipsychotics have that can be used for evaluation? (SZ)

Answer 77

Side effects: Both typical and atypical antispychotics have side effects. Although, typical antipsychotics tend to have more severe side effects. For example:
-Tardive dyskinesia (facial ticks)
-Parkinsonism’s (tremors and instability)
-Agranulocytosis (depletion of white blood cells)
-Seizures, weight gain, headaches, increased cholesterol, dry mouth, constipation
This may lead psychiatrists to consider cost vs benefit before prescribing antipsychotics. May the potential side effects be worse than the symptoms of SZ?

Consent: It has been questioned whether people experiencing severe hallucinations and delusions can give valid consent to taking antipsychotic medication.

Chemical straightjacket: The anti-psychiatry movement claims that antipsychotics are a ‘chemical straightjackets’. This means that they don’t actually work to improve the symptoms for the patient, but are a way to keep the patient under control. This raises an ethical issue if the drugs are being used as a way to improve compliance within psychiatric institutions and society, instead of being a way to alleviate the symptoms of SZ.

Question 78

What social implications do antipsychotics have that can be used for evaluation? (SZ)

Answer 78

Social revolution: The development of antipsychotics has said to revolutionise the treatment and care of people with SZ. It is seen as a social revolution as the patient can lead a relatively normal life within society, when previously they maybe have been confined to an institution. This also benefits society by reducing the costs associated with hospitalisation.

Is the cheapest option always the best option?: In comparison with other therapies and inpatient care, the prescription of antipsychotics is cheaper. This is good for the NHS who have a limited budget - and the best value for money treatment may not always be the best for the patient. However, by prescribing antipsychotics, it may mean that more patients can be treated when the budget may have limited them previously.

Could noncompliance be an issue for society?: If people with SZ do not take the medication they have been prescribed, they may become a danger to themselves or others. Tilhonen et al (2015) noted a 37x increase in suicide in patients who didn’t take their medication. The NCISH (2015) stated that 6% of total homicides committed between 2003-2013 in England were by people who had a history of SZ. Of these homicides, 29% of the people had been noncompliant of their medication before committing the murder.