Schizophrenia

Question 1

What study is there for reliability in SZ diagnosis?

Answer 1

• Rosenhan (1973) got 8 mentally healthy volunteers to go to a mental health hospital and fake the symptom of “hallucinations”
• Once the ppts were in hospital they were told to behave normally, however their normal behaviour was seen as SZ, when they took notes in their diary they said it was “writing behaviour”
• The first patient was discharged after 7 days, the last after 52

Question 2

Evidence for a genetic basis for SZ? (percentages)

Answer 2

• Gottesman et al. found that the rate of SZ in the general population is 1%, for those with a first degree relative it’s 12% and for those with both parents SZ, 40%

Question 3

Evidence for a genetic basis for SZ (twin studies)

Answer 3

• Gottesman and Shields found a 42% concordance rate in MZ twins and 9% for DZ twins

Question 4

What is an issues with twin studies?

Answer 4

Twin studies assume that MZ and DZ twins experience the same shared environement, however we know this is not always the case. MZ twins are often treated as the same person, DZ twins are not. Furthermore, DZ twins may be different genders, leading to them often being treated differently

Question 5

What neurotransmitter is associated with SZ and how does it work?

Answer 5

• Dopamine is a neutotransmitter
• The dopamine hypothesis states that excessive activity of dopamine causes neurons to fire too often and it has been proposed that this excess of dopamine in the synapse is what leads to SZ

Question 6

Strength of the dopamine hypothesis

Answer 6

Practical applications as it can be used to create/prescribe drugs to treat SZ

Question 7

Weaknesses of the dopamine hypothesis

Answer 7

New drugs such as clozapine have been found to be more effective than traditional ones, and affect several neurotransmitters rather than just dopamine, such as seratonin. This indicated that the dopamine hypothesis may be too simplistic

Question 8

(Autopsies) - Strength of dopamine hypothesis

Answer 8

• Autopsies by Owen et al. and Falkai et al. have found increased number of dopamine receptors in schizophrenics, and an increased amount of dopamine in the left amygdala

Question 9

Neural correlates approach to what causes SZ

Answer 9

The neural correlates approach believes SZ is caused by structural/functional brain abnormalities - including enlarged ventricles. Enlarged ventricles are fluid filled gaps between brain areas, and associated with damage to the central brain areas and prefrontal cortex.

Question 10

Research support for neural correlates

Answer 10

Johnstone et al. found that schizophrenics had enlarged ventricles while non-sufferers did not, suggesting SZ is caused by the subsequent loss of brain tissue

Question 11

Weaknesses of neural correlates

Answer 11

• Research by Weyandt indicates that enlarged ventricles are only associated with the negative symptoms of SZ
• Research is inconclusive as to whether the enlarged ventricles cause SZ or are a result of it, especially as evidence points to those with enlarged ventricles being those who have not responded well to medication

Question 12

Psychological explanations of SZ: What is the double-bind?

Answer 12

Suggests SZ is a result of contradictory messages being sent from parents, such as turning away in disgust while saying “I love you”

Question 13

Weaknesses of double-bind

Answer 13

• Evidence to support this is lacking and only ever observational - there was never a study carried out, only inferences from clinical observations
• If evidence pointed to such a communication style being more common in SZ families, could this be a result of the SZ rather than its cause?
• Some studies (Liem) have found no difference in types of parental communiation between SZ and non-SZ families, and other studies have found no difference in degree to which verbal and non-verbal communication is in agreement

Question 14

Expressed emotion

Answer 14

• Where families persistently exhibit criticism, hostility, over-involvement, over-concern for recoving SZs, who react by relapsing and experiencing positive symptom of delusions

Question 15

Strength of EE explanation

Answer 15

Kavanagh condicted a meta-analysis finding that relapse rate for SZs returning to live with high EE families was 48% compared to 21% for those returning to low EE families

Question 16

Weaknesses of EE

Answer 16

• Not all patients who live in high EE homes relapse, and low EE doesn’t completely prevent relapse

Question 17

What is the biological approach to treating SZ?

Answer 17

Typical and atypical antipsychotic drugs are dopamine antagonists that block dopamine receptors to reduce positive symptoms

Question 18

What is the difference between typical and atypical antipsychotics?

Answer 18

Atypical antipsychotics are the second generation medication and act on other receptors as well as dopamine such as seratonin and glutamate

Question 19

Side effects of typical antipsychotics

Answer 19

Dry mouth, constipation, lethargy, tardive dyskinesia

Question 20

Side effects of atypical antipsychotics

Answer 20

Weight gain, cardiovascular issues

Question 21

Two reasons why atypical antipsychotics are preferable

Answer 21

• Less involuntary movements and tardive dyskenesia
• Works on other non-dopamine receptors as well to reduce negative symptoms

Question 22

Strengths of drug therapies

Answer 22

• Leucht’s meta analysis found drug treatments more effective than placebo
• Studies have found atypical, such as clozapine, to be the most effective
• Cost-effective, medicate and move on

Question 23

Psychological treatments: CBT

Answer 23

• Assumes that dysfunctional thought processes are the cause
• ABC (DE) model (Ellis), DE is logically Distrupting, Effect of this
• Reality testing, getting the patient to demonstrate their irrational beliefs are not real

Question 24

Psychological treatments: Family therapy

Answer 24

• Attempts to improve home situation for patient
• Family centered treatment
• Family educated on symptoms, communication improved, problem-solving techniques taught

Question 25

Psychological treatments: Token economies

Answer 25

• Based on skinner’s operant conditioning
• Designed to make behaviour manageable within hospital and prepare patient for life in the community

Question 26

CBT for SZ: AO3

Answer 26

• Evidence shows it may lead to a reduction in both positive and negative symptoms
• No unpleasant side effects
• High cost, highly trained therapist required
• Dropping out is common due to negative symptoms and high cost

Question 27

Family therapy for SZ: AO3

Answer 27

• Leff’s study found outpatient relapse within 9mo was 8% with family therapy, 50% otherwise - rising to 50% after 2 years and 70% for those with no family therapy, only standard outpatient care
• It is about improving and making symptoms more manageable, preventing hospitalisation, symptoms are still present
• Practical issues, requires whole family buy-in, long treatment up to a year, may feel like blaming family

Question 28

Token economies for SZ: AO3

Answer 28

• Limited evidence other than meta analysis to suggest adaptive behaviour is improved
• More about managing patients rather than actively treating them
• Dehumanising, unethical, may make care unecessarily uncomfortable

Question 29

Cochrane and Sashidharan

Answer 29

• Cochrane and Sashidharan examined diagnosis rates of schizophrenia in the UK.
• They compared the rates in people of African-Caribbean origin to the rest of the population.
• They found that those of African-Caribbean origin were seven times more likely to be diagnosed, despite no higher prevalance in the carribean itself