schizophrenia

Question 1

what is the ao1 for bio explanation of Sz (genetics)

Answer 1

family studies - strong relationship between degree of genetic similarity and shared risk of SZ. Gottesman- aunt Sz 2% sibling 9% identical twin 48%
candidate genes- sz polygenic, aetiologically heterogenous- Ripke- 108 genes linked Miyakawa- sz defective PPP3CC gene Brown- link paternal age, risk of Sz

Question 2

what is ao3 for bio explanation of Sz (genetics)

Answer 2

-research support- Hilker et al- 33% concordance MZ 7% DZ
- x can’t be sole factpr- concordance rate MZ twins 40-60% despite genetically identical- individual has predisposition to SZ?

Question 3

what is ao1 for biological explanation of Sz (neural correlates)

Answer 3

original dopamine hypothesis (hyperdopamingeria of subcortex) high dop acitvity in subcortex associated with hallucinations/ speech poverty
updated dopamine (hypodopamingeric) low DA in prefrontal cortex (responsible for thinking) explains negative symptoms
enlarged vesicles- large fluid filled gaps between areas, associated with damage to central brain/prefrontal cortex which links with :( symptoms

Question 4

what is ao3 for bio explanation of SZ (neural correlates)

Answer 4

• dopamine hypothesis has practical app- led to treatment better than neuroleptics at relieving schizophrenic behaviour- help know neurotranmsitter role
• x may be other neurotransmitters - clozapine more effective than traditional ones and targets serotonin and dopamine

Question 5

what is ao1 for bio treatment of Sz

Answer 5

typical antipsychotics- combat positive symptoms e.g. chlorpromazine- dopamine antagonist bind to D2 receptor to reduce their action, normalises neurotransmission so postsynaptic neuron get less dopamine so less hallucination/delusion
atypical - combat positive and negative e.g. clozapine blocks dopamine, serotonin and glutamate- rapidly dissociates D2 receptors so normal Dop distribution. lowers side effects e.g tardive dyskinesia. Risperidone developed due to death with blood condition of clozapine. bind to Dop and sero receptor, stronger so smaller dose

Question 6

what is the ao3 for bio treatment of Sz

Answer 6

• supporting evidence - Lecht et al patients remaining on antipsychotics 27% chance relapse 64% placebo tho - x Meltzer - clozapine more effective than atypical, works 30-50% treatment resistant cases
  -x drugs= palliative- treat symptom not cause= revolving door phenomenon - discharge, readmitted. meds= feel better so stop= worsen
• x side effect - atypical = dizziness, weight gain, tardive dyskinesia

Question 7

what are the positive and negative symptoms of Sz

Answer 7

+= hallucinations (sensory experience with no basis in reality, voices may instruct harmful action) delusions= belliefs with no basis in reality- of persecution= believe others want to harm, of grandeur- important person control- believe under control of others
-= speech poverty (lower amount and quality of speech - short empty replies) avolition= lack motivation everyday tasks, unwilling carry goal directed behaviour

Question 8

what makes it hard to diagnose sz

Answer 8

Rosenhan- 12 pseudo patients diagnose with Sz in remission and 1 with manic depression. All staff actually mentally sane and only said heard voices to be admitted. Suggests issues on diagnosing based on DSM in 1970s

Question 9

what is ao3 for comorbidity (validity issues)

Answer 9

• research support- Buckley half sz pateints had diagnosis of depression (50%) or substance abuse (47%)- people with Sz commonly obtain other mental illnesses
  x Goldman- 50% Sz cases have comorbid med condition so may struggle with treatment due to other physical/mental issues

Question 10

what is ao1 for comorbidity (validity issues)

Answer 10

-more than 1 disorder existing alongside primary diagnosis
2 conditions frequently diagnosed together but might just be hard to tell difference between conditions
e.g. personality disorder + Sz frequently together

Question 11

what is ao1 for symptom overlap (validity issues)

Answer 11

e.g. bipolar and SZ share delusions and avoliton. using international classification for disease (ICD), patient may be diagnosed SZ but use DSM may be bipolar

Question 12

what is ao3 for symptom overlap (validity issues)

Answer 12

-conflicting research - serper found even tho considerable overlap between SZ patient and cocaine abuse, could still make accurate diagnosis as can differentiate

Question 13

what is ao1 for gender bias (reliability issue)

Answer 13

men more likely to be underdiagnosed
Broverman- clinicians in US equated mentally health adult behaviour with mentally healthy male behaviour showing androcentrism. Tendancy for women to be perceived less mentally healthy as don’t show male behaviour

Question 14

what is ao3 for gender bias (reliability issue)

Answer 14

research support- Loring+Powell randomly select 290 m+f psychiatrists. found that 56% patients diagnosed sz when male and 20% when female- shows sz diagnosis affected by gender patient + clinician
x females tend develop Sz 4-10 yrs later than males and more likely develop postnatal Sz- questions sz diagnosis validity

Question 15

what is ao1 for culture bias (reliability issue)

Answer 15

variation in countries when diagnose Sz
e.g western culture- tendancy to overdiagnose ethnic minorities. Harrisons research found those of west Indian origin over diagnosed by white doctors in bristol - ethnic minorities misinterpreted.

Question 16

what is ao3 for culture bias (reliability issue)

Answer 16

-research support- Escobar= white psychiatrists over interpret balck people symptoms during diagnosis. due to differences in language/mannerisms?
x doesn’t acknowledge role of bio- study found children with afrocaribbean mother who had flu when pregnancy hadb88% more likelyhood of sz development- culture bias=reductionist

Question 17

Psych treatment for Sz- ao1 for CBT

Answer 17

sz due to delusions due to faulty interpretation
changes maladaptive thinking to modify and improve systems 5-20 sessions
understand symptom by normalisation (explain hearing voices is ordinary experience)
Turkington treated paranoid client by acknowledging anxiety and explaining less scary situations
CBTp aims establish link to sufferer’s symptoms and level of functioning. Cog techniques involved: distract from intrusive thought, change social activity, relaxation techniques

Question 18

Psych treatment for Sz- ao3 for CBT

Answer 18

• works for those who don’t respond other treatments- Sensky = CBT effective when drug treatments werent. could see improvements 9mths after ended
• supporting reserach - CBTp = fewer postive symptoms and recover to greater degree than antipsychotics- Drury et al- 25-50% reduction in patient recovery time given antispychotic + CBT
  x may not benefit everyone- Kingdon- 142 sz patients not suitable for CBT and older less suitable . Learning difficulties

Question 19

what is ao1 for psych treatment of Sz- family therapy

Answer 19

-based on family dysfucntion affects sz development used alongside drugs
aims to reduce frustration and EE
therapist meets family member and patient for open productive discussion and educate family bout Sz and expectations
encourages family to develop problem solving and communication skills

Question 20

what is ao3 for psych treatment of sz- family therapy

Answer 20

• x nature of therapy cause problems- emphasises openess but family may be reluctant to share due to family tension- cant tackle communication issue
• cost effects- decrease relapse and hospitalisation. £1,004 cheaper than drugs alone
• useful for those who lack awareness of illness or can’t speak coherently as family members can assist and have valuable insight in patient mood and behaviour

Question 21

what is ao1 for token economies

Answer 21

example of behaviour modification based on OC
tokens=secondary reinforcers as exchanged for reward. 3 categories of instituional behaviour can be tackled: personal care, condition related behaviour and social behaviour
token given immediately after desirable behaviour and swapped for rewards delayed= less effective

Question 22

what is ao3 for token economies

Answer 22

• supporting evidence- Glowack review 7 studies all showed less negative symptoms
• x ethical issues - professional power to control other behaviour so can impose social norms. can restrict availability of pleasure to people who don’t behave desirably e.g already ill experiencing distressing symptoms have worse time- benefits outweigh impact on freedom
  -x short lived effects - desirable needs reinforcement so release into community = reinforcement ends. only effective in hospital setting

Question 23

ao1 for psych explanation of sz- family dysfunction

Answer 23

Fromm-Reichmann psychodynamic explanation= schizophrenogenic mothers (cause sz). cold, rejecting and controlling causing climate of tension and secrecy = distrust and delusions
Double bind theory- child regularly trapped by fear doing wrong. conflicting message about wrong, cant express feelings of unfairness. ‘get it wrong’ punished by withdrawal of love so learn world confusing and dangerous = disorganised thinking and delusions
expressed emotion - type of fam communication involving: verbal criticism, hostility and over involvement

Question 24

what is ao3 for family dysfunction - psych explanation of sz

Answer 24

• supporting evidence- found sz adult likley to have insecure attachment. and 69% women 59% men history of abuse - family dysfunction increases vulnerability
• x ethical issues blaming parents - socially sensitive creating additional stress for parent already seeing sz child and taking responsibilty.- research controversial?
• x poor evidence- schizophrenogenic/double bind based on clinical observation of patients and informal assessment of personalities of patients mums - cant explain link between child trauma and sz

Question 25

what is ao1 for cog explanations (psych explanation for sz)

Answer 25

dysfunctional thought processing= lower level of info processing in some brain suggesting impaired cognition. Frith found 2 types:
-meta representation (cog ability to reflect on thoughts/behaviour) leads to hallucinations - dysfunction here disrupts ability to sensation of hallucinations and thought insertion
-central control (ability to suppress auto responses when doing deliberate action) leads to speech poverty. people with sz have derailment of thoughts because each word triggers auto associations

Question 26

what is ao3 for cog explanations (psych explanations of sz)

Answer 26

• supporting evidence- people sz twice as long to name font colour in stroop. shows central control struggle as cant suppress association.
  -research support- O’carroll report cog impairment in 75% sz particularly memory, motor skill and intelligence- shows sz link with cog deficit
• x cause and effect?? found abnormal cognition in sz due to abnormal brain development linked with genetic deficiencies - bio factor??