Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

• Schizophrenia is a serious mental psychotic disorder characterised by a profound disruption of cognition and emotion.
• It is so severe that it affects a person’s language, thought and perception, emotions and even their sense of self.
• It is suffered by around 1% of the population, and found more commonly in men compared to women, cities compared to the countryside and working class compared to middle class people.

Question 2

How can one be diagnosed with schizophrenia?

Answer 2

• The DSM 5 states that you need to show at least two or more positive symptoms or one positive and one negative symptom for one month as well as extreme social withdrawl for six months to be diagnosed with schizophrenia.
• The ICD 11 states that you need to show one positive and one negative symptom or two negative symptoms for at least one month to be diagnosed with schizophrenia.

Question 3

What are the two types of schizophrenia?

Answer 3

• Type 1: Characterised by more positive symptoms. This type of schizophrenia shows better prospects for recovery.
• Type 2: Characterised by more negative symptoms. This type of schizophrenia shows poorer prospects for recovery.

Question 4

What is meant by a positive symptom of schizophrenia?

What are the 4 positive symptoms of schizophrenia?

Answer 4

Positive symptoms of schizophrenia are those which reflect an excess or distortion of normal functions. These include:

• Hallucinations (auditory, visual, olfactory (smelling), tactile): these are sensory experiences of stimuli that either have no basis in reality or are distorted perceptions of things that are there.
• Delusions: irrational, bizzare beliefs, such as being a historical figure or being persecuted by aliens, being under external control, etc.
• Disorganised speech: the individual has problems organising their thoughts and this is represented in their speech, this may include speaking gibberish or slipping from one topic to another.
• Grossly disorganised or catatonic behaviour: The inability or motivation to initiate or complete a task, possibly leading to problems of personal hygeine, being overactive, adopting rigid postures or aimlessly repeating the same behaviours.

Question 5

What is meant by a negative symptom of schizophrenia?

What are the 4 negative symptoms of schizophrenia?

Answer 5

A negative symptom of schizophrenia is that which appears a reduction or loss of normal functions which persist even during low or absent positive symptoms. These include:

• Speech Povert (Alogia): A reduction in the amount and quality of speech.
• Avolition: Difficulty in keeping up with a goal-directed activity due to sharply reduced motivation. Signs of avolition include poor hygiene, lack of energy and lack of persistence.
• Affective flattening: A reduction in the range and intensity of emotional expression, including facial expression, vocal tone, eye contact and body language.
• Anhedonia: A loss of interest or pleasure in most activities, or a lack of reactivity to normally pleasurable stimuli. Physical anhedonia refers to an inability to experience pleasures from things like food or sex, whilst social anhedonia refers to inability to experience pleasures from things like socialisation.

Question 6

How may the diagnosis of schizophrenia be unrelaible?

Answer 6

• Whaley (2001) found the inter-rater reliability between diagnosticians of schizophrenia to be as low as +0.11 using the DSM.
• Chenaiux et al (2009) found that between two psychiatrists attempting to diagnose schziophrenia in 100 patients with the DSM and ICD, one psychiatrist diagnosed 26 (DSM) and 44 (ICD), whilst the other diagnosed 13 (DSM) and 24 (ICD), demonstrating low inter-rater reliability in the diagnosis of schizophrenia.

Question 7

What 3 pieces of research evidence suggest the diagnosis of schizophrenia is invalid?

Answer 7

• Research support suggests that one is more likely to be diagnosed with schizophrenia under the ICD when compared to the DSM.
• Rosenhan (1973) managed to get 8 pseudo patients to admit themselves to psychiatric hospitals. When in the hospital, the pseudo patients acted normally, but only 1 patient was discharged with schizophrenia in remission. This demonstrates low validity in the diagnosis of schizophrenia.
• Birchwood and Jackson (2001) found that 20% of patients show complete recovery, 10% show significant improvement, 30% show some improvement and 40% never recover, with 10% out of those who never recover killing themselves. This suggests poor predictive validity.

Question 8

What is co-morbidity?

How is this a weakness of the diagnosis of schizophrenia?

Answer 8

• The idea that two or more mental disorders occur together at the same time.
• Buckley et al. (2009) found that out of schizophrenia patients, 50% had depression, 47% had substance abuse, 29% had PTSD and 23% had OCD.
• This suggests that there is a difficulty in distinguishing between schizophrenia and other mental disorders. Therefore, they may be seen as a single conditon.

Question 9

How is there cultural bias in the diagnosis of schizophrenia?

Answer 9

• Pinto and Jones (2008) found that those with African and Carribean origins are more likely to be diagnosed with schizophrenia. This may be because Africa holds cultural beliefs in communication with dead ancestors, which might be seen as hallucinations elsewhere, a positive symptom of schizophrenia.

Question 10

What are the 3 genetic explanations for schizophrenia?

Answer 10

• Family studies: Gottesman (1991) found that if both parents had SZ, the offspring had a 46% chance of having it. In one parent had it, the liklihood was 13% and if a sibling had it, the likihood was 9%.
• Twin studies: Gottesman (1991) found a 48% concordance rate for MZ twins and a 17% concordance rate for DZ twins.
• Adoption studies: Tienari et al (2001) found that out of 164 adoptees with biologically SZ mothers, 11 had SZ themselves. Suggests a link between genetics and SZ.

Question 11

What candidate genes are associated with schizophrenia?

Answer 11

• PCM1

Question 12

What are 3 weaknesses of the genetic explanation for schizophrenia?

Answer 12

• There may be a difficulty in separating nature and nurture. For example, MZ twins are treated identically, making it difficult to separate upbringing from genes.
• Biologically reductionist, avoids other explanations such as psychological factors and environmental upbringing.
• SZ can be explained via the diathesis-stress model: people may have a genetic vulnerability to SZ but this is only triggered through the environment.

Question 13

What are neural correlates?

Answer 13

• Neural correlates are measurements of the structure or function of the brain that have a relationship with schizophrenia. These may also refer to how different neurotransmitters such as dopamine and serotonin play a part in SZ.
• Researchers have discovered that many SZ patients have enlarged ventricles (cavities in the brain which supply nutrients and remove waste). These people display more positive than negative symptoms of schizophrenia, and typically respond poorly to typical antipsychotic drugs.
• Researchers have also discovered that the prefrontal cortex, the area responsible for executive control, is impaired in schizophrenia patients.
• Researchers have also also discovered changes in the hippocampus of SZ patients, which contribute to memory impariments.

Question 14

What are 2 strengths of neural correlates in explaing schizophrenia?

Answer 14

• There is research evidence: Torrey (2002) found that the ventricles in SZ patients are 15% larger than non SZ patients.
• Research evidence can be validated through brain scanning techniques which is objective, therefore there is face validity.

Question 15

What are 2 weaknesses of neural correlates in explaing schizophrenia?

Answer 15

• There are individual differences in sufferers of schizophrenia: not all patients have deficits in the functioning of different brain regions.
• Because there are different brain regions responsible for SZ, it may be difficult to pinpoint which brain region is causing the symptoms, therefore making it difficult to establish cause and effect, as evidence is correlational.

Question 16

What is the dopamine hypothesis?

Answer 16

• The dopamine hypothesis is a neural correlate explanation for schizophrenia.
• This states that an excess of the neurotransmitter dopamine is associated with the positive symptoms of SZ.

The two consequnces of this include:

• Hyperdopaminergia in the subcortex: high levels of dopamine in the subcortex may be associated with problems in speech and auditory hallucinations.
• Hypodopamiergia in the cortex: low levels of dopamine in the prefrontal cortex on negative symptoms of schizophrenia.

Question 17

What are 2 strengths of the dopamine hypothesis?

Answer 17

• Drug research evidence supports the dopamine hypothesis, such as dopamine agonists like amphetamines which increase dopamine levels, making SZ symptoms worse.
• Antipsychotic drugs like antagonists, which reduce the levels of dopamine in SZ patients, helps to control symptoms of SZ, suggesting that dopamine levels are high in SZ and can be reduced through drugs.

Question 18

What are 2 weaknesses of the dopamine hypothesis?

Answer 18

• Biologically determinist, as the individual has no control over this whatsoever, but the dopamine hypothesis alone cannot be the sole cause SZ, as there are other biological and psychological factors.
• Correlation-causation: there are a number of neural correlates, therefore, the question of whether high or low levels of dopamine cause SZ remain unanswered.

Question 19

What is the family dysfunction explanation for schizophrenia?

Answer 19

Family dysfunction is a psychological explanation of schizophrenia. There are 3 factors to this:

• 1: The schizophrogenic mother: Fromm-Reichmann (1948) argued that mothers who are cold, rejecting and controlling leads the child to have a lack of trust in relationships, later developing into paranoid delusions, a symptom in SZ.
• 2: Double Bind Theory: Bateson et al. (1972) suggested that children who recieve contradictory messages from their parents (such as a child being told they are loved but that same person shows disgust) are confused about the wider world, seeing it as a dangerous place. This is reflected in symptoms of SZ.
• 3: Expressed Emotion: When a carer shows negative emotions to a patient, such as verbal criticism, hostility and emotional over-involvement in their life, the patients become stressed, causing the onset (if there is a genetic vulnerability - diathesis-stress) or relapse of SZ

Question 20

What are 2 strengths of the family dysfunction explanation of schizophrenia?

Answer 20

• Research support: Tienari et al (1994) found that adopted children with SZ biological parents were more likely to have SZ than non SZ biological parents, however, this difference only emerged in dysfunctional families, suggesting the illness only manifests under certain conditions.
• Read et al. (2005) found that out of schizophrenia patients 69% of women and 59% of men all reported sexual or physical abuse in childhood.

Question 21

What are 2 weaknesses of the family dysfunction explanation of schizophrenia?

Answer 21

• Unethical: this explanation puts blame on the parents, may cause more harm than help on them.
• Enviornmentally reductionist: simplifies the cause to upbringing and ignores other factors like biological explanations

Question 22

What is the cognitive explanation for schizophrenia?

Answer 22

SZ is associated with dysfunctional thought processing. Frith et al. (1992) identified 2 kinds of dysfunctional thought processing:

• Metarepresentation is the ability to reflect on our thoughts and behaviour, allowing us to interpret our intentions and goals. Those with SZ may not be able to recognise these thoughts as their own rather than someone elses, thus leading to delusions, the belief that someone else is putting thoughts into your head.
• Central control is the ability to suppress automatic responses while performing other actions. SZ patients may not have this, causing speech poverty and thought disorder, as well as derailment, as there is too much going on in their thought processes.

Question 23

What are 2 strengths of the cognitive explanation of schizophrenia?

Answer 23

• Stirling et al (2006) tasked 30 patients and 18 people in a control group to participate in the stroop effect (words of colours that are coloured differently, like the word red coloured in blue). Stirling found that the SZ patients took twice as long saying the colour of the word compared to the control group, demonstrating dysfunctional thought processing.
• Cognitive explanations can help to justify CBT in treating SZ. This process may mean a therapist challenges these beliefs, and uses behavioural techniques like positive reinforcement to treat SZ.

Question 24

What are 2 weaknesses of the cognitive explanation of schizophrenia?

Answer 24

• It may be difficult to determine whether dysfunctional thought processing caused SZ or vice verca.
• The cognitive explanation does not take into account biological factors, therefore it is reductionist.

Question 25

How can typical antipsychotics be used to treat schizophrenia?

Answer 25

• These drugs are dopamine antagonists: they work by reducing the effects of dopamine and therefore reducing the symptoms of schizophrenia. They bind to, but do not stimulate dopamine receptors.
• A example of typical antipsychotics is chlorpromazine, an effective sedative. When a patient takes chlorpromazine, dopamine levels would build up, but then the production of dopamine would reduce. Then, the drug normalises the production and transmission of dopamine. This reduces symptoms of SZ like hallucionations.

Question 26

How can atypical antipsychotics be used to treat schizophrenia?

Answer 26

• These drugs work by temporarily occupying dopamine receptors, then rapidly dissociating to allow for normal dopamine transmission, which reduces side effects.
• Clozapine is used as an alternative method if typical antipsychotics don’t work. This binds to dopamine, serotonin and glutamate receptors, helping to improve cognitive function and reducing depression and anxiety.
• Risperidone acts similarly to clozapine, but has less side effects.

Question 27

What are 2 strengths of drug therapy in treating schizophrenia?

Answer 27

• Thornley et al (2003) compared the use of chlorpromazine with a placebo, finding in 13 trials of 1121 people that chlorpromazine was associated with reduced symptoms and better overall functioning.
• Leucht et al (2012) carried out a meta-analysis of 65 studies published between 1959 and 2011. It was found that when patients were taken off of antipsychotic medication and given placebos instead, 64% relapsed.

Question 28

What are weaknesses of drug therapy in treating schizophrenia?

Answer 28

• Drug therapies have side effects. This includes dizziness, agitation, sleepiness, weight gain, etc.
• Ethical issues: as patients are not in their right state of mind when schizophrenic, they may not be able to give fully informed consent in taking the drugs, especially since they have side effects.

Question 29

How can cognitive behavioural therapy be used to treat schizophrenia?

Answer 29

• Assessment: the patient expresses his thoughts to the therapist. Realistic goals for therapy are discussed.
• Engagement: the therapist emphasises with the patients perspective and their feelings of distress.
• ABC Model: the patient gives their explanation of the activating events (A) which causes their emotional and behavioural (B) consequences (C). The consequences can be rationalised, disputed and changed.
• Normalisation: conveying to patients that many people have unusual experiences, making the patient feel less alienated.
• Critical collaborative analysis: the therapist questions the illogical deductions and conclusions, such as ‘if the voices are real why can’t i hear them?’
• Alternative explanations: the patient develops their own alternative explanations for their previously unhealthy assumptions

Question 30

What are 2 strengths of CBT as a treatment of schizophrenia?

Answer 30

• The NICE (2014) review of treatments for SZ found consistent evidence when compared with standard care, reducing rehospitalisation rates up to 18 months.
• Addington and Addington (2005) argue that group based CBT can benefit patients, as it normalises their experience by meeting similar individuals.

Question 31

What is a weaknesses of CBT as a treatment of schizophrenia?

Answer 31

• Haddock et al (2013) found that in the north west of England out of 187 SZ patients, only 13 had been offered CBT, demonstrating its limited availability. Freeman et al. (2013) also found that a significant number of patients refused or failed to attend the sessions.

Question 32

What is family therapy?

Answer 32

Family therapy is a psychological treatment of schizophrena. This form of therapy involves:

• Helping the person and their carers be better suited in understanding the illness.
• Forming an alliance with relatives to care for the person with SZ.
• Reducing the emotional climate within the family and the burden of care for family members.
• Enhancing relative’s ability to anticipate and solve problems.
• Reducing expressions of anger and guilt by family members.
• Maintaining reasonable expectations among family members for patient performance.
• Encouraging relatives to set appropriate limits whilst maintaining some degree of seperation when needed.

Question 33

What study did Pharaoah et al (2010) conduct on family therapy?

Answer 33

• Pharoah reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention. These studies were conducted in Europe, Asia and North America.
• Pharoah found that some studies reported on an improved mental state whilst others didn’t, howver, there was an increase in compliance with medication and a reduction in the risk of relapse.

Question 34

What are 2 strengths of family therapy?

Answer 34

• The NICE review of family therapy studies found that family therapy is associated with significant cost savings when offered in addition to standard care. Due to low relapse rates, the costs of hospitalisation are lower, therefore, family therapy has economical benefits.
• Lobban et al (2013) found that out of 50 family therapy studies, 60% had reported a significant positive impact on at least one outcome category.

Question 35

What is token economy?

Answer 35

• Token economy is a reward system used to help treat schizophrenia. It is based on the principles of operant conditioning and positive reinforcement.
• Tokens can be given to patients when they have carried out a desirable behaviour, such as making their bed, having a shower, etc. These are secondary reinforcers
• The tokens can be swapped for more tangible rewards. These are primary reinforcers, as the behaviour is carried out for these rewards.

Question 36

What is a strength of token economies?

Answer 36

• Dickerson et al (2005) reviewed 13 studies in the use of token economies for SZ. 11 of these studies had reported beneficial effects that were directly attributable to the use of token economies.

Question 37

What are 2 weaknesses of token economies?

Answer 37

• Ethical concerns: rewards may be given in the form of food, privacy, etc, which are things that humans have a basic right to: these are being taken away to be given as rewards instead.
• Corrigan (1991) observed that someone in 24 hour care can be given tokens immediately, however, someone in the real world, someone with SZ won’t be rewarded in the same way. Therefore, token economies lack ecological validity.

Question 38

How may the interactionist approach use the diathesis-stress model to explain the onset of SZ?

Answer 38

• Diathesis - vulnerability (genetic) - many genes are responsible for a vulnerability towards schizophrenia.
• Stress - a negative psychological experience or anything that risks triggering SZ, such as cannabis usage, since it interferes with the dopamine system.

Question 39

What is the interactionist approach to treating schizophrenia?

Answer 39

• Because the interactionist approach acknowledges both biological and psychological factors in SZ, it is compatible with both CBT and antipsychotic medication.

Question 40

What are two strengths of the interactionist approach?

Answer 40

• Tienari et al (2004) found that adopted children with SZ biological parents were more likely to have SZ than non SZ biological parents, however, this difference only emerged in dysfunctional families, demonstrating the role of both genetics and upbringning.
• Tarrier et al (2004) randomly allocated 315 participants to either a control group of medication only, a medication and CBT group or a medication and councelling group. He found that those taking only medicine had more symptom levels compared to the other two treatments.

Question 41

What are two weaknesses of the interactionist approach?

Answer 41

• The diathesis-stress model is too simplistic: multiple genes increase vulnerability, and stress comes in many forms.
• Turkington et al (2006) makes an argument for the treatment-causation fallacy: just because there are better recovery prospects in combined therapies does not mean it can be interpreted in support for the interactionist approach.