Schizophrenia

Question 1

What are the two major classification systems for diagnosing schizophrenia?

Answer 1

ICD-10 - World Health Organisations classification.
DSM-5- American Psychiatric Association and Diagnostic.
They classify differently - in DSM-5 one positive symptom must be present whereas two or more negative symptoms under ICD-10 is efficient.

Question 2

What are positive symptoms of schizophrenia?

Answer 2

Hallucinations - e. g voices
Delusions - irrational beliefs like believing that you are the Pope.

Question 3

What are negative symptoms of schizophrenia?

Answer 3

Avolition - Loss of motivation to carry out tasks.
Speech poverty - Changes in patters of speech, reduces quality.

Question 4

Evaluation of diagnosis and classification of schizophrenia

Answer 4

Low reliability - Cheniaux - two psychiatrists independently diagnosed 100 pps using ICD and DSM. One psychiatrist diagnosed 26 with DSM and 44 with ICD while the other diagnosed 13 according to DSM and 24 according to ICD. Inter-rater reliability was therefore poor.
Poor validity - Sz is more likely to be diagnosed using ICD than with DSM. This means it is either over diagnosed using one or under diagnosed using the other.
Co-morbidity - Buckley found that around half the pps with sz also have a diagnosis of depression which means if severe depression looks a lot like sz it might actually be just one single condition.
Symptom overlap - Under ICD a patient might be diagnosed as schizophrenic but many of those same patients may recieve a diagnosis of bipolar disorder according to DSM criteria.

Question 5

What did Gottesman find in genetic basis of schizophrenia?

Answer 5

They found that in identical twins you will have a 48% risk of developing schizophrenia and if you are fraternal twins it is a 17% risk. There is a strong risk between the degree of genetic similarity and shared risk of sz.

Question 6

What did Ripke find about candidate genes?

Answer 6

He carried out a genome - wide study which 37000 pps genetic makeup was compared to 113,000 controls and it was found that 108 genes were associated with an increased risk in schizophrenia. Genes associated with increased risk were also associated with dopamine.

Question 7

What role does hyperdopaminergia in the subcortex take in the dopamine hypothesis?

Answer 7

It was the original version of the hypothesis which argued that high levels of dopamine in the subcortex e . g an excess of dopamine in Broca’s area may be associated with speech poverty and auditory hallucinations.

Question 8

What role did hypodopaminergia in the cortex take in the dopamine hypothesis?

Answer 8

Abnormal dopamine systems in the brains cortex. Rakic identified a role for low levels of dopamine in the prefrontal cortex in negative symptoms of sz.

Question 9

What are neural correlates?

Answer 9

They are measurements of the structure or function of the brain that correlate with an experience. Both positive and negative symptoms have neural correlates.

Question 10

What are neural correlates of negative symptoms?

Answer 10

One negative symptom is avolition, this involves a loss of motivation, motivation in turn involves the anticipation of a reward. The vental striatum is believed to be involved with the development of avolition.

Question 11

What are neural correlates of positive symptoms?

Answer 11

Allen scanned the brains of patients experiencing auditory hallucinations and compared them to a control group whilst they identified pre-recorder speech as theirs pr others. Lower activity rate in the superior temporal gyrus and the anterior cingulate gyrus were found in the hallucination group. So reduced activity in this area must have something to do withneaural correlates of hallucinations.

Question 12

Evaluation of biological explanations of sz?

Answer 12

Leucht found in a meta-analysis that drug treatments that work via normalising dopamine levels were more effective than a placebo.
Claiming that sz is biologically determined due to genetics and neurochemistry may make sufferers feel disempowered when diagnosed and passively reliant on drug therapies.
Explaining sz through basic cellular and chemical levels has the advantage of the scientific principle of parsimony. It has led to highly effective drug therapied. Taking a biologically reductionist approach does however fail to consider the other psychological causes.

Question 13

What are the abnormal processes in family dysfunction?

Answer 13

The schizophrenogenic mother - Fromm-Reichman - paranoid delusions result from the influence of a cold, rejecting and controlling mother. Atmosphere of stress and secrecy triggers psychosis.
The double-bind theory- Bateson - due to mixed messages they feel unable to do the right thing.
Expressed emotion- Verbal interactions exaggerated involvement, indication that the sufferer is a burden.

Question 14

What does Frith suggest about dysfunctional thought processing?

Answer 14

They argue that sz have trouble in metarepresentation so cannot recognise that they are carrying out their own actions.
They also argue that lack central control and cannot repress automatic thoughts and triggered speech.

Question 15

Evaluation of the psychological explanation for sz?

Answer 15

Butzlaff and Hooley showed that relapse into sz is significantly more likely in families with expressed emotion.
It is socially sensitive to suggest that the family causes sz as this is likely to cause more stress and anxiety.
The evidence within this research is not correlational and it could be that having a sz child is the cause of family dysfunction.

Question 16

What are antipsychotics?

Answer 16

They are neuroleptics which are medications used to control symptoms of psychosis, they are injected or taken as a pill.

Question 17

What are typical antipsychotics?

Answer 17

First-generation drug therapies, used since 1950s. They are less popular due to the harsh side effects. These durgs work as dopamine antagonists as they block dopamine receptors at the synapse, reducing positive symptoms such as hallucinations and delusions. Side effects include a dry mouth, constipation, confusion, lathargy. An example is Chlorpromazine which can be used as a sedative on patients.

Question 18

What are atypical antipsychotics?

Answer 18

Second generation drug therapies developed in 1970s. These were made to avoid the severe side effects of typicals. They block dopamine receptors bust also act on neurotransmitters e . g glutamate and serotonin. Side effects include weight gain, cardiovascular problems and typical is less likely to cause involuntary movements. e , g Clozapine, has a very harsh side effect of causing a blood condition in sufferers so it was remarketed and Risperidone was introduced.

Question 19

Evaluation of Biological treatments of sz?

Answer 19

Drug therapies are cheap, especially compared to providing hospital treatment or one to one psychological therapies.
Drug therapies may only suppress symptoms and not treat underlying issues.
Bagnall found in a study that a typical drugs were found to be more effective than typical in treating overall symptoms, resulting in fewer movement disorder side effects and fewer people leaving the drug treatments early.

Question 20

What is CBT?

Answer 20

5-20 sessions, involves helping patients identify irrational thoughts and trying to change them. It helps patients understand where their thoughts and beliefs are coming from and how to deal and understand them.

Question 21

What is family therapy?

Answer 21

Attempts to resolve the home situation of the person with sz, this is because family dysfunction can increase the risk of the relapse into sz. The treatment is family-centred and intended to change the whole family’s behaviour , not just the person with sz. The family is educated and therefore conflict and stress is reduced

Question 22

What are token economies?

Answer 22

They are designed to make behaviour more managable within a hospital. Tokens are used as positive reinforcement, patients are immediately rewarded when they show a target behaviour. Tokens are exchanged for something else that they want. Behaviours are progressively changed and tokens are given for better and better ones.

Question 23

Evaluation of psychological therapies for sz?

Answer 23

FT - Not a cure for the disorder, while the family will not understand the behaviours and they are more manageable, the symptoms still remain.
TE - They do not directly treat symptoms of sz they only attempt to manage negative symptoms such as poor motivation and poor attention or social withdrawl.
CBT - CBT does not produce unpleasant side effects of drug therapies and make it a preferred treatment plan for many sz.

Question 24

What does the interactionist approach ro sz suggest?

Answer 24

It suggests that the development of sz is due to the combined effect and interaction of biological and social/psychological factors and treatment is effective when combining biological and cognitive therapies.

Question 25

What is the diathesis-stress model?

Answer 25

It is s a psychological concept that a disorder is due to the interaction between a predisposed vulnerability , like genetics (diathesis) and an environmental trigger , like family dysfunction or emotional stress (stressor).

Question 26

Treatment according to the interactionist approach?

Answer 26

It is now increasingly standard practise to use both CBT and also drug therapies in order to treat sz.

Question 27

Evaluation of the interactionalist approach to treating and explaining sz?

Answer 27

Explaining - Tienari studied children of schizophrenogenic mothers who had been adopted , those adopted into healthy families only 5% of children developed sz compared to 40% of children that developed sz when brought up in a dysfunctional household.
The mechanism by which an adverse psychological event triggers a complect biological response resulting in symptoms is till uncertain.
Treating - Taking an interactionist approach to treating sz has the same limitations as both treatment options, the unpleasant side effects of drug therapies and the high financial cost of a trained therapist.