Schizophrenia

Question 1

Outline the DSM-5 in diagnosis of schizophrenia

Answer 1

DSM-5 says two or more of the following symptoms must be apparent for a 6-month period and at least one must be a positive symptom
-Hallucinations
-Delusions
-Disorganised speech
-Negative symptoms

Question 2

Outline the ICD in diagnosis of schizophrenia

Answer 2

-ICD requires symptoms to be present for 1 month

+ This means there is less time in which they my be at risk to themselves and others. Immediate treatment can be provided

Question 3

What is a hallucination?
What is a delusion?
Explain disorganised speech

Answer 3

Hallucination - Hearing, seeing or smelling things which don’t exist

Delusions - Irrational beliefs about yourself or the world

Disorganised speech - Result of abnormal thought processes and the patients struggles to organise and filter their thoughts

Question 4

What is a negative symptom?

Answer 4

The loss of normal experiences and abilities

Question 5

What is a positive symptom?

Answer 5

Experiences which are added in addition to normal experiences

Question 6

Outline 3 negative symptoms

Answer 6

Anhedonia - Loss of interest/pleasure in activities

Avolition - Being unmotivated/lack enthusiasm

Speech poverty - Characterised by lessened speech poverty, due to slowed thoughts

Question 7

Outline 3 positive symptoms

Answer 7

Hallucinations
Delusions
Disorganised speech

Question 8

Research into inter-rater reliability for diagnosis of schizophrenia
(Beck et al)

Answer 8

Beck et al
-Agreement on diagnosis for 153 patients was only 54%, often due to vague criteria for diagnosis and inconsistencies in techniques to gather data, suggesting many people are diagnosed incorrectly

Question 9

AO3
Reliability of diagnosis
(Cheriaux et al)

Answer 9

Had 2 psychiatrists independently diagnose 100 patients using both DSM and ICD criteria

FOUND INTER-RATER RELIABILTY WAS POOR:
-1st psychiatrist diagnosed 26 with Sz according to DSM and 44 according to ICD
-2nd psychiatrist diagnosed 13 according to DSM and 24 according to ICD

Question 10

Explain the subtypes of Schizophrenia

Answer 10

DSM has 5 subtypes
ICD has 7 subtypes

Reliability here is questioned as the sufferer could be diagnosed as one type of schizophrenia according to DSM and a different according to ICD

Question 11

Define Comorbidity

Answer 11

When there could be a presence of 2 different disorders at the same time
Maybe the 2 disorders are actually just one disorder

Question 12

AO3
Outline one weakness of the classification and diagnosis of schizophrenia
(Comorbidity)

Answer 12

One weakness of classification and diagnosis of schizophrenia is the concept of comorbidity.
Buckley found that up to 50% of patients diagnosed with schiz also fit into the diagnosis for depression, 29% for PTSD and 23% for OCD.
This poses a challenge for the validity of schiz as a disorder itself because if we are unable to distinguish it from other disorders, the reliability of diagnosis will be inconsistent. Therefore, this weakens our acceptance of the classification and diagnosis of schizophrenia as it may not be reliable.

Question 13

AO3
Outline one weakness of the classification and diagnosis of schizophrenia
(Gender bias)

Answer 13

-Males first onset is between the ages of 18-25. In females, the first onset is between the ages of 25-35 and this under-diagnosis and difference between genders highlights a lack of validity in diagnosis

-Women’s symptoms of Sz is taken less seriously and underdiagnosed compared to men, as they mask these symptoms of Sz

-Cotton suggests this is due to men’s better social coping strategies leading to being less likely to seek treatment

Question 14

AO3
Outline one weakness of the classification of diagnosis of schizophrenia
(Culture bias)

Answer 14

One weakness of the classification and diagnosis of Sz is that it may be culturally bias.
For example, people with Afro-Caribbean heritage in the UK and African Americans are more likely to be diagnosed with Sz compared to the 1% of the general population.
Wester definitions of mental illness are applied to non-western cultures e.g. Hearing voice such as hallucinations is a symptom in the UK but a religious experience in West Indies.
This suggests the classifications are culturally bias as there are different norms in different societies meaning we cant generalise western definitions of schiz to other cultures with different norms. This is not accounted for by the classifications, thus weakening acceptance of the classifications

Question 15

Outline the biological explanations of schizophrenia

Answer 15

Gottesman:
Mz twins had concordance rates of 48%
Dz twins had concordance rates of 17%

-Ripke et al found 108 genetic variants associated with schizophrenia
-Genes that were associated with an increased risk in Sz included genes that code for the functioning for neurotransmitters

-Sz is aetiologically heterogeneous - One group of genes may cause Sz in one person but a different set of genes in another

Question 16

Outline the Neural correlates of Sz (Dopamine hypothesis)

Answer 16

-Pattern of structure or activity of the brain can be correlated with an increased risk of developing Sz

-Hyperdopaminergia —> Higher levels of dopamine than usual. linked to positive symptoms e.g. hallucinations. Excess dopamine in Broca’s area may be linked to poverty of speech or auditory hallucinations

-Hypodopaminergia —> Lower levels of dopamine than usual. Less dopamine being transmitted across synapse. Linked with negative symptoms

Question 17

Outline the role of agonist drugs

Answer 17

-Chemicals in the brain which mimic other neurotransmitters
-Activates a receptor to produce a biological responses
-Drugs which increase activity
-Can relieve some patients positive symptoms

Question 18

Outline the role of antagonist drugs

Answer 18

-Antipsychotic drugs such as chlorpromazine reduce dopamine activity and help reduce symptoms like hallucinations

Question 19

Brain structure in Schiz

Answer 19

Enlarged ventricles - Produce cerebrospinal fluid, patients with Sz tend to have larger ventricles in comparison to healthy individuals.
AO3 - Data is correlational. Cannot infer whether enlarged ventricles is the cause of Sz. Could be a side effect of medication or a phenotype of schiz

Ventral striatum - abnormality in this brain region is associated with avolition
Juckel et al found people with Sz have lower levels of activity in the ventral striatum. There was a negative correlation between activity levels in the ventral striatum and severity of overall symptoms

Question 20

AO3
Outline one weakness of the biological explanations of Schizophrenia
(Twin studies)

Answer 20

One weakness of the biological explanations of schizophrenia is that concordance rates are not 100%.
For example, Gottesman found a concordance rates of 48% between Mz twins for schizophrenia.
This suggests that there is still 52% is down to other factors such as the environment, which the theory doesn’t account for, suggesting it is biologically reductionist.
Therefore it may be better to adopt an interactionist approach which encompasses both biology and environmental factors. This can be seen in the diathesis stress model, suggesting biology alone cant be responsible for schizophrenia, as the explanation suggests it is.
Therefore this weakens our acceptance of he biological explanations of schiz because it there are other factors which the theory doesn’t account for

Question 21

AO3
Outline one strength of the biological explanations of schizophrenia
(Drugs)

Answer 21

One strength of the biological explanations of schizophrenia is that it has lead to drug development.
For example, through assuming an imbalance of dopamine is responsible for Sz, we can develop agonist and antagonistic drugs to balance out these neurotransmitters.
This suggests, we can develop drugs which reduce symptoms of Sz in a patient and improve their quality of life through these biological explanations, thus strengthening acceptance of the theory as it has positive real world effects.

However, 1/3 of patients are resistant to drug treatment, suggesting other factors are responsible for the onset of schizophrenia, which contradicts the theory, weakening acceptance after all.