schizophrenia

Question 1

classification of schizophrenia: How is Schizophrenia Classified? (A01)

Answer 1

DSM-5 published by American Psychiatric Association (APA)

ICD – 10 produced by World Health Organisation (WHO)

Question 2

classification of schizophrenia: DSM-5 Criteria A for Classification of Schizophrenia (A01)

Answer 2

Two of following symptoms must be present for significant portion of time during 1-month period

1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms

Question 3

classification of schizophrenia: DSM-5 Criteria B for Classification of Schizophrenia (A01)

Answer 3

reduction in 1 or more major areas of functioning eg. work, interpersonal relations or self-care

Question 4

classification of schizophrenia: DSM-5 Criteria C for Classification of Schizophrenia (A01)

Answer 4

Continuous signs of disturbance must persist for at least 6 months during which patient must experience at least 1 month of active symptoms

Question 5

type 1- positive symptoms of schizophrenia: hallucinations (A01)

Answer 5

unusual sensory experiences

About 70% of people w/ schizophrenia suffer from auditory hallucinations

Typically person hears voice- voice/voices may critically comment on their behaviour warn them of future dangers, accuse them of something they did not do or give orders

Question 6

type 1- positive symptoms of schizophrenia: delusions (A01)

Answer 6

irrational beliefs that have no basis in reality

Delusions can make sufferer of schizophrenia behave in ways that make sense to them but seem bizarre to others- most common are:

Delusions of persecution- belief that they are being spied on or plotted against by others such as government

Delusions of grandeur- person believes they are an important historical or religious figure eg. queen or pope

Question 7

type 2- negative symptoms of schizophrenia: speech poverty-ALOGIA (A01)

Answer 7

decrease in speech fluency + productivity

produce fewer words in given time on task of verbal fluency

not due to less verbal ability than people w/x schizophrenia but more difficulty spontaneously producing them

Patients will often slur their responses not pronouncing consonants clearly + their words might trail off into whisper

Question 8

reliability in diagnosis + classification of schizophrenia (A01)

Answer 8

Reliability refers to consistency in diagnosis whether there is agreement in diagnosis of schizophrenia by different psychiatrists across time + cultures- inter-rater reliability

Reliability can also be seen in whether diagnostic tests are consistent on different occasions- test-retest reliability

Question 8

type 2- negative symptoms of schizophrenia: avolition (A01)

Answer 8

reduction of interests + desires as well an inability to initiate + persist in goal-directed behaviour

eg. sitting in house for hours every day doing nothing

distinct from poor social functioning which can be result of other circumstances

classed as avolition there must be reduction in self-initiated involvement in activities that are available to patient

Question 9

reliability in diagnosis + classification of schizophrenia: DSM + ICD tools are routinely used w/high level of reliability by mental health clinicians (A03) (1)

Answer 9

P: DSM + ICD tools are routinely used w/high level of reliability by mental health clinicians

E+ E: Cheniaux asked 2 psychiatrists to independently diagnose 100 patients using both DSM + ICD Inter-rater reliability was poor using DSM 1 psychiatrist diagnosed 26 patients w/schizophrenia whilst other only diagnosing 13

L: weakness of diagnostic systems as they failed to produce consistent results + therefore shows that reliability of diagnosing schizophrenia is poor

Question 10

reliability in diagnosis + classification of schizophrenia: recent research has found that reliability for diagnosing Schizophrenia has improved (A03) (2)

Answer 10

P: recent research has found that reliability for diagnosing Schizophrenia has improved

E: Osorio et al reported excellent reliability for diagnosis of Schizophrenia using DSM-5
Pairs of interviewers achieved inter-rater reliability =.97 and test-retest reliability of =.92

E: suggests that diagnostic system is consistently applied + therefore has good reliability even if reliability of classification systems are not perfect they do provide clinicians w/common language permitting communication of research ideas + findings

L: ultimately lead to better understanding of disorder + more effective treatments

Question 11

co-morbidity: supporting evidence (A03) (1)

Answer 11

P: large body of evidence to suggest that many sufferers do also have issues of substance abuse

E: Buckley found that around 50% of patients w/schizophrenia also have depression or substance abuse- Alcohol, cannabis + cocaine are substances that can be abused by people w/schizophrenia + not only does such co-morbid substance abuse make reliable diagnosis of schizophrenia difficult to achieve

E: also leads to lower levels of functioning increased hospitalisations + lower compliance w/medication which makes effective treatment more difficult to achieve

L: strength bc it demonstrates complexities involved in giving reliable diagnosis if person w/ schizophrenia is also using recreational drugs- sufferers who use recreational drugs may find it difficult to achieve reliable diagnosis as it’s difficult to know what symptoms are direct effect of having schizophrenia + what are symptoms of substance abuse

Jeste et al states that those sufferers of schizophrenia w/co-morbid conditions are excluded from research + yet form majority of patients suggests that research findings to causes of schizophrenia may not be based on reliable research as samples used are not consistent

Question 11

co-morbidity (A01)

Answer 11

issue for reliability of diagnosis of schizophrenia

refers to presence of 1 or more additional disorders or diseases simultaneously occurring w/ schizophrenia

eg. people with schizophrenia also commonly suffer w/following conditions:
substance abuse (7%), Anxiety/panic disorder (15%), symptoms of depression (50%)

sufferer can experience simultaneous disorders this suggests that schizophrenia may not actually be separate disorder

could lead to different medical professionals giving different diagnoses of same patient

Question 12

Culture bias: affecting diagnosis of schizophrenia (A03) (1)

Answer 12

P: diagnosis of schizophrenia is affected by culture bias

E+ E: Pinto + Jones reported that in Haiti some people believe that voices are communications from ancestors- British people of African – Caribbean origin are up to nine times more likely to receive diagnosis than white British people although people living in African – Caribbean countries are not ruling out genetic vulnerability

L: weakness of diagnostic system bc it highlights that difference in diagnostic statistics of some cultural groups is due to biased over interpretations of symptoms by some psychiatrists

but higher statistics could represent effects of poorer housing higher rates of unemployment + social isolation that are more commonly experienced by minority groups eg. African-Caribbean groups

Question 12

Culture bias in diagnosis + classification of schizophrenia (A01)

Answer 12

extent to which diagnostic system reflects beliefs about what is viewed as normal + acceptable in Western predominately white cultures

Culture bias reduces validity of diagnostic system- ICD + DSM were developed by Western clinicians + are criticised for lacking cultural relativism

people who show behaviours eg. hearing voices which may be normal in their own culture are sometimes classified as having schizophrenia

also affect the reliability of diagnostic system- research suggests there is significant variation between cultures when it comes to diagnosing schizophrenia

Copeland gave 134 US + 194 British psychiatrists description of patient 60% of US psychiatrists diagnosed schizophrenia but only 2% of British ones did showing diagnosis was unreliable across different cultures

Question 13

validity in diagnosis + classification of schizophrenia (A01)

Answer 13

extent to which methods used to measure schizophrenia are accurately measuring schizophrenia eg. patient may have hallucinations but is not suffering w/schizophrenia or it may be that psychiatrists are misinterpreting behaviour of patient -different assessment systems may arrive at completely different diagnoses

assess validity by using predictive validity - if diagnosis leads to successful treatment then diagnosis is seen as valid-research findings on whether diagnosis of schizophrenia is valid are very mixed

Some researchers report that when you match patients diagnosed w/ schizophrenia to DSM criteria there is good correlation suggesting that diagnosis is valid -2 diagnosed patients can differ greatly on precise symptoms each displays-suggests that single label of schizophrenia is not valid
more valid to use presence or absence of positive + negative symptoms to distinguish different forms of schizophrenia as DSM-V does

Question 14

validity: threat to validity of diagnosing schizophrenia (A03) (1)

Answer 14

P: threat to validity of diagnosing schizophrenia is highlighted by fact that in same way that people diagnosed w/schizophrenia rarely share same symptoms likewise there is no evidence that they share same outcomes

E+E: prognosis for patients diagnosed w/schizophrenia varies w/about 20% recovering their previous level of functioning- 10% achieving significant + lasting improvement + about 30% showing some improvement w/intermittent relapses

L: problem bc diagnosis has little predictive validity bc some people never appear to recover from disorder while many do

What does appear to influence outcome is more to do w/gender + psycho-social factors eg. social skills, academic achievement + family tolerance of schizophrenic behaviour

Question 15

gender bias in diagnosis + classification of schizophrenia (A01)

Answer 15

diagnosis of schizophrenia occurs when accuracy of diagnosis is dependent on gender of an individual diagnostic criteria may be gender-biased or clinicians may base their judgments on stereotypical beliefs about gender

refers to differential treatment of males + females in diagnoses of schizophrenia

since 1980s men are diagnosed w/ schizophrenia more often than women

due to genetic factors women are genetically less vulnerable than men but seems more likely that women are under diagnosed bc they are more likely to have support around them + therefore function better than men

Cotton found that in patients w/ schizophrenia that female patients function better than male patients

eg. more likely to work + have good family relationships- may explain why women are not diagnosed w/schizophrenia as frequently as men

appears that their better interpersonal functioning may bias clinicians to under-diagnose schizophrenia in women

explains why age of onset tends to be much younger in males than in females

Question 16

gender bias: problem in diagnosis of schizophrenia + subsequent treatment offered (A03) (1)

Answer 16

P: problem in diagnosis of schizophrenia + subsequent treatment offered

E+ E: males could be more likely to be committed to psychiatric institutions when they show mild signs of schizophrenia due to risk of socially deviant behaviour females on other hand are likely to be voluntary patients bc they are more likely to seek help earlier

L: strength as it supports idea that gender differences in diagnosis exist -appears that their better interpersonal functioning may bias clinicians to under-diagnose schizophrenia in women- threatens validity of diagnostic system bc people may get an incorrect or no diagnosis based on their gender rather than their symptoms

Question 17

symptom overlap (A01)

Answer 17

symptoms of schizophrenia are also found in other disorders
eg. positive symptoms eg. delusions and negative symptoms such as avolition occur in both schizophrenia + bipolar disorder

makes it difficult for clinicians to accurately decide which particular disorder someone is suffering from when diagnosing

Question 18

symptom overlap: issues when accurately + reliably diagnosing schizophrenia (A03) (1)

Answer 18

P: issues when accurately + reliably diagnosing schizophrenia

E+ E: Ophoff found genetic overlap between bipolar disorder + schizophrenia 3 of 7 gene locations on genome associated w/ schizophrenia were also associated w/bipolar disorder- both schizophrenia + bipolar disorder involve positive symptoms + negative symptoms

L: problem when trying to distinguish schizophrenia from other illnesses + in terms of classification this suggests that schizophrenia + bipolar disorder may not be 2 different conditions but variations of single condition

Question 19

symptom overlap: contradictory evidence (A03) (2)

Answer 19

P: contradictory evidence

E: Ellason + Ross point out that not only is there great deal of overlap between SZ + bipolar disorder but people w/another disorder called ‘Dissociative Identity Disorder’ (DID) actually have more symptoms of schizophrenia than people diagnosed as being schizophrenic

E: problem as it brings into question whether SZ, bipolar disorder + DID are separate disorders at all or part of same spectrum- due to symptom overlap this can lead to years of delay in receiving relevant treatment leading to further degeneration in mental health + an increase in suicidal risk

L: again calls into question validity methods used to assess schizophrenia despite these issues fact that classification + diagnostic symptoms are updated + revised is 1 way to try + improve accuracy + reliability by creating more clear + distinct labels for illnesses

Question 20

reliability + validity of classification + diagnosis of Schizophrenia: invalid or unreliable diagnosis of SZ (A03) (1)

Answer 20

P: invalid or unreliable diagnosis of SZ relates to social stigma carried by being incorrectly labelled

E+ E: Such inaccurate diagnosis can have long-lasting negative impact on lives of those diagnosed despite these problems classification systems do at least allow professionals to share common language which helps in communicating ideas

L: allows greater opportunities for research which can lead to better understanding of schizophrenia

Question 21

Biological Explanations of Schizophrenia: neural correlates (A01)

Answer 21

measurements of structure or function of brain that correlate w/ experience

correlates have allowed abnormalities w/in specific brain areas to be associated w/ development of schizophrenia

Question 22

Biological Explanations of Schizophrenia: dopamine hypothesis (A01)

Answer 22

biochemical explanation suggests that positive symptoms of schizophrenia are result of overactive transmission of neurotransmitter dopamine

Sufferers of Sz are thought to have abnormally high numbers of D2 receptors on receiving neurones resulting in more dopamine binding + therefore more neurones firing Dopamine neurones play key role in guiding attention so disturbances in this process may well lead to problems relating to attention, perception + thought found in people w/schizophrenia

eg. excess of dopamine has been found in Broca’s area- responsible for speech production an excess of dopamine in this area may be responsible for auditory hallucinations

Recent versions of dopamine hypothesis have focused on abnormal dopamine levels in pre-frontal cortex

eg. low levels in prefrontal cortex are linked to negative symptoms of schizophrenia- appears that both high + low levels of dopamine in different brain regions are involved in schizophrenia

Question 23

dopamine hypothesis as cause of schizophrenia: evidence from PET scans (A03) (1)

Answer 23

P: evidence from PET scans

E+ E: Wong found an increase in no. of dopamine receptors in several brain regions in patients w/ schizophrenia

L: strength bc it supports view that schizophrenia is caused by unusually high levels of these receptors increasing validity of dopamine hypothesis

Question 24

dopamine hypothesis as cause of schizophrenia: evidence from drug use (A03) (2)

Answer 24

P: evidence from drug use

E: Drugs such as cocaine + amphetamines increase dopamine levels in brain causing schizophrenic-like symptoms in normal people

E: Parkinson’s disease is caused by lack of dopamine in brain + drug called L-dopa is used to increase these levels but if dosage is too high patients suffer from schizophrenic-like side effects

L: strength bc they lend further support to view that dopamine is primary cause of many schizophrenic symptoms

Question 24

dopamine hypothesis as cause of schizophrenia: practical application (A03) (3)

Answer 24

P: practical application

E+E: led to creation of anti-psychotic drugs eg. chlorpromazine which reduce amount of dopamine in brain + therefore reduce positive symptoms of schizophrenia

L: strength bc success of these drugs strengthens validity of dopamine hypothesis as an explanation for Schizophrenia eg. if drugs help reduce symptoms of schizophrenia by reducing levels of dopamine this suggests symptoms are caused by high levels of dopamine

Question 25

dopamine hypothesis as cause of schizophrenia: symptoms of schizophrenia can take several weeks (A03) (4)

Answer 25

P: drugs affect dopamine levels quickly but for many sufferers effect on symptoms of schizophrenia can take several weeks

E+ E: suggests that cause of schizophrenia is more complex than simply high levels of neurotransmitter dopamine Atypical antipsychotic drugs eg. clozapine which affect serotonin as well as dopamine are more successful in treating negative symptoms than typical antipsychotics that only alter dopamine levels

L: highlights that dopamine hypothesis may be oversimplifying cause of schizophrenia + that many other neurotransmitters are involved

Question 26

enlarged ventricles (A01)

Answer 26

Originally evidence was limited to post-mortems conducted upon brains of dead people who had suffered w/schizophrenia but research now uses non-invasive scanning techniques eg. fMRI which gives picture of brain in action through magnetic fields

Early research was focused on people w/schizophrenia having enlarged ventricles

Enlarged ventricles are especially associated w/damage to central brain areas + prefrontal cortex which recent scanning studies have also linked to disorder

Early research focused on sufferers of schizophrenia having enlarged ventricles + these were associated w/negative symptoms of schizophrenia such as avolition + speech poverty

Question 27

enlarged ventricles: neural correlates of negative symptoms (A01)

Answer 27

1 negative symptom is avolition this is loss of motivation

Motivation is anticipation of receiving reward 1 area of brain ventral striatum is involved in anticipation

therefore logical that abnormality of this area may be involved in development of avolition

Juckel measured activity levels in ventral striatum in schizophrenics + found lower levels of activity than those in control group

observed negative correlation between activity levels in ventral striatum + severity of overall negative symptoms

activity in ventral striatum is neural correlate of negative symptoms of schizophrenia

Question 28

enlarged ventricles: neural correlates of positive symptoms (A01)

Answer 28

positive symptoms also have neural correlates

Allen scanned brains of patients experiencing auditory hallucinations + compared them to control group brains whilst they identified pre-recorded speech as theirs or others

Lower activation levels in superior temporal gyrus + anterior cingulate gyrus were found in hallucinations group who also made more errors than control group

reduced activity in these 2 areas of brain is neural correlate of auditory hallucinations

Question 29

enlarged ventricles as cause of schizophrenia: impossible to establish causation (A03) (2)

Answer 29

P: impossible to establish causation

E+ E: eg. possible that schizophrenic symptoms cause changes in brain
not all patients w/schizophrenia have evidence of enlarged brain ventricles + some people have enlarged ventricles but do not suffer w/schizophrenia

L: weakness bc it makes it difficult to draw firm conclusions about role of neural correlates in causes of schizophrenia reducing validity of this theory + clearly demonstrating how using enlarged ventricles theory alone to explain cause of all types of schizophrenia is not possible

Question 30

neural correlates as an explanation for cause of schizophrenia: not accepted as complete explanation of schizophrenia (A03) (1)

Answer 30

P: no longer accepted as complete explanation of schizophrenia

E+ E: diathesis-stress model faulty levels of dopamine alone are unlikely to cause disorder- would suggest that while faulty dopamine levels may make person vulnerable to developing schizophrenia onset of condition

L: must be triggered by stressful life events such as family problems or drug abuse

Question 31

enlarged ventricles as cause of schizophrenia: supporting biological evidence (A03) (1)

Answer 31

P: supporting biological evidence

E+ E: eg. Yoon et al used fMRI scans to examine brains of 18 patients w/schizophrenia + 19 people w/x schizophrenia performing memory task- schizophrenic Ps had decreased activity in prefrontal cortex + diminished connectivity between other parts of brain stronger symptoms of schizophrenia were

L: suggests that abnormal functioning of prefrontal cortex-basal ganglia brain circuit may be related to cognitive deficits experienced by schizophrenic

use of objective, replicable, brain scans as evidence for this explanation has increased scientific credibility of this explanation for schizophrenia as it has allowed for direct objective comparison of neurological differences between brains of patients w/disorder + those w/x schizophrenia

Question 32

biological explanations of schizophrenia: genetic explanation (A01)

Answer 32

argued that schizophrenia is passed on from 1 generation to next through genetic inheritance- more closely related family member is to person w/schizophrenia greater their chance of developing disorder

No single gene is thought to be responsible for development of schizophrenia + it is more likely that different combinations of genes make individuals more vulnerable to disorder + so schizophrenia is believed to be ‘polygenic’

Much of evidence for this explanation comes from family studies twin studies + adoption studies- used to establish aconcordance rate

eg. identical + non-identical twins where one of each twin pair has schizophrenia can be compared to see how often other twin also shows the illness- schizophrenia is genetic then it is argued that MZ twins should have higher concordance rates for disorder than DZ twins

Gottesman found that children w/
2 schizophrenic parents had concordance rate of 46% children w/1 schizophrenic parent rate of 13% + siblings concordance rate of 9%.

Question 33

biological explanations of schizophrenia: specific gene identified (A01)

Answer 33

Genes associated w/increased risk included those coding for functioning of neurotransmitter dopamine

been found that NRG3 gene variants interact w/both NRG1 + ERBB4 gene variants

Question 34

genetic explanation of schizophrenia: supporting evidence from twin studies (A03) (1)

Answer 34

P: genes as cause of schizophrenia

E+ E: Twin studies have found concordance rate of 40% for MZ twins compared to only just over 7% for DZ twins

L: suggests genetic cause of schizophrenia since MZ twins share 100% of their genes + had higher concordance rates for disorder compared to DZ twins who share only 50% of their genes

Question 35

genetic explanation of schizophrenia: concordance rates (A03) (1)

Answer 35

P: schizophrenia is caused by genetic factors alone

E+ E: then concordance rates would be expected to be 100% for identical twins since they have exactly same genetic makeup
some critics have claimed that higher concordance rates for MZ twins compared to DZ twins is because they are more likely to be treated similarly + have same environmental experiences

L: suggests that genetic explanation of schizophrenia may not provide complete explanation

Question 36

genetic explanation of schizophrenia: supporting evidence from adoption studies (A03) (3)

Answer 36

P: Adoption studies allow for separation of nature + nurture factors so we are able to investigate if genetic factors are more of an influence on development of schizophrenia

E+ E: Tienari et al compared adopted children whose biological mothers had SZ compared to control group of adoptees w/x any genetic risk- found much higher rate of SZ amongst those whose biological mothers had SZ

L: strength bc even when environmental influence of biological mother was removed genetic risk was still evident therefore supporting theory that genetic factors cause schizophrenia

Question 37

genetic explanation of schizophrenia: supporting evidence from family studies (A03) (2)

Answer 37

P: supporting evidence from family studies

E+ E: Varma found 16% of 1st degree relatives of someone w/ schizophrenia developed schizophrenia compared to only 7% of controls

L: strength of genetic explanation because it demonstrates that closer genetic relatedness to someone w/schizophrenia greater chance of developing disorder

but it is possible that increased rate of schizophrenia amongst those w/parents w/schizophrenia was due to environmental rather than genetic influences-means that not possible to firmly conclude that schizophrenia is caused by maladaptive genes

Question 38

genetic explanation of schizophrenia: supporting research evidence (A03) (4)

Answer 38

P: supporting research evidence

E: Sekar et al analysed 100,000 human DNA samples from 30 different countries- identified gene called C4 which is part of immune system- genetic analysis of 65,000 people found those who had particular forms of C4 gene showed higher risk of developing schizophrenia

E: C4 plays role in pruning synapses but excessive pruning could lead to symptoms seen in schizophrenia Test mice w/increased levels of C4 activity lost more brain cells as they matured explain why schizophrenia symptoms appear after adolescence + why brains of people w/schizophrenia have thinner cerebral cortex w/fewer synapses than healthy brains

L: research offers hope that in future drug therapies may be able to ‘turn down’ level of synaptic pruning in individuals who show early signs of disorder this may prevent schizophrenia from developing

Question 39

ALL biological explanations of schizophrenia: deterministic (A03) (1)

Answer 39

P: both neural correlates + genetics are deterministic

E+ E: means that disorder is inevitable in those with the wrong genes nobody would try to argue that person w/schizophrenia has free will + choice in their experience of suffering w/illness but taking deterministic view when explaining an illness can be controversial

L: deterministic view of cause of Sz could be viewed both positively + negatively On one hand biological explanations could be said to be more humane bc sufferer is not blamed for their illness as it is not something they can control

Question 40

ALL biological explanations of schizophrenia: diathesis-stress model doesn’t claim deterministic view (A03) (2)

Answer 40

P: diathesis-stress model doesn’t claim deterministic view

E: suggests people w/genetic abnormalities may have predisposition-if person reduces their risk factors they can influence whether they develop schizophrenia or not

E: biological explanations could also be said to be reductionist bc they focus wholly on one level of explanation eg. internal factors + ignore environmental factors are psychological explanations of schizophrenia eg. family explanations which argue that way parents treat their child is main influence on schizophrenia onset or that poor people are more at risk of schizophrenia

L: result biology alone may not explain all aspects of schizophrenia

Question 41

biological treatments for schizophrenia drug therapy: typical antipsychotic drugs (A01)

Answer 41

Chlorpromazine is dopamine antagonist that works to reduce effects of dopamine

achieve this by binding to dopamine receptors but not stimulating them blocking their action

reducing effect of dopamine positive symptoms of schizophrenia eg. hallucinations + delusions are reduced- symptoms are linked to excesses of dopamine + are reduced

Question 42

biological treatments for schizophrenia drug therapy: atypical antipsychotic (A01)

Answer 42

Clozapine + Risperidone are ‘newer’ types of drug treatments

Clozapine acts on dopamine system by blocking D2 receptors- drugs only temporarily block dopamine receptors before dissociating to allow normal dopamine transmission

effect being that it reduces positive symptoms of schizophrenia + temporary effect on D2 receptors leads to less extra-pyramidal side effects

also affect serotonin (5-HT) receptors in brain particularly 5-HT2A receptors which are considered to be vital in role of negative symptoms of schizophrenia

atypical drugs help improve patients’ mood + improve cognitive functioning

Question 43

biological treatments for schizophrenia drug therapy: supporting evidence for typical drugs (A03) (1)

Answer 43

P: supporting evidence for typical drugs

E: Thornley reviewed studies comparing effects of Chlorpromazine to reduce symptoms some sufferers were given drug + others were given placebo- data included over 1,000 participants + found that

E: Chlorpromazine was associated w/better overall functioning + reduced symptoms + also that relapse rate was lower when drug was taken compared to placebo group

L: quantitative data shows clear support for effective use of typical anti-psychotics has also used scientific way of conducting research w/control group comparisons

Question 44

psychological explanations of schizophrenia: family dysfunction (A01)

Answer 44

Many of psychological explanations of schizophrenia have focused on role of family

‘Family dysfunction’ explanations claim that risk of SZ is increased when there are abnormal patterns of communication w/in family

Parents of sufferers often display 3 types of dysfunctional characteristics:
1. High levels of interpersonal conflict
2. Difficulty communicating w/each other
3. Being excessively critical + controlling of their children

Question 44

biological treatments for schizophrenia drug therapy: side effects (A03) (3)

Answer 44

P: serious side effects

E: Serious side effects of typical antipsychotics can lead to movement disorders eg. Tardive Dyskinesia characterised by involuntary chewing + sucking jerky movements + twisting of mouth face all of which can be permanent

E: About 30% of people taking antipsychotic medication go on to develop tardive dyskinesia- side effect is irreversible in 75% of cases

L: weakness bc it often leads to sufferers stopping medication + suggests that drug therapy is not most effective treatment for some sufferers of schizophrenia

Question 45

biological treatments for schizophrenia drug therapy: supporting evidence for atypical drugs (A03) (2)

Answer 45

P: supporting evidence for atypical drugs

E+ E: Meltzer concluded that Clozapine was more successful in treatment resistant cases of schizophrenia than typical antipsychotics

L: clear support for use of atypical antipsychotic medication to treat schizophrenia + supports idea that Schizophrenia is caused by chemical imbalance as drugs correct imbalance of neurotransmitters

but Critics have argued that there are serious flaws w/evidence showing drug therapy is an effective treatment for schizophrenia Healy claims most studies only focus on short term effects + positive effects have been exaggerated bc data has been published numerous times means that caution should be observed when evaluating success of drug therapy as an effective treatment for schizophrenia

Question 46

biological treatments for schizophrenia drug therapy: drop out rates (A03) (4)

Answer 46

P: side effects can lead to problems w/patient compliance

E+ E: argued that average 50% of schizophrenia patients stop taking their medication after year + 75% after 2 years-causes “Revolving Door Syndrome”- where patient is reluctant to take their medication + regularly relapses before being admitted for care treated successfully w/drugs again only to then avoid taking them when released

L: problem as it raises doubt over how appropriate antipsychotic treatments are if they rarely lead to long-term + stable recovery also suggests that at least for some patients they may benefit from psychological treatments in addition to drug therapy to prevent relapse

Question 47

psychological explanations of schizophrenia: double blind hypothesis (A01)

Answer 47

Bateson suggested children can find themselves ‘trapped’ in situations where they fear doing wrong thing but are not given clear guidance on what ‘the wrong thing’ is

When they do ‘get it wrong’ parent withdraws love as punishment- child frequently receive contradictory messages from parents eg. where verbal message is given but opposite behaviour is exhibited

eg. if mother tells her son that she loves him yet at same time turns her head away in disgust child receives 2 conflicting messages about their relationship

Bateson argued this was reflected in symptoms such as disorganised thinking + paranoid delusions

double-bind behaviour from parent can lead to negative reaction from child of social withdrawal + flat affect in order to escape double bind situations

Bateson was also clear he viewed these double-binds as risk factor rather than sole cause of schizophrenia

Question 48

psychological explanations of schizophrenia: high expressed emotion (EE) (A01)

Answer 48

level of negative emotion expressed towards patient by their carers
EE contains several elements:
1. Verbal criticism of patient
2. Hostility towards patient
3. Emotional over-involvement in life of patient

high levels of EE towards patient are serious source of stress for patient- argued that this stress can trigger onset of schizophrenia in person who is already genetically vulnerable to disorder

EE has been primarily linked to course of disorder rather than being seen as cause

High levels of EE in carers have been found to lead to poorer outcomes + an increased likelihood of relapse + return to psychotic experiences for the patient

Question 49

psychological explanations of schizophrenia: schizophrenogenic mother (A01)

Answer 49

Fromm-Reichmann schizophrenogenic mother is cold rejecting, controlling + tends to cause family environment characterised by tension + secrecy

leads to distrust which may manifest itself to paranoid delusions in child

often family schism or skew w/ dominant mother + passive father

Question 50

family dysfunction as explanation for schizophrenia: supporting evidence for double bind communication (A03) (1)

Answer 50

P: supporting evidence for double bind communication

E+ E: Berger found that sufferers of Sz reported higher recall of double-blind statements from their mothers than non-sufferers

L: seems to suggest contradictory messages during upbringing may increase risk of SZ in later life

but most professionals now agree that while there is evidence that poor childhood experiences w/in family are associated w/adult schizophrenia there is very little support for double bind + schizophrenogenic mother explanations

theories have been based on clinical observations + personality assessments of mother of someone w/ schizophrenia + are not viewed as valid in comparison w/other objectively supported theories

Question 51

family dysfunction as explanation for schizophrenia: supporting evidence for high EE (A03) (2)

Answer 51

P: supporting evidence for high EE

E+ E: Tienari et al assessed adopted children whose biological mother had SZ compared to control group of adoptees w/x any genetic risk- found that when parenting style of adoptive family was characterised as highly critical w/low levels of empathy- greatly increased risk of SZ but that being reared in ‘healthy’ adoptive family had protective effect on those at high genetic risk

L: suggests that EE in families can increase risk of SZ but also that being low EE family can help prevent SZ

but there is difficulty in establishing cause + effect w/this theory eg. having child suffering w/ schizophrenia w/in family can be problematic + stressful on family relationships

Question 52

family dysfunction as explanation for schizophrenia: real world application (A03) (3)

Answer 52

P: family dysfunction theories is that they have led to practical applications

E+ E: means focus on role of family in SZ has led researchers to develop family therapy to increase patient’s chance of recovery + decrease chances of relapse evidence for this comes from NICE who found that relapse rate in family therapy condition was 26% compared to 50% relapse in control group receiving ‘standard’ care

L: positive as it suggests family dysfunction theories have led to psychological therapies that have benefitted real people’s lives supporting family it allows sufferer of schizophrenia reduced chance of relapse

Question 53

cognitive explanation: metarepresentation (A01)

Answer 53

cognitive ability to reflect on our own thoughts + behaviour

believed that dysfunction in metarepresentation contributes to onset of hallucinations

eg. person may start to believe that their actions + thoughts are being carried out by others

dysfunction in metarepresentation may also cause patient to believe that their own inner voices are actually thoughts of others being projected to their heads

Question 53

cognitive explanation (A01)

Answer 53

based on mental processes + explains symptoms of schizophrenia as being result of disruption of normal thought processing

Compared to controls research has found evidence of dysfunctional thought processing in people w/ schizophrenia eg. they process information differently to those w/x disorder

Question 54

cognitive explanation: central control (A01)

Answer 54

cognitive ability to suppress automatic responses while we perform deliberate actions instead

Disorganised speech + thought disorder could result from inability to suppress automatic thoughts + speech triggered by other thoughts

eg. sufferers w/schizophrenia tend to experience derailment of thoughts + spoken sentences because each word triggers associations + patient has difficulty supressing an automatic response to these

Question 55

cognitive explanation as an explanation for schizophrenia: real world application (A03) (2)

Answer 55

P: real world application

E: helped in development of Cognitive Behavioural Therapy for psychosis (CBTp) which has been extremely effective in treating schizophrenia-evidence for this comes from NICE who reviewed range of treatments for schizophrenia + found that compared w/antipsychotic drug therapy CBTp was far more effective in reducing symptom severity + improving social functioning

L: positive as theory leading to treatment has benefitted real people’s lives in helping them to develop strategies to improve cope w/ + improve their dysfunctional thought processes

Question 56

cognitive explanation as an explanation for schizophrenia: supporting evidence (A03) (1)

Answer 56

P: supporting evidence

E: O’Carroll reviewed available evidence + found that cognitive impairments existed in 75% of people w/schizophrenia mainly affecting attention, memory + verbal learning also found that cognitive impairments often pre-dated illness

E: evidence of dysfunctional thought processing in sufferers of schizophrenia comes from Stirling who compared performance on range of cognitive tasks in 30 people w/schizophrenia + control group of 30 people w/x schizophrenia tasks included Stroop test where Ps have to name font-colours of colour words so have to suppress tendency to read words aloud-Frith’s central control theory people w/schizophrenia took over twice as long on average than control group to name the font colours

L: Both studies show clear support for cognitive explanation of schizophrenia bc it demonstrates impairment in cognitive processes in sufferers compared to those w/x schizophrenia

Question 57

cognitive explanation as an explanation for schizophrenia: medication could be cause (A03) (3)

Answer 57

P: cognitive impairments found in schizophrenia may be due to antipsychotic medication

E+ E: medication has serious side effects that may account for some of deficits found in patients w/ schizophrenia-also been suggested that cognitive differences are result of neural correlates + abnormal neurotransmitter levels rather than cause of schizophrenia

L: casting doubt on belief that cognitions are to blame for schizophrenia

Question 58

cognitive explanation as an explanation for schizophrenia: lacks explanation (A03) (4)

Answer 58

P: critiqued for only identifying reason for current symptoms

E+ E: theories identify faulty cognition as cause of some of symptoms eg. disordered thinking + deficits in processing but does not explain what led to cognitive impairments in 1st place- faulty cognition explains symptoms but not causes

L: weakness bc it suggests that we cannot fully explain cause of schizophrenia using cognitive theory alone

Question 59

cognitive behavioural therapy (CBT) used in treatment of schizophrenia (A01)

Answer 59

Cognitive Behavioural Therapy for psychosis (CBTp) is name given to CBT for patients w/schizophrenia It usually takes place for between 5 + 20 sessions either in groups or individually

CBT therapist begins by developing trusting relationship w/ schizophrenic patient helping them to see that many of their symptoms eg. having paranoid thoughts are more common than they think helping to reduce anxiety levels

Question 60

CBT used in treatment of schizophrenia: assumptions (A01)

Answer 60

basic assumption of CBTp is that it is not events themselves that cause person problems but beliefs (B) they have about events- if person has distorted beliefs this will in turn have negative effect on their feelings and behaviours

eg. someone w/schizophrenia may believe their behaviour is being controlled by something else- CBTp is used to help patient identify and correct these faulty interpretations or beliefs

therapist will discuss w/patient how likely these irrational beliefs are to be true + consider other more rational beliefs instead- CBTp allows patient to make sense of how their delusions + hallucinations impact on their feelings + behaviour

Question 60

CBT used in treatment of schizophrenia: ‘ABCDE’ model (A01)

Answer 60

eg. if patient hears voices + believes voices are demons they will naturally be very afraid- thinking about these more rational disputing beliefs client should feel ‘Effect’ (E) of challenging irrational thoughts + become less anxious which will have positive effect on their behaviour- called ‘ABCDE’ model

Patients are also encouraged to develop coping strategies- common coping strategy employed to deal w/auditory hallucinations is to limit time they actively listen to voices eg. 30 minutes per day rest of time- patient is encouraged to ignore voices

Question 61

CBT in treatment of schizophrenia: supporting evidence (A03) (1)

Answer 61

P: supporting evidence

E+ E: Tarrier- reviewed 20 studies using CBTp + found persistent evidence of reduced positive symptoms lower relapse rates + faster recovery rate in ill patients in the short term Jauhar et al reviewed 34 studies + concluded that CBTp has significant but fairly small effect on both positive + negative symptoms

L: findings suggest that CBTp is an effective therapy for helping people w/schizophrenia control their symptoms

Unlike drug therapy CBTp produces no side effects + could be considered more suitable treatment for many people w/schizophrenia making condition more manageable + improve patient’s quality of life eg. CBTp helps to raise patient’s self-esteem by helping them realise that healthy people also sometimes experience delusions + hallucinations

Question 62

CBT in treatment of schizophrenia: drop out rates (A03) (2)

Answer 62

P: patients w/severe symptoms of schizophrenia drop out of CBTp

E+ E: Tarrier found 45% of sample refused to cooperate or dropped out during trial patients need to be highly motivated + have ability to put in time + effort for therapy to be success some patients w/schizophrenia suffer w/avolition so engaging in lengthy therapeutic process will be problematic for those patients in particular

L: suggests CBT may not be suitable treatment for all patients suffering w/schizophrenia + alternative treatments such as drug therapy may be more appropriate

Question 62

CBT in treatment of schizophrenia:
combination therapy may be best approach (A03) (3)

Answer 62

P: effectiveness of CBT is increased when mixed w/combination of treatments + may depend on stage of disorder

E+ E: Addington + Addington claim that in initial phase of schizophrenia self-reflection on symptoms is not particularly appropriate but following stabilisation of symptoms w/ antipsychotic medication individuals can benefit from group-based CBT which can help normalise their experience by meeting other individuals w/similar issues-suggests that CBT may only be useful for specific stages of treatment + may need to be constantly adapted

L: CBT may not be an effective for all patients w/schizophrenia + alternative treatments may be necessary

Question 62

Family therapy used in treatment of schizophrenia: supporting evidence (A03) (1)

Answer 62

P: supporting evidence-found to be effective

E+ E: Pharoah et al carried out meta-analysis on 53 studies to compare effectiveness of family therapy for treatment of schizophrenia w/antipsychotic medication-found reduction in risk of relapse + reduction in hospital admission during treatment + in 24 months after- use of family therapy also increased patient’s compliance w/medication

L: suggests that family therapy is an effective treatment which could hint that better family relationships are the key element in helping patient to recover

Question 63

Family therapy used in treatment of schizophrenia (A01)

Answer 63

form of psychotherapy which is based on the idea that communications + interactions amongst family of patients w/ schizophrenia are dysfunctional

therapy involves patient’s whole family + aims to improve quality of communication + interaction between family members + to reduce levels of EE + stress

Family therapy is usually offered for period of between 3 + 12 months + at least 10 sessions

Family therapists such as Pharoah aim to improve functioning of family w/member suffering schizophrenia by employing number of strategies:
1. Forming a therapeutic alliance w/ all family members
2. Reducing stress of caring for relative w/schizophrenia
3. Problem solving
4. Reduction of anger + guilt
5. Helping family members achieve balance between caring for individual w/schizophrenia + maintaining their own lives
6. Improving believes + behaviour towards schizophrenia

NICE recommends that family therapy should be offered to all individuals diagnosed w/ schizophrenia who are in contact w/or live w/family members- also stress that such interventions should be seen as priority where there are persistent symptoms or high risk of relapse

Question 63

Family therapy used in treatment of schizophrenia: highly beneficial for family members + not just sufferer of schizophrenia (A03) (3)

Answer 63

P: highly beneficial for family members + not just sufferer of schizophrenia

E+ E: Lobban et al analysed results of 50 family therapy studies that had included an intervention to support relatives-60% of these studies showed positive impact of intervention on at least 1 outcome for relatives eg. coping + problem solving skills shows that investment in family therapy can have positive consequences for many family members

L: which in long term should be cost effective in reducing relapse + re-hospitalisation of person w/ schizophrenia + mental health of carers

Question 64

Family therapy used in treatment of schizophrenia: useful for patients who lack insight into their schizophrenia (A03) (2)

Answer 64

P: useful for patients who lack insight into their schizophrenia

E+ E: family members are able to assist w/providing lots of useful info about patient’s schizophrenia in coherent way whereas patient may be unable to do so have insight into patient’s moods + are able to speak for them when patient cannot speak for themselves

L: help them start to receive therapy immediately + is clear strength of family therapy in helping to treat schizophrenia effectively

Question 65

Family therapy used in treatment of schizophrenia: contradictory findings (A03) (4)

Answer 65

P: not all evidence suggests that family therapy is effective in treating schizophrenia

E+ E: Garety et al found little difference in improvement of symptoms of schizophrenia in patients that received family therapy compared to patients that received no family therapy but had carers patients in both groups had low incidences of relapse researchers found that carers had low levels of EE + this could explain why there was little difference between 2 groups

L: clearly shows that low levels of EE are important for improving symptoms of schizophrenia but it also shows that family therapy may not necessarily be any more effective than high quality standard of care provided by emotional responsive carers

Question 66

token economy used in management of schizophrenia (A01)

Answer 66

behavioural therapy used primarily in hospitals based on principles of operant conditioning

aim of token economy is to change maladaptive behaviours shown by individuals w/schizophrenia into more desirable behaviours through use of tokens

tokens reinforce desirable behaviour helps in management of schizophrenia- idea is that the token is given immediately on completion of desired behaviour

eg. getting dressed in morning, making bed, engaging in conversation- tokens can be later swapped for material treats eg. sweets, magazines or for services such as having room cleaned, breakfast in bed or privileges eg. walk outside hospital

Question 67

token economy in management of schizophrenia: effective (A03) (1)

Answer 67

P: effective in managing symptoms of schizophrenia

E+ E: Glowacki identified 7 studies published between 1999 + 2013 + reported that all studies had shown reduction in negative symptoms + decline in frequency of unwanted behaviours

L: findings demonstrate support for view that token economies are effective in managing schizophrenia in hospitalised patients- bc it is possible to control environment + ensure that patients are rewarded consistently for desirable behaviours tokens can be tailored to individual patients’ requirements + used to target different behaviours

but critics argue that using only 7 studies to support effectiveness is limited + may not accurately represent effectiveness of token economies to manage symptoms of schizophrenia

Question 67

token economy used in management of schizophrenia: improvements on token economy (A01)

Answer 67

early stages of token economy frequent exchange periods mean that patients can be quickly reinforced + target behaviours can then increase in frequency

Over time to encourage further improvements more may be expected of patients to achieve token rewards

eg. they may only be rewarded for helping others or completing ‘chores’- their behaviour can be developed + ‘shaped’ over time, working towards being more + more able to function + look after themselves + become less reliant on staff, carers + medication too

Question 68

token economy in management of schizophrenia: only effective for negative symptoms (A03) (2)

Answer 68

P: not effective in managing all symptoms of schizophrenia

E+ E: Token economy is only really effective in treating negative symptoms which involve social withdrawal yet not effective in treating positive symptoms eg. hallucinations + delusions also been argued that token economies produce only token learning eg. possible that what patients learn in token economies is merely to imitate normal behaviour without any deeper changes in their thoughts + beliefs

L: suggests therapy may be limited in terms of its effectiveness in that it may be very superficial + temporary -it may only be useful w/in institution + may not provide patient w/skills for living in outside world

Question 69

token economy in management of schizophrenia: ethical issues (A03) (3)

Answer 69

P: could be viewed as manipulative + unethical

E: Most significantly that privileges + services become more accessible for patients w/milder symptoms + less available for patients w/severe symptoms has potential for abuse

E: Corrigan claimed that token economy can be abusive + humiliating- potential for taking away power from patient + allowing others to have power over patient

L: suggests token economy therapies may not always be appropriate when they are used for reasons other than treatment of patients

Question 70

diathesis-stress model: what it stands for (A01)

Answer 70

Diathesis – Underlying vulnerability

Stress – generic name which refers to ‘trigger’ for development of schizophrenia

In context of schizophrenia stress means negative psychological experience

diathesis-stress model suggests that individual must have genetic vulnerability + stress-trigger present in order to develop condition

individual may have more than 1 underlying biological factor which would make them vulnerable to developing schizophrenia but onset of schizophrenia is triggered by stress

Psychological triggers for schizophrenia can be things eg. family dysfunction, substance abuse, stressful life events

Question 70

importance of interactionist approach for explaining schizophrenia (A01)

Answer 70

acknowledges that there are biological + psychological/societal factors that contribute to development of schizophrenia

Biological factors include: Genetic Vulnerability, Neurochemical Abnormality + Neurological Abnormality

Psychological/Societal factors include: Stress + poor quality

Question 71

diathesis-stress model: biological (A01)

Answer 71

know that many genes have been linked to causing schizophrenia ‘polygenic’

We also know that early + severe trauma can affect developing brain

eg. HPA system becomes more over-active this makes person more vulnerable to later stress + so can also be diathesis as well as genes

Question 72

importance of an interactive approach for explaining schizophrenia: research support (A03) (1)

Answer 72

P: support dual role of vulnerability + stress in development of schizophrenia

E: sufferer of sz compared to control group of adoptees w/x any genetic risk- found that parenting style characterised as high levels of criticism + conflict w/low levels of empathy was implicated in development of disorder but only for children w/high genetic risk + not in control group suggests that both genetic vulnerability + family-related stress are important in development of sz + that poor parenting could be possible source of stress.

E: Varese found that children who experienced severe trauma before age of 16 were three times as likely to develop schizophrenia in later life compared to general population- relationship between level of trauma + likelihood of developing sz w/those severely traumatised as children being at greater risk

L: suggests that early trauma is diathesis meaning person was vulnerable to developing sz later due to their early experience-fact that they developed sz was due to presence of stress trigger later in life evidence supports modern understanding of diathesis in diathesis stress explanation of schizophrenia

Question 72

importance of an interactive approach for explaining schizophrenia: genetic inheritance (A03) (2)

Answer 72

P: twin studies offer further support that an interactionist approach is important to explain the cause of schizophrenia

E+ E: MZ twin concordance rates for schizophrenia seldom rise above 50% supporting view that environmental factors must also play role in determining whether biological vulnerability actually develops into disorder

L: supports an interactionist view when explaining development of schizophrenia bc it clearly demonstrates that genetic vulnerability alone does not automatically lead to disorder developing- genes alone were cause we would be expecting 100% concordance for MZ twins when 1 of twins has schizophrenia

Question 73

diathesis-stress model: psychological (A01)

Answer 73

much recent research has looked at cannabis as triggering ‘stress’ factor due mainly to fact that cannabis appears to increase schizophrenia rates by seven times

probably bc cannabis interferes w/dopamine system

Question 74

importance of interactionist approach for treating schizophrenia (A01)

Answer 74

interactionist model of schizophrenia acknowledges both biological + psychological factors in schizophrenia it is therefore compatible w/both biological + psychological treatments

model would recommend to combine antipsychotic medication and psychological therapies

Turkington believes it is possible to believe in biological causes for schizophrenia + still practise CBT to relieve psychological symptoms

many patients they will be treated w/number of treatments such as CBT + family therapy alongside antipsychotic medication

Question 75

importance of interactionist approach for treating schizophrenia: combining treatments for schizophrenia is highly effective (A03) (1)

Answer 75

P: combining treatments for schizophrenia is highly effective

E+ E: Tarrier studied 315 patients who were randomly allocated to either: 1. Medication + CBT 2. Medication + Counselling or 3. Control group-Tarrier found symptom levels were lower in both combination groups compared to control group although there was no difference in rates of hospital readmission

L: clearly demonstrates benefits of adopting interactionist approach when treating schizophrenia

Question 76

importance of interactionist approach for treating schizophrenia: difficult to assess which treatment is most successful (A03) (2)

Answer 76

P: combination of treatments for schizophrenia is that it is difficult to assess which treatment is most successful

E+ E: evidence suggests combination of antipsychotics + CBT is most effective treatment for schizophrenia but it is uncertain which of these therapies is having greatest effect

L: just bc treatment is effective does not mean that cause was biological or psychological