Schizophrenia

Question 1

What is schizophrenia

Answer 1

A type of psychosis, a server ,mental disorder characterised by profound disruption of cognition and emotion so that contact with external reality and insight are impaired.

Question 2

What is classification

Answer 2

Organising symptoms into categories based on which symptoms cluster together

Question 3

What is diagnosis

Answer 3

Deciding on whether someone has a particular mental illness using the classifications.

Question 4

What are positive symptoms

Answer 4

Atypical symptoms experienced in addition to normal experiences- including hallucinations and distortions.

Question 5

What are negative symptoms

Answer 5

Atypical experiences that are the loss of a usual experience- loss of a normal function

Question 6

What are the two positive symptoms of schizophrenia

Answer 6

Hallucinations and delusions

Question 7

What are hallucinations

Answer 7

Disturbances of perception in ant sense. False perceptions of reality (hearing voices). Many schizophrenics hear many voices or see people telling them to do something e.g. harming themselves or commenting on their behaviour

Question 8

What are the 4 types of delusion

Answer 8

Delusion of persecution
Delusions of grandeur
Delusions of control
Delusions of reference

Question 9

What are delusions of persecution

Answer 9

The belief that others want to harm, threaten or manipulate you e.g. The government

Question 10

What is reliability in schizophrenic classification

Answer 10

Reliability is the level of agreement/ consistency on the diagnosis of schizophrenia by different psychiatrists

Question 11

What is validity in schizophrenia

Answer 11

The extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms

Question 12

What are the four issues with the reliability and validity in the diagnosis and classification of schizophrenia

Answer 12

Co- morbidity
Symptom overlap
Cultural differences/ bias
Gender bias

Question 13

What are the two negative symptoms of schizophrenia

Answer 13

Avolition
Speech poverty

Question 14

What are the two negative symptoms of schizophrenia

Answer 14

Avolition
Speech poverty

Question 15

What is avolition

Answer 15

A lack of purposeful, willed behaviour. It is the reduction, difficulty or inability to start and continue with goal-directed behaviour i.e. actions performed to achieve a result. People with schizophrenia often have a sharply reduced motivation to carry out a range of activities and results in lowered activity levels.

E.g. no longer being interested in going out and meeting friends, poor hygiene and grooming, lack of persistence in work or education, sitting in the house every day doing nothing.

Question 16

What is avolition

Answer 16

A lack of purposeful, willed behaviour. It is the reduction, difficulty or inability to start and continue with goal-directed behaviour i.e. actions performed to achieve a result. People with schizophrenia often have a sharply reduced motivation to carry out a range of activities and results in lowered activity levels.

E.g. no longer being interested in going out and meeting friends, poor hygiene and grooming, lack of persistence in work or education, sitting in the house every day doing nothing.

Question 17

What is speech poverty

Answer 17

limited speech output with limited, often repetitive content. It involves reduced frequency (amount) and quality of speech. This is sometimes accompanied by a delay in the sufferer’s verbal responses during conversation. It’s not that they don’t know the words, but that they have a difficulty in spontaneously producing the speech.

Question 18

What is the definition of symptom overlap

Answer 18

There is considerable overlap between the symptoms of schizophrenia and other conditions, despite the claim that the classification of positive and negative symptoms would make for more valid diagnoses (symptom overlap).

Question 19

How can symptom overlap the validity of classification

Answer 19

lack of distinction calls into question the validity of the classification and diagnosis of schizophrenia as a unique syndrome with its own characteristics, signs, and symptoms.

Question 20

How can symptom overlap the validity of classification

Answer 20

lack of distinction calls into question the validity of the classification and diagnosis of schizophrenia as a unique syndrome with its own characteristics, signs, and symptoms.

Question 21

what is co- morbidity

Answer 21

refers to the extent that two or more conditions occur together. Co-morbidities are common among patients with schizophrenia

Question 22

What was Serper et al. (1999) study into co- morbidity in schizophrenia

Answer 22

They assessed patients with co-morbid schizophrenia and cocaine abuse, cocaine intoxication on its own and schizophrenia on its own. They found that despite there being considerable symptom overlap in patients with schizophrenia and cocaine abuse, it was actually possible to make accurate diagnoses.

Question 23

What was the process of Ketter’s (2005) research into symptom overlap and what did it tally us about receiving treatment

Answer 23

Ketter points out that misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur, as well as high levels of suicide- so symptom overlap can have serious consequences. Focusing on fixing this issue could save money and lives.

Question 24

What did Buckley et al. Tell us about the diagnosis of schizophrenia

Answer 24

They concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression (50%) or substance abuse (47%). PTSD also occurred in 29% of cases and OCD in 23%.

Question 25

How can you evaluate the classification of schizophrenia with cultural bias

Answer 25

Research suggests that there is a significant variation between cultures when it comes to diagnosing schizophrenia.

African Americans and English people of Afro-Caribbean origin are several times more likely to be diagnosed with schizophrenia. Given that rates in Africa and the West Indies aren’t high, the diagnosis seems to be the result of cultural bias. Positive symptoms of hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors. Therefore, people are readier to acknowledge such experiences. When reported to a psychiatrist from a diverse cultural tradition, these experiences are likely to be seen as bizarre and irrational.

This calls into question the validity of diagnoses of schizophrenia- psychiatrists may impose their own cultural standards for schizophrenia onto those from other cultures (imposed) and so are biased towards what is ‘normal’ in their culture (ethnocentric).

Question 26

What did Longnecker et al.’s study in 2010 tell us about the influence of gender bias on the classification of schizophrenia

Answer 26

They reviewed studies of the prevalence of schizophrenia and concluded that since the 1980s, men have been diagnosed with schizophrenia more often than women. Prior to this, there had been no difference.

This may be due to a gender bias in the diagnosis of schizophrenia. It appears that female patients typically function better than men, being more likely to work and have good family relationships. This high functioning may explain why some women have not been diagnosed with schizophrenia where men with similar symptoms might have been.

Therefore, women’s better functioning may bias practitioners to under-diagnose schizophrenia either because their symptoms are masked altogether by good interpersonal functioning, or because the quality of interpersonal functioning makes the case seem too mild to warrant a diagnosis.

Consequently, clinicians failing to consider these issues could affect the validity of diagnosis of schizophrenia.

Question 27

What are biological explanations of schizophrenia

Answer 27

Biological explanations emphasise the role of inherited factors and dysfunction of brain activity in the development of schizophrenia.

—> Most modern psychologists believe that schizophrenia is at least partly biological.

Question 28

What are biological explanations of schizophrenia

Answer 28

Biological explanations emphasise the role of inherited factors and dysfunction of brain activity in the development of schizophrenia.

—> Most modern psychologists believe that schizophrenia is at least partly biological.

Question 29

We main biological explanations

Answer 29

• Genetics
• The dopamine hypothesis (the role of neurotransmitters)
• Neural correlates

Question 30

Describe Gottesmans 1991 study into the genetic explanation for schizophrenia

Answer 30

conducted a large-scale family and found much higher concordance rates in MZ identical twins (48%) in comparison to DZ fraternal twins (17%). The data showed that the greater amount of genetics shared between people correlates to a greater risk of developing schizophrenia. Other data included general population 1%, half siblings 6%, siblings 9% and children 13%.

Keynote: you must explain how this supports the genetic explanation (using the % of genes they have in common and the concordance rates) to get high marks.

Question 31

How can we describe the theory that schizophrenia is polygenic

Answer 31

Schizophrenia is thought to be polygenic (it requires several different factors to work in combination) and so different combinations of genes can lead to the condition. Research suggests that there are 108 genetic variations associated with increased risk of schizophrenia.

Question 32

Explain the original dopamine hypothesis explanation

Answer 32

Dopamine is a neurotransmitter that generally has an excitatory effect and is associated with the sensation of pleasure. Unusually high levels are associated with schizophrenia, particularly the positive symptoms. Messages from neurons that transmit dopamine fire to easily or too often in those with schizophrenia.
Schizophrenics are thought to have abnormally high levels of D2 receptors on post-synaptic neurons, resulting in more dopamine binding and therefore more neurons firing. This is thought to lead to hallucinations and delusions.

(This only accounts for the positive symptoms of schizophrenia)

Question 33

What was the original dopamine hypothesis criticised

Answer 33

Because it only focused on the positive symptoms of schizophrenia

Question 34

Who created the revised dopamine hypothesis

Answer 34

Davis and Khan in 1991

Question 35

What did Davi’s and Khan suggest in the revised dopamine hypothesis

Answer 35

positive symptoms= caused by higher levels or activity of dopamine in the subcortex (central areas of the brain).
E.g. An excess of dopamine receptors in Broca’s area may be associated with speech poverty and/or auditory hallucinations.

The negative symptoms= lower levels of dopamine in the pre- frontal cortex. It may be that both high and low levels of dopamine in different brain regions are involved in schizophrenia.

Question 36

What is the explanation of Neural correlates in the biological explanations of schizophrenia

Answer 36

Neural correlates are measurements of the structure or function of the brain that occur in conjunction with (correlates with) the characteristic symptoms of schizophrenia, and so may be implicated in the origins of schizophrenia.

• Lower activation levels in the superior temporal gyrus and anterior cingulate gyrus have been found in those experiencing auditory hallucinations.

Therefore, reduced activity in these two areas is a neural correlate of auditory hallucinations (positive symptoms).

Question 37

How can we use gottesman and tienari et al.s research into biological explanations of schizophrenia to explain the relationship between schizophrenia and genetic

Answer 37

P= There is supporting research to prove biology can be used to explain schizophrenia

E= There is now strong evidence for genetic vulnerability to schizophrenia from a variety of sources. E.g. Gottesman’s (1991) study.
Additionally, Tienari et al.’s (2004) adoption study found that children of schizophrenia sufferers are still at heightened risk of schizophrenia if adopted into families with no history of schizophrenia.

L= This supports the idea that genetic factors make some people much more vulnerable to developing schizophrenia than others (remember that you need to explain how exactly). This does not mean that schizophrenia is entirely genetic—> there are a number of environmental factors associated with risk of schizophrenia, but the available evidence suggests that genetic susceptibility is very important!

Question 38

How can we use Leucht et al.s research into anti-psychotic drugs to explain the impacts of genetics on the development of schizophrenia

Answer 38

supporting evidence for the genetic explanation’s being the cause for schizophrenia.

E= Much of the evidence supporting the dopamine hypothesis comes from the success of drug treatments that attempt to change levels of dopamine activity in the brain. The basic method mechanism of anti-psychotic drugs is to reduce dopamine activity and so reduce the effect of schizophrenia.
Leucht et al. (2013) found that anti-psychotic drugs were significantly more effective than placebo in the treatment of positive and negative symptoms. Dopamine agonists that increase the levels of dopamine make schizophrenia worse and can produce schizophrenia-like symptoms in non- sufferers (Curran et al., 2004).

L= This suggests that normalisation of dopamine activity levels treats schizophrenia and therefore that dopamine activity levels may cause schizophrenia, supporting the biological explanation.

Question 39

What are drug therapies as a treatment for schizophrenia

Answer 39

Drug therapies involve the treatment of schizophrenia through the use of antipsychotic medication to reduce the symptoms of the disorder.

Question 40

How do antipsychotics work

Answer 40

All antipsychotics work by reducing dopaminergic transmission i.e. reducing the actions of the neurotransmitter dopamine in areas of the brain associated with the symptoms of schizophrenia

Question 41

What are the two types of antipsychotics

Answer 41

• Typical
• Atypical

Question 42

What do typical anti-psychotics do as drug treatments

Answer 42

chlorpromazine are dopamine antagonists they bind to (and so block) dopamine receptors but don’t stimulate them, reducing the action of dopamine. Initially dopamine levels build up, but the production is reduced.

This normalises neurotransmission in key areas of the brain, by reducing stimulation of the dopamine system reducing positive symptoms such as hallucinations- permanent

Question 43

What do atypical anti-psychotics do as drug treatments

Answer 43

clozapine and risperidone also block dopamine receptors like typical antipsychotics. However, they only temporarily occupy the receptors and then rapidly dissociate to allow normal dopamine transmission.

This is thought to be responsible for fewer side effects. They also act on other neurotransmitters, particularly serotonin and they address negative symptoms e.g. avolition as well as positive symptoms.

Question 44

What are dysfunctional families in the psychological explanations of schizophrenia

Answer 44

A dysfunctional family is when there exist certain unfavourable behaviours between family members, such as a lack of empathy, and unhealthy interactions between parents and their children. These may create a confusing situation for the child, which may, in turn, produce erratic behaviours.

Question 45

What research did Fried Fromm-Reichmann do and what theory did he propose

Answer 45

Fried Fromm-Reichmann proposed a psychodynamic explanation based on account she had heard from her patients about their childhood. – the schizophrenogenic mother AKA the = schizophrenia Causing mother

Whilst being overprotective she’s also cold, rejective and controlling. Creates a family dynamic of secrecy and tension which leads to distrust and later paranoid delusions.

Question 46

What are some problems of the schizophrenic mother theory

Answer 46

• pressurises mothers
  -economic impacts and social stigmas

Question 47

What research and hypothesis did Bateson et al. Of 1972 develop

Answer 47

Bateson et al. (1972) when individuals received two or more conflicting messages.

Double blind hypothesis= Children who frequently receive these messages from their parents are more likely to develop schizophrenia. Results in the child feeling trapped in situations where they seek doing the wrong things. Can’t seek clarification- getting it wrong results in a withdrawal of love which fosters an understanding of the world as a dangerous and confusing place. Leads to period delusions and disorganised thinking.

Question 48

What is expressed emotions and what can they develop into.

Answer 48

Negative expressed emotions is the level of negative emotion expressed towards the patients by the carer=

• Verbal criticism including violence
• Hostility, anger, or rejection
• Emotional over involvement

Serious source of stress and can trigger a schizophrenic episode in someone who is vulnerable, or someone who is susceptible to schizophrenia because of their genotypes.

Question 49

What are the two cognitive theories of dysfunctional thinking

Answer 49

Metarepresentation
Central control

Question 50

What is metarepresentation

Answer 50

Refers to the ability to reflect on thoughts and behaviour.

insight into our own intentions and goals. Allows us to be conscious of what we intend to achieve with our actions. Also allows us to interpret the actions of others and interpret what their intentions are.

Therefore, schizophrenic patients with impaired metarepresentation have disrupted thoughts and actions, as they being their own thoughts are being carried out by ourselves rather than someone else- explains auditory disillusions and delusions.

Question 51

What is central control

Answer 51

Ability to suppress automatic responses whilst we perform deliberate actions.

Speech poverty and disorganised speech could result from this inability., as one thought triggers another thought and another speech. Derailment of thoughts- each word triggers associations, because we can’t suppress automatic responses

Question 52

What are the three main types of therapies for schizophrenia

Answer 52

• Cognitive behavioural therapy (CBT)
• family therapy
• token economy system

Question 53

How does CBT work to treat schizophrenia

Answer 53

Addressing irrational beliefs, working through them logically which works for positive symptoms such as hallucinations and delusions.

Question 54

What type of testing is used as a core part of CBT

Answer 54

Reality testing which helps cases of positive schizophrenic symptoms

Question 55

What are the type steps of the CBT process

Answer 55

Assessment and engagement

Question 56

What is assessment in the CBT process

Answer 56

Patients explain their situation to their therapist, identifying problematic thoughts and the potential causes for these thoughts.

Reflection is a core aspect of the assessment stage, requiring the patient to truly think back on themselves and understand where their symptoms are coming from and what makes them better/worse. Rating scales are used to monitor progress.

Question 57

What is engagement process in the CBT process

Answer 57

Once the above issues have been identified, the therapist can set out a cognitive framework to address these issues and logically work through them.

Socratic questioning is employed, alongside a vulnerability-stress model. Empathy is heavily emphasized between patient and therapist.

Question 58

What are family therapies for schizophrenia

Answer 58

Family therapy focuses on the people around the patient, involving them in the treatment process. Research has shown that many relapses in schizophrenia tend to occur after a patient has returned to their family environment.

Question 59

What are the main purposes of family therapies (Caqueo-Urizar et al. 2015)

Answer 59

• Psychoeducational.
• Opportunities for stress reduction.
• Avenues for emotional processing.
• Cognitive reappraisal.

Question 60

What is the token economy system for schizophrenic treatments

Answer 60

In schizophrenic patients, token economies focus on maladaptive behaviours that prevent a patient from adapting to new situations, treating both positive and negative symptoms of schizophrenia.

Question 61

What does the behavioural based reward system in token economies do

Answer 61

behavioural-based reward system= encourages ‘good behaviours’ and discourages ‘bad behaviours’. It is based on the concept of operant conditioning.

Question 62

What is the process of TES/ token economy treatments

Answer 62

• TES is introduced as soon as a patient enters the setting: rewards and good behaviours are established.

• They use physical tokens or tally systems: they can be earned and easily understood/quantified by introducing physical tokens or tally systems. These are the secondary reinforcers.

• They then trade these tokens in: Rewards can be given based on how many tokens a person has earned with good behaviour —> These are the primary reinforcers.

Question 63

What did the interactionalist explanation for schizophrenia suggest

Answer 63

Suggests schizophrenia is caused by a combined effect of biological and social/psychological factors

Question 64

What is Diathesis in schizophrenia? And what is the Diathesis stress model?

Answer 64

Diathesis stress model is a psychological concept that a disorder is due to the interaction between a predisposed vulnerability (Diathesis) and an environmental trigger later in life.

Diathesis in schizophrenia is often considered to be a genetic vulnerability, potentially resulting in a dopamine imbalance.

Question 65

What are stressors in schizophrenia

Answer 65

Stressors in schizophrenia are later negative environmental experiences such as family dysfunction, emotional stress, or a major negative life event. This emotional event then triggers the disorder.

Question 66

What does the interactionalist approach suggest about treatments for schizophrenia

Answer 66

the effective treatment of schizophrenia would combine psychological aspects such as CBT and biological drug therapies to address both psychological and biological causes.

Question 67

What study that we have previously learnt about can we link to the interactionalist explanation for schizophrenia

Answer 67

Gottesmans 1991 study into the correlation of MZ and DZ twins and the development of schizophrenic symptoms