Schizophrenia

Question 1

What is the definition of schizophrenia?

Answer 1

A severe mental disorder characterised by disruption of cognitive and emotional functioning. It effects language, thoughts, perception and sense of self. The individual may hear voices and see visions.

Question 2

What are some causes of schizophrenia?

Answer 2

1) genetics
2) brain damage
3) drugs and alcohol
4) childhood trauma

Question 3

What is type 1 acute schizophrenia?

Answer 3

Obvious positive symptoms appear suddenly usually after stressful events

Question 4

What is type 2 chronic schizophrenia?

Answer 4

The illness takes many years to form and gradual chnages of increased distrurbance and withdrawal occur. Characterised by negative symptoms.

Question 5

What are the two manuals that diagnose schizophrenia?

Answer 5

ICD-10- produced by world health organisation and focuses on subtypes of schizophrenia
DSM-V- subtypes of schizophrenia were removed

Question 6

What is the DSM-V criteria for schizophrenia?

Answer 6

A- need 2 or more of the following (delusions, hallucinations, disorganised speech, grossly disorganised/ catatonic behaviour, negative symptoms eg flattening/avolition)

B- since the onset of schizophrenia, one or more areas of functioning will be negatively affected eg work or interpersonal life.

C- continuous signs of disturbance will be present for 6 months or more. Symptoms from criteria a have been present for at least 1 month.

Question 7

What is the meaning of positive symptoms?

Answer 7

This refers to excesses or symptoms that have been added to the patinet’s personality because they now have the illness of schizophrenia. These symptoms were not present when the person was healthy eg hallucinations and delusions.

Question 8

What is the meaning of negative symptoms?

Answer 8

This refers to loss of normal functioning. The person will have a weakened ability to cope and manage everyday life. They lose the ability to do certain things eg speech poverty.

Question 9

What are some positive symptoms of schizophrenia?

Answer 9

1) hallucinations - these can be auditory, visual, olfactory or tactile. They may see or hear things that do not actually exist.

2) delusions- they have a strong belief about something even though it’s based on mistaken and unrealistic views.

3) disorganised speech- the individual may make up random words or string random words together in a sentence that don’t make any sense.

4) catatonic behaviour- the patient have reduced reactions to environmental stimuli and can adopt rigid postures and standing completely still for long periods of time.

Question 10

What are some examples of negative symptoms?

Answer 10

1) speech poverty- speech is lessened in terms of fluency and patinets thinking is slow and thoughts may be blocked. Usually leads to brief replies and minimal elaboration.

2) avolition - the patient have reduced interest and motivation to complete goals and are happy sitting around doing nothing.

3) affective flattening- the patient has restricted ability to respond to emotional stimuli. They may behave inappropriately in social situations eg laugh when told bad news.

4) anhedonia- general lack of interest in almost all activities and a lack of interest in pleasurable stimuli eg interacting with others.

Question 11

What is reliability in schizophrenia?

Answer 11

Reliability is the level of agreement on the diagnosis by different psychiatrists across time. For the classification system to be reliable, different clinicians using the same system eg the DSM-V and should arrive at the same diagnosis for the individual.

Question 12

What is validity in schizophrenia?

Answer 12

Validity is the extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms. For the classification system to be valid, it should be meaningful and classify a real pattern of symptoms, which result from a real underlying cause.

Question 13

What is co-morbidity?

Answer 13

This refers to the extent that two or more conditions occur simultaneously in the same individual. For example a patient with schizophrenia may also be suffering from depression. This makes validity difficult because the symptoms of the two disorders may be the same for example depression and schizophrenia both involve low levels of motivation, so which causes issues in classifying the illness as schizophrenia. This also causes reliability issues as psychologists may diagnose one condition but not the other and there may be differences in diagnosis.

Question 14

Evaluation of co-morbidity?

Answer 14

1) The DSM ans ICD can be criticised because they lack validity. There is too much of an overlap between schizophrenia, mood disorders and OCD so it is very easy to misdiagnose patients. A second opinion from a clinician may be necessary to make a valid diagnosis.

2) research conducted by SIM found that the diagnosis of schizophrenia can be invalid and unreliable because of co-morbidity. He found that 32% of 142 hospitalised schizophrenic patients had additional mental disorders which is an issue when diagnosing the illness.

3) it has been found that schizophrenia patients have used alcohol, drugs and suffer from substance abuse before they were diagnosed with the illness making it difficult to give a reliable and valid diagnosis of schizophrenia, because some of the symptoms of the illness are the same as those who use drugs and alcohol.

Question 15

What is culture bias?

Answer 15

Culture has an influence on diagnosis and classification of schizophrenia. Luhrmann interviewed 60 adults with schizophrenia and found that though all reported hallucinations, patients from the USA reported the most significant negative symptoms compared to India and Ghana so culture has na affect on reliability of diagnosing schizophrenia.

Davidson and Neale explain that in Asian cultures, some people are praised if they do not show that they are suffering from a psychological problem so there is less data available from these regions so there is a cultural bias.

Question 16

Evaluation of culture bias?

Answer 16

1) research has found evidence for cultural relativism. Afro-Caribbean people have little immunity to the flu, and children born to mothers who has the flu during their second trimester has an 88% chance increase in developing schizophrenia. Therefore there may be cultural vulnerability which means Afro-Caribbean’s might be more at risk from developing schizophrenia than the white population.

2) Barnes found research evidence for cultural differences when diagnosing schizophrenia. The ethnic culture hypothesis predicts that ethnic minorities experience less distress if they suffer from schizophrenia because social structures exists in their culture. 184 individuals were studied from different backgrounds and found that Americans has more symptoms than other cultures because they have less supportive features in their cultures.

3) one weakness is cultural relativism. Psychologists might not be able understand a patinet’s symptoms correctly due to not fully understanding the patient’s cultural background and can lead to the misdiagnosis of schizophrenia.

Question 17

What is gender bias?

Answer 17

Male sufferers of schizophrenia tend to show more negative symptoms than women, and also seem to suffer from more substance abuse. Males have an earlier onset (18-25 years old) of schizophrenia than females (25-35 years old).

There seems to be disagreement amongst clinicians when diagnosing schizophrenia, especially when gender is taken into account. Critics argue that the DSM displays healthy behaviour for males rather than females. Therefore the DSM can be seen as gender biased, especially when classifying schizophrenia.

Question 18

Evaluation of gender bias?

Answer 18

1) research by Kulkarni has found supporting data to suggest that females might be less vunerable than males to schizophrenia. He found the female sex hormone estradiol can help treat schizophrenia in females, especially when paired with anti-psychotic drugs, so estradiol can be seen as a protective factor for females.

2) gender bias affects diagnosis of schizophrenia. In a study, Psychologists had to judge two patients using diagnostic criteria. When the patient was male, 56% of psychologists diagnosed schizophrenia however when the patient was female 20% of psychologists diagnosed schizophrenia, so there is a gender bias that males are more likely to be classified as schizophrenic.

3) the validity of the diagnosis of schizophrenia can be questioned, especially since females develop schizophrenia 4-10 years later than males, and there are also different types of schizophrenia that males and females are more vulnerable to, which must be taken into account when diagnosing schizophrenia.

Question 19

What is symptom overlap?

Answer 19

The positive and negative symptoms of schizophrenia are a valid diagnosis, however some of the symptoms of schizophrenia can also be found in other disorders such as depression and bipolar disorder and this is known as symptom overlap, so shared symptoms can lead to an invalid diagnosis.

Some illnesses that have symptom overlap with schizophrenic are bipolar depression, depression and schizotypical personality disorder. The person may exhibit a symptom typical of schizophrenia eg delusions but could have another condition with the same symptom eg bipolar disorder.

Question 20

Evaluation of symptom overlap?

Answer 20

1) to support correct diagnosis of schizophrenia in a valid way, clinicians should conduct a brain scan or EEG. This can examine the brain in detail, and especially check the grey matter in the brain, Since schizophrenic people suffer from the deterioration of grey matter. People with bipolar disorder do not have reduced grey matter so can help lead to more valid diagnosis.

2) Ketter found evidence of schizophrenia being misdiagnosed as another illness, because of symptom of overlap. This causes years of delays where schizophrenic patients do not get the correct treatment that they need and their illness gets worse. Therefore is it important that patients gets a valid diagnosis first time.

3) research evidence has also shows inter-rated reliability is actually quite low, especially when asking psychologists to agreement on diagnosing schizophrenia and not another condition. It was found that only 54% of psychologists agree on the same diagnosis, so shows how different psychologists give different diagnosis to the same patient who display the same symptoms of schizophrenia.

Question 21

What is the genetics explanation of schizophrenia?

Answer 21

Schizophrenia is inherited through generations and transmission of genes and DNA. Schizophrenia runs in families and involves a combination of genes (polygenic). The gene NRG1 contributes to the genetics of schizophrenia. NRG1 participates in glutamatergic signalling. NRG3 is another schizophrenia susceptibility gene so if these are inherited from the parent, the individual is more likely to develop schizophrenia.

Question 22

What is the dopamine hypothesis?

Answer 22

Schizophrenic patients tend to have excess levels of the neurotransmitter dopamine in subcortical areas of the brain which increases the firing of neurons. This is known as hyperdopaminergia. When drugs such as phenothiazine’s are given to patients’ that block dopamine at synapses in the brain, yhe positive symptoms of schizophrenia seem to reduce eg hallucinations but negative symptoms of schizophrenia tend to remain.

Question 23

Strengths of the dopamine hypothesis?

Answer 23

1) there is a lot of research to support the hypothesis that schizophrenic patients have high levels of dopamine in their brain. For example Davidson found that when schizophrenic patients were given the drug L-Dopa their schizophrenic symptoms got worse.

2) one strengths is that it uses a lot of scientific evidence and support for the dopamine hypothesis as a cause of schizophrenia. Most respect has used evidence that have come brain scans such as PET and fMRI which is highly valid and reliable.

Question 24

Weaknesses of the dopamine hypothesis?

Answer 24

1) a problem is that cause and effect is not clear. Could it be that an increase in dopamine causes schizophrenia to develop or could it be that schizophrenia develops first and this causes a rise in dopamine levels.

2) another issue is that the dopamine hypothesis can be seen as reductionist. It looks at the complicated phenomenon of the causes of schizophrenia and reduces it down to the component of dopamine alone. There may be other factors such as neuroanatomy that are ignored.

Question 25

What are the neural explanations of schizophrenia?

Answer 25

Schizophrenia may develop due to structural and functional brain abnormalities. we use fMRI to investigate brain abnormalities. Swayze conducted a Study where Patients with schizophrenia were given cognitive and memory tasks to do and this was compared to normal healthy patients whilst conducting MRIs. It found that schizophrenic patients had structural abnormalities like:
- a decrease in brain weight
-enlarged ventricles
- a smaller hypothalamus
-less grey matter and some structural differences in the prefrontal cortex.

Question 26

Strength of neural explanations?

Answer 26

1) there is a lot of research support to suggest that neural correlates seem to be an important factor when looking at the cause of schizophrenia eg the research by Swayze have pointed out problems in brain functioning that could have contributed to causing the illness.

Question 27

Weaknesses of neural explanations of schizophrenia?

Answer 27

1) a problem is that cause ans effects needs to be established. It is that brain abnormalities cause schizophrenia or does schizophrenia occur first and this leads to brain abnormalities later on.

2) Andreason has criticised the neural correlates explanation of schizophrenia. He found that the extent to which the ventricles in the brain are enlarged in schizophrenic patients is not significant and there is actually very little difference between neural correlates of schizophrenic patients’ and normal people.

Question 28

Rosenhan’s study on schizophrenia?

Answer 28

It was a field experiment in the USA where 8 sane people sought admission to 12 different mental hospitals.
Patients claimed they had hallucinates and heard words like “thud” “hollow” and “empty”
When admitted in hospital they stopped showing symptoms of schizophrenia and behaved normally.
All pseudo patients except one were given the diagnosis of schizophrenia.
35/118 of the genuine patients could tell that the pseudo patients did not have schizophrenia whereas psychiatrists couldn’t.

Question 29

Evaluation of Rosenhan’s study?

Answer 29

1) a problem is that this study was conducted a long time ago. The DSM and ICD have improved since then and are better at diagnosing and classifying schizophrenia. Also nowadays, you need at least two psychiatrists to agree that the patient has schizophrenia to be diagnosed so Rosenhan’s study does not apply to today’s world.

2) This Study raises many issues. For example, if we accept Rosenhan’s statement that psychiatrists cannot detect the sane from the insane, then this means psychiatrists cannot be trusted to accurately make a diagnosis of schizophrenia. This means they should use multiple opinions before deciding on a diagnosis.

3) you have to be cautious when saying that the psychiatrists were misdiagnosing. If a patient shows up to a hospital with schizophrenic symptoms, most psychiatrists would measure the symptoms and diagnose them with schizophrenia and it would be negligent to turn the patient away. We could argue that the psychiatrists made the valid decision to admit the patients into the hospital thinking they needed help.