Schizophrenia Flashcards
Outline Schizophrenia
Schizophrenia is a psychotic disorder, characterised by incoherent and illogical thoughts, behaviours and speech. Those who are experiencing psychosis endure a range of symptoms resulting in them having a loss of contact with reality.
Symptoms are most commonly onset between the ages of 15-35 and is most diagnosed in males.
Outline the positive symptoms of SZ
Positive symptoms are those which are additional to typical experiences an involve an excess of unusual functioning.
Hallucinations: additional sensory experiences, most typically auditory.
Delusions: fixed and false convictions that are irrational and not shared by others.
Grandiose, persecutory and referential are all forms of delusions. Delusions can cause an individual to believe the have remarkable qualities, that others are out to get them, or believe all ordinary events or behaviours from others is directed to them personally.
Disorganised speech
Abnormal motor movements: this can include agitation and catatonia. Catatonia refers to a lack of responsiveness to ones environment and may include the individual sitting in stage postures and carrying out repetitive movements.
Outline negative symptoms of schizophrenia
Negative symptoms refer to ones which refer to a loss of typical functioning.
Most commonly, individuals may experience a sense of avolition and a loss of any motivation towards goal directed behaviour. This can result in feelings of apathy, poor hygiene and a lack of persistence with work and social activities.
Speech poverty - reduction in quality and quantity of speech.
Discuss the reliability of SZ diagnosis/classification
When diagnosing SZ, clinicians will often use guidance from diagnostic manuals, most commonly the ICD-10 or DSM-V. However, different manuals vary in regards to the criteria outlined in order to receive a diagnosis. For example, the ICD-10 requires 2+ negative symptoms whereas the DSM-V only requires the presence of one positive symptom in order to receive a diagnosis. This could lead to practitioners arriving at different diagnoses’ depending on what classification system they are using, thus decreasing the reliability of SZ diagnosis’s’.
Cheniaux et al found when getting two psychiatrists to independently diagnose the same 100 patients using both the ICD and DSM-V, that they arrived at conflicting conclusions. One psychologist diagnosed 24 individuals using the ICD and 13 with the DSM-V. Whereas, the other diagnosed 44 using the ICD and 26 with the DSM-V. This limits the reliability of SZ diagnosis’s as the lack of inter-rater reliability indicates there is a lack of consistency in regards to the diagnosis of schizophrenia.
Discuss the validity of the diagnosis of SZ
Co-morbidity refers to the occurrence of 2+ disorder simultaneously. For example, Buckly found co-morbidity rates with SZ of 50% and 47% with depression and drug abuse respectively.
The issue of co-morbidity is coupled with the problem of symptom overlap, with SZ sharing symptoms with other disorders. For example, bipolar disorder and SZ both share similar positive symptoms such as delusions. Therefore, it could be possible that these two disorders are not distinct and in fact variations of the same condition.
These limitations make it increasingly difficult to distinguish SZ from other disorders. This can lead to a patient being diagnosed with one condition when they are in fact suffering with an other.
Discuss gender bias in reference to SZ
Men have been found to be more commonly diagnosed with SZ in contrast to women, however, research suggests that this is the result of diagnostic biases opposed to a real gender difference.
Loring and Powell found when having over 200 psychiatrists independently assess identical patient case studies but with varying descriptions of the patients race and/or gender, that there was an underdiagnosis of SZ in female patients and over diagnosis of SZ in black case studies.
As the exact same behaviour was concluded as schizophrenic in males but not in females, this indicates there is a gender bias in the diagnosis of schizophrenia and therefore some clinicians may be diagnosing the disorder based on biases opposed to factual evidence. This can result in female patients not receiving adequate treatment if their symptoms are being dismissed.
Discuss culture bias in reference to the diagnosis of SZ
Individuals of an Afro-Caribbean decent have been found to be 10x as more likely to be diagnosed with SZ in contrast to their white British counterparts. However, when looking at SZ rates in these countries of origin, they mirrored the same 1% as the rest of the general population.
This therefore indicates that this difference in diagnostic rates is not the result of a genetic vulnerability in black individuals but rather a culture bias.
Western clinicians may misinterpret the symptoms of individuals outside their culture as unusual or bizarre because they are not understanding them within their specific cultural context - cultural relativism. For example, Afro-Caribbean societies may attribute hearing voices to signs of a religious experience, whereas those outside this culture may view this as signs of schizophrenia.
The misinterpretation of symptoms in Black people may result in certain ethnic groups being discriminated against due to a culturally biased diagnostic system.
Outline the biological explanation for schizophrenia
Genes: The biological approach suggests that schizophrenia has a genetic basis, However since it is polygenic, meaning many genes are implicated in it, there is not one clear definitive gene causing the disorder. This also indicates SZ is aetiologically heterogeneous
Gottesman found concordance of 48% and 17% for schizophrenia in MZ twins and DZ twins respectively.
Tienari et al found in a sample of adoptees whose biological mother was schizophrenic, 7% of these went on to receive the same diagnosis. In contrast, a sample of control adoptees, only 2% went on to receive a schizophrenia diagnosis.
Neural correlates: when particular patterns of brain activity occur in conjunction with a certain experience and are thought to be the cause of said experience.
David et al: revised dopamine hypothesis suggests that abnormal levels of dopamine are implicated in the disorder. With excess dopamine levels in the reward pathway in the brain being linked to the positive symptoms of schizophrenia and a deficiency of dopamine in regions of the frontal lobe being correlated with negative SZ symptoms.
Patel et al found that PET scans showed low levels of activity in the frontal lobes of SZ patients compared to a control group.
Evaluate the biological explanation for schizophrenia
Research support for dopamine hypothesis:
Raindrop et al found when giving rats amphetamines they went on to display symptoms similar to those of schizophrenia. As amphetamines increase dopamine levels this indicates an excess of certain neurotransmitters are involved in schizophrenia.
Gottesman found concordance rates of 48% and 17% for SZ, in MZ and DZ twins respectively. Tienari found that 7% of adoptees with a biologically schizophrenic mother went on to receive the same diagnosis, compared to 2% of control adoptees. These studies are consistent with each other and indicate that genetics can make someone more vulnerable to developing the disorder.
Reductionist: reducing a complex and nuanced disorder to solely biological factors negates other possible variables implicated in SZ. For example, both childhood trauma and smoking THC rich cannabis in teenage years have both been associated with the development of mental health problems in general in adulthood and have now been suggested to be possible risk factors in the onset of SZ. Yet by ignoring environmental factors, the biological explanation cannot account for these possible causes. Therefore a holistic account which takes into consideration the entirety of all factors implicated in SZ may provide a more comprehensive explanation.
Research support is often correlational.
Biologically deterministic: suggests someone’s physiological makeup will inevitably lead to schizophrenia, in turn making sufferers feel helpless and disempowered when diagnosed. As a result this could not only exacerbate negative symptoms of SZ such as feelings of apathy, but it could also hinder efforts of rehabilitation programmes as patients are less likely to be motivated in managing their disorder if they believe they have no control over it. Therefore, alternative explanations may be more beneficial. For example cognitive explanations which take a soft-determinist approach suggest patients can improve their symptoms of SZ can be improved by managing their mental processes (through the use of free will.)
Outline the role of family dysfunctions as a psychological explanation for schizophrenia
Psychologists have attempted to link schizophrenia to childhood and adult experiences of living in a dysfunctional family, suggesting factors such as cold parenting styles, poor communication and high levels of expressed emotion can be a risk factor in the development of the disorder.
The Schizophrenogenic Mother is a psychodynamic explanation proposed by Fromm-Reichmann suggesting that a patients current internal conflicts are rooted in aversive childhood experiences.
The SM is characterised by a cold, rejecting and controlling maternal figure. This parenting styles creates a tense, toxic and secretive family environment which is theorised to lead to distrust and paranoia in the child.
Bateson’s Double-Bind theory proposes that poor communication within the family can lead to SZ; children who frequently receive contradictory and unclear messages feel trapped and in fear of doing the wrong thing as they receive mixed messages on how to behave. When the child inevitably does the wrong this this leads to the withdrawal of parental love and ultimately leaves the child with an understanding of the world as one which is unpredictable and confusing. Symptoms such as disorganised thoughts and paranoid delusions reflect this incoherent perception of the world.
Negative expressed emotion: Suggests high levels of negative expressed emotion towards a patient from their carer can trigger a relapse in SZ symptoms and has been theorised to possibly cause the disorder in those already vulnerable. This can involve hostility and anger towards the patient, verbal criticism and emotional over-involvement; all elements which create a serious source of stress for a patient.
Discuss the role of dysfunctional families in SZ.
Can lead to parent blaming by suggesting childhood experiences and certain parenting styles are responsible for someone’s state of psychological distress. Such theories may be causing additional stress and guilt for families who are already dealing with their relative’s difficult behaviour.
However, psychologists shouldn’t shy away from such research topics. With the correct precautions and ethical considerations taken (ie: how research will be used, impact on subjects studied) the benefits of these studies can significantly outweigh the costs; understanding the potential role a family can have on SZ can provide insights into how the disorder can be better managed or even prevented. For example, family therapies have been shown to be a successful intervention due to their attempts at reducing expressed emotion.
Mokved reported that a significant proportion of SZ sufferers had had at least one experience of childhood trauma. This provides evidence supporting the link between dysfunctional families and SZ.
Tienari et al found that when comparing adoptees with a biologically SZ mother, >35% went to receive the same diagnosis when adopted into a dysfunctional family, compared to less than 6% of those adopted into a family deemed psychologically healthy.
However, there is a lack of research directly supporting theories into the role of the family. For example, Fromm-Reichmann’s SM was based on informal assessments of the personalities of patients’ mothers rather than systematic evidence. This reduces the credibility of such theories due to the lack of objectivity within its supporting evidence.
The theory of the schizophrenogenic mother shows a clear gender bias by indicating the mother plays a key destructive role into the onset of SZ. The misogynistic nature of these theories wrongly portrays mothers as harsh and withholding, whereas, in reality, many mothers face significant emotional challenges due to their child’s condition. The emphasis on maternal blame perpetuates social stigma and fails to account for paternal roles or family dynamics as a whole.
Outline the cognitive explanation for schizophrenia
The cognitive approach theorises that schizophrenia is a result of dysfunctional thoughts and information processing.
Firth’s attention deficit theory suggests that schizophrenics have a faulty attention system. This means that preconscious thoughts and irrelevant information which are usually filtered out, are not, leading to an overwhelming amount of information and environmental stimuli overloading the brain.
Firth identified two types of dysfunctional processing: meta-representation and central control.
Outline meta-representation
Meta-representation refers to the ability to recognise one’s thoughts and behaviours as their own. This also includes being able to gain insight into intentions and the goals behind our actions.
Firth suggests that their is an impairment in schizophrenics’ meta-representation, meaning they fail to recognise their behaviour as their own and may view it as a result of an external force. This can account for positive symptoms such as auditory hallucinations when schizophrenics fail to differentiate the voices they hear with their own thoughts.
Outline central control
Central control is the ability to supress automatic thoughts and behaviours that result from a certain stimuli. In schizophrenics, these urges are failed to be supressed. This can account for positive symptoms such as speech derailment when they cannot supress the urge to express automatic thoughts.
Discuss the cognitive explanation for schizophrenia
Research support:
Stirling found when having participants complete the Stroop test (where they were required to name the font colour of the word rather than the word itself) , schizophrenics took twice as long on average to complete the test compared to the control group. This time difference is alignment with what Firth’s theory would hypothesise and is suggested to be a result of schizophrenics having an increased difficulty in supressing the urge to read aloud the word.
McGuigan found that schizophrenics often mistook their own speech for that of someone else, increasing the credibility of Friths suggestion that they have an impairment within their meta representation.
Only provides a proximal explanation, meaning they only explain what is presently happening and causing the symptoms rather than the underlying cause of them which distal theories attempt to explain. This means the cognitive approach can only provide a partial explanation and thus is limited.
Reductionist - studies have found brain damaged patients experience the same cognitive deficits to schizophrenics such as problems with attention and issues with memory and perception. Despite this, they do not go on to develop the same symptoms of schizophrenia, indicating that cognitive factors alone are not the sole cause of schizophrenia. Yet by being reductionist and simplifying SZ to only cognitive factors thereby negating the role of biochemistry and social factors which can increase someone’s risk of developing SZ, the cognitive explanation can only provide a partial one.
Real life applications. CBT is commonly used as a treatment for SZ in attempts of managing ones thoughts. The effectiveness of such treatments suggest that cognitions are implicated in the disorder.
Outline biological treatments for schizophrenia
Antipsychotics are most commonly used as a biological treatment for psychotic disorders such as schizophrenia and work by reducing the action of neurotransmitters.
Dopamine antagonists work by reducing the action of dopamine in neural regions associated with the symptoms of SZ.
Typical antipsychotics, such as chlorpromazine work by binding dopamine receptor sites at the posts synaptic neuron without stimulating them. This is thought to reduce positive schizophrenic symptoms and also have a sedative effect.
Atypical antipsychotics (such as clozapine) work in the same way but only temporarily occupy receptor sites before disassociating to allow for normal transmission of dopamine. This is thought to reduce extrapyramidal side effects which occur with typical antipsychotics. In addition, atypical antipsychotics act on serotonin and glutamate sites enabling a mood enhancing effect by reducing symptoms of depression and anxiety, thereby reducing negative symptoms such as avolition.
Evaluate the biological treatments for schizophrenia
Research support:
Thornley et al found in 13 trials, chlorpromazine was more effective than a placebo at reducing symptom severity and improving overall functioning.
Meltzer found clozapine was more effective than typical psychotics and effective in up to 50% of treatment resistant cases of SZ.
Lots of studies only investigate short term effects of biological treatments thereby only giving a limited conclusion to the overall effectiveness of antipsychotics.
Side effects - Most antipsychotics lead to side effects such as agitation, dizziness, weight gain and in extreme cases of long term use of typical antipsychotics, tardive dyskinesia and neuroleptic malignant syndrome - NMS occurs as a result of the blockage of dopamine in the hypothalamus subsequently resulting in feverish symptoms, comas and can be fatal in severe cases.
Kapur found that for typical antipsychotics to be effective they had to block 60-70% of receptor site in the mesolimbic dopamine pathway. However, this also results in the blockage of sites in other neural regions. For example, this can effect extrapyramidal regions of the brain which are responsible for motor functioning. This can lead to side effects such as tardive dyskinesia which refers to the involuntary movement of the tongue, jaw etc:
Ethical issues - the calming effects of antipsychotics, make patients more manageable by reducing their distressing symptoms. This ability could potentially be exploited for the gain of others to make schizophrenics easier to work with opposed to their own benefit.
Outline the interactionist approach
The interactionist approach acknowledges that there is a multitude of contributing factors implicated in the development of schizophrenia and thus takes a more holistic approach to explaining the disorder.
Outline the diathesis-stress model
The diathesis stress model suggests a disorder occurs when a pre-existing vulnerability is triggered by a negative experience.
Meehl first applied this to schizophrenia suggesting the vulnerability is entirely genetic and caused by a single schizogene. According to Meehl, a combination of this pre-existing biological vulnerability and chronic stress through childhood adolescence (eg: the presence of a SM) could result in the development of the disorder.
Evaluate the interactionist approach
Research support:
Tienari et al: >35% of adoptees with a biologically schizophrenic mother went on to receive the same diagnosis when adopted into a dysfunctional family. This figure was less than 6% if the child was adopted into a family deemed psychologically healthy. This supports the diathesis-stress models as it indicates despite having the same pre-existing vulnerability, the development of schizophrenia was more likely to occur if the diathesis had been exposed to a stressful environment.
Oversimplistic:
The explanation that SZ is caused by a single schizogene triggered by the stress of schizophrenic parenting is overly simplistic. Ripke found SZ is polygenic and thus a variety of genes have been shown to be implicated in the disorder, not solely one. Moreover, contemporary understandings of diathesis have shown that pre-existing vulnerabilities are not necessarily solely biological. For example it was found that early traumatic experiences can create vulnerabilities to schizophrenia - childhood trauma has been shown to make the HPA overactive, subsequently making someone more sensitive to stress. Similarly, stress has now gained a more comprehensive understanding and isn’t limited to being only psychological. Houston et al, found that excessive smoking of THC rich cannabis can increase the likelihood of developing schizophrenia by 7x.
Practical value: The interactionist approach has been shown to have huge practical applications in terms of treatment. Tarrier et al found that patients experienced a greater reduction in symptom severity when receiving medical treatment alongside psychological therapies compared to patients who only received medical treatment. This shows the benefits of an interactionist approach in both providing a more comprehensive and holistic understanding of schizophrenia but also in resulting in better healthcare outcomes for sufferers.
Outline token economies in reference to schizophrenia
Token economies aim to manage SZ and are a form of behavioural therapy working off of the principles of operant conditioning, using reinforcement to encourage the repeat of desirable behaviours.
Tokens are given immediately to a patient in response to the demonstration of desired behaviours, eg: getting dressed. Tokens serve as secondary reinforcers as they have no value in themselves but can be swapped for tangible rewards such as sweets or more free time.
They attempt to combat the issue of institutionalised which arises after prolonged stays in hospital care and is thought to exacerbate a patients’ bad habits such as poor personal hygiene and their socialisation with other. Matson argued token economies help target 3 types of behaviours; personal care, condition related and social behaviour.
Tokens aim to improve a patients’ stay whilst in hospital as well as make their transition back into society smoother by encouraging “normalised” behaviours and routines.
Discuss the use of token economies
Azrin et al: found that TES were effective at reducing both negative symptoms and maladaptive behaviours in female schizophrenic patients.
Glowaki found in a meta-analysis of 7 studies which used TES for patients with prolonged chronic mental health conditions and found they were effective at reducing negative symptoms.
Sultana et al identified limited research into the long term effectiveness of TES.
Ethical issues: TES give professionals significant levels of control of patients behaviour. It is imposing a norm onto a patient which may be appropriate in societal settings, is unfair to expect this perfection. Similarly using Skinerian principles on patients can be seen as ethically problematic and dehumanising as it is effectively manipulating them in the way Skinner’s rats were.
TES are not applicable to patients with the most distressing symptoms. The severity of a patients’ symptoms will influence their willingness to engage, for example poor motivation. Removal of small pleasures due to an inability to engage seems unfair.
Outline the role of CBT in the treatment of SZ
CBT attempts to address a patients faulty cognitions and utilise Ellis’ ABC model by challenging the rationale behind their beliefs thoughts through logical arguments. This can help a patient make sense of their dysfunctional thoughts and create coping strategies on how to manage these.
A patient may engage in reality testing to demonstrate to themselves that their irrational beliefs ( eg: delusions ) are not real.
Evaluate CBT as a treatment for SZ.
Research support: Sensky found that after 19 CBT sessions patients who were unresponsive to drug treatment had both a reduction in positive and negative symptoms. These changes were sustained and even continued to improve 9 months following the CBT programme ending. This is highly suggestive that CBT is an effective way of treating SZ and a reliable alternative to drug therapies.
More time consuming and less economical.
Not applicable to all patients. Those with the most distressing symptoms are unlikely to have the motivation required to engage in CBT sessions. Similarly, the effectiveness of CBT is reliant on a trusting relationship between therapist and the patient. However, patients experiencing extreme paranoia and persecutory delusions are unlikely to be able to establish this relationship of trust, subsequently making the session ineffective.
Outline the role of family therapy
As family dysfunction has been identified as a risk factor for the potential onset or relapse of schizophrenia symptoms, family therapy aims to reduce high levels of expressed emotion and to reduce the likelihood of relapse. Family therapies don’t serve as a treatment to SZ but rather try to to manage the condition by changing the behaviour of the family as well as the patient.
Family psychoeducation involves getting families to gain a better understanding of their relatives and their condition.
Family therapies may address issues such as anger within the family and caring responsibilities in attempts of reducing conflicts and stress. Similarly, carers may be encouraged to focus on their own needs rather than solely their relative’s in order to reduce self sacrifice.
Discuss the use of family therapies
Left found that 8% of patients relapsed after 9months of family therapy sessions. This was compared to 50% of patients who relapsed after only receiving standard outpatient care. However, these figures rose to 50% and 75% respectively 2 years after. Therefore, whilst this suggests family therapy is more successful at reducing relapse rates compared to standard treatment, positive changes in family behaviour appear difficult to establish in the long term.
Family therapy can enable patients to feel less isolated and alone within their condition. By establish a stable support system within the home, patients may feel less reliant on external mental healthcare providers, in turn helping the economy. Family therapy can also have other economical benefits as research suggests it lowers relapse rates, therefore meaning hospital care will not be needed.
