Schizophrenia

Question 1

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
What is schizophrenia (Sz)?

Answer 1

Sz: a disorder in which a person has difficulty distinguishing what is real from what is in their imagination.

Question 2

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Finish these sentences:
Sz is experienced by about [ ]% of the world’s population.
It is more commonly diagnosed in [ ], [ ]-[ ] and [ ] socio-eonomic groups.
The symptoms of Sz can interfere severly with everyday tasks, so that many people with Sz end up [ ] or [ ].

0/7 = 1
2/7 = 2
4/7 = 3
6/7 = 4
7/7 = 5

Answer 2

Sz is experienced by about 1% of the world’s population.
It is more commonly diagnosed in men, city-dwellers and lower socio-eonomic groups.
The symptoms of Sz can interfere severly with everyday tasks, so that many people with Sz end up homeless or hospialised.

0/7 = 1
2/7 = 2
4/7 = 3
6/7 = 4
7/7 = 5

Question 3

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
What’s the difference between a classification and a diagnosis?

Answer 3

classification: identifying clusters of symptoms that occur together and classifying it as one disorder (e.g. hallucinations, delusions)
diagnosis: identifying symptoms a person has and deciding what disorder it is (e.g. schizophrenia)

Question 4

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Match up the following key terms to their definitions:

Co-morbidity
Gender bias
Culture bias
Symptom overlap
_______________________________________________________________________
A psychiatrist from one culture may misdiagnose people from a different cultural background.
When two disorders frequently occur together (e.g. Sz and bipolar disorder).
When disorders share the same symptoms which makes it difficult to distinguish between them.
When one gender is under diagnosed and/or one is over diagnosed (e.g. women may be underdiagnosed for Sz in the UK).

Answer 4

• Co-morbidity: When two disorders frequently occur together (e.g. Sz and bipolar disorder).
• Gender bias: When one gender is under diagnosed and/or one is over diagnosed (e.g. women may be underdiagnosed for Sz in the UK).
• Culture bias: A psychiatrist from one culture may misdiagnose people from a different cultural background.
• Symptom overlap: When disorders share the same symptoms which makes it difficult to distinguish between them.

Question 5

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Define ‘positive’ and ‘negative’ symptoms.

Answer 5

positive symptoms: additional experiences beyond those of ordinary existence (add-ons) (e.g. hallucinations, delusions)
negative symptoms: loss of usual abilities and experiences (losses) (e.g. speech poverty, avolition)

Question 6

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline hallucinations as a positive symptom of Sz.

Answer 6

HALLUCINATIONS:
- unusual sensory experiences
- could be random, could be related to the individual’s environment
- commonly hearing voices (auditory) (often critic)
- can be any sense: tactile (feeling things crawling on you), visions (distorted facial expressions)

Question 7

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline delusions as a positive symptom of Sz.

Answer 7

DELUSIONS (also known as paranoia/irrational beliefs):
- make a person behave bizarrely
- e.g.) the individual believes they are in important historical figure like Napoléon or Jesus
e.g.) the individual believes they’re being persecuted by the government or aliens
- e.g.) the individual believes they have superpowers
- e.g.) the individual believes they are under external control

Question 8

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline speech poverty as a negative symptom of Sz.

Answer 8

SPEECH POVERTY:
- a reduction in the quality and amount of speech
- changing topics mid-sentence, incoherent speech
- sometimes accompanied by a delay in a person’s responses in conversations

Question 9

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline avolition as a negative symptom of Sz.

Answer 9

AVOLITION:
- a lack/struggle to keep up/begin goal-directed activity
- sharp reduction in motivation
- poor hygiene + grooming, lack of persistence in work/education, lack of energy (the 3 signs of avolition identified by Andreasen)

Question 10

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding low reliability.

Answer 10

P: One limitation of the diagnosis of Sz is that these diagnoses have low reliability.
E: For example, Cheniaux et al (2009) found when two psychiatrists independently assessed 100 clients using the ICD10 and DSM4, 68 were diagnosed according to the ICD10 system compared to only 39 under the DSM4 system.
E: This is a weakness because it suggests the ICD10 and DSM4 were not reliable in the diagnosis of Sz there was inconsistency between these two classification systems. This study also suggests that one of these is also more valid than the other since they produced a dramatically different number of diagnoses for the same disorder.
E: However, Osorio et al (2019) reported high inter-rater reliability (+0.97) and test-retest (+0.92) reliability using the DSM5. This suggests that this latest version of the DSM (DSM5) has high reliability due to the empirical evidence and therefore we can trust this classification system for reliable diagnoses for Sz.
L: As a result, the credibility of the DSM5 as a classification system for diagnosing Sz is increased due to its reliability, but there needs to be some more work done to ensure consistency across all classification systems to ensure the appropriate people are correctly diagnosed with Sz.

Question 11

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding low validity.

Answer 11

P: One limitation of the diagnosis of Sz is that these diagnoses sometimes have low validity.
E: For example, Buckley et al found that Sz is commonly diagnosed alongside other conditions (e.g. substance abuse) because it is a co-morbid disorder.
E: This is a weakness because it suggests our current diagnosis strategy provides an incomplete criteria for the symptoms of Sz to provide an accurate diagnosis, since Sz symptoms cannot be fully explained by just a diagnosis of Sz but is often diagnosed with other disorders.
E: Furthermore, there is some symptom overlap between Sz and other conditions, such as symptoms appear in both Sz and Bipolar disorder such as delusions and avolition. This further suggests that a diagnosis of Sz is not always diagnosed accurately since it could easily be confused/misdiagnosed for other disorders with very similar/the same symptoms.
L: As a result, the diagnosis of Sz suffers from low validity due to the incomplete explanation and criteria for what symptoms Sz encompasses.

Question 12

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Outline one limitation of the diagnosis of Sz, regarding biased diagnoses (gender and cultural).

Answer 12

P: One limitation of the diagnosis of Sz is that these diagnoses are affected by gender and cultural biases.
E: For example, Sz diagnoses can be affected by cultural bias because some symptoms have different meanings in different cultures, e.g. hearing voices in Haiti may actually be interpreted as communication from ancestors. Furthermore, British people of African-Caribbean heritage are 9x more likely to receive a diagnosis than White British people.
E: Furthermore, Sz diagnoses can be affected by gender bias because men are diagnosed more often than women (1.4(men):1(women)).
E: These are weaknesses because is suggests that Sz is being inconsistently diagnosed between cultures and genders, which means those with a lower chance of being diagnosed, such as women, are less likely to receive the treatment they need to improve their quality of life.
L: As a result, the credibility of the diagnosis of Sz is reduced unreliable and inconsistent diagnoses across cultures and genders.

Question 13

DIAGNOSIS AND CLASSIFICATION OF SCHIZOPHRENIA
Briefly outline and evaluate one study of validity in relation to the diagnosis of schizophrenia. [4 marks]

Answer 13

ROSENHAN (1973)
AO1:
- 7 students visited 12 different asylums in USA
- all faked hearing voices “hollow, empty, thud”
- all were admitted to a ward as ‘insane’
- once inside they behaved normally, saying the symptom had gone away and they were fine
- none were detected as being pseudo-patients

AO3:
- strength: brought about a revision of the classification system to incorporate a more in-depth overview of mental disorders
OR
- limitation: brought about widespread distrust of psychiatrists to accurately diagnose mental disorders

Question 14

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the original dopamine hypothesis.

Answer 14

• high levels of dopamine in subcortical regions in the brain
• subcortical hypERdopaminergia
• e.g.) excess of dopamine receptors in Boca’s area explains speech poverty as a symptom of Sz

Question 15

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the updated dopamine hypothesis.

Answer 15

(- in addition to hypERdopaminergia)
- low levels of dopamine in cortex
- cortical hypOdopaminergia
- e.g.) defecit of dopamine in prefrontal cortex (thinking) could explain cognitive problems (-ve symptoms)
- cortical hypOdopaminergia leads to subcortical hypERdopaminergia

Question 16

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
What acronym can we use to remember the original and updated dopamine hypotheses?

Answer 16

Only
Happy
Squirels
Bury
Seeds
Under
Large
Coarse
Pine
Cones

Original
High (=hyper)
Subcortical
Broca
Speech
Updated
Low (=hypo)
Cortex
Prefrontal
Cognitive

Question 17

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Briefly outline one strength and one weakness of the dopamine hypotheses.

Answer 17

strength:
- research has shown that drugs that increase the levels of dopamine produce schizophrenic symptoms => shows higher levels of dopamine are linked to Sz symptoms which supports dopamine hypothesis

weakness:
- clozapine is the most effective drug at reducing Sz symptoms + acts on dopamine and serotonin => dopamine hypothesis isn’t a complete explanation if serotonin is also being acted on because this suggests that serotonin also has a role to play in Sz, which isn’t included in the dopamine hypothesis

Question 18

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline family studies as a genetic explanation of Sz.

Answer 18

family studies:
- Gottesman (1991) large-scale family study: risk of Sz increases with genetic similarity to a relative with the disorder
- e.g.) aunt with Sz => 2% chance of developing Sz
- e.g.) sibling with Sz => 9% chance of developing Sz
- e.g.) identical twin with Sz => 48% chance of developing Sz
- family members tend to share aspects of their environment as well as may of their genes so the correlation represents them both, but family studies still give good support for the importance of genes in Sz

Question 19

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline candidate genes as genetic explanation of Sz.

Answer 19

candidate genes:
- Sz is polygenetic (lots of genes involved)
- the most likely genes are the ones coding for neurotransmitters (dopamine)
- Ripke et al (2014) combined all data from genome-wide studies of Sz, 108 separate genetic variations were associated with slightly increased risk of Sz
- Sz is aetiologically heterogeneous (different combinations of factors, including genetic variation, can lead to the condition)
- Benzel et al (2007): there are 3 genes that have been associated with excess dopamine in specific receptors, leading to positive symptoms such as delusions and hallucinations: COMT, DRD4, AKT1

Question 20

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline the role of mutation as genetic explanation of Sz.

Answer 20

mutation:
- Sz can have genetic origin despite the absence of a family history of it
- mutation in parental DNA caused by radiation, poison or viral infection
- positive correlations between paternal age (associated with increased risk of sperm mutation) and risk of Sz (0.7% risk with fathers under 25 and 2% with fathers over 50)

Question 21

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one weakness of biological explanations of Sz, regarding biological reductionism.

Answer 21

P: One limitation of biological explanations of Sz is that they are considered biologically reductionist.
E: For example, the complex behaviour of Sz is being broken down into its constituent components and explained through genetic and neural processes.
E: This is a weakness because there is evidence that suggests that environmental factors also increase the risk of developing Sz including birth complications (Morgan et al, 2017) and smoking THC-rich cannabis in teenage years (Di Forti et al, 2015). Furthermore, Morkved et al (2017) found that 67% of people with Sz reported at least one childhood trauma as opposed to 38% of a matched control group with non-psychotic mental health issues. This suggests that, on their own, biological explanations do not provide a holistic and complete explanation for Sz.
E: Furthermore, the dopamine hypothesis takes the most reductionist level of explanation at the neurochemical level. Research from post-mortem and brain scanning studies demonstrate that other neurochemicals such as glutamate also seem to be abnormally higher in people with Sz (McCutcheon et al, 2020).
L: As a result, the credibility of biological explanations is reduced as they are not sufficient as stand-alone explanations.

Question 22

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one strength of biological explanations of Sz, regarding real-world application.

Answer 22

P: One strength of biological explanations for Sz is that they have real-world application.
E: For example, one application of our understanding of the likely role of genes in schizophrenia is genetic counselling. If one or more potential parents have a relative with Sz, they risk having a child who would go on to develop Sz. For instance, based on Gottesman’s study, the child would have a 6% probability if the parent has a half-sibling with Sz. Genetic counselling involves informing potential parents of these probabilities so they can make informed choices about whether to have children who risk having a poor quality of life if they develop Sz.
E: However, the risk estimate provided by genetic counselling is just an average figure based on the whole population. It won’t really reflect the probability of that particular child going on to develop Sz because any given child will be exposed to a particular environment which also exposes the child to risk factors. For example a child’s risk of developing Sz would be higher than its genetic probability if they experience childhood trauma and go on to smoke cannabis in their teens. Therefore genetic counselling only provides an estimate of risk of the unborn child going on to develop Sz.
E: Furthermore, by examining the role of neurochemicals such as dopamine (DA), antipsychotics have been produced to attempt to regulate levels of dopamine for individuals with Sz. According to Taylor et al (2014), these drugs reduce DA activity and the intensity of the symptoms of those with Sz. This is a strength because it allows individuals suffering with Sz to have an improved quality of life and could potentially allow them to return to work and therefore contribute positively to the economy.
L: As a result, the credibility of biological explanations of Sz is increased as they provide practical applications to individuals.

Question 23

BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA
Outline one weakness of biological explanations of Sz, regarding inconsistent evidence.

Answer 23

P: One limitation of biological explanations of Sz is that there is inconsistent evidence on the dopamine hypothesis from amphetamine psychosis.
E: For example, amphetamines (speed) can reproduce symptoms of Sz, which Tenn et al (2003) did in rats to then relieve the symptoms with drugs that reduce DA activity. In other research, amphetamines have been found to raise DA levels (Curran et al 2004) and amphetamines in high doses can produce auditory hallucinations that resemble those often seen in Sz. This evidence of a link between amphetamines and Sz symptoms supports the dopamine hypothesis.
E: However, other drugs that also increase DA levels (apomorphine) do not cause Sz-like symptoms (Dépatie and Lal, 2001). Also, Garson (2017) has challenged the idea that the symptoms of amphetamine psychosis closely mimic Sz. This is an issue because it suggests the relationship between dopamine and Sz is not well understood as evidence is contradictory.
E: Furthermore, psychologists should be mindful about the conclusions made from amphetamine psychosis about dopamine levels as a lot of the research comes from animal studies which may not be generalisable to humans, since we have different psychological and cognitive systems and structures. Therefore the link between amphetamine psychosis and Sz may not be as close as some have suggested.
L: As a result, the credibility of the biological explanations of Sz is reduced since amphetamine psychosis is not particularly strong evidence to support the dopamine hypothesis.

Question 24

DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Fill in the blanks:
The most common treatment for Sz involves the use of [ ] drugs. These drugs may be required on a [ ]-[ ] or [ ]-[ ] basis. They can typically be divided into two types and administered in [ ], [ ] or [ ] form:
- [ ] antipsychotics: these are [ ] drugs that have typically been used since the 1950s
- [ ] antipsychotics: these drugs have been used since the 1970s. They aim to improve the effectiveness of drugs in [ ] symptoms of psychosis AND minimise the [ ] [ ].

0/14 = 1
4/14 = 2
7/14 = 3
10/14 = 4
14/14 = 5

Answer 24

The most common treatment for Sz involves the use of antipsychotic drugs. These drugs may be required on a short-term or long-term basis. They can typically be divided into two types and administered in tablet, injection or syrup form:
- Typical antipsychotics: these are older drugs that have typically been used since the 1950s
- Atypical antipsychotics: these drugs have been used since the 1970s. They aim to improve the effectiveness of drugs in suppressing symptoms of psychosis AND minimise the side effects.

0/14 = 1
4/14 = 2
7/14 = 3
10/14 = 4
14/14 = 5

Question 25

DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline the following pieces of information about Chlorpromazine:
- Typical or atypical?
- How is the drug administered? Typical Dosage?
- How does the drug work?
- Evidence for effectiveness?
- Side effects?

Answer 25

Typical or atypical?
- typical

How is the drug administered? Typical Dosage?
- tablet, syrup, injection
- general dosage 400-800mg
- if orally taken: max dosage of 100mg

How does the drug work?
- antagonistic to DA (reduces DA levels) because it blocks DA receptors in the brain
- initial build-up of DA => production decreases
- also effective in calming patients with Sz or other conditions (effective sedative due to histamine), e.g. in psychotic episode

Evidence for effectiveness?
- chlorpromazine associated with better overall functioning and reduced symptom severity in 1121 ptps (Thornley et al, 2003)

Side effects?
- dizziness, agitation, sleepiness/drowsiness, stiff jaw, itchy skin, weight gain
- most serious: neuroleptic malignant syndrome (NMS) (results in high temp, delirium, coma or even death)

Question 26

DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline the following pieces of information about Clozapine:
- Typical or atypical?
- How is the drug administered? Typical Dosage?
- How does the drug work?
- Evidence for effectiveness?
- Side effects?

Answer 26

Typical or atypical?
- atypical

How is the drug administered? Typical Dosage?
- last resort (!) and must have regular blood tests if prescribed
- tablet or syrup
- generally 300-400mg per day

How does the drug work?
- antagonistic to DA (reduces DA levels) because it binds to the DA receptors in the brain
- initial build-up of DA => production decreases
- also targets serotonin and glutamate, which helps to improve mood + reduce depression and anxiety + may improve cognitive functioning
- typically prescribed to patients at high risk of suicide

Evidence for effectiveness?
- Meltzer (2012) concluded that clozapine is more effective than typical antipsychotics and other atypical antipsychotics and that it is effective in 30-50% of treatment-resistant cases where typical antipsychotics have failed

Side effects?
- caused deaths due to agranulocytosis (blood condition) so was stopped
- until discovered to be more effective than others

Question 27

DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline the following pieces of information about Risperidone:
- Typical or atypical?
- How is the drug administered? Typical Dosage?
- How does the drug work?
- Side effects?

Answer 27

Typical or atypical?
- atypical

How is the drug administered? Typical Dosage?
- tablets, syrup or injection (which lasts 2 weeks)
- small, gradual daily dose to 4-8mg (max of 12mg)

How does the drug work?
- binds to DA receptors (and serotonin receptors) more strongly so is more effective in smaller doses

Side effects?
- fewer than other antipsychotics

Question 28

DRUG THERAPY AS A BIOLOGICAL TREATMENT OF SCHIZOPHRENIA
Outline one strength of drug therapy as a biological treatment of Sz, regarding evidence for its effectiveness.

FINISH

Answer 28

P: One strength of drug therapy as a biological treatment of Sz is that there is evidence for its effectiveness.
E: For example, Thornley et al (2003) reviewed data from 13 trials of antipsychotics with a total of 1121 ptps and found that chlorpromazine was associated with better overall functioning and reduced severity of symptoms compared to a placebo. Moreover, Meltzer et al (2012) concluded that clozapine is more effective than other

Question 31

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Fromm-Reichmann’s (1948) explanation for Sz: the Schizophrenogenic Mother.

Answer 31

SCHIZOPHRENOGENIC MOTHER
- psychodynamic explanation, based on accounts from her patients about their childhoods
- schizophrenogenic (literally translates to ‘Sz-causing’) mother is cold, rejecting and controlling and creates a family climate characterised by tension and secrecy
- this leads to distrust that later develops into paranoid delusions

Question 32

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Bateson et al’s (1972) explanation for Sz: the Double-Bind theory.

Answer 32

DOUBLE-BIND THEORY
- emphasises the role of communication style within a family
- a developing child regularly finds themselves trapped in situations where they fear doing the wrong thing
- they receive mixed messages about what the wrong thing is and feel unable to comment on the unfairness of the situation or seek clarification (incoherent version of reality caused by mixed messages)
- e.g. when a verbal behaviour contradicts the non-verbal behaviour etc.
- when they get it wrong, they are punished by withdrawal of love
- this leaves the developing child with an understanding that the world is a confusing and dangerous place which can lead to symptoms like disorganised thinking and paranoid delusions.

Question 33

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Expressed Emotion (EE) as an explanation for Sz.

Answer 33

EXPRESSED EMOTION (EE):
- the negative emotional climate that is characterised by a family communication style of criticism, hostility and emotional over-involvement
- criticism: negative comments said between family members
- hostility: any aggressive behaviour, such as threats
- emotional over-involvement: behaviour that involves interfering in other family members’ affairs; these family members can also seem overly moralistic (having a very strong sense of what is right and wrong)
- high levels of EE are more likely to influence the relapse rates of people recovering from Sz who return to their families after treatment; it’s the high stress levels that this EE creates that trigger a Sz episode
- these families may also feature secret alliances between members which encourage paranoid symptoms, such as delusions of persecution

Question 34

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline one strength of family dysfunction as an explanation of Sz

Answer 34

possible strengths:
- Berger (1965): people with Sz reported a higher recall of double-bind statements by their mothers than people without the disorder
- Kalafi and Torabi: a negative emotional climate (overprotective mothers and rejecting fathers) led to a higher relapse rate in Sz

Question 35

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline one limitation of family dysfunction as an explanation of Sz,

Answer 35

possible limitations:
- high EE among families could be a symptom rather than a cause since Sz individuals can be difficult to care for
- it implies that parents are responsible for the problems of their children (mixed messages) which is socially sensitive
- info from childhood experiences is gathered after the development of symptoms and a diagnosis of Sz = > individuals have a distorted view of reality so their memory of childhood experiences may also be distorted

Question 36

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
What is the aim of family therapy?

Answer 36

to improve the quality of communication and interaction between family members and the ‘identified patient’

Question 37

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Pharoah’s (2010) strategies for family therapy.

Answer 37

REDUCING EXPRESSED EMOTION (EE)
- therapists should aim to reduce the level of emotion generally but especially negative ones (anger and guilt, which can cause stress)
- reducing stress can reduce the likelihood of a relapse

FORM A THERAPEUTIC ALLIANCE
- family members should be encouraged to all agree on the aims of the therapy
- this may include improving the family’s beliefs about and behaviour towards Sz

BALANCE
- the therapist should also encourage the family members to achieve a balance in caring for the individual with Sz whilst maintaining their own lives

Question 38

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline Burbach’s (2018) 7-phase model for working with families dealing with Sz.

Question 39

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline one strength of family therapy as a treatment for Sz, regarding evidence for effectiveness.

Answer 39

P: evidence for effectiveness
E: review of studies by McFrlane (2016): family therapy was one of the most consistently effective treatments available for Sz; relapse rates found to reduce typically by 50-60%; also effective to do family therapy as mental health initially starts to decline; NICE recommends family therapy for everyone with Sz
E: family therapy is likely beneficial for those with and before a diagnosis of Sz
E: However… not always appropriate to use if safeguarding concerns arise or if family is not available (dead or not in contact)

Question 40

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: FAMILY DYSFUNCTION
Outline one strength of family therapy as a treatment for Sz, regarding benefits for the whole family.

Answer 40

P: benefits to whole family
E: Lobban and Barrowclough (2016) concluded that by strengthening the functioning of the whole family, family therapy lessens the negative impact of Sz on other family members and strengthens the ability of the family to support the person with Sz

Question 41

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATION
Outline metarepresentation as one of the dysfunctional thought processes outlined by Frith (1992).

Answer 41

METAREPRESENTATION: the cognitive ability to reflect on one’s own thoughts
- allows us insight into our own intentions and goals
- allows us to interpret the actions of others
- dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else (i.e. we know which thoughts are our own)
- this would explain hallucinations of hearing voices and delusions like thought insertion (having thoughts projected into one’s mind by others)

Question 42

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATION
Outline central control as one of the dysfunctional thought processes outlined by Frith (1992).

Answer 42

CENTRE CONTROL: the ability to suppress automatic responses while we perform deliberate actions
- speech poverty and thought disorder could result in the inability to suppress automatic thoughts and speech triggered by other thoughts
- e.g. people with Sz tend to experience derailment of thoughts because each word triggers associations and the person cannot suppress automatic responses to these

Question 43

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATION
Outline one strength of the cognitive explanation of Sz

Answer 43

Stirling et al (2006): 30 ptps with Sz performed poorly on cognitive tasks such as the Stroop task in comparison to a group of controls
=> supports central control dysfunction because people with Sz struggle to suppress the thought of saying the word instead of the colour the word is written in and so they say the incorrect answer

Question 44

PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA: COGNITIVE EXPLANATION
Outline one limitation of the cognitive explanation of Sz

Answer 44

dysfunctional thinking could be a consequence of Sz rather than a cause, and we are unsure because such cognitive abilities are often retrospectively noticed
=> shows something else could cause Sz in the first place and may be a factor that leads to distortions in cognition

Question 45

COGNITIVE BEHAVIOUR THERAPY (CBT) AS A TREATMENT FOR SCHIZOPHRENIA