Schizophrenia

Question 1

How is schizophrenia classified?

Answer 1

ICD-10 = 2+ negatives.

DSM-5 = 1 positive.

Question 2

What are the positive symptoms of schizophrenia?

Answer 2

1) . Hallucinations –> sensory with no basis of reality.

2) . Delusions –> beliefs not based on reality.

Question 3

What are the negative symptoms of schizophrenia?

Answer 3

1) . Avolition –> loss of motivation.

2) . Speech poverty –> frequency and quality affected.

Question 4

Evaluate the classification and diagnosis of schizophrenia?

Answer 4

1). Reliability = Cheniaux =

• 1 psychiatrist = 26 patients (DSM), 44 (ICD)
• 1 psychiatrist = 13 (DSM), 24 (ICD).

2) . Validity =
- more likely to be diagnosed with ICD than DSM.
3) . Co-morbidity =
- Buckley et al. = 50% (depression), 47% (drug abuse).
4) . Gender bias =
- Longenecker = 1980s –> more men than women = women have better interpersonal skills.
5) . Cultural bias =
- black people more likely = normal to hear voices in African culture.

Question 5

What are the 3 biological explanations of schizophrenia?

Answer 5

1) . Genetic basis of schizophrenia.
2) Dopamine hypothesis.
3) . Neural correlates.

Question 6

What did Gottesman find in his twins study?

Answer 6

MZ = 48%.

DZ = 17%.

Question 7

How is schizophrenia polygenetic and aetiologically heterogenous?

Answer 7

• Polygenetic = individual genes increase risk.

- Aetiologically heterogenous = different combinations.

Question 8

How many genetic variations did Ripke et al. find?

Answer 8

108 (candidate genes).

Question 9

Where/what is hyperdopaminergia?

Answer 9

Subcortex –> high dopamine activity =

• hallucinations + speech poverty.

Question 10

Where/what is hypodopaminergia?

Answer 10

Prefrontal –> low dopamine activity =

• affects thinking and decision making.

Question 11

What did Juckel et al. find about the ventral striatum and avolition?

Answer 11

Low activity = loss of motivation (avolition).

Question 12

What did Allen et al. find about the superior temporal gyrus and hallucinations?

Answer 12

Low activity = hallucinations.

Question 13

What are the evaluations of the biological explanations of schizophrenia?

Answer 13

1) . Could be environment =
- not 100% MZ, 50% DZ.
2) . Evidence for genetic vulnerability = Tienari et al. =
- adopted children from a schizophrenic mother are still at risk.
3. Correlation-causation =
- cant tell whether the structure causes the symptoms, or vice versa.
4) . Support from drug studies =
- increased dopamine in Parkinson’s = normality (opposite of schizophrenia).

Question 14

What are the 2 psychological explanations of schizophrenia?

Answer 14

1) . Family dysfunction.

2) . Cognitive explanation.

Question 15

How does Fromm-Reichmann explain schizophrenia?

Answer 15

Schizophrenic mother.

• cold, rejecting and controlling mothers cause schizophrenia.

Question 16

How does Bateson et al. explain schizophrenia?

Answer 16

Double-bind theory.

• confusing communications = receive conflicting messages from parents –> disorganised thinking and delusions.

Question 17

What is meant by expressed emotion as a psychological explanation?

Answer 17

Hostility and verbal criticism causes a relapse in schizophrenic patients.

Question 18

What are the cognitive explanations of schizophrenia?

Answer 18

1) . Dysfunctional thought processing =
- lower levels of info processing.
2) . Metarepresentations =
- lack reflection on thoughts and behaviour –> hallucinations/delusions.
3) . Poor central control =
- unable to suppress automatic responses –> speech poverty.

Question 19

Evaluate the psychological explanation of schizophrenia?

Answer 19

1) . Support for family dysfunction =
- Read et al. –> many patients report child sexual abuse.
2) . Weak evidence for family-based explanations =
- little evidence to support schizophrenic mother/double-bind - may encourage blaming parents.
3) . Evidence for dysfunctional thought processing =
- Stirling et al. –> patients took longer in Stroop task, showing impairment.
4) . Biological factors are sometimes overlooked =
- the diathesis-stress model is more valid than psychological/biological alone.

Question 20

What are the biological therapies for schizophrenia?

Answer 20

1) . Typical antipsychotics –> old.

2) . Atypical antipsychotics –> new.

Question 21

How do typical anti… work?

Answer 21

Dopamine antagonists =

• blocks dopamine, reducing activity.

Question 22

What is an example of typical anti…?

Answer 22

Chlorpromazine =

• also a sedative.

Question 23

What are the evaluations of typical anti…?

Answer 23

1) . Evidence for effectiveness =
- Thornley at al. –> associated with better functioning when compared to placebo.
2) . Serious side effects =
- e.g. dizziness, lip-smacking, NMS (can be fatal).

Question 24

How do atypical anti… work?

Answer 24

Target dopamine and serotonin receptors.

Question 25

What is an example of atypical anti…?

Answer 25

1) . Clozapine =
- reduces depression and anxiety, improves mood.
2) . Risperidone =
- fewer side effects, developed to tackle deaths from clozapine (agranulocytosis).

Question 26

What are the evaluations of atypical anti…?

Answer 26

1) . Evidence for clozapine’s effectiveness =
- Meltzer –> more effective than typical.
2) . Depends on dopamine hypothesis =
- have to accept dopamine hypothesis for drug use to be rational (acts on dopamine).

Question 27

What are the 3 psychological therapies for schizophrenia?

Answer 27

1) . CBT.
2) . Family therapy.
3) . Token economies.

Question 28

What is CBT?

Answer 28

Helps patients identify and change irrational thoughts/beliefs.

• helps them understand their symptoms –> reduces anxiety.

Question 29

What is family therapy?

Answer 29

• Reduces EE = aim to improve communication in the family, reducing stress, preventing relapse.

Question 30

What strategies did Pharaoh et al. identify family therapists use to prevent relapse?

Answer 30

1) . Reduce stress of care.
2) . Improve family’s ability to anticipate and solve problems.
3) . Reduce guilt and anger in family members.

Question 31

How do token economies reduce symptoms of schizophrenia?

Answer 31

• tokens given to patients for desirable behaviours (operant conditioning).
• reward given immediately to reduce ‘delay discounting’.
• associated with primary reinforcers (classical conditioning - they know what they can get with them).

Question 32

What are the evaluations of the psychological therapies for schizophrenia?

Answer 32

1) . Evidence for effectiveness =
- Jauhar et al. (CBT), Pharoah et al. (family therapy) and McMonagle and Sultana (token economy) –> shown modest benefits to schizophrenic patients.
2) . Improve quality of life but not care =
- don’t cure schizophrenia, just help to cope and avoid relapse.
3) . Ethical issues =
- token economy –> severely ill less able to comply, so no rewards.
- CBT –> challenges beliefs part of their identity.

Question 33

What is the interactionist explanation of schizophrenia?

Answer 33

Diathesis-stress model =

• vulnerability + stress trigger = schizophrenia.

Question 34

What is Meehl’s model?

Answer 34

schizophrenia = schizogene + schizophrenic mother (without gene, they wouldn’t develop schizo).

Question 35

What is the modern understanding of diathesis and stress?

Answer 35

Vulnerability not due to 1 ‘schizogene’ =

• many vulnerability factors including multiple genes, trauma and stress.
• stress = cannabis can increase stress trigger = schizophrenia.

Question 36

Evaluate the interactionist approach to schizophrenia?

Answer 36

1) . Evidence for role of vulnerability + triggers =
- Tienari et al. –> schizophrenia = children with genetic vulnerability and parents with high criticism/low empathy.
2) . Original diathesis-stress model over-simplified =
- trauma causes vulnerability (not genes), cannabis is the stressor.
3) . Support for combining therapies =
- CBT + drugs = more effective than alone.