Schizophrenia

Question 1

Schizophrenia

Answer 1

Schizophrenia is a serious mental disorder suffered by about 1% of the world population. More in men than women, more in cities than the countryside and more in working class rather than middle class. The symptoms can interfere with everyday tasks, many end up homeless or hospitalised. Contact with reality and insight are impaired.

Question 2

Classification of schizophrenia

Answer 2

Schizophrenia doesn’t have a single defining characteristic, it is a cluster of symptoms. They use the ICD-10 and the DSM-5(America). These differ slightly in their classification. In the DSM-5 one of the positive symptoms or speech disorganization must be present, where as two or more negative symptoms are sufficient in the ICD-10.

Question 3

ICD-10

Answer 3

Recognises a range of subtypes of schizophrenia. Paranoid schizophrenia- characterised by powerful delusions and hallucinations, but relatively few other symptoms.
Hebephrenic schizophrenia- mostly negative symptoms.
Catatonic schizophrenia- disturbance to movement- immobile or overactive.

Question 4

Positive symptoms of schizophrenia

Answer 4

Additional experiences beyond those of ordinary existence. Include hallucinations and delusions.

Question 5

Hallucinations

Answer 5

A positive symptom, these are sensory experiences of stimuli that have either no basis in reality or are distorted perceptions of things that are there. Can be any sense, hearing voices or seeing things.

Question 6

Delusions

Answer 6

A positive symptom. Also known as paranoia. They involve irrational beliefs that have no basis in reality, for example, that the sufferer is someone else or that they are the victim of a conspiracy. Eg. think that aliens are after them, or that they are jesus. Suffers behave in a way that make sense to them but bizarre to others.

Question 7

Negative symptoms of schizophrenia

Answer 7

Involve the loss of usual abilities and experiences. Avolition, speech therapy

Question 8

Avolition

Answer 8

Finding it difficult to begin or keep up with goal directed activity. They usually have reduced motivation to caryy out a range of activities. Andreason identified 3 signs of avolition; poor hygiene and grooming, lack of persistence in work/education and lack of energy.

Question 9

Speech poverty

Answer 9

Changes in patterns of speech. ICD-10- emphasis on reduction in the amount and quality of speech. Sometimes a delay in the sufferers verbal responses.
DSM-5- speech disorganisation, speech becomes incoherent or the speaker changes topic mid sentence.

Question 10

Diagnosis and classification of schizophrenia- evaluation (Reliability)

Answer 10

Reliability- Cheniaux et al has 2 psychiatrists independently diagnose 100 patients using both the DSM and ICD criteria. Inter-rater reliability was poor. One diagnosed 44 using the ICD and 26 with the DSM and the other diagnosing 24 using the ICD and 13 with the DSM. This is a weakeness of diagnosis of schizophrenia.

Question 11

Diagnosis and classification of schizophrenia- evaluation (validity)

Answer 11

From the Cheniaux et al study, it is more likely for schizophrenia to be diagnosed using the ICD rather than the DSM. This suggests that schizophrenia is either over diagnosed in the ICD or under diagnosed in the DSM. So poor validity.

Question 12

Diagnosis and classification of schizophrenia- evaluation (co-morbidity)

Answer 12

Morbidity- how common a medical condition is. Co-morbidity is the phenomenon that 2 or more conditions occur together. Buckley et al, concluded that around half of patients with a diagnosis of schizophrenia also have a diagnosis of depression or substance abuse. PTSD and OCD occurred in around 25% of schizophrenia diagnosis’s. Maybe we’re bad at telling the difference between the 2 conditions.

Question 13

Diagnosis and classification of schizophrenia- evaluation (symptom overlap)

Answer 13

There is considerable overlap between the symptoms of schizophrenia and other conditions. E.g. both schizophrenia and bipolar involve positive symptoms like delusions and negative symptoms like avolition. ICD may diagnose as schizophrenic and DSM as bipolar. Lacks validity.

Question 14

Biological explanations for schizophrenia- Genetic basis and candidate genes

Answer 14

Schizophrenia runs in families, however this is week evidence for a genetic link as they often share aspects of their environment. However, we do share 100% genes with MZ twins and 50% with DZ twins, siblings and parents.
Candidate genes are believed to be associated with risk of inheritance. Genes associated with increase risk included those coding for the functioning of a number of neurotransmitters including dopamine.

Question 15

Biological explanations for schizophrenia- the dopamine hypothesis

Answer 15

Neurotransmitters (the brain’s chemical messengers) appear to work differently in the brain of schizophrenic. Dopamine is believed to be involved.

Question 16

Biological explanations- the dopamine hypothesis- Hyperdopaminergia in the subcortex

Answer 16

High levels of activity of dopamine in the subcortex (central areas of the brain). Eg. an excess of dopamine receptors in Broca’s area may be associated with poverty of speech or the experience of auditory hallucinations.

Question 17

Biological explanations- the dopamine hypothesis- Hypodopaminergia in the cortex

Answer 17

Goldman-Rakic et al identified a role for low levels of dopamine making in the negative symptoms of schizophrenia. It may be that both Hyper and Hypodopaminergia are correct explanations as both high and low levels of dopamine in different brain regions are involved in schizophrenia.

Question 18

Biological explanations- Neural correlates

Answer 18

Neural correlates are measurements of the structure or function of the brain that correlate with an experience, in this case schizophrenia. Both positive and negative symptoms have neural correlates.

Question 19

Biological explanations- Neural correlates of negative symptoms

Answer 19

Avolition involves the loss of motivation, motivation involves the anticipation of reward. The ventral striatum is believed to be particularly involved in this anticipation, so abnormality in the ventral striatum may be involved in the development of avolition. Juckel found lower levels of activity in the ventral striatum within schizophrenics. They observed a negative correlation between activity levels in the ventral striatum and the severity of overall negative symptoms.

Question 20

Biological explanations- Neural correlates of positive symptoms

Answer 20

Allen et al, scanned brains of patients experiencing auditory hallucinations and compared them to a control group. Lower activation levels in the superior temporal gyrus and anterior cingulate gyrus were found in the hallucination group, who also made more errors than the control group. Reduced activity in these 2 areas of the brain in a neural correlate of auditory hallucination.

Question 21

Biological explanations for schizophrenia- evaluation- genetic basis

Answer 21

Strong evidence for genetic vulnerability to schizophrenia, Gottesmans study clearly shows how genetic similarity and shared risk of schizophrenia are closely related. However, it doesn’t mean its fully genetic, could be environment or other factors.

Question 22

Biological explanations for schizophrenia- evaluation- the dopamine hypothesis

Answer 22

Dopamine antagonists such as amphetamines that increase the levels of dopamine make schizophrenia worse and can produce schizophrenic like symptoms in non sufferers. Antipsychotic drugs work by reducing dopamine activity. Although dopamine is likely to be one important factor, so are other neurotransmitters (glutamate).

Question 23

Biological explanations for schizophrenia- evaluation- neural correlates

Answer 23

The correlation- causation problem- Does the unusual activity in a region of the brain cause the symptom or is it that something wrong in that region means less information passes through causing the reduced activity.

Question 24

Psychological explanations for schizophrenia- Family dysfunction

Answer 24

The schizophrenogenic mother, double bind theory, expressed emotion

Question 25

Psychological explanations for schizophrenia- The schizophrenogenic mother

Answer 25

Fromm-Reichmann noted many of her patients spoke of a particular type of parent; cold, rejecting and controlling, and tends to have a family climate of tension and secrecy. This leads to distrust that later develops into paranoid delusions and ultimately schizophrenia.

Question 26

Psychological explanations for schizophrenia- Double bind theory

Answer 26

Bateson, emphasised the role of communication style within a family. The developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what this is. When they get it wrong, they are punished with withdrawal of love. Develop paranoid delusions and disorganised thinking.

Question 27

Psychological explanations for schizophrenia- Expressed emotion

Answer 27

Is the level of emotion, particularly negative, expressed towards a patient by their carers. E.g, verbal criticism, hostility, emotional over involvement. These high levels of expressed emotion are a serious source of stress for the patient, that may trigger the onset of schizophrenia in a person who is already vulnerable. (diathesis stress model.)

Question 28

Psychological explanations for schizophrenia- evaluation

Answer 28

There is evidence to suggest that difficult family relationships in childhood are associated with increased risk of schizophrenia in childhood. Read et al reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of women and 59% of men with a diagnosis of schizophrenia had a history of physical or sexual abuse in childhood. Or insecure attachments. However this information was collected after the diagnosis so they may have distorted recall.
No evidence to support the schizophrenogenic mother or double bind.
Also it is already stressful enough for the parents having to look after their children, never mind having the blame put on them.

Question 29

Cognitive explanations of schizophrenia

Answer 29

Schizophrenia is associated with several types of abnormal information processing. Schizophrenia is characterised by disruption to normal thought processing. E.g. reduced processing in the ventral striatum is associated with negative symptoms. This suggests that cognition is likely to be impaired.

Question 30

Cognitive explanations of schizophrenia- two kinds of dysfunctional thought processing

Answer 30

Frith- Metarepresentation- the cognitive ability to reflect on thoughts and behaviour. Dysfunction in this would disrupt our ability to do this. This would explain hallucinations of voices and delusions.
Central control- the cognitive ability to suppress automatic responses while we perform deliberate actions instead. Disorganised speech and thought disorder could result from the inability to suppress automatic responses. E.g. association triggers from words when speaking.

Question 31

Cognitive explanations of schizophrenia- evaluation

Answer 31

Strong evidence for dysfunctional information processing- Stirling et al- compared 30 patients with a diagnosis of schizophrenia (+18 control) on a range of cognitive tasks, including the stroop test. In which participants have to name the ink colour not the word, suppressing the impulse to read the words. Patients took over twice as long to do this as the control group.

Question 32

Biological therapies for schizophrenia- drug therapies

Answer 32

The most common treatment for schizophrenix is antipsychotic drugs, which may be needed short term or long term. Antipsychotics can be divided into typical (traditional) or atypical (newer).

Question 33

Biological therapies for schizophrenia- Typical antipsychotics

Answer 33

E.g. Chlorpromazine. There is a strong association between the use of typical antipsychotics and the dopamine hypothesis. They work by acting as antagonists in the dopamine system (block dopamine receptors in the synapses of the brain, reducing the action of dopamine).

Question 34

Biological therapies for schizophrenia- Atypical antipsychotics

Answer 34

E.g. Clozapine. Newer drugs to try and improve effectiveness and minimise side effects. Clozapine binds to dopamine receptors in the same way that Chlorpromazine does but it also acts on serotonin and glutamate receptors. It can help moods and reduce depression/anxiety. It is often prescribed to suicidal schizophrenics as 30-50% attempt suicide at some point. However at first it caused blood conditions that led to death so patients need regular blood checks.

Question 35

Biological therapies for schizophrenia- evaluation

Answer 35

Evidence supports both atypical and typical antipsychotics are effective in tackling the symptoms of schizophrenia. Thornley compared Chlorapromazine to a placebo and found overall better functioning and reduced symptom severity. It also showed that relapse rate was lower when this drug was taken.
Serious side affects- dizziness, stiff jaw, itchy skin and NMS which can induce a coma or death.
It has been found that dopamine levels apart from in the subcortex are too low so how can dopamine antagonists help.

Question 36

Psychological therapies for schizophrenia- CBT

Answer 36

Cognitive behaviour therapy, can be in groups of individual. Aim to help patients identify their irrational thoughts and try to change them. They discuss how likely the patients beliefs are to be true and consider other less threatening possibilities. It doesn’t treat but can make patients cope with their symptoms. Offering psychological explanations for their delusions/hallucinations can lower anxiety as they may think demons are talking to them.

Question 37

Psychological therapies for schizophrenia- Family therapy

Answer 37

Takes place with families, aiming to improve quality of communication and interaction between family members. Family therapists are concerned with reducing stress within the family that might cause relapse. (aims to reduce expressed emotion). Pharoah’s strategies- helping famility members to achieve balance between caring and their own lives, improving families beliefs towards schizophrenia.

Question 38

Psychological therapies for schizophrenia- Token economies

Answer 38

Reward systems to improve maladapted behaviour from being in psychiatric hospitals. As it is common for patients to develop bad hygiene or remain in pj’s all day. Modifying there bad habits helps their quality of life and makes it more likely that they can live outside a hospital setting. Operant conditioning
Tokens- non monetary tokens given immediately after desirable behaviour such as getting dressed.
Rewards- tokens can be exchanged for privileges or items. Tokens are secondary reinforcers as they only have value when they learn they can get rewards.

Question 39

Psychological therapies for schizophrenia- CBT- evaluation

Answer 39

Jauhar reviewed 34 studies of CBT for schizophrenia and concluded that CBT has a significant but fairly small effect on positive and negative symptoms.
CBT helps by allowing patients to make sense of and in some cases challenge some of their symptoms, however the failure to cure it is a weakness.
CBT may interfere with an individuals freedom of thought. (ethical issue).

Question 40

Psychological therapies for schizophrenia- Family therapy- evaluation

Answer 40

Pharoah et al reviewed the evidence for the effectiveness of family therapy. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission and improves quality of life for the family/patients. However different studies were inconsistent with findings.
Helps reduce stress of living with schizophrenia for the family and patient. Don’t cure.

Question 41

Psychological therapies for schizophrenia- Token economy- evaluation

Answer 41

Mcmonagle and Sultana- randomly allocated patients to 3 studies, to conditions. Only one of the studies showed improvement in symptoms and none gave useful information about behaviour change.
Help by making patient’s behaviour more socially acceptable so that they can better re-integrate into society. Don’t cure.
Privileges become more available to patients with mild symptoms. This means that the most severely ill patients suffer discrimination, it is less used now because of this.

Question 42

The interactionist approach to schizophrenia

Answer 42

An approach that acknowledges that there are biological, psychological and societal factors in the development of schizophrenia.

Question 43

The interactionist approach- explanation- diathesis stress model

Answer 43

The diathesis stress model says that both a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition. In early versions of the model (Meehl’s), vulnerability was genetic and the triggers were psychological. Now both gene and trauma (trauma can affect brain development) are seen as diatheses and stress can be psychological or biological in nature. (cannabis)

Question 44

The interactionist approach- treatment according to this model

Answer 44

Associated with combining antipsychotic medication and psychological therapies, mostly CBT. In britain, it is increasingly standard practice to treat patients with a combination of these 2.

Question 45

The interactionist approach- evaluation

Answer 45

Strong direct support for the importance of adopting an interactionist approach to schizophrenia- Tienari, 19000 children adopted by Finnish mothers. Poor parenting is a possible source of stress.
The original diathesis stress model is over simple. Its not just one gene, there is now multiple genes which increase vulnerability. Therefore vulnerability and stress to not have one single source. Could be early trauma too as well as genetic make up.