Schizophrenia

Question 1

Diagnosis and classification of schizophrenia- definition and DSM 5, ICD 10

Answer 1

It is a collection of seemingly unrelated symptoms. There is no single defining characteristic.
DSM 5 - 1 positive symptom must be present
ICD 10 - 2 or more negative symptoms are sufficient for diagnosis

Question 2

Diagnosis and classification of schizophrenia- positive symptoms

Answer 2

Hallucinations- sensory experiences that have no basis in reality or distorted perceptions of real things. E.g hearing voices
Delusions - beliefs that have no basis in reality. They make a person behave in strange ways e.g beliefs they are really important.

Question 3

Diagnosis and classification of schizophrenia- negative symptoms

Answer 3

Avolition - severe loss of motivation to carry out everyday tasks, results in lowered activity levels and unwillingness to fulfill goals

Speech poverty - a reduction in amount and quality of speech. DSM emphasises speech disorganisation and incoherence.

Question 4

Diagnosis and classification of schizophrenia- issues of diagnosis

Answer 4

Reliability - the extent to which the diagnosis is consistent
Validity - diagnosis and classification techniques measure what they are designed to measure
Co-morbidity - occurrence of two illnesses together which confuses diagnosis and treatment
Symptom overlap - when two or more conditions charge symptoms, questioning the validity of the classification

Question 5

Diagnosis and classification of schizophrenia- A03

Answer 5

Limitation - schizophrenia is more likely to be diagnosed using ICD. 2 psychiatrists independently diagnosed 100 patients using both DSM and ICD. 1) 26 DSM and 44 ICD 2) 13 DSM 24 ICD. Poor inter rather reliability, inconsistency.
LIMITATION- criteria validity. More likely to be diagnosed using ICD than DSM. over diagnosed or under diagnosed. Needs to be a balance.
LIMITATION - a psych said 50% of his patients with SZ had depression.
LIMITATION - gender bias, females are better at hiding symptoms.

Question 6

Biological explanation - genes

Answer 6

Strong relationship between genetic similarity of family members and likelihood of developing SZ. 108 different gene variations some of which effect dopamine levels
Study - if you have 2 schizophrenic parents 46% likely of developing, 1 parent 13% and a sibling 9%. They stack.

Question 7

Biological explanation - dopamine hypothesis

Answer 7

DA is widely believed to be involved in schizophrenia because it is featured in the functioning of brain systems related to the symptoms of SZ.
HYPERDOPAMINERGIA - HIGH levels of dopamine in subcortex is believed to cause hallucinations and speech poverty.
HYPODOPAMINERGIA - LOW levels of dopamine in the prefrontal cortex - avolition

Question 8

Biological explanation - Neural correlation

Answer 8

Measurements of the function or structure of the brain that correlate with the positive or negative symptoms of SZ
Ventral striatum is involved in anticipation of reward (related to motivation). Avolition in SZ may be explained by low levels here
Superior temporal gyrus is involved in positive symptoms.

Question 9

Biological explanation - A03

Answer 9

STRENGTH - 164 adoptees wth an Sz mum, 6.7% developed SZ. 197 adoptees with non SZ mums 2% developed SZ. genetic basis.
STRENGTH - deterministic, screen babies leads to early diagnosis and treatment.
STRENGTH - practical application. Dopamine agonists increase symptoms. Antipsychotics reduce.
LIMIATION - correlation not causation.

Question 10

Psychological explanations for schizophrenia- family dysfunction

Answer 10

FROMM - psychodynamic approach
The mothers are cold and rejecting and create a family climate of tension and secrecy. This causes paranoid delusions of schizophrenia.
Double blind theory - conflicting family communication. They recieve conflicting ideas of what to do. When they get it wrong the child is punished by lack of love
Expressed emotion - EE is the level of emotion expressed towards an SZ patient and includes:
Verbal criticism
Hostility
Emotional over involvement
High levels of EE cause stress, a primary explanation for relapse.

Question 11

Psychological explanations for schizophrenia- cognitive explanations

Answer 11

Dysfunctional though processing - lower levels of information processing in some areas of the brain suggest cognition is impaired.
Metarepresentation is the cognitive ability to reflect on thoughts and behaviour. It disrupts our ability to recognise our thoughts as our own. Leads to hallucinations and delusions.
Dysfunction of the central control. The central control being the ability to suppress automatic responses while preforming deliberate actions. In SZ they can’t suppress this.

Question 12

Psychological explanations for schizophrenia- A03

Answer 12

COGNITIVE DYSFUNCTION
STRENGTH - real life application. CBT created
LIMITATION - biological explanation
FAMILY DYSFUNCTION
LIMITATION- socially sensitive research
LIMITATION- can’t validate patients with SZ recall
STRENGTH - family therapy

Question 13

Biological therapies for schizophrenia- typical antipsychotics

Answer 13

Around since the 1950s
They work acting as antagonists in the dopamine system and aim to reduce the action of dopamine.
They work by blocking dopamine receptors in the synapses in the brain, reducing the action if dopamine.
Chlorpromazine - normalises neurotransmission in the key areas of the brain which reduces symptoms like hallucinations.
Sedates and calms
400-800mg
Has an effect on dopamine

Question 14

Biological therapies for schizophrenia- Atypical antipsychotics

Answer 14

Used since 1970s
The aim was to improve effectiveness of drugs in suppressing psychoses such as schizophrenia and minimise side effects.
Target neurotransmitters including dopamine and serotonin.
Clozapine - binds to dopamine receptors but also serotonin and glutamate receptors.
More effective than typical
Reduces anxiety and depression
450mg
Risperidone - was developed because clozapine caused deaths because of a blood condition.
Binds to dopamine and seretonin receptors
Binds more strongly so smaller doses.
4-8mg

Question 15

Biological therapies for schizophrenia- A03

Answer 15

TYPICAL
LIMITATION- can cause neuroleptic malignant syndrome, causing no control over facial features.
STRENGTH- reviewed data 13 trials. Chlorpromazine was associated with better functioning and reduced symptoms compared to placebo.
ATYPICAL
STRENGTH- meltzer - that atypical is more effective than typical 30-50% more.
LIMITATION - reliant on drugs. Psychological treatments.

Question 16

Psychological therapies for schizophrenia- CBT

Answer 16

The aims of CBT is to help patients identify irrational thoughts and try to change them
Involves discussion on how likely a patients belief is and consideration of less threatening possibilities.
Patients are helped to make sense of how their delusions and hallucinations impact on their feelings and behaviours
Offering explanations for these symptoms reduces anxiety and helps the patients realise their beliefs are not based on reality

Question 17

Psychological therapies for schizophrenia- family therapy

Answer 17

Aims to improve communication and interaction in the family
Reduce stress in the family that may contribute to a patients relapse
1) reduce stress of caring for patient
2) improve ability of family to anticipate and solve problems
3) reduce guilt and anger in family members
4) improve beliefs about and behaviour toward schizophrenia

Question 18

Psychological therapies for schizophrenia- token economies

Answer 18

Reward systems (operant conditioning) used to manage the behaviour of patientswith SZ who spend long periods in hospital 
Get given tokens for desirable behaviours which they can then swap for rewards later. 
Because they are given immediately it prevents delay discounting

Question 19

Psychological therapies for schizophrenia- A03

Answer 19

STRENGTH - CBT helps patients make sense of symptoms
LIMITATION - CBT won’t cure
STRENGTH - reduces stress in families
LIMITATION - families can get over concerned
LIMITATION - seriously ill patients won’t have access to rewards