Schizophrenia

Question 1

What is reliability and validity in relation to the diagnosis and classification of schizophrenia

Answer 1

• Definitions of reliability - level of agreement on the diagnosis by different psychiatrists across time and cultures; stability of diagnosis over time given no change in symptoms
• Definitions of validity – the extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms

Question 2

Discuss issues surrounding the classification and diagnosis of schizophrenia.

Answer 2

• The reliability of the major classification systems ICD and DSM.
• The availability of other diagnostic criteria for schizophrenia eg Schneider criteria.
• The lack of homogeneity in schizophrenic symptoms.
• The problems of labelling.
• The problem of co-morbidity.
• The problem of distinguishing schizophrenia from, for example, mood or personality disorders.
• The lack of objective tests for schizophrenia.
• The difficulty of being able to predict outcome or response to treatment.
• Cultural differences in symptom presentation.
• The question of whether schizophrenia is a mental disorder at all.

Question 3

Briefly outline family dysfunction as an explanation for schizophrenia.

Answer 3

• Characteristics of dysfunction eg difficulties in communication, high levels of interpersonal conflict
• Critical and controlling parents, expressed emotion
• The role of double bind in the development of negative symptoms
• The role of hostility and disapproval in positive symptoms and relapse
• The role of expressed emotion in relapse

Question 4

explain one limitation of drug therapy for schizophrenia.

Answer 4

• All drugs have side effects that can be severe and may lead to patients avoiding medication and hence to relapse
• It is questionable whether or not severely affected patients can give informed consent to medication
• Drugs may simply be supressing symptoms

Question 5

‘I could never talk to mum. She fussed over me all the time. I tried to do what she said, but could never please her. One minute she seemed all affectionate and the next minute she would make nasty comments. My dad hated all the arguments and stayed out of it.’

Describe the family dysfunction explanation for schizophrenia and explain how Jack’s experiences can be linked to the family dysfunction explanation

Answer 5

AO2
• several references to conflict (‘arguments’), communication problems (‘could never talk to mum’), criticism (‘nasty comments’) and control (‘tried to do what she said’)
• Jack experiences the double-bind (mother’s behaviour alternates between affection and nastiness) so Jack doesn’t know how she wants him to behave and becomes confused – loses touch with reality
• the family show high expressed emotion – over-fussy (‘she fussed over me..’) and critical (‘nasty comments’)
• Jack’s mother is cold and unpredictable, (schizophrenogenic characteristics) and father was passive (‘stayed out of it’).
• symptoms of skewed family – father is uninvolved

Question 6

Family dysfunction

Answer 6

• schizophrenia is due to family experiences of conflict, communication problems, criticism and control
• double-bind communication (Bateson 72) - child receives mixed messages and cannot do the right thing – results in disorganised thinking and paranoia
• high expressed emotion where family shows exaggerated involvement, control, criticism which increases likelihood of relapse (Kavanagh 1992); relapse rate is doubled (Butzlaff and Hooley 1998)
• psychodynamic theorists recognised a schizophrenogenic (schizophrenia-causing) mother – typically cold, controlling and rejecting which leads to excessive stress which triggers psychotic thinking; father in such families is often passive.
• family schism and skew

Question 7

She has been taking a typical antipsychotic drug and there have been improvements in her positive symptoms. However she still suffers negative symptoms and side effects. Her psychiatrist wants to change her medication from typical antipsychotics to one of the atypical antipsychotics

explain why Jenny’s psychiatrist wants to move her on to one of the atypical antipsychotics. [

Answer 7

• Atypical antipsychotics have been shown to be more effective against negative symptoms
• Typical antipsychotics (such as chlorpromazine) are liable to produce movement side effects, sometimes resembling Parkinson’s disease.
• They mainly affect dopamine pathways
• Atypical antipsychotics are less liable to produce movement side effects; they have less action on the dopamine system, and instead affect a wide range of neurotransmitter systems