Schizophrenia Essay plans Flashcards
Discuss the biological explanations of Schizophrenia
A01
- Family studies, Gottesman found that someone with an aunt with Schizophrenia have a 2% chance of developing it, a sibling, 9% and 48% identical twin. (Increases in line with genetic similarity).
- Candidate genes, 108 genetic variations were found in 37,000 people with a diagnosis of Schizophrenia, compared to 113,000 controls. (Schizophrenia is polygenic)
- Dopamine hypothesis, hyperdopaminergia in the sub-cortex of brain (amygdala, basal ganglia, hippocampus) responsible for production of positive symptoms. However, hypodopaminergia in the PFC causes negative symptoms.
A03
- Evidence for dopamine hypothesis, Curran et al found that amphetamines (which increase dopamine) worsen symptoms of Schizophrenia. -STRENGTH
- Evidence for genetic links – adopted children with their biological parents suffering from schizophrenia have an increased risk of developing Schizophrenia (Tienari at al) and Rikke at al 2018 found a concordance rate of 33% for MZ twins and 7% DZ twins but there are environmental factors - STRENGTH
- Environmental factors – smoking cannabis during teenage years (Di Forti at al), birth complications, childhood trauma. - possibly reductionist ??? - LIMITATION
Discuss psychological explanations of Schizophrenia
AO1
Fromm-Reichman – schizophrenogenic mother
Bateson et al - Double bind theory
Kavanagh found that increased EE in family members causes relapses in schizophrenia, high EE – 48%, low EE 21%
Frith - Dysfunctional thought processing – lack of theory of mind and meta representation causes paranoid thoughts, meaning they are unable to distinguish which thoughts are coming from themselves, and which are coming from elsewhere, leading to hallucinations. They are also unable to suppress automatic thoughts, as each word triggers associations which causes thought disorder and speech poverty
A03
Research support – Morkved at al found most adults with schizophrenia have at least one childhood trauma but little reliable evidence to support double bind theory and schizophregenic mother
Socially sensitive – parent blaming
Disregards biological factors
Research support for cognitive – Stirling et al – font colour words – 30 schizophrenic ppl took twice as long than 30 controls
Outline and evaluate the use of drug therapy for schizophrenia
A01
Typical antipsychotics such as Chlorpromazine is a dopamine antagonist, binds to receptors in the post-synaptic neuron – reducing action.
Also has sedating effects
Often taken as syrup as it is absorbed faster
Atypical antipsychotics include Clozapine, - binds to dopamine, serotonin, and glutamate receptors. Taken in lower doses, has mood enhancing effects so often prescribed when induviduals are at high risk of suicide, (30 – 50%) of schizophrenic people attempt. Causes serious side effects such as agranulocytosis – blood tests must be taken frequently.
Atypical antipsychotic – Risperidone – binds to serotonin and dopamine receptors, much stronger, so taken in lesser dosage – 4-12mg a day
A03
Thornley et al found 1121 participants from 13 trials had better functioning and reduced severity of symptoms when taking Chlorpromazine compared to placebos.
Meltzer found Clozapine is more effective where typical antipsychotics do not work. (30 – 50%) - COUNTERPOINT – Healy suggests that evidence for effectiveness is flawed as most studies only present short-term effects. He also suggested that the calming effects of antipsychotics does not represent the overall reduction in severity of symptoms.
Side effects – dizziness, agitation, sleepiness, weight gain, itchiness. Serious side effects include tardive dyskinesia, and neuroleptic malignant syndrome where dopamine receptors in the hypothalamus (a part of the brain responsible for body system regulations) are blocked causing high temps, delirium, comas.
Mechanisms unclear with updated version of the dopamine hypothesis.
Biologically reductionist – thinking a simple medication can solve schizophrenia when there are many other factors.
Diagnosis and Classification
AO1
There are two different diagnoses systems – ICD-10 and DSM-5
Positive symptoms include hallucinations and delusions
Negative symptoms include speech poverty and avolition (poor hygiene and grooming, lack of persistence in work or education and lack of energy
AO3
Possible low validity as when Cheniaux et al found that when two independent psychiatrists assessed 100 clients, using either the ICD-10 or the DSM-5, 68 of them were diagnosed under the ICD-10 system and 39 under the DSM-5. However, Osorio et al found that there was high reliability as pairs of interviewers achieved a +.97 inter-rater reliability and there was a test-retest reliability of +0.92 with 180 clients when only using DSM-5.
Culture bias as British people of African-Caribbean origin are 9 times more likely to be diagnosed (Pinto and Jones 2008) however, there has been no evidence of any genetic vulnerability related.
Gender Bias – women are significantly underdiagnosed, this may be due to men having an increased genetic vulnerability, however it could also be that women are more sociable than men are and more likely to cope better, leading to a decreased need for support.
Psychological therapy AO1 & AO3
AO1
- CBT
The therapist can help the client understand where their auditory hallucinations come from (malfunctioning speech centre in the brain)
They also question and challenge their irrational beliefs, encourage positive self talk, coping strategy enhancement, ABCDE model
- Family therapy - working on schizophrenogenic mother and EE
- Token economies
AO3
- Evidence for effectiveness Jauhar et al found after reviewing 34 studies of using CBT with schizophrenia that there is clear evidence of improvement on positive and negative symptoms
- Token economy is unethical
- CBT doesn’t cure so it would be best to use the interactionist approach with anti-psychotics.
- McFarlane found that there was a reduced rate of relapse (50-60%)
