Schizophrenia (general)

Question 1

Outline the genetic theory of schizophrenia

Answer 1

Genes form DNA, which make up the brain, which is the source of our mental state, which is faulty in people with schizophrenia

Question 2

Outline the findings from Gottesman’s family study

Answer 2

Gottesman found that as genetic similarity increases, as does the probability of sharing schizophrenia. MZ twins have a concordance rate of 48%, DZs 17%, and half-siblings 5%, in comparison with 1% for the general public.

Question 3

Describe research done into the genes involved in schizophrenia

Answer 3

Although Meehl’s model identified a single ‘schizogene’, more modern research by Ripke et al found 108 different genes associated with increased risk of schizophrenia, in particular those coding for the production of neurotransmitters

Question 4

What is one strength of the evidence supporting the role of genes in schizophrenia?

Answer 4

Findings have been replicated and triangulated through the use of many family, twin, and adoption studies, meaning that weaknesses of one approach are strengths of another.

Question 5

Outline the research done into the effect of amphetamines.

Answer 5

Curran et al found that amphetamines (a recreational drug) increase dopamine levels and worsen schizophrenic symptoms. This supports the dopamine hypothesis.

Question 6

What are two criticisms relating to the research done into the effect of amphetamines?

Answer 6

The findings are only correlational, raising the correlation vs causation issue. The findings also come from animal studies, which makes their application to humans limited.

Question 7

Outline the research done into the effect of anti-psychotics.

Answer 7

Tauscher et al found that anti-psychotics (used to treat schizophrenia) reduce dopamine levels and reduce schizophrenic symptoms. This supports the dopamine hypothesis.

Question 8

What is one criticism relating to the research done into the effect of anti-psychotics?

Answer 8

The study found that anti-psychotics are only effective for 2/3 of patients, which means that factors other than dopamine levels must affect schizophrenia.

Question 9

Outline research done into the effect of L-dopa.

Answer 9

L-dopa is a drug used to treat Parkinson’s, a disease associated with low dopamine levels. L-dopa has been found to increase dopamine levels and worsen schizophrenic symptoms. This supports the dopamine hypothesis.

Question 10

What is one criticism relating to research done into the effect of L-dopa?

Answer 10

The findings are not true of all L-dopa patients,

Question 11

Outline research done into neural correlates of negative symptoms.

Answer 11

Juckel et al compared activity levels in the ventral striatum in schizophrenics and controls during a task involving motivation (controlled by the ventral striatum). They found lower activity levels in schizophrenics, and a negative correlation between activity and severity of negative symptoms. This supports activity in the ventral striatum as a neural correlate of negative symptoms.

Question 12

Outline research done into neural correlates of positive symptoms.

Answer 12

Allen et al scanned the brains of schizophrenics with auditory hallucinations and compared with controls while the participants identified pre-recorded speech and their own or others. They found lower activity levels in the superior temporal gyrus and anterior cingulate gyrus in schizophrenics, as well as higher error rates. This supports reduced activity in these areas as a neural correlate of auditory hallucinations.

Question 13

What are the three types of expressed emotion? Examples?

Answer 13

Verbal criticism occasionally accompanied by violence(e.g. you’re useless), hostility including anger and rejection (e.g. don’t talk to me), emotional over-involvement including needless self-sacrifice (e.g. let me help you with everything)

Question 14

Outline support for family dysfunction as a risk factor for the development of schizophrenia

Answer 14

Read et al reviewed 46 studies of sexual abuse and schizophrenia, and found that 69% of schizophrenic women and 59% of schizophrenic men had a history of physical or sexual abuse in childhood.

Question 15

Outline the procedure and findings of the stroop task study.

Answer 15

Stirling et al compared 30 schizophrenics with 18 controls in their performance in the stroop task. They found that on average the schizophrenics took twice as long to name the ink colour. This suggests that schizophrenics find it difficult to suppress automatic processing, indicating dysfunctional information processing.

Question 16

What are the three methods for taking antipsychotics?

Answer 16

Tablets, syrup, or injection

Question 17

Outline the research done into the effectiveness of chlorpromazine.

Answer 17

Thornley et al reviewed studies comparing the effects of chlorpromazine with a placebo. They found that chlorpromazine was associated with better overall functioning, reduced symptoms severity, and reduced relapse rates.

Question 18

Name the 8 common side effects of typical antipsychotics.

Answer 18

Dizziness, agitation, sleepiness, stiff jaw, weight gain, itchy skin, tardive dyskinesia (involuntary facial movements), NMS

Question 19

Name the 1 common side effect of atypical antipsychotics.

Answer 19

Aranlocytosis - a reduction of which blood cells which can be fatal

Question 20

Explain why support for the effectiveness of anti-psychotics is compromised by their powerful calming effect.

Answer 20

Healy suggested that as anti-psychotics have powerful calming effects, studies will easily conclude that they have some positive effect on patients. However, this is not the same as reducing the severity of psychosis, which is what such drugs should be achieving.

Question 21

Outline research done into the effectiveness of CBT.

Answer 21

Jauhar et al reviewed the results of 34 studies into the effectiveness of CBT. They found that CBT has a significant but fairly small effect on both positive and negative symptoms.

Question 22

Outline research done into the effectiveness of family therapy.

Answer 22

Pharoah et al reviewed evidence for the effectiveness of family therapy. They found that family intervention may decrease relapse frequency, reduce hospital readmission, encourage compliance with medication, improve general social impairment, and improve levels of EE within families.

Question 23

Outline research done into the effectiveness of token economies.

Answer 23

McMonagle and Sultana reviewed just 3 trials investigating the effectiveness of token economies. One of these found that this approach produce a positive ‘change in mental state’. This weak support makes it unclear if these results are reproducible or clinically meaningful.

Question 24

What ethical issue arises from the use of token economies as a psychological therapy?

Answer 24

Patients with mild symptoms are more able to carry out the desired behaviour, and are therefore more likely to receive the rewards/privileges than patients with severe symptoms. This means that the most severely ill patients suffer discrimination.

Question 25

Describe Meehl’s model of schizophrenia.

Answer 25

This is the original diathesis-stress model, in which genetics is the diathesis and stress through childhood is the stress. The genetic vulnerability is the result of a single ‘schizogene’, and if you don’t have this gene, no amount of stress could lead to schizophrenia.

Question 26

Describe the modern understanding of ‘diathesis’.

Answer 26

It is now clear that there is no ‘schizogene’, and that many genes can increase vulnerability. Modern views of diathesis now extend past genetics, including psychological trauma. Severe trauma in early life can seriously effect brain development.

Question 27

Describe the modern understanding of ‘stress’.

Answer 27

Stress includes anything that risks triggering schizophrenia, not just psychological stress. This includes factors such as smoking large amounts of cannabis.

Question 28

Briefly explain the interactionist approach to schizophrenia.

Answer 28

The interactionist approach acknowledges a large range of factors combined, including psychological and biological factors, are involved in the development of schizophrenia. The approach encourages a combination of medication and psychological therapy for treatment.

Question 29

Outline the procedure of research done into the role of vulnerability and triggers.

Answer 29

Tienari et al investigated 19000 children adopted from schizophrenic mothers. Their adoptive parents were assessed for child-rearing style, and the rates of schizophrenia in the children were compared to a control group of adoptees without genetic vulnerability.

Question 30

Outline the findings of research done into the role of vulnerability and triggers.

Answer 30

Tienari et al found that a child-rearing style characterised by high conflict and criticism and low empathy was implicated in the development of schizophrenia in children with genetic vulnerability, but not in those without. This suggests that both genetic risk and family-related stress are important in the development of schizophrenia.

Question 31

Outline research supporting the effectiveness of combined treatment.

Answer 31

Tarrier et al compared the symptom levels between schizophrenic patients who received medication + CBT, medication + counselling, and just medication. They found lower symptom levels in the combined treatment groups, although there was no difference in hospital readmission rates. This partially supports the effectiveness of combining treatments.

Question 32

Briefly outline one piece of supportive evidence for the dopamine hypothesis.

Answer 32

Lindstroem found that chemicals needed to produce dopamine are taken up more quickly in schizophrenics. This suggests that schizophrenia is linked with high levels of dopamine.

Question 33

Briefly outline one piece of contradictory evidence for the dopamine hypothesis.

Answer 33

Moghaddam and Javitt found that other neurotransmitters such as glutamate also seem to be centrally involved in schizophrenia. This challenges the crucial link between dopamine and schizophrenia.

Question 34

Outline research supporting the modern account of diathesis.

Answer 34

Housten et al found that the combination of childhood sexual trauma and cannabis use produces a 12% risk of schizophrenia, despite neither factor being genetic.

Question 35

Name a study which supports Juckel et al’s findings regarding neural correlates.

Answer 35

Simon et al found a similar negative correlation between ventral striatum activity and avolition. Similarly to Juckle et al’s study, this supports the ventral striatum as a neural correlate for negative symptoms.

Question 36

Outline research supporting the effectiveness of addressing expressed emotion in therapy.

Answer 36

Multiple meta-analyses have found lower relapse rates, reduced hospital admission, and increased compliance with medication in patients who have undergone family therapy involving the reduction of expressed emotion.

Question 37

Describe a piece of research suggesting that expressed emotion is an effect of schizophrenia rather than a cause.

Answer 37

King et al interviewed 28 patients and their mothers 3 times at 9 month intervals. They found that critical comments and emotional over-involvement tend to be influenced by the patient’s overall symptom severity. This suggests that expressed emotion is an effect rather than a cause.

Question 38

Outline research supporting the link between expressed emotion and schizophrenia.

Answer 38

Kavanagh et al reviewed 26 studies of expressed emotion, and found that the mean relapse rate for schizophrenics living in high EE families was 48% compared with 21% for low EE families.

Question 39

In what circumstance will a patient move from FGAs to SGAs?

Answer 39

If the side effects of the FGAs are too severe.

Question 40

Make 3 comments on the appropriateness of Clozapine.

Answer 40

It is suitable for patients who don’t improve on typical anti-psychotics, it is more acceptable for long-term treatment, it leads to fewer adverse side effects.

Question 41

Outline the review into the effects of Clozapine.

Answer 41

The Cochrane review of 52 trials found greater clinical improvement and lower relapse rates in patients taking Clozapine compared with typical neuroleptic drugs, however there was little difference in broad outcomes including mortality and ability to work.

Question 42

Explain how bias compromises the reliability of findings such as those from the Cochrane review.

Answer 42

Cochrane states that the trials used in the review are at a ‘significant risk of bias’. As the trials would have mainly been sponsered by drug companies, they would have been motivated to produce positive outcomes supporting the effectiveness of the drug. If this did not happen, the results simply wouldn’t be published. This means that the trials used in Cochrane’s review are likely to be biased.

Question 43

Outline Ellis’ ABC model.

Answer 43

A= activating event
B= belief
C= consequences

Question 44

Comment on the effectiveness of token economies in the community.

Answer 44

The use of token economies requires the 24 hour care available in hospitals, not the 3-8 hours received outside of hospital, as behaviour needs to be constantly monitored. Additionally, patients may feel no need to comply with the advised behaviours as outside of the hospital they have freedom to do what they like and staff have little control over the privileges they receive.

Question 45

Briefly explain why a combination of biological and psychological therapy is effective.

Answer 45

The use of medication reduces symptom severity, enabling the patient to engage in the psychological therapy, which teaches them long-term methods to combat the illness.

Question 46

What 4 factors should be taken into account when deciding on the appropriate therapy combination?

Answer 46

1. The stage of the illness
2. The type and severity of symptoms
3. The patient’s life circumstances
4. Likely triggers

Question 47

State 2 possible consequences of a false positive diagnosis.

Answer 47

Great distress for the patient, and the admission of unnecessary/unhelpful treatment with potentially harmful side effects

Question 48

State 2 possible consequences of a false negative diagnosis.

Answer 48

Confusion and dissatisfaction for the patient, and severity of the illness increases

Question 49

Outline the procedure of one study into the reliability and validity of the diagnosis of schizophrenia

Answer 49

Cheniaux et al had two different psychiatrists diagnose 100 patients according to two different diagnosis manuals (the DSM and ICD) to test inter-rater reliability, and the validity of diagnostic manuals

Question 50

Outline the findings of one study into the reliability and validity of the diagnosis of schizophrenia

Answer 50

Cheniaux et al found that one psychiatrist gave 26 positive diagnoses with the DSM and 44 with the ICD, while the other gave 13 according to DSM and 24 according to IDC. This indicates poor inter-rater reliability and diagnostic validity.