Schizophrenia - Paper 3 *****

Question 1

What is schizophrenia?

Answer 1

a long-term mental health condition which is commonly described as a type of psychosis - people may not be able to distinguish their thoughts and ideas from reality.

Question 2

What are type 1 or positive symptoms of sz?

Answer 2

positive are additional to normal experience

auditory/visual hallucinations
delusions of control, grandeur or paranoia

Question 3

What are type 2 or negative symptoms of sz?

Answer 3

negative are loss of usual experience

speech poverty
avolition

Question 4

What is classification?

Answer 4

the process of organising symptoms into categories based on which symptoms cluster together in sufferers.

Question 5

What is validity in the Diagnosis & Classification of SZ.

Answer 5

The extent to which sz is a unique syndrome with its own characteristics, symptoms and signs.

Question 6

What is the genetic explanation of sz + example?

Answer 6

SZ is genetic and inheritable through DNA.

There are candidate genes associated with the risk of sz, including those associated with coding for a number of neurotransmitters.
E.g. Type 3 dopamine receptor gene (DRD3) which coded for dopamine

Question 7

What are drug therapies?

Answer 7

Drugs used short or long term for patients.

Patients can take for a short course without the return of symptoms.

Other patients require antipsychotics for life or face the likelihood of a recurrence of sz.

Question 8

Typical antipsychotic drugs

Answer 8

Include chlorprozamine which are dopamine antagonists.

They block D2 dopamine receptors at the synapse, reducing the action of dopamine.

Patients report an improvement in the positive symptoms such as hallucinations after taking the medication.

Have an almost sedative (calming) effect.

Question 9

Appropriateness of typical antipsychotic drugs

Answer 9

P - A weakness of typical antipsychotic drugs is that they have side effects.

E - Side effects of typical antipsychotics include dry mouth, constipation, lethargy and confusion.

E - 20-25% of sufferers will have side effects that involve disorderd motor movements like tremors or tardive dyskinesia (involuntary tics).

L - 50% of sufferers stop taking antipsychotics in the first year, which means they are not appropriate.

Question 10

Effectiveness of typical antipsychotic drugs

Answer 10

P - A strength is that typical antipsychotic drugs is there is evidence to support the effectiveness of the treatment.

E - Julien found that positive symptoms reduced in 70% of people with sz after taking typical antipsychotic drugs.

E - They also decreased the average length of time a person was hospitalised for.

L - This means that typical antipsychotic drugs are effective.

Question 11

Atypical antipsychotic drugs

Answer 11

Introduced in 1970s. Includes clozapine.

They block dopamine receptors and also act on other neurotransmitters eg serotonin.

Temporarily bind to the D2 dopamine receptors then rapidly disassociate allowing for normal dopamine transmission. This reduces side effects eg tardive dyskinesia.

They address negative symptoms eg avolition possibly as a result of also acting on the serotonin system.

Increase patient mood, reduce depression/anxiety to improve cognitive functioning.

Daily dosage is lower than typical antipsychotics.

Question 12

Appropriateness of Atypical antipsychotic drugs

Answer 12

P - A weakness of atypical antipsychotic drugs is that they can have serious side effects.

E - A major problem with come atypical drugs is that some can cause agranulocytosis.

E - This is the extreme lowering of white blood cell count and high risk of serious infections, which can be fatal. For this reason, patients need to have their blood monitored monthly.

L - This can be a problem for patients with sz as their symptoms may interfere with their ability to make this commitment, which means atypical antipsychotics are not always appropriate.

Question 13

Effectiveness of atypical antipsychotics

Answer 13

P - There is evidence to support the effectiveness of atypical antipsychotics.

E - Meltzer concluded that Clozapine is more effective than typical antipsychotics.

E - Patients showed an improvement in their symptoms (even in the 30-50% treatment resistant cases where typical antipsychotic drugs failed).

L - This shows that atypical antipsychotic medication is effective at reducing the symptoms of sz.

Question 14

What are the implications of biological treatments for sz (Drug Therapy)?

Answer 14

P - There are economic implications of biological treatments (Drug Therapy) of sz.

E - Drug therapies tend to be cheaper than other psychological therapies as they require the patient to take a tablet rather than having regular therapy appointments.

E - As drug therapies reduce the chance of relapse and symptoms of sz (effective), they also reduce the likelihood of patients being hospitalised.

L - This means that biological treatments (Drug Therapy) for sz have a positive impact on the economy.

Question 15

Do biological treatments treat the underlying cause of SZ (Drug Therapy)?

Answer 15

P - drug therapies do not treat the underlying cause of sz.

E - Many psychologists state that drugs may simply be suppressing the syptoms of sz due to the sedative nature of the medication.

E - Many of the studies into the effectiveness of drug therapies focus on the short-term effects only and should focus on assessing long-term benefits to the medication.

L - This means that a reduction in symptoms of sz may return when the medication is stopped.

Question 16

What is family dysfuntion + examples of risk factors?

Answer 16

Problems within family contribute to the onset and relapse of sz.

Poor family communication, cold parenting and high levels of expressed emotion are risk factors for the development and maintenance of sz.

Question 17

Double bind communication

Answer 17

Bateson (1956) argued that double bind was a risk factor for developing sz.

When child recieves mixed messages about their relationship that contradict each other.
eg a mother saying she loves her child but with aggressive tone.

Child feels trapped and doesn’t know how to repsond , as whatever they do they feel they will be wrong.

Question 18

What symptoms of sz do does double bind communcation cause?

Answer 18

Paranoid delusions - Suspicions about people trying to hurt them. Looking for hidden meanings

Disorganised thinking - See the world as confusing. Leads to avolition.

Question 19

Supporting evidence for double-bind exposure

Answer 19

P - There is supporting evidence for the role of double-bind communication in the risk of sz.

E - Berger (1965) studied the retrospective family experience with a diagnosis of sz compared with a control group of students without a diagnosis of sz.

E - It was found that patients with sz had a higher recall of double bind statements in their childhood.

L - This shows that there is a relationship between double-bind communication and sz.

Question 20

What is expressed emotion?

Answer 20

The level of negative emotion expressed to a person by their carers.

• Exaggerated emotional involvement in the life of the patient.
• High levels of control and verbal criticism.

Question 21

What symptoms of sz does expressed emotion cause?

Answer 21

The primary explaination of relapse of patients with sz.

High expressed emotion directed towards a person can cause stress.
Suggested that stress is a trigger for the onset of sz for those who are already vulnerable.

Question 22

Supporting evidence for expressed emotion (on Relapse Rates).

Answer 22

P - There is evidence to support the role of expressed emotion in the relapse rates of patients with sz.

E - Butzlaff and hooley (1998) conducted a meta analysis of 27 studies of the expressed emotion outcome relationship in sz.

E - They found that relapse rates were double in patients with high levels of expressed emotion in the family.

L - This suggests that family dysfunction has a role in the relapse rates of sz.

Question 23

Contradictory evidence for studying family as explanation of sz

Answer 23

P - There are issues with studying the family as an explanation for sz.

E - Family dysfunction may be the result of a child’s disturbing behaviour rather than the cause of sz, which makes it difficult to establish cause and effect.

E - Additionally, studying families relies on retrospective recall of data as patients will report childhood experiences after they have developed sz and recall can be inaccurate.

L - This means that caution must be taken when interpreting the findings of studies into family dysfunction as a cause of sz as they may lack validity.

Question 24

What the cognitive explanation for sz?

Answer 24

Focuses on impaired information processing. Their information processing is different to those that don’t have the disorder.

Symptoms caused by Impaired info processing include:

• Hallucinations and delusions.
• Hypervigilance (extreme awareness) of surroundings.

Question 25

Cog exp: 2 types of dysfunctional thought processes

Answer 25

Frith identified 2 types of dysfunctional thought processes that underlie some of the symptoms of sz.

1) deficits in metarepresentation: the ability to reflect on thoughts and behaviour. Deficits in metarepresentation disrupts a person’s ability to distinguish whether their thoughts originate from within themselves or from their external environment.
Explains hallucinations and delusions.

2) deficits in central control: the ability to suppress (hold back) automatic responses and perform deliberate actions instead.
Explains disorganised speech from inability to suppress automatic thoughts and speech triggered by other thoughts.

Question 26

Supporting evidence for dysfunctional thought processes

Answer 26

P - There is supporting evidence for the role of dysfunctional thought processes in the risk for sz.

E - Shen who compared 86 people with 86 controls. The researchers carried out 13 different computerised tests eg pressing a response key whenever a cross appears on a screen and the Stroop test.

E - They found that people with sz performed significantly worse on tasks that required sustained and focused attention.

L - This shows that there is a relationship between impaired information processing and sz.

Question 27

Contradicting evidence for dysfunctional thought processes

Answer 27

P - However, there is contradictory evidence for the role of dysfunctional thought process is in the risk for schizophrenia.

E – McKenna Found that people with schizophrenia do not seem to be any easier to distract than people without schizophrenia when engaged on cognitive tasks. This challenges the idea that schizophrenia is the result of cognitive deficits.

E - In addition, although cognitive explanations of evidence to support the existence of dysfunctional thought process is, they do not reveal anything about the origins of those dysfunctional cognitions.

L - Therefore, cognitive explanations can account for the symptoms but not the origin of SZ.

Question 28

Other explanation for psychological explanations of sz.

Answer 28

P - There are other explanations for schizophrenia, for example biological explanations, which are supported by ample evidence.

E - The biological explanation states that schizophrenia has a genetic cause rather than an environmental (family) Or cognitive cause.

E - For example, the DRD3 gene codes for dopamine, which is a neurotransmitter, that is associated with the development of schizophrenia.

L - This means that psychological explanations for schizophrenia are not fully comprehensive alone.

Question 29

Issues and debates of psychological explanation of sz

Answer 29

P - The psychological explanation can be criticised for being socially sensitive research.

E - Family dysfunction theory states that the environment causes Schizophrenia, eg high levels of expressed emotion.

E - The cognitive explanation States and individuals dysfunctional thought processing leads to schizophrenia.

L - This means the psychological explanation for schizophrenia places blame on the family or the individuals Parent, which can lead to further stress, pressure and distress. Therefore, psychologists must be cautious when interpreting and publishing their findings.

Question 30

Aims of Family Therapy Treatment: Psychological Treatment

Answer 30

Aims - Develop cooperative relationship and improve communication skills within the family.

Question 31

Procedure of Family Therapy Treatment: Psychological Treatments.

Answer 31

1. Therapist provides info of SZ cause, symptoms etc. Family members including SZ sufferer share their experiences of SZ.
2. Develop practical coping skills that enable them to manage to issues of SZ in the family.
3. Family learns constructive ways of communicating with each other.
4. Family are encouraged to recognise early signs of relapse, so they can respond quickly to reduce its severity.

Question 32

Time Length of Family Therapy Treatment: Psychological Treatments.

Answer 32

3-12 months.

Question 33

Appropriateness of Family Therapy Treatment: Psychological Treatments.

Answer 33

P - FT isn’t always suitable treatment of SZ.

E - If person has severe symptoms (hallucinations + delusions), they may find it difficult to attend family therapy.

E - The therapy is only suitable for people with SZ who live in a family set up and are sufficiently motivated to attend the therapy.

L - FT is not appropriate for all people with SZ.

Question 34

Effectiveness of Family Therapy Treatment: Psychological Treatment.

Answer 34

P - Evidence to support effectiveness of FT.

E - Pharoah (2010) conducted a meta-analysis of 53 trials from Europe, Asia and N.America comparing FT with drug treatment and standard care (just drug treatment).

E - FT reduces amount of expressed emotion, frequency of relapse, chance of hospital admissions and encourages compliance with medication.

L - This means FT appears to be a useful treatment.
However, as treatment is used alongside drug therapies, it’s difficult to establish the effectiveness of FT alone.

Question 35

Cognitive Behavioural Therapy (CBT) Treatment: Psychological Treatment.

Answer 35

CBT are based on assumptions that faulty thought processes make a person vulnerable to sz.

Aims to identify and challenge the negative and irrational thoughts

Question 36

Procedure of CBT

Answer 36

1. Patient and therapist work together to clarify the patients problems (e.g. delusional thoughts).
2. Identify the thoughts (faulty cognitions) that would benefit from challenge.
3. Patient should challenge the thoughts taking an ctive role in their treatment (realisty testing).
4. Patients are encouraged to test the reality of their delusional beliefs (eg via homework) recording when they have the behaviour and testing the effectiveness of the coping strategies outlined below.
   The scientist can use this as evidence that irrational beliefs are incorrect if the patient reverts to deulsional thinking.

Question 37

What is the coping strategy enhancement form of CBT?

Answer 37

• Patients develop cognitive strategies to cope with their hallucinations and delusions
  eg the use of distraction, concentrating on a specific task and positive self-talk.
• Behavioural strategies including initiating or withdrawing from social contact, relaxation techniques and breathing exercises and finding ways of drowning the hallucinatory voices by shouting STOP! or turning up the tv.

Question 38

What is the appropriateness of CBT?

Answer 38

P - CBT has practical issues.

E - It requires regular therapy sessions over a long period of time.

E - Negative symptoms of sz such as avolition can result in patients not being willing to engage. eg not completing homework tasks.

L - This means that cognitive behaviour therapy may not be an appropriate treatment for everyone with sz.

Question 39

What is the effectiveness of CBT?

Answer 39

P - There is evidence to support the effectiveness of CBT in the treatment of sz.

E - Piling et al (2002) conducted a meta-analysis of cognitive behaviour therapy that included a total of 392 participants.

E - Research findings indicated that cbt produced higher rates of ‘important improvement’, that had positive effects on mental state and low drop-out rate.

L - This shows that cognitive therapy is an effective treatment as it improves the mental state of patients both during treatment and at a follow up.

Question 40

What are token therapies for the management of sz?

Answer 40

These are reward systems used to manage the behaviour of patients with schizophrenia.

Aimed particularly at those who’ve been institutionalised for a long period of time and likely to have developed bad habits such as lack of personal hygiene.

Aim to improve a patient’s quality of life.

Question 41

How are token therapies used to manage sz?

Answer 41

Based on the principles of operant conditioning.

Staff positively reinforced the patients by giving them tokens when they perform desirable behaviours, eg getting dressed in the morning.

Tokens are secondary. Reinforces that patient swap for tangible rewards. Eg Being able to go for a walk or sweets.

Question 42

Appropriateness of token therapy

Answer 42

P - Token economies do not address the symptoms of schizophrenia and therefore cannot be classified as a ‘treatment’.

E - Patients are treated as Lab Rats who can be manipulated using principles based on animal behaviour, which underestimates the role of cognitive factors such as motivation.

E - Privileges may be more available to those with mild symptoms and less likely for those with severe symptoms that prevent them from exhibiting desirable behaviours.

L - This means that token economies can be viewed as unethical and discriminative. Therefore, token economies are not appropriate for everyone.

Question 43

Effectiveness of token economy

Answer 43

P - There is evidence to support The use of token economy systems in management of schizophrenia.

E – McMonagle & Sultana Conducted a meta analysis of token economy systems involving 110 people. They found slight evidence from prove mental state, especially with negative symptoms.

E - However, there were only three studies where participants have been randomly allocated to conditions. It is likely that patients with less severe symptoms will be placed in the token economy group.

L - This suggests there is limited support for token economies used for management of schizophrenia.

Question 44

Implications of psychological treatments for sz

Answer 44

P - The economic implications of psychological treatments of schizophrenia.

E – Drug (Biological) therapies tend to be cheaper than psychological theories as they do not require regular therapy appointments.

E - However, psychological therapies have led to a reduction in relapse rates and hospital stays, which can be very costly to the economy.

L - This means that psychological treatments for schizophrenia have a positive impact on the economy as the treatment tends to provide a long term strategy for relapse avoidance.

Question 45

Underlying cause: psychological treatments for sz

Answer 45

P - Psychologist dispute whether psychological treatments treat the underlying cause of schizophrenia.

E - Psychological therapies offer patients a way of managing their symptoms and as such are not necessarily a cure. Eg Taken economy systems are simply a form of behaviour management.

E - Others argued they are more likely to treat the underlying cause (eg Family therapy reducing expressed emotion) than biological therapies, which only treat the symptoms whilst being taken.

L - This suggests that psychological treatments can lead to patients having an Enhanced quality of life in the long term as a strategies can be used even after the treatment has stopped.

Question 46

What is the interactionist approach?

Answer 46

A broad approach to explaining schizophrenia, which acknowledges a range of factors including biological, psychological and social factors which were involved in the development of schizophrenia.

Biological factors: Genetic vulnerability, neurochemical and neurological abnormality.

Psychological factors: include stress, resulting from life events or poor quality relationships within the family.

Instead of assessing what’s the ‘best’ explanation it is better to see sz as being developed through several interacting factors.

Question 47

EXPLAINING - diathesis-stress model

Answer 47

Suggest that sz is caused by a combination of internal vulnerability and environmental factors. Vulnerability was originally thought to be genetic, but now include vulnerabilities due to childhood trauma (under 19) which might have affected brain development.

A stress trigger could be any negative psychological experience eg breakdown of relationships, academic pressure, ect.

For example, a genetic vulnerability may lead to a biochemical abnormality, eg dopamine system. This leads to an inability to process information normally. The addition of disrupted family communications, drug abuse or other traumatic life events could then be enough to trigger the development sz.

Question 48

TREATING

Answer 48

As schizophrenia is best explained by interactionist approach. This suggests that combine treatments would be most effective.

Biological treatments, such as antipsychotic drugs, could address biological factors with psychological therapies eg CBT addressing the psychological symptoms.

Reset suggests that combination treatment (where more than one treatment is given at the same time) Is the most effective way to treat sz.

Generally, a patient be given antipsychotic drugs to reduce symptoms so that they can engage with psychological treatments which enable them to cope with their symptoms.

Drug treatments continue while the psychological therapy is in progress.

Question 49

Supporting evidence for interactionist approach

Answer 49

P - There is evidence to support the interactionist approach to explaining schizophrenia.

E – Gottesman Conducted a large scale family study and found that MZ Twins had a concordance rate of 48% compared to 17% for DZ Twins.

E - As the concordance rate is much higher than the general population risk of 1%, this indicates the genetic role in the development of schizophrenia.

L - As the MZ Twin concordance rate is not 100%. There must be an environmental trigger eg Dysfunctional family environment, which supports the interactionist approach.

Question 50

Contradicting evidence for interactionist approach

Answer 50

P - However, the interactionist approach does not fully explain schizophrenia.

E - There is strong evidence to suggest some underlying vulnerability coupled with stress can lead to schizophrenia.

E - The mechanisms by which the symptoms of schizophrenia appear and how both from ability and stress produced them, is currently not understood.

L - This means that further research is needed to fully explain in treat schizophrenia effectively.

Question 51

Issues and debates of interactionist approach

Answer 51

P - Interactionist approach takes a holistic approach to explaining and treating schizophrenia.

E - By using the diathesis stress model, it suggests that schizophrenia cannot be explained by reducing it down to the basic elements like genetic inheritance.

E - Any explanation must also include a variety of psychological and social factors.

L - If this is the case, then the most effective treatment for schizophrenia would also be holistic (Using both biological and psychological treatments)