Schizophrenia - Paper 3

Question 1

What is schizophrenia?

Answer 1

It is a severe psychiatric condition that involves a disconnection from reality and can include positive and negative symptoms.

Question 2

How do psychologists diagnose and classify schizophrenia?

Answer 2

Classification is organising symptoms using the DSM and the ICD.
Diagnosing is assigning a label of a disorder to a patient.
The ICD only needs negative symptoms present and the DSM needs only positive symptoms present.

Question 3

What do positive symptoms of schizophrenia mean?

Answer 3

The addition/excess or distortion of normal functions.

Question 4

What are 3 examples of positive symptoms?

Answer 4

Hallucinations, Delusions and psychomotor disturbances.

Question 5

What are the 4 types of hallucinations?

Answer 5

1. Auditory: Where people hear voices in their head that may be urgent or demand things. They can be whispers, murmurs or sound angry.
2. Visual: Where people see lights, objects, people or patterns. They often see dead loved ones and can have trouble with depth perception and distance.
3. Olfactory and Gustatory: Good or bad smells and tastes. People may think they are being poisoned so refuse to eat.
4. Tactile: Where people feel things moving on their body like hands or insects.

Question 6

What are the 6 types of delusions?

Answer 6

1. Persecutory: Where people think they’re being followed and someone is after them, stalking, hunting, framing or tricking them.
2. Referential: Where people think that public forms of communication like radio are a special message for them. For example, a TV show host making gestures is directed towards them.
3. Somatic: Focuses on the body. People think they have serious and bizarre illnesses like having damage from cosmic rays.
4. Erotomanic: Where people are convinced that celebrities are in love with them or their partner is cheating or someone they like is trying to pursue them.
5. Religious: Where people think they have a special relationship with a god or are possessed by demons.
6. Grandiose: Where people believe they are a major figure on the world stage like an entertainer or a politician.

Question 7

What are psychomotor disturbances?

Answer 7

Where people can seem jumpy and repeat movements over and over again. Or they can stay perfectly still for hours at a time which is known as being catatonic.

Question 8

What do negative symptoms of schizophrenia mean?

Answer 8

Disruption or loss of normal functions.

Question 9

What are 3 examples of negative symptoms of schizophrenia?

Answer 9

Anhedonia, Speech poverty (alogia), Avolition.

Question 10

What is anhedonia?

Answer 10

Where a person may not seem to enjoy anything anymore.

Question 11

What is speech poverty (alogia)?

Answer 11

The inability to speak properly.
Characterised by not being able to produce fluent words and is thought to reflect slowed or blocked thoughts.
Can manifest as empty and short answers to questions.

Question 12

What is avolition?

Answer 12

The reduction, difficulty or inability to start and continue with goal directed behaviours like going to school in order to get a job.
It can seem like disinterest and can include no longer being interested in going out and meeting friends.

Question 13

What is reliability of diagnosis and classification of Schizophrenia?

Answer 13

It refers to the consistency of diagnosis.
It includes inter-rater reliability which is where 2 or more assessors diagnose the same condition.
Inter-rater reliability of schizophrenia in the DSM-V is only 0.46.

Question 14

What can cause problems with the reliability of diagnosis of schizophrenia?

Answer 14

Cultural differences.

Question 15

Why can cultural differences cause issues with reliability of diagnosis of schizophrenia?

Answer 15

1. The DSM originated in the US but is routinely used by clinicians elsewhere.
2. Harrison et al (1984) suggested that West Indian people were over diagnosed by white doctors in Bristol. This could be because symptoms like hallucinations and hearing voices are more acceptable in African cultures due to their beliefs of communicating with ancestors. However, this could seem like strange and irrational behaviour to psychiatrists so it causes cultural bias towards what is ‘normal’ and therefore they may mislabel symptoms.
3. Copeland et al (1971) described symptoms of a patient to 134 US and 194 British psychiatrists, 69% of US diagnosed schizophrenia but only 2% of British.

Question 16

What is validity of diagnosis and classification of schizophrenia?

Answer 16

It refers to the extent to which methods used to diagnose mental illnesses are accurate.
For example, that methods are able to distinguish schizophrenia from other similar disorders.

Question 17

What are the 4 issues with validity of schizophrenia diagnosis?

Answer 17

Co-morbidity, Symptom Overlap, Gender bias and cultural bias.

Question 18

What is Co-morbidity?

Answer 18

The extent to which 2 or more conditions occur together.
Buckley (2009) found that half of schizophrenia patients also have depression. This called into question the ability to tell the difference between these 2 conditions and diagnose them accurately. For example, it could actually be severe depression but present as schizophrenia as they both have extremely low motivation.

Question 19

What is symptom overlap?

Answer 19

Refers to the symptoms of one condition being present in another condition.
For example, both schizophrenia and Bipolar disorder have symptoms of delusions and avolition.
Symptom overlap makes it very hard to accurately diagnose specific conditions as under the ICD, someone may be diagnosed with schizophrenia but under the DSM they would be diagnosed with bipolar.

Question 20

What is gender bias in validity of diagnosis and what is an example?

Answer 20

The tendency to describe behaviour of men and women in theory and research in a way that does not accurately represent characteristics of either gender.
Since the 1980’s, men have been diagnosed with schizophrenia more than women ( around 1.4:1 ratio).
Broverman et al found that US clinicians equated ‘mentally healthy’ with mentally healthy males.

Question 21

What is an example of cultural bias in validity of diagnosis for schizophrenia?

Answer 21

Cochrane (1977) reported that the incidence of schizophrenia in the West Indies and the UK was 1% but that people of Afro-Caribbean origin were 7 times more likely to be diagnosed when living in the UK. This means that the diagnosis of schizophrenia in Afro-Caribbean people may lack validity.

Question 22

Why may gender bias in validity of diagnosis occur?

Answer 22

Gender bias may occur due to criteria in the DSM-V and ICD or clinicians allowing gender biased stereotypes to influence their diagnosis.

Question 23

What is the evaluation for comorbidity?

Answer 23

There is evidence that co-morbid conditions often diagnosed with schizophrenia can reduce the validity of diagnosis.
Schizophrenia is often diagnosed with other conditions like depression and substance abuse. Buckley (2009) found that half of all schizophrenics also had depression.
This therefore reduces the validity as the patient struggles with both conditions but often may only be diagnosed with depression and have their schizophrenia looked past.

Question 24

What is the double evaluation for Co-morbidity?

Answer 24

Similarly, a number of studies have examined single co-morbidities with schizophrenia but have only had small sample sizes.
In contrast, Weber et al (2009) looked at around 6 million hospital discharge records and found evidence of many co-morbid non-psychiatric conditions such as asthma, hypertension and type 2 diabetes.
Authors concluded that the very nature of a psychiatric diagnosis was that patients received lower standards of medical care which adversely affects the prognosis of schizophrenic patients.

Question 25

What is the evaluation for symptom overlap?

Answer 25

There is supporting evidence that symptom overlap can reduce the validity and reliability of diagnosis. Sometimes, schizophrenia and Bipolar Disorder can be wrongly diagnosed as one another.
There is considerable overlap between symptoms of schizophrenia and other conditions like Bipolar Disorder as they both share positive symptoms of delusions and negative symptoms of avolition. Ophoff et al (2011) examined genetic material from 50,000 participants and found that of 7 gene locations on the genome associated with schizophrenia, 3 of them were also associated with bipolar. This suggests a huge genetic overlap between these 2 disorders and is a reason for symptom overlap.
This lack of distinction calls into question the validity of both diagnosis and classification of schizophrenia.

Question 26

What is the double for the symptom overlap evaluation?

Answer 26

Furthermore, Ellason and Ross (1995) point out that patients with DID have more schizophrenic symptoms than people diagnosed with schizophrenia! Using the ICD, a patient may be diagnosed with schizophrenia but many of the same patients are diagnosed with bipolar under the DSM.
Misdiagnosis due to symptom overlap can lead to years of delay in receiving relevant treatment, during which time suffering and further degeneration can occur along with high levels of suicide. So symptom overlap can have serious consequences and by focusing on fixing this issue, we may save money and lives.

Question 27

What is the evaluation for gender bias?

Answer 27

Some psychologists suggest that possible gender bias in schizophrenic research can affect validity of diagnosis.
According to Longenecker et al (2010), schizophrenic diagnosis may suffer from gender bias as more men than women are diagnosed with the disorder. This could be because men have a higher genetic vulnerability, or it could be that women are able to function better with the disorder. According to Cotton et al (2009), women are better able to continue to work and have good family relationships. This better interpersonal functioning may lead practitioners to miss symptoms of schizophrenia in women.
Therefore, this leads to under diagnosis of schizophrenia in women as they may be more resilient so they may not get the help they need.

Question 28

What is the evaluation for culture bias?

Answer 28

Some psychologists found that culture bias can reduce validity and reliability of schizophrenia diagnosis.
Culture bias may account for higher numbers of African Americans or others of Afro-Caribbean descent being diagnosed with schizophrenia than in Africa or the West Indies, where rates are lower. This may be because in some African cultures, symptoms like hallucinations and hearing voices are more acceptable due to their cultural beliefs of communicating with ancestors. This means that symptoms acceptable in some cultures may be seen as atypical in others. Escobar (2012) suggests that because the psychiatric profession is dominated by white people, psychiatrists may over-interpret symptoms and may distrust the honesty of black people.
Therefore, the influence of Western cultures on the DSM may lead to the misrepresentation of schizophrenia symptoms in other cultures such as Africa.

Question 29

What does the biological explanation say about schizophrenia?

Answer 29

That no one gene is thought to be responsible for schizophrenia but more likely that different combinations of genes make people more vulnerable to it.

Question 30

What are the 2 Family studies that support genetic factors influencing schizophrenia?

Answer 30

1. Kendler (1985):
   Showed that first degree relatives of those with schizophrenia were 18 times more at risk than the general population.
2. Gottesman (1991):
   Found that schizophrenia is more common in biological relatives of a schizophrenic and the more closely related you are, the greater the risk.

Question 31

What is the evaluation for family studies as a genetic explanation for schizophrenia?

Answer 31

This evidence strongly suggests that genetics are a factor.
However, it could be explained by the fact that genetically similar family members spend more time together and are treated similarly due to similarities in looks. So the environment could also affect risk.

Question 32

What are the 2 twins studies for genetic explanations of schizophrenia?

Answer 32

1. Gottesman:
   Studied 40 twins and found that the concordance rates were 48% for MZ and 17% for DZ.
2. Joseph (2004):
   Calculated that all the data from twin studies collected before 2001, showed concordance rates of 40.4% for MZ twins and 7.4% for DZ twins.

Question 33

What is the evaluation for twin studies used in genetic explanations of schizophrenia?

Answer 33

It is hard to separate the influences of nature vs nurture.
The fact that the concordance rates were not 100%, means that schizophrenia cannot be fully explained by genetics and it may be that individuals have a pre disposition to the disorder which means they are more at risk of developing it, but environmental factors may also increase this risk.
This suggests that the biological account can’t give a full explanation of the disorder. But adoption studies help us to separate the influence of nature vs nurture.

Question 34

Why are adoption studies used as evidence of genetics being a factor in schizophrenia and what is the study?

Answer 34

Due to the difficulty in separating the influences of environment and genetics for those who share genes and an environment, studies of biologically related individuals who have been reared apart are used.
Tienari et al (2000) studied 164 adopted children whose biological mums had schizophrenia and they had a concordance rate of 6.7% compared to 2% in adopted children whose parents were not schizophrenic.
This is strong evidence that genetics are a risk factor.

Question 35

What is the evaluation of adoption studies as an explanation of genetic factors?

Answer 35

Only small populations were studied due to the rarity of both adoption and schizophrenia. Which makes it hard to generalise.

Question 36

What is the dopamine hypothesis?

Answer 36

The dopamine hypothesis is the theory that an excess of the neurotransmitter dopamine in the limbic and subcortical regions of the brain is associated with positive symptoms of schizophrenia. It is also thought that schizophrenics have abnormally high numbers of D2 receptors on receiving neurons, resulting in more dopamine binding and more neurons firing.

Question 37

What is the revised dopamine hypothesis?

Answer 37

Revised by Davis and Khan (1991) to propose that positive symptoms are caused by an excess of dopamine in the subcortical regions specifically the mesolimbic pathway. And negative symptoms are caused by a deficit of dopamine in the prefrontal cortex specifically the mesocortical pathway.

Question 38

What are the 4 pieces of evidence for the dopamine hypothesis?

Answer 38

1. Patel et al (2010)
2. D2 receptors
3. Drugs that increase dopaminergic activity
4. Drugs that decrease dopaminergic activity.

Question 39

What is the evidence for d hypothesis by Patel 2010?

Answer 39

He used PET scans to assess levels of dopamine in schizophrenic and normal people and found lower levels in the dorsolateral PFC of schizophrenics compared to normal.

Question 40

What is the evidence for D2 receptors?

Answer 40

Owen et al (1987) showed that autopsies found generally high numbers of dopamine receptors in schizophrenics. Falkai et al (1988) found an increase of dopamine in the left amygdala and Owen et al 1978 also found an increase in the caudate nucleus and putamen.

Question 41

What is the evidence for drugs that increase dopaminergic activity?

Answer 41

Amphetamines stimulate nerve cells containing dopamine, causing synapses to be flooded. Normal people with no history of psychological disorders were given a large dose of amphetamines and produced behaviours similar to those of paranoid schizophrenia. Low doses were also given to schizophrenics and tended to worsen their symptoms.

Question 42

What is the evidence for drugs that decrease dopaminergic activity?

Answer 42

Antipsychotics block the activity of dopamine in the brain by reducing activity in neural pathways that used dopamine as a neurotransmitter. Leucht et al 2013 did a meta analysis of 212 studies and found that antipsychotic drugs were far more effective than placebo drugs in the treatment of positive and negative symptoms.

Question 43

How does dopamine affect hallucinations?

Answer 43

Hallucinations may result from the interaction of excess dopamine in the striatal area and the processing of sensory perception. Essentially dopamine signalling issues may increase the chance that the brain ‘fills in the gaps’ with expectations rather than reality.

Question 44

What is the double evaluation for mixed evidence for the dopamine hypothesis?

Answer 44

There is mixed evidence for the dopamine hypothesis. There is definitely evidence that dopamine levels are higher in schizophrenics.
For example, Lindstroem et al (1999) radioactively labelled a chemical called L-DOPA which is used to produce dopamine in the brain. They administered L-DOPA to 10 untreated patients with schizophrenia and a control group of 10 people with no diagnosis. Using a scanning technique called PET scanning, they were able to trace what happened to the L-DOPA. It was taken up far more quickly in the schizophrenic patients suggesting that they were producing more dopamine than the control group. This is strong objective evidence supporting the higher levels of dopamine in schizophrenics.

However, Noll 2009 claims that there is strong evidence against both the original dopamine hypothesis and the revised dopamine hypothesis.
He argues that antipsychotic drugs do not alleviate hallucinations and delusions in around 1/3 of the people that experience them. Noll also points out that, in some people, hallucinations and delusions are still present despite normal levels of dopamine.
This suggests that rather than dopamine being the sole cause of positive symptoms, other neurotransmitter systems, acting independently to the dopaminergic system, may also produce the positive symptoms associated with schizophrenia.

Question 45

What are 2 psychological explanations?

Answer 45

Family dysfunction and cognitive.

Question 46

What 3 theories make up the family dysfunction explanation?

Answer 46

The schizophrenogenic mother, the double bind theory and expressed emotion.

Question 47

Who discovered the double bind theory and what is it? (5)

Answer 47

It was suggested by Bateson et al 1956 who thought that schizophrenia was not a disease but rather a result of social pressure from life.
The double bind theory suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia.
For example, their parent may say they care about them whilst appearing critical or express love whilst appearing angry.
These interactions may prevent the development of internally coherent constructions of reality as one message invalidates the other. This may manifest as a flattening effect, hallucinations, delusions, incoherent thinking and speaking or in some cases paranoia.

Question 48

What is the expressed emotion theory?

Answer 48

Expressed emotion is another family variable associated with schizophrenia which consists of a negative climate and more generally, a high degree of expressed emotions.
Expressed emotion is a family communication style where the members of a family of a psychiatric patient talk about them in a critical and hostile manner which indicates emotional over involvement and over concern with the patient and their behaviour.
For example, Kuipers et al 1983 found EE family members talk more and listen less which makes high levels of EE more likely to influence relapse. Also, Linszen et al 1997 found that patients returning to a high EE environment, are 4 times more likely to relapse than patients returning to a low EE environment. This suggests that people with schizophrenia have a lower tolerance for intense environmental stimuli specifically emotional comments and interactions. A negatively emotional climate may lead to stress beyond their already impaired coping mechanisms so may result in a schizophrenic episode.

Question 49

What type of family can help a patient become less dependant on meds?

Answer 49

A supportive and undemanding family.

Question 50

Who made the theory of the schizophrenogenic mother and what is it?

Answer 50

This is a psychodynamic explanation by Fromm-Reichmann 1948.
This theory suggests that patients with schizophrenia develop paranoid delusions as a result of influence of cold, rejecting and controlling mothers and passive fathers. They create an atmosphere of tensions and stress and secrecy in the family.
This atmosphere triggers psychotic thinking and distrust.

Question 51

What is the family dysfunction evaluation for Tienari et al study?

Answer 51

The importance of family relationships in schizophrenia was demonstrated in an adoption study by Tienari et al 1994.
In this study, adopted children with schizophrenic biological parents were more likely to become ill than adopted children with non-schizophrenic biological parents. However, this difference only emerged in situations where the adopted family was rated disturbed. Suggesting that the illness only manifests itself under appropriate environmental conditions, therefore family relationships are important to consider in the development of schizophrenia as they clearly increase risk.

Question 52

What is the evaluation for family dysfunction being reductionist?

Answer 52

The family dysfunction theory as an explanation for schizophrenia can be considered reductionist as it fails to consider biological predispositions too.
For example, some families are supportive , undemanding and not particularly highly emotionally expressive but still have a child with schizophrenia and vice versa. Altorfer et al 1998 found that 1/4 of the patients they studied showed no physiological response to stressful comments from relatives which shows that they are not influenced by EE and the double bind theory. An explanation for this could be genetic vulnerability for example a study done by Gottesman found a concordance rate for schizophrenia of 48% in MZ twins and only 17% in DZ. This suggests that specific combinations of genes can make an individual significantly more likely to develop the disease. Furthermore, this could be due to inheriting genes coding for an excess of D2 receptors which causes more dopamine binding, more neurons firing resulting in positive symptoms. For example Owen et al 1987 found autopsies of schizophrenics had a higher number of dopamine receptors than non-schizophrenics.
Therefore, although family variables can certainly exacerbate the risks of developing schizophrenia, in many cases the child may already be genetically determined to develop the disorder through inheritance of combinations of genes. Thus, other factors must be considered as family dysfunction alone cannot fully explain schizophrenia.

Question 53

What is the evaluation for evidence for double bind?

Answer 53

There is some evidence to support the account of how the double bind theory in family dysfunction may lead to schizophrenia.
For example, Berger 1965 found that schizophrenics report to a higher recall of double bind statements from their mothers than non-schizophrenics. However, other research is less supportive like Liem 1974 who measured patterns of parental communication in normal families with a schizophrenic child and found no difference when compared to normal families without a schizophrenic child.
Despite these inconsistencies in research, Gibney 2006 claims that the real value of the double bind theory was that it led to the development of family therapy. As, if interactions could be problematic and illness producing, then they could be organised more constructively to be health producing.

Question 54

What is one limitation of drug treatment?

Answer 54

Both types of drugs have side effects but typical antipsychotics are more severe, causing extrapyramidal effects. These are movement issues like tardive dyskinesia and parkinsonian like uncontrollable movements. More than half of the patients taking these drugs experience these symptoms which can lead to them stopping taking the medication that they need.