Szhizophreina

Question 1

What are symptoms?

Answer 1

Issues which a patient would show

Question 2

What are features?

Answer 2

General information about the disorder

Question 3

What is schizophrenia?

Answer 3

Schizophrenia is a psychotic disorder. Psychosis is the general term for disorders that involve a loss
of contact with reality.
This may make it difficult for the person suffering from a psychotic disorder to function, because their ability to perceive, process, and respond to environmental stimuli is
impaired.
Schizophrenia is often marked by periods of remission, where the patient has no symptoms, followed by relapses, where their symptoms reoccur.

Question 4

What are positive symptoms

Answer 4

Positive symptoms are strange and bizarre additions to normal behaviours.

Question 5

What are negative symptoms

Answer 5

negative symptoms refer to the loss or absence of normal characteristics.

Question 6

What are cognitive symptoms

Answer 6

Cognitive symptoms in schizophrenia refer to issues to do with information processing.

Question 7

List the positive symptoms of schizophrenia

Answer 7

• Delusions (false beliefs)
•Hallucinations (seeing or hearing things that aren’t there)
•Disorganised thinking/speech
•Abnormal motor behaviour

Question 8

What are delusions?

Answer 8

false or bizarre beliefs which persist even in the presence of disconfirming evidence.

Question 9

List the type of delusions (false beliefs) schizophrenics may experience

Answer 9

•Delusions of reference (where the patient believes that other people’s behaviour is directed specifically at them)
•Delusions of grandeur (god like)
•Delusions of persecution (being plotted or conspired against)
•Thought insertion (person believes that their thoughts have been implanted by some kind of external force over which they have no control)
•Thought broadcasting (believe others can hear their thoughts)

Question 10

Explain how cultural differences are relevant to the positive symptom of delusions

Answer 10

Often, the delusions tend to reflect the predominant themes and values of a person’s culture. In industrially advanced countries like America, patients’ delusions tend to focus on sinister uses of technology and surveillance. So, delusions differ according to the patient’s culture.

Question 11

What are hallucinations?

Answer 11

perception of stimuli not actually present. The most common type of hallucination in schizophrenia are auditory hallucinations i.e. hearing voices.

Question 12

Explain how cultural differences are relevant to the positive symptom of hallucinations

Answer 12

people from different cultures may
interpret the voices that they hear differently.

Luhrmann (2015) found that in some cultures the voices heard were harsh and critical, but in other cultures they were seen as kind. So the symptoms of schizophrenia may vary from culture to culture.

Question 13

What is disorganised thinking/ speech as a positive symptom of schizophrenia?

Answer 13

This is where there is an underlying problem with conscious thought that has an effect on a person’s language. Sometimes the patient’s speech is so jumbled that is it described as “word salad”, This is due to loose associations in thoughts where one idea constantly triggers another and so they jump from topic to topic. In addition, thought patterns may be reflected in the inventions of new words. These are known as neologisms.

Question 14

List the negative symptoms of schizophrenia

Answer 14

1. Lack of energy and motivation; for example, no motivation to do daily chores.
2. Social withdrawal (for example, avoiding family and friends)
3. Flatness of emotion, where a person’s face becomes emotionless, and the voice dull with no rise and fall of intonation.
4. Not looking after appearance and. self
5. Lack of pleasure in everyday things
6. Speaking little even when required to interact.

Question 15

List the cognitive symptoms of schizophrenia

Answer 15

1. Difficulties in concentrating and paying attention
2. Problems with working memory
3. Difficulties with executive functioning (understanding and decision making).

Question 16

What is the acronym for features of schizophrenia

Answer 16

Prognosis
Risk factors
Onset
Prevalence

Question 17

Describe the onset for schizophrenia

Answer 17

The onset of schizophrenia is typically between the late teens and the mid-30’s. (This links to the topic of developmental psychology: it may be that schizophrenia is triggered by some aspect of development during these years; either biological or social.)

Question 18

Describe the prevalence for schizophrenia

Answer 18

(prevalence refers to how common a disorder is): schizophrenia has been observed all around the world, in
various countries, cultures and races, and thus, there is no doubt that it is a universal illness. The likelihood of a person developing schizophrenia is somewhere between 0.7 and 1%.

Question 19

Describe prognosis for schizophrenia

Answer 19

(this refers to the likely course of the disease): About 25% of people who have had a schizophrenic episode
recover and do not have another episode. About 50% of people have recurrent episodes; between episodes they are symptom free. And about 25%
of people experience schizophrenic symptoms continually, without any breaks. Average life expectancy for a person with schizophrenia is about 10 years less than the overall population
average. Males are likely to show a higher proportion of negative symptoms, and have a longer duration of the disorder than females. Both of these factors are associated with poor
prognosis.

Question 20

How can Individual differences link to schizophrenia

Answer 20

•different people suffering from schizophrenia may show different symptoms.
•The issue of individual differences is also relevant to prognosis because males show more negative symptoms and have a longer duration of the disorder than females, and both these factors are associated with poor prognosis.
•People who experience social problems, such as poverty and unemployment, are more likely to develop schizophrenia than other sections of the population, this links to the issue of individual differences.

Question 21

How can cultural differences link to schizophrenia

Answer 21

•Schizophrenia is found in all cultures. This indicates that there is a biological component to its cause.
• However, the symptoms shown vary between cultures. For example, voices heard in people with schizophrenia in Ghana tend to be more positive than voices which American patients hear.
•Patients with this disorder in developing countries have a more positive prognosis than do comparable patients in western industrialised societies

Question 22

What is dopamine?

Answer 22

Dopamine is a neurotransmitter associated with many functions, including motivation, and feeling pleasure.

Question 23

What is the dopamine hypothesis?

Answer 23

suggests that schizophrenia can be explained by changes of dopamine functioning in the brain. The positive symptoms of schizophrenia (e.g., hallucinations and delusions) may be
explained by excess dopamine activity in the mesolimbic pathway in the brain, the negative symptoms may be explained by low levels of dopamine in the mesocortical pathway.

Question 24

What are the possible causes of excess dopamine? (hyperdopaminergia)

Answer 24

• This may be caused by low levels of the enzyme beta- hydroxylase, which should break down dopamine. This means that more dopamine is available in the brain
•More recent research suggests
that people with schizophrenia
have an excess number of dopamine receptors in the brain (Owen 1978). Evidence from this comes from post- mortem examinations.
•due to hypersensitivity of certain
dopamine receptors (D2 receptors).

Question 25

Give evidence for the theory of neurotransmitters as an explanation for schizophrenia

Answer 25

The theory is backed up by evidence from drug treatment: many antipsychotic medications used to treat schizophrenia work by blocking dopamine.

Question 26

Give evidence against the theory of neurotransmitters as an explanation for schizophrenia

Answer 26

But not all patients with schizophrenia respond to these drugs. For example, Alpert and Friedhoff (1980) found that some patients did not improve at all after taking dopamine antagonists.

Question 27

Give a strength of the methodology for the theory of neurotransmitters as an explanation for schizophrenia

Answer 27

The main supporting evidence for the neurotransmitter explanation comes from PET scans in investigating dopamine levels in patients with schizophrenia. This provides an objective measure of neurotransmitter functioning in areas of the brain.

Question 28

Give methodology against the theory of neurotransmitters as an explanation for schizophrenia

Answer 28

•PET scans can be a stressful experience for patients, and therefore may not have produced valid findings about dopamine functioning.
•Reductionist explanation, because it
focuses purely on the role of neurotransmitters, ignoring all other factors that may influence whether someone develops schizophrenia, such as other biological, psychological and social factors. For example Brown and Birley (1968) found that 50% of schizophrenic patients reported a major life event in the three weeks prior to relapse, suggesting that social conditions may trigger relapse.

Question 29

Give applications for the theory of neurotransmitters as an explanation for schizophrenia

Answer 29

The neurotransmitter explanation has practical applications as many antipsychotic medications used to treat schizophrenia work by blocking dopamine receptors.

Question 30

What are the possible causes of dopamine deficiency? (hypodopaminergia)

Answer 30

the negative symptoms of schizophrenia may be explained by irregular serotonin activity. There is an interaction between serotonin and dopamine: serotonin regulates
dopamine levels in areas such as the mesolimbic pathway. Other neurotransmitters that may have a role in schizophrenia include GABA and glutamate.

Question 31

Give two specific genes which may explain schizophrenia

Answer 31

•The COMT gene
-Regulates dopamine levels
-Deletion of this gene would cause high levels of dopamine
-Which as you know is associated
with schizophrenia.
•The DISC1 gene
-Disrupted-in-schizophreniagene
-Codes for the creation of GABA, a
neurotransmitter that regulates
other neurotransmitters such as
glutamate and dopamine in the
limbic system.

Question 32

Describe genetics as an explanation of schizophrenia

Answer 32

Hilker et al (2018) suggest that there is a 79% heritability rate for schizophrenia. This suggests that genetics play a part in the cause of schizophrenia.
Schizophrenia can appear in the absence of a family history, but may still be due to genetic factors. This is because genes may mutate due to an environmental factor, or to an error in cell division.

Question 33

What are the three major types of research used to investigate the possibility of the role of genetics in
schizophrenia?

Answer 33

•Family Studies
-These investigate whether close biological relatives also have schizophrenia. Families tend to share the same environment. So…. Confounding variable: nature vs nurture - can’t tell if genes or the environment explain schizophrenia
•Adoption Studies
-Can separate nature and nurture: control variable of environment. Thus, a genetic factor can be looked for in adopted children who have been reared apart from their biological parents.
•Twin Studies
-Can compare concordance rates in MZ and DZ twins.

Question 34

What was the aim of Gottesman and Sheilds (1966)

Answer 34

To investigate how far schizophrenia
was genetic.

Question 35

What was the procedure of Gottesman and Sheilds (1966)

Answer 35

The researchers gathered secondary data from one hospital, for twins who had been diagnosed with schizophrenia:
•16 consecutive years of records from 1948
•392 patients
Data was obtained from:
•Hospital notes case histories (secondary data)
Primary data:
•Blood tests
•Visual tests
•Semi-structured interviews (primary data)
•Personality testing
•Test to look at thought disorders

Question 36

What was the results of Gottesman and Sheilds (1966)

Answer 36

•The concordance rate for schizophrenia was much higher in
monozygotic twins (42%) compared to dizygotic twins (9%)
•The concordance rate for severe schizophrenia was much higher in
monozygotic twins (75%) compared to dizygotic twins (22%)
•Concordance rates for schizophrenia were higher in females compared to
males (for both MZ and DZ twins)

Question 37

What was the conclusions of Gottesman and Sheilds (1966)

Answer 37

•The results suggest that schizophrenia does have a biological basis as the chance of developing schizophrenia
appears to be influenced by a person’s genes.
•However, schizophrenia is not totally caused by genes as the concordance rate for monozygotic twins was not 100%.
Therefore genes are a risk factor for developing schizophrenia, but environmental triggers may be necessary also.

Question 38

Give a strength of evidence of genes an explanation for schizophrenia

Answer 38

The theory has credibility because
it is supported by evidence.
For example, Gottesman and
Shields (1991) found that the
concordance rate for
schizophrenia for monozygotic
twins was 48% compared with
17% concordance rate for
dizygotic twins.

Question 39

Give evidence against the
genetic explanation for schizophrenia

Answer 39

•The genetic explanation can be considered to be reductionist. It does not provide a complete answer: environmental factors may also be involved in the development
of the disorder.
•A more holistic explanation could be the diathesis- stress model, where a biological disposition to schizophrenia may be triggered by environmental factors (Bentall 2012)

Question 40

Give applications for the genetic explanation for schizophrenia

Answer 40

The genetic explanation has practical applications in terms of diagnosing and
helping patients with schizophrenia.
For example, by using the DSM to help gather information on family
history, a possible genetic predisposition to schizophrenia can be
identified, which can then lead to appropriate intervention. For example,
genetic counselling can be offered to families.

Question 41

Evaluate the methodology of genes an explanation for schizophrenia

Answer 41

The main supporting evidence for the genetic explanation comes
from Twin studies. For example,
Gottesman and Shields (1966)
collected a wide range of data
including hospital notes, self-report
questionnaires, self-report interviews,
personality testing and tests to
measure disordered thinking.
Qualitative and quantitative data were
gathered which increases the validity
of the study.
Twin studies have
flawed methodologies.
For example, they tend
not to take account of
the fact that genes may
function differently in
different environments.

Question 42

Give a weakness of genes an explanation for schizophrenia to do with reliability and methodology

Answer 42

There is also some confusion as to exactly which genes are responsible for predisposing a person to schizophrenia. It has not yet been possible to reliably identify the specific gene or genes responsible for schizophrenia. Research suggests that there are many genes which may be
involved in causing schizophrenia. Wright (2014) suggested that as many as 700 genes have been linked to schizophrenia; this number continues to grow as more research is conducted.

Question 43

Compare the neurotransmitter explanation for schizophrenia and the genetic explanation for schizophrenia.

Answer 43

• P: Both theories are reductionist as they do not
include other factors in the explanation.
• E: For example, the genetic explanation for
schizophrenia focuses on the concordance rate of
monozygotic twins. However, Gottesman and
Shields’ (1991) findings show the concordance
rate for MZ twins suffering with schizophrenia was
48% so genetics cannot be a complete explanation
• E: Similarly the neurotransmitter explanation does
not consider other biological, psychological and
social factors. For example, Brown and Birley
(1968) found at 50% of schizophrenic patients
reported a major life event three weeks prior to
relapse
ON THE OTHER HAND /
• P: The neurotransmitter explanation may be more
directly useful than the genetic explanation
• E: This is because the neurotransmitter
explanation suggests treatments in the form of
drugs which work on neurotransmitters: for
example drugs which block the uptake of
dopamine.
• E: However the genetic explanation does not lead
directly to a specific treatment, as medical science
has not yet been able to use gene therapy widely
to treat schizophrenia (although its use is being
developed).

Question 44

What is the Social Causation Theory of Schizophrenia

Answer 44

The Social Causation Hypothesis suggests that schizophrenia may be caused by factors within the environment (both the physical environment and the people in it).

Question 45

List the 5 social factors which may play a role in causing schizophrenia

Answer 45

1. Social Adversity
2. Urbanicity
3. Social Isolation
4. Immigration and Minority Status
5. Family Dysfunction and childhood trauma

Question 46

Explain Social Adversity as a social factor causing schizophrenia

Answer 46

If a child grows up in an environment where their physical, intellectual, emotional and social needs are not met, this may make them vulnerable to mental health disorders. For example,
families affected by unemployment, poverty, and a poorer standard of living may be exposed to considerably more stress than other families. Furthermore, people from lower socio-economic groups may not be able to access treatment for schizophrenia, resulting in a poorer prognosis

Question 47

Explain Urbanicity as a social factor causing schizophrenia

Answer 47

Schizophrenia is more associated with living in cities than rural communities. Urban stressors include noise, air pollution, criminality, faster pace, and
greater anonymity. The increased population density in cities also makes life more competitive, which may increase the experience of social defeat, another stressor. These stress factors may accumulate to collectively make a person more vulnerable to developing schizophrenia.
Supporting evidence for urbanicity as a cause of schizophrenia comes from a meta-analysis by Vassos et al (2012) They correlated location (urban to rural) with schizophrenia risk and found that the risk of schizophrenia was 2.37 times higher for people living in the most urban environments compared to the most rural environments.

Question 48

Explain Social Isolation as a social factor causing schizophrenia

Answer 48

Faris (1934) suggested that cultural isolation, where people are cut off
from close contact with friends and family may lead to the symptoms
of schizophrenia.
This might be because they don’t get any, feedback from others as to which thoughts and behaviours are
inappropriate; therefore, they begin to act strangely. Faris suggested
that his theory was supported as prisoners in solitary confinement, who
are socially isolated, may develop symptoms of schizophrenia. In
addition to this, he found that treatment by re-establishing social
contracts showed some success.

Question 49

Explain Immigration and minority status as a social factor causing schizophrenia

Answer 49

Immigrants are at greater risk of developing schizophrenia than the general population: Evidence for this comes from census data in the UK, which shows that there is a higher incidence of schizophrenia in Afro-Caribbean and black immigrant people than in the general population.
The increased risk of schizophrenia may be because the immigrant population has increased stress due to, for example, discrimination and poorer living conditions, such as overcrowded
housing. Veling (2008) used data gathered through self-reported questionnaire data to suggest
that schizophrenia may be a reaction to long-term prejudice and discrimination of an outgroup.
Second generation immigrants are at higher risk of schizophrenia than first generation immigrants. This may be because second generation immigrants have, more so than their parents, adapted to the norms and values of their new society. This means that they may have different norms and values to their parents and extended family. These differences may be a cause of stress, which acts as a risk factor for schizophrenia.

Question 50

Explain Family dysfunction and family trauma as a social factor causing schizophrenia

Answer 50

Family dysfunction and childhood trauma may be a social cause of schizophrenia. For example, Popovich et al (2019) suggest that childhood trauma makes individuals more likely to develop schizophrenia.
They suggest that childhood trauma may interact with other pre-existing risk factors, such as genes, to trigger schizophrenia in vulnerable individuals.

Question 51

Strengths of the social causation hypothesis for schizophrenia (evidence)

Answer 51

A strength of the social explanation for schizophrenia is that it is supported by research evidence. An example of this is Vassos et al 2012 used a meta-analysis and found that the risk of schizophrenia was 2.37x higher for people living in the most urban environments compared to the most rural environments. This is a strength because it means that the theory has scientific credibility.

Question 52

Strengths of the social causation hypothesis for schizophrenia (applications)

Answer 52

A strength of the social causation hypothesis for schizophrenia is that is has useful practical applications. This is because it draws attention to some of the social factors which affect mental
health. So for example when housing is designed it should reduce overcrowding while still encouraging neighbourhood cohesion to reduce social isolation.

Question 53

Weaknesses of the social causation hypothesis as an explanation for schizophrenia (methodology)

Answer 53

One weakness of the social causation hypothesis for schizophrenia is that some of the research used to support the theory is correlational. This is a weakness as it means that a cause and effect link between schizophrenia and environmental factors can’t be proved. An example of this is Vassos 2012 who correlated location (urban to rural) with schizophrenia risk. They found the risk was 2.37 times higher in the most urban environments compared to the measurable environments.

Question 54

Weaknesses of the social causation hypothesis as an explanation for schizophrenia (holistic)

Answer 54

A weakness of the social causation hypothesis for schizophrenia is that it is difficult to isolate specific environmental factors to see if they cause schizophrenia. For example, it is hard to separate out the effects of environmental factors such as air pollution in cities from social factors such as lack of social support in cities.

Question 55

Weaknesses of the social causation hypothesis as an explanation for schizophrenia (not complete)

Answer 55

A weakness of the social causation hypothesis for schizophrenia is that it is not a complete explanation. This is because it suggests that environmental factors my only trigger the onset of
schizophrenia in people who are genetically predisposed to schizophrenia.

Question 56

What are the standards which the HCPC sets out for clinical practitioners.

Answer 56

•Character
•Health
•Standard of Proficiency
•Standards of conduct, performance and ethics
•Standards of continuing personal development
•Standards of education and training
•Standards of prescribing

Question 57

Summarise character from the standards the HCPC sets out for clinical practitioners.

Answer 57

Registrants have to provide credible character references from people who have known them for at least three years. To give an idea of the character traits they have that may make them suitable for the role.

Question 58

Summarise health from the standards the HCPC sets out for clinical practitioners.

Answer 58

Registrants must provide info every two years about their health. They are required to provide information on any health issues that they have only if they are likely to affect their ability to practice safely.

Question 59

Summarise standards of education and train from the standards the HCPC sets out for clinical practitioners.

Answer 59

Is a set of minimum levels of qualifications specified before people can register to practice in different areas of health and care professionals.

The HCPC also set up standards for training courses to ensure that any registrants who attend will be able to meet the choir standards for proficiency expected for the area of practice.

Question 60

Summarise standards of prescribing from the standards the HCPC sets out for clinical practitioners.

Answer 60

The standard set outside of practice for prescribing medication via health and care professionals. This also includes the required knowledge and training to be able to prescribe within professional practice.

Question 61

Summarise standards of continuing personal development from the standards the HCPC sets out for clinical practitioners.

Answer 61

Professionals are expected to take part in and document regular training that they undertake to develop their own practice. This will include training events that they will attend evidence of how they have changed their practice and an evaluation of the effectiveness of the changes.

Question 62

Why is drug treatment used?

Answer 62

If the assumption is that abnormal behaviour is caused either by a genetic predisposition or a
biochemical imbalance then any treatment used for mental disorder will have a biological basis.
Treatments based on this approach are therefore physical in nature (not psychological) and
attempts are made to ‘cure’ the biological causes of mental disorder.

Question 63

Give Strengths of Drug Treatment for Schizophrenia (effectiveness)

Answer 63

•Drug treatment has been shown to be eftective in reducing the symptoms of schizophrenia. Evidence for this comes from Zhao et al (2016) conducted a
meta-analysis and found that 17 of the 18 anti-psychotics tested had significantly lower relapse rates than the placebo.
•Overall, drug therapy is probably more effective than any other form of therapy in the treatment of schizophrenia because it reduces symptoms more quickly than psychological therapies do.

Question 64

Give Strengths of Drug Treatment for Schizophrenia (usefulness)

Answer 64

•Drug therapy is useful because, with the assistance of antipsychotic drugs, which reduce such symptoms as delusions and hallucinations, patients diagnosed with schizophrenia can be ‘more available’ to psychological therapies, such as psychodynamic or cognitive therapies. They may
allow people to avoid the emotional and financial costs of hospital treatment.
•Drug therapy has allowed many patients with schizophrenia to live relatively normal lives. Prior
to the introduction of phenothiazines in the 1950’s schizophrenia was considered untreatable and patients were interned in mental institutions. As Rosenhan and Seligman (1995) vividly explain, the wards of mental hospitals were called ‘snake pits’ filled with inmates who were unreachable or
catatonic or were wild with delusions and in strait jackets.

Question 65

Give weaknesses of Drug Treatment for Schizophrenia (effectiveness)

Answer 65

•The effectiveness, and therefore the usefulness, of drug therapy for schizophrenia is limited as it
is palliative rather than curative - this means that drug therapy suppresses the symptoms of the disorder without addressing the underlying causal processes. Because the underlying processes are not eliminated, patients often have to take drugs for several years.
•Some patients are resistant to drugs, so the drugs are not effective with everyone.

Question 66

Give weaknesses of Drug Treatment for Schizophrenia (ethics)

Answer 66

Ethical issues are raised by the use of drug therapy. The drugs often produce side eftects, some
of which can be unpleasant and have serious health effects. In addition, people with very serious conditions would be unable to give their informed consent! Taking drugs may lead to addiction and dependency.

Question 67

How is drug treatment relevant to the issue of social control?

Answer 67

Many of the old drugs made patience more passive and therefore easier for staff and institutions to control which may have made the drugs open to abuse in busy wards. Also pharmaceutical companies argue to be more interested in making money than actually helping patients you take them.

More should be done to help treat them long-term and help avoid the side effects associated with the use of antipsychotic drugs.

Question 68

How does the cognitive approach explain abnormal behaviour?

Answer 68

The cognitive model of abnormality assumes mental disorder is created by errors in thinking.

Question 69

Describe the four steps which a cognitive therapist might go through when trying to change a
patient’s thoughts.

Answer 69

•Focusing on the present symptoms (NOT going back to past issues that may have caused the problem)
•Looking at how the person thinks about how an event has affected a person - what they felt and how they behaved
•Challenge negative thoughts and reinterpret/ change them for more realistic and positive thoughts
•The person will feel better and behaviour will change.

Question 70

Describe the aim of CBT when treating schizophrenia.

Answer 70

The aim of CBT is to reduce the stress felt by the patient with schizophrenia and allow them to help them manage and understand their symptoms.

Question 71

Name and describe three techniques commonly used in CBT for schizophrenia.

Answer 71

1. Belief modification: delusional thinking is challenged directly, and there is testing against reality.
2. Focusing and re attribution: This is used to help with auditory hallucinations. The therapist
   focuses on the attributes of the voices (e.g., how many, loudness, tone, gender etc). Then the content of the voices is looked at. Next, the focus moves to what the patient believes and thinks about the voices. The therapist aims to show that the voices are self-generated and need not be feared.
3. Normalising the experiences of the person with schizophrenia; Patients are encouraged to look at their experience rationally. They are taught to examine the evidence, look for alternative explanations, and faulty thinking is challenged. The psychotic symptoms are looked at as more normal and less of a catastrophe, to reduce the fear and distress related
   to them.

Question 72

Strengths of CBT as a treatment for schizophrenia (effectiveness)

Answer 72

•Research shows that CB is useful as it can be effective in treating schizophrenia. Patients show
an increase in coping skills, and decreased hallucinations and delusions. Evidence for this comes
from research done by Sensky et al (2000). which compared CBT with non-specific ‘befriending
interventions’ for patients with schizophrenia, and found that CB was more effective in reducing
both positive and negative symptoms of schizophrenia.
•CBT can be particularly effective in treating people who have not responded well to medication.

Question 73

Strengths of CBT as a treatment for schizophrenia (ethics)

Answer 73

•CBT is perhaps the most ethical of the three treatments we have considered. It can be argued
that is able to empower patients by educating them in self-help strategies. The patient has more
control over the process than in, for example, drug therapies. Patients can also use the skills which
they have learned on their own, without needing the presence of a therapist. This means that it
allows them to be more independent.

Question 74

Strengths of CBT as a treatment for schizophrenia (usefulness)

Answer 74

It is argued that the strategies learned can easily be incorporated into a patient’s life. This makes
it a particularly useful treatment. CBT often also involves developing social skills; this means that
people can cope better with independent living and daily interactions.

Question 75

Limitations of CBT as a treatment for schizophrenia (effectiveness)

Answer 75

•Effectiveness of CBI for schizophrenia may be limited. This is because, some argue, for CBT to be effective a patient must have insight into their condition and good problem-solving skills. A patient suffering severe schizophrenia may well lack these skills.
•Effectiveness is hard to judge for example, most studies compare CBT to a control treatment
and find it to be superior. However, the difference may be because cognitive treatment is
superior, or because the control treatment is inadequate. Control treatments are sometimes but
not always) given by non-experts. Thus, the use of inadequate control treatment conditions might
explain some of the findings.

Question 76

How might CBT for schizophrenia link to the issue of social control?

Answer 76

Therapists aim to change and alter patient’s thoughts so subsequently try to change their behaviour.

Could be argued to control/brainwash patients.

Therapist is replacing the patient’s thoughts with more socially acceptable thoughts. However CBT can only take place if the patient themselves is willing to do the treatment

Question 77

Compare CB and drug treatment as treatments for schizophrenia.

Answer 77

One similarity between CBT in drug treatment is that they are both useful forms of treatment. CBC is useful as a strategies learned can easily be incorporated into a patient’s life. Drug treatments Also useful as they can make patience more available to psychological therapies. On the other hand one difference is CBT is more ethical than drug treatments. CBC empowers the patient by educating them on self-help strategies the patient also has more control over the processes.

This is Different to drug treatments as ethical issues of race due to the side-effects they produce which can be very serious and unpleasant.

Question 78

What is a review article?

Answer 78

A review article summarizes previously published studies, rather than reporting new facts or analysis.
Useful because it often looks at topics such as:
recent major advances and discoveries
significant gaps in the research
current debates
ideas of where research might go next

Question 79

What was the aim of Carlsson’s review article?

Answer 79

1. Provide evidence for and against the dopamine hypothesis of schizophrenia
2. Look beyond the dopamine hypothesis at the interaction of neurotransmitters including
   glutamate, serotonin and GABA.
3. Look at specific brain areas with regard to neurotransmitter interactions.
4. Use the information on psychosis and neurotransmitter functioning to produce new anti- psychotic drugs that could be more effective, with fewer side effects.

Question 80

Give three types of study which
Carlsson’s research looked at when
coming to their conclusions.

Answer 80

1. Studies which used rodents to test
   neurotransmitter functioning and
   related brain structure functioning,
2. Studies on people with acute
   schizophrenia and on people with
   schizophrenia in remission.
3. The research includes studies which
   used brain scans to investigate
   psychosis.

Question 81

Describe one piece of evidence which Carlson describes which supports the
dopamine hypothesis.

Answer 81

that PET scans provide evidence to
show that high levels of dopamine
are related to psychosis (Abi- Dargham et al (1998) OR Breier et al (1997)

Question 82

What other neurotransmitters, aside from dopamine, may be implicated in schizophrenia?

Answer 82

Glutamate and serotonin (aswell as dopamine)

Question 83

Which neurotransmitters are easiest to study in the brain?

Answer 83

Dopamine and serotonin. Links to practical issues if a neurotransmitters easy to study more research will be done on it

Question 84

What does glutamate do?

Answer 84

• Glutamate plays an essential role in normal brain functioning, and its levels
must be tightly regulated. It is important that levels mustn’t be too high or too low.
•Glutamate is important in learning and memory

Question 85

What does Carlsson suggest about the link between glutamate and
schizophrenia?

Answer 85

•Low levels of glutamate may play a role in schizophrenia
-Glutamate failure in the cerebral cortex may lead to negative symptoms of schizophrenia.
-Glutamate failure in the basal ganglia could be responsible for the positive
symptoms.

Question 86

Provide two pieces of evidence that
suggest that serotonin is implicated in
schizophrenia.

Answer 86

• Clozapine, which is used
to treat psychosis, works by reducing both dopamine and serotonin levels in the brain.
• NDA antagonists, which limit glutamate, seem to stimulate serotonin levels (Too much serotonin may be a cause of schizophrenia)

Question 87

Explain how the thalamic filter
may be related to schizophrenia

Answer 87

The thalamus is an area of the brain which ‘filters off’
neurotransmitters coming from the striatum to stop
the cerebral cortex from overloading (1 mark)
There are two pathways associated with
schizophrenia, the indirect and direct pathway (1
mark)
In the indirect pathway too much dopamine
(hyperdopaminergia) or too little glutamate
(hypoglutaergia) reduces the thalamus’s filtering
ability (or ‘protective ability’) which links to positive
symptoms (1 mark)
• In the direct pathway abnormal dopamine and
glutamate activity ‘excite’ the thalamus (too much
filtering) and this links to negative symptoms of
schizophrenia (1 mark)

Question 88

Name the two main theories about the causes of schizophrenia investigated in
Carlsson review.

Answer 88

• High levels of dopamine cause schizophrenia
• Low levels of glutamate cause schizophrenia

Question 89

What were the conclusions for ur contemporary study for schizophrenia

Answer 89

Conclusions
There may be different subpopulations of those with schizophrenia, where schizophrenia is
caused by different abnormal levels of different neurotransmitters, not just dopamine. This
has implications for treatment.
2. Glutamate deficiency should be studied to explain schizophrenia.
3. Glutamate deficiency may explain increased dopamine responsiveness.
4. Increased serotonin activity is found in people with schizophrenia. It is thought that both
dopamine and serotonin contribute to both the positive and negative symptoms in
schizophrenia.
5. More focus on other neurotransmitters, such as acetylcholine, GABA and neuropeptides. is
needed.

Question 90

Evaluate the generalisability of Carlsson’s study

Answer 90

33 studies reviewed at the time, 14 that he took part in - a very
representative selection of what was going on at the time in his
field.
Some of the findings come from research done on animals and
therefore may not generalise to humans. Furthermore, culture
may influence the type of auditory hallucinations a person may
experience (Luhrman 2015). This cannot be investigated using
animals.
It may be time locked (year 1999/2000) - research no longer
representative of state of scientific ideas.
However, Carlson’s reviews have been expanded on rather than
refuted

Question 91

Evaluate the reliability of Carlsson’s study

Answer 91

Studies cited by Carlson are
all lab experiments - many of
them on animals and also PET
scans
These techniques are
CONTROLLED &
STANDARDISED, making
research reliable

Question 92

Evaluate the application of Carlsson’s study

Answer 92

Useful in developing better anti-
psychotic drugs
Improved dopaminergic drugs that have
fewer side-effects based on better
understanding of dopamine pathways &
new atypical drugs that affect other
neurotransmitters like serotonin &
glutamate
Glutamate anti-psychotics are still in
development (Papanastasiou et al.,
2013). - Could bring relief to people
who don’t respond to typical
antipsychotics

Question 93

Evaluate the validity of Carlsson’s study

Answer 93

Carlson is questioning the validity of the dopamine hypothesis (that he himself helped develop back in 1950’s)
Cites Clozapine which reduces psychotic symptoms by reducing dopamine and serotonin levels
Carlson considers Glutamate as a possible contributor to schizophrenia ( another hypothesis)
Carlson argues BOTH hypotheses may be true & research should continue in both. Evidence seems to suggest this
•Sendt (2012) literature review supports Carlsson’s findings (concurrent validity)

Question 94

Evaluate the ethics of Carlsson’s study

Answer 94

Review article
- so no direct ethical
issues
Uses study with animal studies - drugs
to bring on psychotic symptoms in mice
Other studies use humans - with or
without schizophrenia being given
amphetamines or PCP or other drugs
that increase psychotic symptoms
Patients don’t know whether they are
being given real drug or placebo.
Therefore issues of deception & risk

Question 95

Explain the issue of psychology as science in relation to Carlsson’s study

Answer 95

In favour
• Use of scientific methods e.g.
PET scans
• Looks at a wide range of studies,
therefore increasing validity
• Use of animals - controlled; lab
studies
Against
• Review articles use secondary
data so Carlson’s research may
be affected by flaws in the
earlier research which it uses.
• Animal studies
generalisability?
Scientific credibility?

Question 96

Explain the issue practical issues in relation to Carlsson’s study

Answer 96

It’s difficult to study the functioning of neurotransmitters in the brain. Therefore, the neurotransmitters which are easiest to study (dopamine and serotonin) tend to be most researched, and other neurotransmitters, which may also be important, tend to be ignored.

Question 97

Explain the issue of reductionism in relation to Carlsson’s study

Answer 97

Maybe reductionist as it does not look at other factors such as genetics or non-biological causes.

Although it is less reductionist than dopamine hypothesis as it moves beyond dopamine and looks a variety of neurotransmitters and investigates the interaction including glutamate and serotonin

Question 98

Explain the issue of how psychological understanding has developed over time in relation to Carlsson’s study

Answer 98

•The study shows that our
understanding of how neurotransmitters may cause
schizophrenia has become clearer over time, as methods of investigating neurotransmitters have become
sophisticated.
•Further research suggested by the article will lead to more changes.

Question 99

Explain the issue of the use of psychological knowledge within society in relation to Carlsson’s study

Answer 99

Carlson’s research is useful to society because it suggests areas for further research into neurotransmitters as an explanation for schizophrenia, which can then be used to inform treatments for schizophrenia.