Schizophrenia

• what is positive symptoms of Sz

  Hallucinations - can be experienced in relation to any sense. The person may, for example, see distorted facial expressions or occasionally people or animals that are not there. 

  Delusions - Delusions also commonly involve being persecuted, perhaps by government or aliens or of having superpowers. Another class of delusions concerns the body. Delusions can make a person behave in ways that make sense to them but bizarre to others. 
• what is a negative symptom of Sz

  speech poverty - Sz is characterised by changes in patterns of speech. Speech poverty is seen as a negative symptom because the emphasis is on reduction in the amount and quality of speech in schizophrenia.
• what does the biological explanation to Sz (neural correlates) - suggest

  An excess of the neurotransmitter dopamine has been implicated in symptoms of Sz. This means too much dopamine causes schizophrenia. Dopamine neurons are important in regulating behaviour. Therefore, if the process is disturbed it may lead to problems with attention, perception and thought, which is characteristics of Sz.  
• what is hyperdoperminergia - biological explanation to Sz - neural correlates

  this is a condition of having too much dopamine activity. This means people will get positive symptoms of Sz.
• what is hypodoperminergia - biological explanation to Sz - neural correlates

  this is a condition of having too little dopamine activity. This means people will get negative symptoms of Sz. 
• strength - L Dopa - neural correlates - biological approach

  A strength of the neural correlate's explanation is there is evidence that drugs that are given to treat Parkinson's disease. L Dopa is given to people with Parkinson's disease to give them more dopamine. However, if people take too much L Dopa they could develop positive Sz from too much dopamine. This proves that Sz is caused by too much dopamine.  
• strength - real world application - neural correlates - biological explanation

  One strength of the neural correlate's explanation is it has real world application. Chlorpromazine is an anti-psychotic drug used in the treatment of Sz. Chlorpromazine binds to receptor cells and reduces levels of dopamine in the brain. This means people have less dopamine in the brain which means the symptoms lessen. This shows the importance of chlorpromazine in schizophrenia. 
• limitation - biologically deterministic - neural correlates - biological approach

  One limitation of neural correlates is that it is biologically deterministic. This means that this disorder is out of their control. The only treatment to this is drug therapy which can make people feel helpless as this is the only realistic outcome. If they then become dependant on drugs this can have a very negative impact on their health. 
• what does the biological explanation to Sz (genetic explanation) suggest

  Sz is a heritable condition that passes down from one generation to the next. Twin, adoption and familial studies clearly points to a genetic component in sz. This explanation looks at how genes affect brain development and may be partly responsible for symptoms of sz. 

  Family studies have established that sz is more common among biological relatives of a person with sz. The closer the degree of genetic relatedness, the greater the risk. 
• what does Gottesman (1991) suggest - biological explanation - genetic

  Gottesman (1991) was a large scale family study which highlighted this as the risk of developing sz was: 

  • 9% chance if a sibling had sz 
  • 48% chance if an identical twin had sz 
•   what is the COMT gene - biological explanation - genetic


  Another genetic explanation for sz is that there is a specific gene (COMT) responsible for regulating dopamine. Deletion of the COMT gene would mean dopamine levels are not controlled effectively. If this happens in regions such as the frontal lobes, hallucinations and the characteristic loss of reality associated with psychosis can result.
• limitation - biologically deterministic - biological explanation - genetic

  One limitation of the genetic explanation of schizophrenia is it is biologically deterministic. This means that this disorder is out of their control because it is pre-determind due to the persons genetic biology. The only treatment for this is drug therapy which can make people feel helpless as this is the only realistic outcome. If they then become dependent on drugs this can have a very negative impact on their health. This may also make the person feel helpless. 
• limitation - environmental factors - biological approach - genetic

  One limitation of the genetic explanation of schizophrenia is research suggests that it is due to family dysfunction (environmental factors). According to Fromm-Reichmann the schizophrenogenic mother is cold, rejecting and controlling, and tends to create a family climate characterised by tension and secrecy. This leads to the child becoming schizophrenic. This suggests that Sz is due to environmental factors, not genetic factors.  
• strength - genetics play a part - biological explanation - genetic

  One strength of the genetic approach is there is evidence to suggest genetics play a part in sz. However, it needs interaction with the environment to cause sz. The schizogene is a risk factor, however when it interacts with the environment such as a Sz mother, the gene begins to develop and the person develops schizophrenia. This suggests that genetics plays a role in sz. 
• what is a Sz mother - psychological explanation - family dysfunction

  A Sz mother is cold, rejecting and controlling. This then creates an environment of tension and secrecy. This creates a perception of the outside world as being dangerous. This then leads to positive symptoms of schizophrenia.  
• what is the double bind theory - psychological explanation - family dysfunction

  This is where a child is given mixed messages. Whatever decision the child makes will be the incorrect situation. This is a no-win situation. This creates paranoia within the child and gives them delusional thinking. An example is, if a parent asked a child for a hug but then the parents told the child off for being too clingy. 
• what is expressed emotion - psychological explanation - family dysfunction

  A schizophregenic patient receives verbal criticism from a parent. This can often include: 

  • Verbal criticism of the person, occasionally accompanied by violence 
  • Hostility towards the person, including anger and rejection 
  • Emotional overinvolvement in the life of the person, including needless self-sacrifice. 

  These high levels of emotion expressed towards the individual is stressful for them. This usually causes relapse for people with Sz.  
• what is dysfunctional thinking - psychological explanations - cognitive explanations

  A cognitive explanation focuses on the role of mental processes. Sz is associated with several types of dysfunctional thought processing and these can provide possible explanations for Sz. Sz is characterised by disruption to normal thought processing which is shown through many of its symptoms.  Reduced thought processing in the Ventral Striatum is associated with negative symptoms, while reduced processing of information in the temporal and cingulate gyri is associated with hallucinations.
• what is metarepresentation - psychological explanation - cognitive explanation

  Frith et al (1992) identified two kinds of dysfunctional thought processes. The first is metarepresentation. This is the cognitive ability to reflect on thoughts and behaviour. This allows us to insight into our own intentions and goals. It also allows us to interpret the actions of others. Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else. This would explain hallucinations of hearing voices and delusions
• what is central control dysfunction - psychological approach - cognitive explanation


  Frith et al also idenfitied issues with the cognitive ability to supress automatic responses while we preform deliberate actions. Speech poverty and thought disorder could result from the inability to supress automatic thoughts and speech triggered by other thoughts. For example, people with Sz tend to experience derailment of thoughts because each word triggers associations, and the person cannot supress automatic responses to these. 
• limitation - family dsfunction - alternative explanation

  One weakness of the family dysfunction explanation is their is an alternative explanation which suggests that Sz is down to biological factors. The biological evidence comes from the neural correlates explanation which suggests Sz is down to an imbalance of dopamine. This has resulted in drug therapies. This suggests that Sz is not psychological, but biological in origin. 
• strength - family dysfunction - rwa

  One strength of family dysfunction is it has real world application. Family dysfunction has lead to family therapy. This aims to address the root cause of schizophrenia. This allows individuals to overcome a source of disorder and allow them to contribute more to society again. 
• strength - cognitive explanation - rwa

  One strength of the cognitive explanation is it has real world application. Cognitive therapy has lead to CBT. This aims to address the root cause of schizophrenia. This allows individuals to overcome a source of disorder and allow them to contribute more to society again. 
• limitation - family dysfunction - socially sensitive

  One limitation of family dysfunction is it is socially sensitive. This leads to the children blaming the parents because they have schizophrenia due to the family dysfunction. This means that the parents are labelled and stigmatised as bad.  
• limitation - cognitive explanation - lack of scientific credibility

  One limitation of the cognitive explanation is that it has lack of scientific credibility. This is because metarepresentation and central control dysfunction cannot be objectively tested. 
• what is chlorpromazine (typical anti-psychotics)- biological therapy

  This is taken as a tablet, syrup or injection. This supports the original dopamine hypothesis. This is antagonist because it blocks dopamine receptors in  the synapse, reducing levels of dopamine. This reduces positive symptoms (hallucinations). This can also be an effective sedative to calm patients. 
• what is clozapie (atypical anti-psychotics) - biological therapy

  This is due to fatal side effects not available for injection. This is antagonist because it blocks dopamine receptors in the synapse just like chlorpromazine. Also acts on serotonin and glutamate receptors which helps mood and reduces depression/anxiety that improves cognitive functioning. This reduces negative symptoms (avolition). 
• limitation - side effects - biological therapy

  One limitation of drug treatment to Sz is side effects. One side effect to typical anti-psychotics is it can lead to involuntary muscle movements such as tardive dyskinesia. This is where the individual will randomly roll the tongue, sucking movement of the lips, chewing motions and involuntary movements of the body. This means that participants are likely to stop taking drugs which will lead to gaining sz again. Therefore, this is a limitation because drug therapy's aren't overall effective.  
• limitation - side effects - biological treatments

  One limitation is side effects. One side effect to atypical anti-psychotics is that it can lead to involuntary muscle movements such as neuroleptic malignant syndrome. NMS blocks dopamine action in the hypothalamus which regulates body symptoms eg, temperature and hunger. This is dangerous, because people can loose their mind completely, meaning the results can be fatal. This means that people will stop using drug therapy which will lead to symptoms of sz again. They may also decide to use a different type of treatment such as therapy. 
• strength - cost effective - biological treatments

  One strength of drug therapy is that they are cost effective. This is because drugs can be mass produced compared to therapy where the therapist get paid around 70000-80,000. Drugs are also a lot cheaper meaning. Because they are mass produced, it means that patients can get them quicker than therapy and they have effects quicker meaning the patient is being treated quicker. This means that the patient can deal with their sz quicker meaning they can go and contribute to society.  
• CBT - psychogical therapy

  CBT is commonly used to treat people with Sz. It takes 5-20 sessions either as individuals or in groups. CBT aims to deal with both thoughts and behaviour. It allows a client to make sense of how their irrational thoughts affect their feelings and behaviours. If a therapist can convince them that the voice inside their head actually comes from the malfunctioning speech centre in their brain and it cant hurt them, it will be less scary. CBT doesnt eliminate symptoms of Sz but it helps people cope with it and improve their ability to function adquately.  
• family therapy - psychological therapy

  Family therapy takes place with families aswell as the identified patient. The therapy aims to improve the quality of communication and interaction between family members. There is a range of approaches to family therapy for Sz.  Fiona Pharoah et al (2010) identified a range of strategies that family therapists use to try to improve the functioning of a family rhat has a member with Sz.
• family therapy - psychological therapy - pharoahs strategies - 1

  Reduces negative emotions – family therapy aims to reduce levels of expressed emotion (EE). I.e. reduce the level of emotion generally but especially negative emotions such as anger and guilt which create stress. Reducing stress is important to reduce the likelihood of a relapse. 
• family therapy - psychological therapy - pharoahs strategies - 2 

  Improves the familys ability to help – the therapist encourages family members to form a theraputic alliance whereby they all agree on the aims of therapy. The therapist also tries to improve families beliefs about the behaviour towards Sz. A further aim is to ensure that family members achieve a balance between caring for the individual with Sz and maintaining their own lives.
• strength - ethical treatment - psychological therapy

  One strength of psychological treatments of sz is that it is a more ethical treatment. Taking therapy can elaviate the symptoms of sz quite quicky and this allows the patient to live in the community with support. Historically, sufferers of schizophrenia would be consigned to a mental health asylum. This would mean patients are poorly treated, which wont allow them to overcome this. However therapy allows them to live in society and contribute to the economy.
• strength - ethical treatment - psychological treatment

  One strength of family therapy is that it is a more ethical treatment. Taking family therapy is a safer treatment than drug therapy as it isnt fatal meaning it is less risky as a form of treatment. However, therapy can be quite traumatic for a client to take part in meaning they may decide to opt out.  
• token economies - managementof sz

  Tokens are administered immediately after a good behaviour. This is important to prevent ‘delay discounting’ (reduced effect of delayed reward). Rewards can include film, walk outside, appointment with social worker to plan for life after hospitalisation.  
• developing token economies - managementof sz

  Allyon and Azrin (1968) trialled a token economy system in a ward of women with a diagnosis of Sz. Every time the patients carried out a task such as making their bed or cleaning up, they were given a plastic token with the words ‘one gift’ on it. These tokens could then be swapped for ward priveleges, eg, being able to watch a film. The number of tasks carried out increased significantly. Token economies were mainly used in the 1960’s and 70’s when the norm for treating Sz was long term hospital.  
• strength - rwa - management of sz(token economies)

  One strength of token economies is it has real world application. McMonagle and Sultana (2000) reviewed token economy regimes over a 15 year period, finding they did reduce negative symptoms. This suggests that token economies is a positive method as it helps improve behaviour and is an effective method. 
• strength - rwa - counterpoint - management of sz(token economies)

  However, it was unclear if behavioural changes were maintained beyond were maintained beyond the treatment programme. Studies often do not focus on what happens once the individual is released, this suggests it is not a positive long lasting strategy. This is because once the patient has left the institution, they wont recieve rewards, meaning that they are likely to go back to their old ways.