Schizophrenia

• Schizophrenia

  It is a type of psychosis which makes it hard for sufferers to understand reality as it is. Around one person in every hundred receives a diagnosis, around 500,00 people in the UK.
• Positive symptoms

  Hallucinations- could be hearing voices, seeing things etc that others don't. A type of hallucination is formication.

  Delusions- holding strong beliefs that others don't share. There is paranoid and grandiose delusions.

  Disordered thinking- thoughts and speech seem to jump from one topic to another. There's also thought insertion where the person believes their thoughts are not their own.
• Negative symptoms

  Alogia- poverty of speech

  Avolition- individuals appear indifferent to their surroundings

  Anhedonia- individual doesn't react appropriately

  Flatness of effect- little to no emotion or facial expressions

  Catatonic behaviour- could be fast, repetitive movements or little to no movements.
• Subtypes ICD-10

  There are various subtypes of schizophrenia which can be diagnosed based on main symptoms: paranoid, disorganised and catatonic behaviour.
• Subtypes ICD-11

  Used in the UK and Europe to diagnose mental illnesses. Symptoms must be present for at least a month. This includes: hallucinations, delusions, disorganised speech, negative symptoms and thought insertion etc.
• Dopamine hypothesis

  The drug L-Dopa increases dopamine in the brain but causes side effects like hallucinations.

  Two main pathways associated with schizophrenia are mesolimbic and mesocortical pathway.

  Positive symptoms are linked with too much dopamine in mesolimbic pathway. Negative symptoms are linked with too much dopamine in mesocortical pathway.
• Evaluation of dopamine hypothesis

  S-Griffith et al induced psychosis by increasing dopamine

  C-Gottesman et al found genes change dopamine levels

  A-doesn't explain what causes dopamine imbalances

  M-hard to measure the levels of neurotransmitters

  P-only a partial explanation as another transmitter, serotonin is involved
• Structural abnormalities

  In some schizophrenics the ventricles are larger which have been linked to negative symptoms.

  Cortical atrophy is the loss of neurons which appears in 20% to 35% of schizophrenics.

  In many schizophrenics have a larger right hemisphere which is linked with speech poverty.
• Evaluation of structural abnormalities

  S-McCarley et al found a link between cortical atrophy and schizophrenia using brain scans. Vita et al found that 33% of people showed moderate to severe cortical atrophy.

  M-Brain scans show abnormalities but they could be due to medication like antipsychotics.

  P-Brain abnormalities are not present in all schizophrenics.
• Psychodynamic explanation

  Someone that is fixated at a stage may regress to it as an adult. If someone orally regresses they may become inward focusing. Regression in the oral stage can lead to the self-obsessed, narcissistic ideas of schizophrenia (delusions).
• Evaluation of psychodynamic

  S-Eysenck found 44% who had psychoanalysis were classified as 'improved' showing its helpful for most.

  M-Freuds theory was based on one mans self-report so it lacks empirical research support.

  P- overlooks the role of genetics

  Lacks effective treatment- Strupp et al found therapies can lead to harmful rather than beneficial effects.
• Cognitive Explanation

  Beck (2008) argues negative symptoms such as alogia are the result of negative conditions.

  Symptoms of schizophrenia could be explained through processes like perception, language or attention. Beck proposes a diathesis-stress model of the negative symptoms.

  Schizophrenics thoughts only allow in negative messages leading to negative symptoms.
• Evaluation of cognitive

  S-Wykes et al found CBT showed the greatest effects on symptoms

  M-Its unclear how theories can be applied to both positive and negative symptoms

  P-Becks theory cant explain positive symptoms

  Cause and effect-doesn't explain where the initial negative thoughts come from.

  May blame patient-suggests that negative symptoms are a choice rather than pre-determined symptom.
• What are the types of delusions?

  Paranoid and grandiose delusions
• What types of symptoms must be present for ICD-11

  hallucinations, delusions, disorganised speech
• How to measure neurotransmitters?

  measure metabolite levels in cerebrospinal fluid
• What did McGlashan (2009) suggest?

  psychosis is similar to a phantom limb
• Why is psychoanalysis harmful for patients?

  requires patients to experience traumatic memories
• Double bind theory

  Bateson et al (1956) stated communication within the family can cause symptoms.

  When a child is exposed to 2 conflicting messages it can cause schizophrenia due to children being unable to meta-communicate.

  Long-term exposure means a child perceives the world in terms of contradictory input.
• Evaluation of double bind theory

  S-Berger (1965) found that schizophrenic ppts reported a higher incidence of double bind statements than college students.

  C-Liem found the theory may be based on an effect rather than a cause.

  A-double bind may be a symptom of mental illness in the parent, meaning we cant rule out genetic factors.
• Expressed emotion

  Brown found patients discharged to live with parents were more likely to relapse, 58%.

  High EE families displayed critical comments about the behaviour of schizophrenics. Including hostility and emotional over-involvement.

  Low EE families displayed warmth, positive regard and reinforcing statements where the caregiver expresses support and appreciation.
• Evaluation of expressed emotion

  S-Vaughn & Leff found 53% of schizophrenics who had a high EE relative relapsed within 9 months but only 12% with low EE.

  C-McCreadie & Philips failed to find higher subsequent 6 and 12 month relapse rates in high EE homes.

  A-evidence has found there are 108 genes linked with schizophrenia which reduces the EE theory. Using a diathesis-stress model could act as a psychological trigger.
• Antipsychotic drugs

  Chlorpromazine revolutionised treatments for schizophrenia.

  Typical antipsychotics: a low potency drug as a large amount is needed. An example is Fluphenazine which is given as an injection and works as a dopamine antagonist

  Atypical antipsychotics: an example is clozapine which acts on dopamine and serotonin levels. Kapur & Remington found they can only occupy dopamine receptors temporarily.
• Effectiveness of antipsychotic drugs

  Supporting research- Cole et al found 75% of those given medicine were much improved.

  Differences in effectiveness- Ravanic et al found clozapine had the best reduction in symptoms.

  Non compliance- many schizophrenics struggle to adhere to a medication schedule
• Ethical implications of drugs

  Harm- many drugs have side effects like weight gain and uncontrollable movements.

  Lack of valid consent- patients experiencing psychosis may be unable to fully understand side effects.

  Lack of understanding- we cant explain why treatments only work for some. Many drugs have different side effects.
• Social implications of drugs

  Less institutions- patients can return to paid employment and reduce the stigma around schizophrenia.

  Less community care- there is a release of violence, the NCISH found 29% of murderers had been non-adherence to their medicine.

  Cost of drugs- not providing a drug treatment may save money in the short term.
• Cognitive Behavioural Therapy

  Engagement strategies: therapist will try and build a relationship with the client.

  Psychoeducation: patients learns about the symptoms of their illness to manage it.

  Empirical disputing: challenges the patient to find evidence that supports their delusions.

  Behavioural skills: gives the patient strategies that help them cope with symptoms.
• Effectiveness of CBT

  Supporting research- Kuipers et al found CBT is effective when used with antipsychotics. Kingdon and Kirschen found many patients were not deemed suitable for CBT.

  Hard to measure- hard the measure the effectiveness as its always given alongside medication.

  Not suitable- patients who suffer with severe symptoms may not access therapy.
• Ethical implications of CBT

  Lack of side effects- CBT doesn't have any side effects

  Ethical issues- without medication CBT is ineffective

  Valid consent + right to withdraw- CBT gathers the patients full consent. Patients can withdraw at any time
• Social implications of CBT

  Lottery- CBT is not always available for schizophrenics in some areas of the UK. The amount of people offered ranged from 67% to 14%.

  Additional costs- the cost of CBT is between £1750 and £1800 per patient. This is a cost on top of the cost of drugs.

  CBT is cost effective- Kuipers et al found the costs of CBT is likely to be offset by the reduced utilisation of service costs in the future.
• Biological application to medication

  S-One explanation is biological which includes dopamine hypothesis

  O-There's a link between high levels of dopamine and schizophrenia.

  J-This hypothesis is biological because it focuses on neurotransmitters

  O-The first drug was chlorpromazine which works as a dopamine antagonist.

  L-Medication links with biological explanations as both see the cause of the condition as being biological.
• Individual differences to CBT

  S-One explanation is individual which includes cognitive explanation

  O-Beck explained negative symptoms in terms of a negative cognitive triad since negative thoughts lead to negative symptoms.

  J-Its an individual difference as it focuses on differences in mental processes and thinking.

  O-CBT includes engagement strategies, psychoeducation and cognitive strategies.

  L-CBT links with individual differences as they both see condition as being caused by the individual.
• Social explanation to family therapy

  S-One explanation is social which includes Browns EE theory

  O-Brown found patients with a high EE family were more likely to relapse. They displayed high levels of anger and sadness.

  J-This is social as it focuses on relationships with family

  O-Family therapy allows families to better their communication which reduces expressions of anger and guilt.

  L-Family therapy links with social explanations as they focus on the importance of family communication.