A01: Psychological Explanations for Schizophrenia

• Psychological Explanations for SZ:

  • Family Dysfunction
  • Cognitive Dysfunction/Explanations
• Psychological Explanations for SZ: Family Dysfunction

  • Schizophrenogenic Mothers
  • Double-bind theory
  • Expressed emotion
  • Marital Schism
• Psychological Explanations for SZ: Cognitive Dysfunction/Explanations

  • Dysfunctional Thought Processing

  Frith’s Model (1992):

  • Metarepresentation (leads to hallucinations)
  • Attention
  • Memory
  • Central Control dysfunction (leads to speech poverty)
• Family Dysfunction: Schizophrenogenic Mother:

  Fromm-Reichmann's (1948) psychodynamic explanation of patient's early experiences of 'schizophrenogenic mothers' (SZ causing mothers )

  • They cold, rejecting & controlling, tends to create family climate characterised by tension, mistrust & secrecy. This leads to distrust, later developing into paranoid delusions & ultimately SZ.
  • Mother often engages in double bind communication, overprotective, encouraging dependence, rigidly moral, emotionally disturbed, perfectionist, domineering, lacks sensitivity 'refrigerator mother'
• Family Dysfunction: Double-bind theory:

  Conflicting/contradictory family communication style

  • Bateson et al (1972) described how kid may regularly find themselves trapped in situations where they fear doing wrong thing, but receive conflicting/mixed messages about what counts as wrong.
  • They cant express their feelings about unfairness of situation OR ask for clarification
  • When they 'get it wrong' (often) child punished by withdrawal of love - this lead to them developing idea; world is confusing & dangerous, leading to/manifesting as paranoid delusions & disorganised thinking.
• Family Dysfunction: Expressed Emotion:

  Criticism and hostility lead to relapse

  • Expressed emotion (EE) refers to amount of (usually -ve) emotion expressed towards a patient with SZ by their carer. It includes:
  • Verbal criticism of the person with SZ sometimes accompanied by violence
  • Hostility towards them including anger & rejection
  • Emotional over-involvement in their life, including needless self sacrifice
  • High levels of EE cause serious source of stress in the person with SZ, may trigger onset of SZ, but more likely to cause a relapse.
  • Carer = usually parent
• Family Dysfunction: Marital Schism:

  Lidz et al (1956)

  • Conflict between mum & dad but neither party yields to other
  • Each partner constantly strives to satisfy their own needs while ignoring the other partners needs.
  • This perpetual battle for dominance between parent inevitable involves the children as the parents competes for their affections and enrols them as supporters
  • This split in loyalties can lead to a split in the mind manifesting in psychotic symptoms.
• Family Dysfunction

  If you do that again I will shout at you = hostility

  Can't you do anything right? = Criticism (-ve comments)

  You can always come to me if you need to talk about your personal life = emotional over-involvement
• Cognitive Dysfunction: Frith’s Model (1992):

  • Metarepresentation 
  • Attention 
  • Memory 
  • Central Executive (Control):
• Metarepresentation

  Frith et al (1992)

  This cognitive ability to reflect upon own thoughts/behaviours to gain insight into our motivations/goals.

  • Use this skill when observing others to interpret their motivations/goals
  • Dysfunction in our metarepresentation would seriously disrupt our ability to recognise one’s own actions & thoughts as our own.
  • Struggle to see difference between words & underlying message (read between lines).
  • Healthy recognise internal monologue, unhealthy can't
• Metarepresentaion dysfunction - lead to?

  Could lead to sensation of/Sz symptoms manifesting this as?:

  • Hearing voices (auditory HALLUCINATIONS)
  • (Paranoid) Delusions like thought insertion: experience of having thoughts placed in the mind by others & delusions of control (someone else is trying to control your mind) 
• Attention

  Frith et al (1992) Model

  • Often Sz sufferers cant filter info therefore they are bombarded with external stimuli which they cant separate or interpret.
  • They cant recognise when communication is meant for them or someone else.
  • Sensory store in MSM filters out information in healthy people

  Which Sz symptom might this manifest as?

  This would explain delusions:

  • Delusions of grandeur (where the sufferer believes that all communication is intended for them)
  • Delusions of paranoia (where the sufferer believes that all communication is about them)
• Memory

  Frith et al (1992) Model:

  • Sz sufferers often fail to activate schemas leading to inability to distinguish between current information stored (memories) and new incoming sensory information.
  • They cant distinguish between what is a memory & what is really in front of them. 

  Which Sz symptom might this manifest as?

  • This explain hallucinations: as sufferer believes they are seeing/hearing things which are actually just memories which appear real to them.
  • Auditory & visual hallucinations
• Central Executive (Control):

  Frith et al (1992) Model:

  One feature of the central executive being the cognitive ability to suppress automatic responses in order to perform a deliberate action.

  • A healthy person can carry out a conversation and stay focused as they suppress automatic connections and associations their mind makes with every word.
  • A Sz sufferer with cannot suppress such thoughts.
  • Another function of the central executive is the ability to problem solve.
• Central Executive (Control) - Symptoms:

  Which Sz symptom might this manifest as?

  • Dysfunction of central executive control: explain speech poverty.
  • This explain thought disordered & disorganised speech (tangential speech) as each word will trigger an automatic association or connection to something else and the sufferer cannot suppress these leading to derailment of thought and spoken sentences.
• Cognitive Dysfunction: Dysfunctional Thought Processing

  Something happens during the processing of normal stimuli to lead to faulty thinking and behaviour in Sz sufferers.

  Lower levels of information processing in some areas of the brain suggest cognition is impaired 

  • Healthy Output: ‘Someones told a funny joke’
  • Unhealthy output: ‘They are laughing at me, whats wrong with me'

  E.g reduced processing in the ventral striatum is associated with negative symptoms