Schizophrenia

• Diagnosis and classification of schizophrenia -

  Strength - it is reliable. Oso’rio reported excellent reliability in 180 individuals using the DSM-5. Pairs of interviewers achieved inter-rater reliability of +.97.

  Limitation - low validity. Cheniaux had two psychiatrists independently diagnosed the same 100 clients either using the ICD-10 or the DSM- IV, 68 with diagnosed with schizophrenia under the ICD, and 39 under DSM.

  Limitation - culture bias. Pinto and Jones found that Afro-Caribbean British people are 9 times more likely to receive a diagnosis that a white person. Discriminatory.
• The genetic basis of schizophrenia -

  Strength - research support. Family studies such as Gottesman show that risk increases with the genetic similarity to a family member with schizophrenia. Tienari found that biological children of parents with schizophrenia are at a heightened risk, even if they grow up in an adoptive family. Hilker show the concordance rate of 33% for identical twins and 7% for non-identical twins.

  Limitation - environmental factors also influence. Di Forte show that smoking THC-rich cannabis in teenage years was a risk factor. Genetic factors alone do not explain.
• Neural correlates of schizophrenia -

  Strength — research evidence. Curran found that aphetamines increase dopamine and worse than symptoms involved in schizophrenia, and induced symptoms in people without schizophrenia. Taushcer found that antipsychotic drugs reduced dopamine activity, and also reduced the intensity of symptoms.

  Limitation - Evidence for glutamate. Post-mortem and live scanning studies have showed raised levels of the neurotransmitter glutamate in several brain regions of people with schizophrenia ( McCutcheon ) . Maybe other transmitters involved?
• psychological explanations, family dysfunction -

  Strength- research support. Read found that adults with schizophrenia, a disproportionately likely to have an insecure attachment. Read also found that 69% of women and 59% of men with schizophrenia, have a history of physical and/or sexual abuse.

  Limitation - Poor evidence for explanations. No research support to show the importance of traditional family based theories, such as the schizophrenogenic mother and double bind theory.
• psychological explanations, cognitive explanations -

  Strength - research support. Stirling Compared cognitive tasks with 30 people with schizophrenia and a control group of 30 people without. Stroop tasks, people with schizophrenia took over twice as long on average.

  Limitation - only explain the proximal origins of the symptoms. proximal explanations only consider how the symptoms are being produced in the present, and not where the condition was initially induced (distal explanations). Only partial explanations.
• drug therapy - TA

  Strength - Thornley reviewed data from 13 trials with 1121 participants showing that chlorpromazine reduced symptom severity in comparison to a placebo. COUNTERPOINT -> Healy suggested flaws with research on drug effectiveness, most studies only study short term effect, successful trials have been published multiple times exaggerating evidence. Suggests drug effectiveness is less impressive than it seems.
• Drug therapy

  Limitation - side effects. TA (typical antipsychotics) can cause dizziness, stiff jaw and itchy ski. Long term use of drugs can cause tardive dyskinesia which causes involuntary facial movements, caused by dopamine super sensitivity. Antipsychotics can cause neuroleptic malignant syndrome (NMS), can result in a coma and can be fatal as dopamine is blocked from the hypothalamus (associated with bodily systems). Antipsychotics can cause more harm
• CBT, cognitive behavioural therapy

  Strength - Jauhar reviewed 34 studies, evidence for small but significant effects on all symptoms of schizophrenia. Pontillo found reductions in frequency of sever auditory hallucinations by using CBT.

  limitation - Thomas points out that different studies used different CBT techniques to treat people, there a lots of CBT techniques, don’t know which techniques are helpful.
• Family therapy

  Strength - McFarlane found that relapse rates reduced typically by 50-60%. Clinical advice from NICE recommends family therapy for people with schizophrenia.

  Strength - benefits all the family members. Lobban and Barrowclough concluded that these effects are important because families provide the bulk of care for people with schizophrenia. Strengthens the ability of the family to support the individual.
• Token economies

  Strength - Glowacki identified, 7 high-quality studies that proves the effectiveness of token economies. All studies showed a reduction in negative symptoms and a client in the frequency in unwanted symptoms.

  Counterpoint - studies used are a very small sample to indicate the effectiveness of the technique. This is the file drawer problem, a bias towards published findings, because the opposite results have been ‘filed away’.
• Token economies

  Limitation - ethical issues. Token economies give professionals considerable power to control the behaviour of people as a patient. Token, economies, impose norms on others, and this can be problematic if target behaviours are not identified sensitively. It restricts people from the availability of pleasures. Legal action by the families of patients in token economies has been taken due to the ethics.

  Limitation - Chiang concluded that art therapy is a good alternative. High gain low risk. Less ethical issues when managing schizophrenia.
• Interactionist approach

  Strength - Tienari followed 19,000 Finnish children with biological mothers who had schiz with high genetic risk. Also had a control group with no genetic links o anyone with schiz. Genetically vulnerable children in hostile adopted families were strongly associated with the development of schizophrenia.

  Limitation - it is oversimplified. Stress is not limited to family dysfunction, multiple gene combinations are associated with a genetic vulnerability to schizophrenia. Houston showed that sexual abuse in childhood was a massive underlying vulnerability to shchiz.