Schizophrenia

• Inter-rater reliability: To extent which two clinicians would be consistent in their diagnosis of the same patient.

  AO3:

  Cheniaux et al: Had two psychiatrists independently diagnose the same 100 patients using both DSM and ICD criteria.

  Psychiatrist 1 diagnosed 26 patients using DSM and 44 patients using ICD.

  psychiatrist 2 diagnosed 13 patients using DSM and 24 using the ICD
• Test-retest reliability: If the same patient is assessed two or more times do they consistently receive the same diagnosis, if so they diagnosis of schizophrenia is reliable

  AO3:

  Baca-Garcia: assessed 2322 schizophrenia patients at least 10 times whilst in hospital. 2/3 of the patients retained the same diagnosis. This suggest that generally test-retest is good for schizophrenia.
• Criterion validity: Different assessment systems are compared to see if they each arrive at the same diagnosis for the same patient.

  AO3:

  Cheniaux et al: Icd potentially over diagnoses, suggesting poor criterion validity in the diagnosis of schizophrenia.
• Co-morbidity: refers to when two or more conditions co-exist.

  AO3:

  Buckley: Half of patients also tend to be diagnosed with depression or substance abuse. Diagnosis is poor
• • Negative symptoms of schizophrenia are when patients experience a loss of normal experiences and abilities. Examples are avolition, speech poverty or an inability to communicate fluently.
• Genetic basis for schizophrenia:

  Gottesman- family method:

  Mz twins =48%

  DZ twins= 17%

  If parents had schizophrenia- increased risk of developing by 6%

  Tieneri- Adopted methods:

  Adopted with biological parents with schizophrenia = 6.7%

  Adopted with no parents with schizophrenia =2%
• The Dopamine Hypothesis (Neural explanation): Dopamine is assumed to be involved in the onset of schizophrenia. Generally it is thought, an excess in levels of dopamine is associated with positive symptoms. This is because, neurons which transmit dopamine fire too easily.
• Drugs which increase Dopaminergic activity: Amphetamines = psychotic symptoms (similar to SZ)

  Therefore amphetamines can cause an increase in dopamine activity which then can cause psychosis
• The second dopamine hypothesis: SZ is caused by abnormal functioning of dopamine systems in the brains cortex.

  Prefrontal cortex has low activity of dopamine this is linked to causing the negative symptoms.

  Whilst increased dopamine in other region was causing the symptoms such as hallucinations
• Biological explanations for schizophrenia AO3:

  Research support- Owen et al found a larger number of dopamine receptors in schizophrenic patients, examined through autopsies.

  This suggest that dopamine is implicated in schizophrenia as more receptors may lead to more neural fire and an over production of messages which could result in some of the positive symptoms
• Drug therapy:

  Typical- older class of drugs, effective in treating positive and only some negative symptoms. They are tightly bound to D2 receptors.

  Atypical- Newer forms of drugs. Less side effects than typical. Temporarily and loosely bind to D2 receptors. Effective in treating both positive and negative symptoms
• Drug therapy:

  Haloperidol- Typical

  symptoms:

  • hallucinations
  • delusions.
  • It blocks certain types of neurons activity in the brain.
  • Blocks D2 receptor

  side effects:

  • Dizziness
  • low blood pressure
  • blurred vision
• Clozapine- Atypical

  Symptoms:

  • Hallucinations
  • Dementia
  • delusions
  • Restores the balance of neurotransmitters e.g dopamine and serotonin
  • side effects:
  • blurred vision
  • confusion
• Family Dysfunction:

  The schizophrenogenic mother- cold, rejecting and controlling and tends to create a family climate characteristic by tension. SZ symptoms: paranoid, delusions

  Double-bind theory- Parent gives mix signals toward the child. punish child by withdrawing their love for the child. SZ symptoms: delusions

  Expressed emotions- Negative emotions towards patient by carer, hostility towards the patient including anger and rejection. SZ symptoms: Relapse in patient with SZ
• Cognitive explanations:

  Metarepresentation- cognitive ability to reflect on thoughts and behaviour. This allows us 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 ha someone else. This would explain hallucinations of voices and delusions.
• Cognitive explanations:

  Central control- cognitive ability to suppress automatic responses while we perform deliberate actions instead. Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts
• family dysfunction AO3:

  strength- Read et al reviewed studies of child abuse and schizophrenia and found over half the cases of female SZ patients had a history of neglect or abuse. This suggests that people with insecure attachment with primary caregiver more like to have SZ. Further validates.
• Cognitive explanations AO3:

  strength- Stirling et al compared 30 schizophrenia patients with 18 non-patient controls and found that patients took twice as long to name the ink colours in the stroop test as the controls did. This suggest that information is processed differently in SZ patients. However, lacks of validity to real-life situations
• Cognitive behaviour therapy:

  helping patients identify irrational thought me and try change them.

  This may involve arguments or discussion of how likely the patient beliefs are to be true and a consideration of other less threatening possibilities

  CBT can help suffers understand their maladaptive responses to life’s problems is often the result of distorted thinking
• CBT:

  During therapy, the therapist lets the patient develop their own alternatives to these previous Distorted thoughts, mainly looking for alternative explanations.

  Delusions are challenged so that a patient can come to learn their beliefs are not based on reality
• Family therapy:

  takes Place within families rather than individuals patients, aiming to improve the quality of communication and interactions between family members.

  Family therapist see more concerned with reducing stress within a family that might contribute to a patients risk of relapse. In particular family therapy aims to reduce levels of expressed emotions
• Family therapy help suffers:

  Pharoah et al identify a range of strategies which aim to improve the functioning of a family member suffering from Sz by reducing stress and expressed emotions and increasing the chances the patient will comply with medication (and thus reducing the likelihood of relapse):

  • Reducing stress of caring for a relative with SZ
  • Reduction of anger and guilty in family members
  • Improving families beliefs about and behaviour towards SZ
  • Improving the ability of the family to anticipate and solve problems
• CBT AO3:

  Strength- The NICE* review found consistent evidence, that when compared with standard care, CBT was effective in reducing rehospitalisation rates. It has also been shown to reduce symptom severity and in some cases improved social functioning. This suggest that CBT is an effective treatment.

  limitation- CBT is not as widely available, despite being recommended. 1 in 10 patients have access to this form of therapy. Not appropriate as not widely available
• Family therapy AO3:

  strength- There are some economic benefits of family therapy. Even though family therapy comes at a cost itself, this is offset but the reduction in hospitalisation because of the lower relapse rates associated with family therapy intervention. This suggest that there are lower relapse rates
• Token economy AO3:

  Limitation- Token economy systems become more available to patients with mild symptoms and less so for those with more severe symptoms of Sz. Meaning that the most severely ill patients suffer discrimination in addition to other symptoms, and some families of patients have challenged the legality of this.This shows that token economy is not appropriate for those patients suffering from severe symptoms
• Interactionist approach AO3:

  Tarrier- 315 patients randomly allocated to

  1. medication + CBT group
  2. medication + supportive counselling
  3. control group (medication only)

  Combination groups had lower levels of symptoms compared to control group. This supports the interactionist approach because combining treatment help with SZ.
• Interactionist approach AO3:

  Tienari- Studied 145 adopted children with biological mothers who had SZ between 1960 and 1979.

  Their upbringing was assessed for 12 years, looking for factors like low empathy, high level of criticism and conflict

  Found: higher levels of SZ in those raised in dysfunctional families

  This supports the interactionist approach