Schizophrenia

• Psychological Explanations- Family Disfunction 16/20

  • Family dysfunction: caused by abnormal patterns of communication. Double bind theory: contradictory family communication, child can’t win (BATESON). Expressed emotion: family criticism/hostility, initial cause or later relapse.
  • +Research evidence: TIERNARI; adopted with schizo bio parents=more likely to develop- but only if adopted family was rated as disturbed.
  • -Information from childhood was gathered after development of symptoms, disorder may distort patients childhood.
  • -Ethical implications: parent blaming.
• Psychological Explanations- Cognitive 16/21

  • Dysfunctional thought processing: processing information differently to those without disorder. Metarepresentation: can’t recognise thoughts as ones own, leads to hallucinations/delusions.
  • Central control, cant suppress automatic responses, leads to speech poverty.
  • +Research support: people with schizophrenia take much longer to complete the Stroop task, showing impaired cognition (STIRLING).
  • -A proximal explanation: explains symptoms of schizophrenia now but not their origins, whereas genes/family dysfunction are distal explanations.
• Psychological Explanation- Schizophrenia 16/21

  • Cognitive behaviour therapy (CBT) Deals with irrational thinking. 5-20 sessions.
  • +Effectiveness: 34 studies, moderate benefit for positive/negative symptoms (JAUHAR).
  • -Different studies focus on different techniques so not clear which ones may help (THOMAS).
  • Family therapy: reduce negative emotions, expressed emotion.
  • +Effectiveness: relapse rates down 50-60%, more effective at beginning of symptoms (MCFARLANE).
  • +Benefits whole family, reduces negative impact/strengthens support (LOBBAN/BARROWCLOUGH).
• Biological Explanations 18/20

  • Candidate genes: polygenic, 108 variations (RIPKE).
  • +Research support: family risk, genetic similarity e.g. 2% aunt, 9% sibling (GOTTESMAN). Adoption (TIENARI)still heightened risk even when adopted by normal families.
  • -Environmental: increase risk: psychological factors (trauma).
  • Original DA hypothesis: high in subcortex (hyperdopaminergia). (speech pov) (Broca’s). Updated: high in subcortex+low in cortex. (negative symptoms).
  • +Support: LEUCHT meta analysis; all drugs that normalise D levels were more effective than placebos.
  • -Correlation-causation problem.
• Biological Therapies 8/22

  • Typical antipsychotics=Dopamine antagonists: Block D, normalises neurotransmission. (chlorpromazine)
  • Atypical antipsychotics minimise side effects (Clozapine) binds to dopamine/serotonin receptors.
  • +Effectiveness, chlorpromazine better than placebo (THORNLEY).
  • -Serious side effects, mild (e.g. sleepiness), serious (tardive dyskinesia) and occasionally fatal (neuroleptic malignant syndrome).
  • -Mechanisms unclear, most antipsychotics based on dopamine hypothesis which may be wrong. Theoretically they should not work.
• Management of Schizophrenia

  • Tokens; Quality of life in hospital improved. ‘Normalises’ behaviour—prepares for life after hospital. Given immediately for desirable behaviour, swapped later for rewards. (Operant conditioning=secondary reinforcers, exchanged for primary reinforcers).
  • +Effectiveness, seven studies show reduced negative symptoms/behaviours (GLOWACKI).
  • -Counter: small evidence base=file draw problem (only positive findings published).
  • -Ethical issues: gives professionals power to control behaviour. Also restricting pleasures in seriously ill people.