Schizophrenia

• Schizophrenia


  A very severe type of psychotic disorder characterised by disturbance across many aspects of a person's thoughts, feelings, experience and behaviour
• Diagnosis


  • Symptoms must be present for at least one month and not be due to another health condition
• Positive symptoms


  • An experience that is 'in addition' or a 'distortion' to a normal experience
• Delusions- positive symptom


  • Bizarre: beliefs that seem real but are not real
  • Grandeur: belief that you are famous or very important
  • Persecution: belief that you are being conspired against
  • Reference: belief that events in the environment are related to you
• Experience of control- positive symptom


  At times the patient experiences her thoughts, actions and bodily movements are controlled by another agent
• Hallucinations- Positive symptom


  • Auditory: voices are heard coming from outside the person head giving instructions on how to behave
  • Visual: visual perceptions of things that aren't present
• Negative symptoms


  Where level of functioning falls below normal level
• Flattening affect- negative symptom


  Patients may speak in a dull flat voice and their face does not change (no emotional expressions) and struggle to understand emotions in other people
• Alogia- negative symptom


  Lessening of speech fluency and productivity (reflects slowing or blocked thoughts)
• Disordered thinking- negative symptom


  Thoughts have been inserted or withdrawn from the mind (belief their thoughts are being broadcast and people can hear them)
• Biological explanations in schizophrenia include genetic and dopamine factors
• Genetic explanation


  Belief that genes can be passed on which can combine to produce the disorder. Studies on twins showed higher concordance rates for identical twins (MZ) compared to DZ twins.

  Likelihood of developing schizophrenia went from 1% in general population to 48% if you had a identical twin
• Dopamine explanation

  There is an excess in dopamine for schizophrenics. The neurons that transmit dopamine fire too often and easily.
• Antipsychotic medications

  • First generation: Worked by binding to D2 receptors to block dopamine from entering, but had many side effects like tardive dyskinesia
  • Second generation: Clozapine, worked by blocking dopamine but only for a short time allowing normal transmission, had less side effects but could cause drowsiness and poor focus
• Evidence for effectiveness of antipsychotic medications comes from randomised control trials and double blind placebo studies, which found 50% of those taking meds showed improvement in 4-6 weeks
• Cognitive explanation

  Caused by disorganised or faulty/errored thinking and information processing. Schizophrenia patients fail to recognise perceived hallucinations are just inner speech.
• Cognitive Behavioural Therapy (CBT) for schizophrenia


  CBT: aims to change or modify peoples beliefs and the way they process information

  1.The therapist challenges irrational/faulty thoughts and behaviours

  2. Patients will be asked to complete tasks outside of face-to-face therapy to help challenge these thoughts

  3. For schizophrenics- intention is to help the patient make sense of psychotic experiences and reduce the negative effects and distress they may feel
• Sensky has evidence that shows CBT is an effective treatment for schizophrenia for at least 9 months post treatment when comparing it with befriending