Paper 3 Schizophrenia

• Type 1 Schizophrenia


  Positive symptoms (added symptoms)

  - distortion of reality

  - Delusions

  - Grossly disorganised/catatonic behaviour

  - Hallucinations

  - Disordered speech
• Type 2 Schizophrenia


  Negative symptoms (take away reality)

  - Lack normal function

  - Affective flattening

  - Speech poverty

  - Avolition
• Prognosis - Rule of Thirds


  1/3 recover

  1/3 episodic impairment

  1/3 chronic disorder
• DSM classification of schizophrenia


  - Characteristic symptoms : 2+ symptoms from list for most of 1 month period

  - Social/occupational dysfunction : 1+ areas of functioning must be below level before

  - Duration : at least 6 months
• Diagnostic reliability


  - Results are repeatable

  - Inter-rater reliability

  - Eli Cheniaux et al = 2 psychiatrists diagnose 100 patients using DSM and ICD, inter-rater reliability poor
• Mojitabi and Nicholson


  50 senior psychiatrists, difficult differentiating between bizarre and not bizarre, could impact reliability
• Cheniaux (validity)


  - Validity is if the correct thing is diagnosed

  - Greater diagnosis of schizophrenia when using ICD than DSM, lack of validity in one diagnosis
• Buckley et al (co-morbidity)


  50% of people with schizophrenia could also be given a diagnosis of depression.

  In some cases depression can look like shcizophrenia
• Cotton et al


  Female patients typically function better than men, being more likely to work and have good family relationships

  So women are less likely to be diagnosed
• Escobar


  White psychiatrists over interpret symptoms and distrust black people when diagnosing
• Bio approach = Dopamine hypothesis


  - Schizophrenia is a result of too much dopamine

  - Golman -Rakic = Not enough dopamine in prefrontal cortex (responsible for decision making)
• Bio approach = Dopamine hypothesis AO3


  - Drugs that block dopamine reduce symptoms,

  - Parkinson's disease treated to increase dopamine increase symptoms of schizophrenia

  - Barlow and Durand = Neuroleptic drugs block dopamine quickly, fail to reduce symptoms

  - Kane et al = new drug block dopamine less than neuroleptic drugs.

  - Correlational evidence
• Bio approach = Neural correlates


  - When we find which part of the brain correlated to which function

  - Ventral striatum is involved in anticipation, cause problem with motivation
• Bio approach = Neural correlates AO3


  - Juckel = measured activity levels in ventral striatum in schizophrenia lower levels of activity

  - Allen = support low level of activation by scanning brains with auditory hallucinations
• Bio approach = Twin studies Gottesman


  Suggested greater genetic similarity is positively associate with the increased risk of schizophrenia. 48% chance if MZ twin, 17% chance DZ
• Bio approach = Twin studies Gottesman AO3


  + strong evidence

  + good meta-analysis

  + all twin studies show higher concordance in MZs

  + Concordance for MZ raised apart is similar to together

  + Schizophrenia
• Bio approach = Adoption studies Tienari


  164 adoptees whose bio mothers has been diagnosed with schizophrenia 11 had diagnosis themselves, compared to 4% whose mothers didn't have illness, but were adopted
• Bio approach = Adoption studies Tienari AO3

  + Shows some role of environment

  - Could be that adoptive parents of children expected them to get the illness, influence outcome
• Bio approach = Candidate genes


  Individual genes associated with risk of inheritance
• Bio approach = Candidate genes AO3


  Role of mutation = mutation of parental DNA by radiation or viral infection

  Brown = paternal age increase with schizophrenia risk 0.7% fathers under 25 to 2% fathers over 25
• Bio treatment = Typical antipsychotics


  - Chlorpromazine

  - Block dopamine

  - Prevent dopamine binding to the D2 receptor

  - Kapur et al = 60-70% of D2 receptors in mesolimbic dopamine pathway blocked for drugs to be effective
• Bio treatment = Typical antipsychotics side effects


  - Extrapyramidal side effects = tardive dyskenia (facial tics)

  - Caused by too many dopamine receptors being blocked
• Bio treatment = Atypical antipsychotics


  - Risperidone and Clozapine

  - Block dopamine temporarily then dissociate to allow normal transmission

  - Stronger affinity for seretonin

  - Less side effects only weight gain
• Bio treatment = risperidone vs clozapine


  - Risperidone has less side effects and one dose lasts 2 weeks

  - Risperidone binds more strongly to dopamine receptors
• Bio treatment AO3 = Leucht et al

  - meta analysis of 65 studies 1959-2011 = 6000 patients stabilised on atypical, some receive placebo

  - 64% placebo relapse

  - 27% drug relapse
• Bio treatment AO3 = Extrapyramidal side effects


  - Typical antipsychotics cause extrapyramidal side effects, extended periods cause tardive dyskenia
• Bio treatment AO3 = Ethical problems with typical antipsychotics


  - Antipsychotic cost benefit analysis is negative as more side effects than positives

  - Oppose article 3 of human rights act
• Bio treatment AO3 = Advantages of atypical over typical

  - Atypical better than typical as there are less side effects as with continued treatment symptoms reduce
• Bio treatment AO3 = Crossley et al


  - Meta analysis of 15 studies no sig diff between effectiveness

  - Atypical more weight gain

  - Typical more side effects
• Bio treatment AO3 = Motivational deficits


  - Medication ignores importance of social impact, reduce suffering if understood
• Psych explanations = cognitive explanation


  - Can't filter stimulus and process to extract meaning

  - Become overwhelmed with sensory info and unable to process and interpret
• Psych explanations = Frith's model


  - Can't distinguish between conscious and preconscious processing

  - Delusions = unimportant info gets seen as important

  - Hallucinations = Bombarded with sounds constantly and preconscious mechanisms interpret and reach conscious
• Psych explanations = Hemsley's model


  - Schizophrenics schema not activated, they are subject to overload of sensory info and don't know which to attend to

  - Internal speech and thoughts not recognised but come external source
• Family dysfunction = Schizophrenogenic mother


  Fromm - Reichman

  - Schizophrenia arose from being reared by cold and domineering mother who is overprotective but rejecting, confuse emotions
• Family dysfunction = Double bind

  Bateson et al

  - Members of family communicate in destructive fashion, schizophrenia is reaction to pathological parent presenting child with contradicting messages
• Psychological treatments = Cognitive treatment


  Assume schizophrenics have irrational thoughts about themselves and they world around them. Irrational thoughts contribute to development and maintenance.

  Challenge irrational thoughts
• Psychological treatments = CBT

  - Disputing = use common sense

  - Empirical = Ask for evidence

  - Pragmatic = So what?
• Psychological treatments = Token economy


  - Behavioural approach

  - selective positive reinforcement, rewarded for behaving correctly by tokens exchanged for real rewards

  - Tokens are secondary reinforcers as they obtain tokens and get primary reinforcers from these
• Psychological treatments = Token economy AO3


  - Ethical issues = gives professionals power over individual and impose norms upon others, restrict pleasure and personal freedom

  - Patronising

  - Too simplistic and ignore hallucinations
• Psychological treatments = expressed emotion


  Level of emotion expressed toward person with schizophrenia by carers