clinical

• features of schizophrenia


  it is found in any nation at a rate of about 1.4-4.6 per 1000 people

  1/4 people recover after one schizophrenic episode and dont get another

  50% have periods of recovery and periods of symptoms
• diagnosis of schizo


  according to DSM it requires 1 month of 2 or more positive symptoms
• schizo first rank and second rank symptoms

  first rank symptoms- hearing voices and ideas being guided by others

  second rank symptoms- flattened emotions
• types of schizo


  paranoid- when someone is suspicious of others

  disorganised- characterised by speech being disorganised

  catatonic- withdrawn and has little physical movement

  residual- psycotic symptoms

  undifferiated- doesnt fit a description
• schizo- positive symptoms


  hallucinations- hearing or seeing things that are not real- eg controlling voices

  delusions- refers to a person thinking movements are being controlled
• schizo- negative symptoms


  lack of energy

  flatness of emotions

  social withdraw

  not looking after appearance
• eye tracking for diagnosing schizo


  sweeney et al carried out study analysing schizo patients and eye movements

  • some success that schizo eye movement abnormalties
• blood testing to diagnose schizo

  perkins- analysed blood from 32 patients with symptoms that show pyschosis

  researchers looked for biomarkers for inflammative oxidative stress, metabolism and hormones
• Dopamine hypothesis


  dopamine receptors can be present in the brain in different numbers and its been suggested that development of receptors in 1 area may inhibit development on another

  the dopamine hypothesis suggests that the brain of schizophrenic patients produce more dopamine than the brain of a 'normal person'

  have high number of D2 receptors

  researchers suggest that presence of the excess number of dopamine receptors at the synapses in the brain contributes to schizo

  increase dopamine in mesolimbic pathway- positive symptoms

  increase dopamine in mesocortical pathway- negative symptoms
• dopamine hypothesis- strengths


  some genes linked with dopamine production are found when greater frequency in those with schizo

  people with schizo are more sensitive to dopamine uptake that if someone is given amphetamines there is a greater release of dopamine compared to not schizo people
• dopamine hypothesis- weaknesses


  PET scans show that blocking dopamine receptors doesnt always remove symptoms

  ampetamine(recreational drug) produces positive symptoms

  social/ environmental factors also involved
• Glutamate Hypothesis


  Carlsson supports the idea that schizo symptoms are linked to excess of dopamine in their brain and says there is other factors

  decrease in glutamate= increase in dopamine

  Glutamate controls amount of dopamine released by brain and normally seems to lower dopamine levels

  PCP leads to lower levels of glutamate- increase dopamine
• glutamate hypothesis- strengths


  glutamate hypothesis works with the dopamine hypothesis and expands on it - shows strength and reliability

  evidence from neuroimaging and animal studies to show blocking glutamate it leads to psychotic symptoms
• glutamate hypothesis- Weaknesses


  animal studies being used for human behaviour- unable to be generalised

  PET scanning to obtain evidence about neurotransmitters functioning- Carlsson- said under pressure people are likely to respond differently
• non biological explaination for schizo- social class Cooper 2005

  lower class is at risk of schizo

  suggests that for single men - the rate of schizo in social class 5 was 4:1 times as high as in social class 1
• non biological explaination for schizo-

  schizo is asscoiated more in cities than in rural areas

  study shows that 'social adversity' in childhoos relates to development in later life

  features the environment can affect schizo

  • unemployment
  • social isolation
  • separation from parent
• non biological explaination for schizo- living in 'alien' neighbourhood- brown 2010


  wrote a review focusing on enviroment and susceptibility to schizo

  wrote about effects of living in different neighbourhood relating to immigration status

  Veling et al carried out study in Hague found that when immigrants were in a neighbourhood where their ethnic group was not predominate there was higher chance of psychotic disorder
• non biological explaination for schizo- immigrant population- fearon 2004

  estimated that there are 4 times as many incidences of schizo in these immigrant populations as in white population

  risk of schizo is not only greater only for Afro carribean immigrants but also for African born black immigrants
• what is social causation Hypothesis?

  how socioeconomic inequality causes stress that sees a rise to mental health problems
• the idea of social drift- explanation for schizo

  those with schizo become lower class because of difficulties that arise from having schizo

  study found that the social class of schizo men was lower than their fathers social class

  those who develop schizo did not achieve as well in education
• the idea of social adversity- explanation for schizo


  characteristics associated with living in urban areas

  there is a higher incidence of schizo in urban areas compared to rural areas- more likely to be unemployed and live in poor area

  Hjem et al showed that social adversity in childhood leads to schizo later
• evaluation of social class as risk factor for schizo

  tendency to schizo seems to come from what happens to someone in childhood rather than lower socioeconomic status

  • link between schizo and low socioeconomic class that comes from children living in these circumstances as much as adults from social status
• strengths of social causation hypothesis

  idea that social adversity contributes to developing schizo and helps to eplain that although there are more people with schizo in lower classes and black immigrants are more likely to be diagnosed compared to white lower classes

  stress diathesis model supports it- helps to explain the enviromental part of interaction between biology and environment causing schizo
• weaknesses of social causation hypothesis

  those in lower socioeconomic groups living alone, unemployed and living in poverty might likely to be diagnosed with schizo suggesting a diagnosis problem not enviroment

  it is hard to separate environmental factors to see if they cause schizo eg social drift theory that people drift from society when they ar diagnosed with schizo
• weaknesses of social causation hypothesis

  idea of 'environmental breeders' help to explain that although there are more people with schizo in the lower class, they are concentrated in the inner city areas and black immigrants are more likely to be diagnosed with schizo than white lower class groups
• biological explanation of schizo- heston 1966


  aim- to see how many adopted children of biological mothers with schizo would go to develop schizo

  method- 47 adults were found who were adopted because their mother had schizo

  47 adults whose mothers were mentally well were also picked- they were all assessed to see if they would develop schizo

  findings: found that the risk of developing schizo if 1 parent had schizo was 10% - 10% of adopted children of schizo mothers developed schizo
• genetic explaination of schizo- Tiwari et al 2010


  given that 2/3 of schizophrenic cases are where schizo occurs sporadcally - not unexpected that any genetic cause comes from the rare variation gene
• Genetic explanation of schizo- gottesman and shields


  wanted to look how far schizo was genetic and try to replicate other studies

  foucused on monozygotic and dizygotic twins and found out if they had schizo

  392 participants

  high concordance rate for monozygotic twins- 42% mono and 9% dizyg
• family studies


  children of 2 schizophrenic parents- 46% chance of developing schizo
• ACT- dixon 2004

  points out that since the 1980s ACT has been used/ seen as the model for mental health practices
• ACT- Bond et al


  summarised 25 controlled studies that looked at the effectiveness of ACT

  compared ACT to standard community care

  • act was highly effective as it engaged with clients well
• What is ACT?


  a psychological treatment

  used the recovery model

  assertive- being confident in individuals values

  used for people who had frequent lapse of hospitalisation to help them to be cared for in the community

  helps to make patients independent and avoid homelessness by assisting their recovery

  use of multidisciplinary teams
• problems with ACT

  1. the treatment doesnt reduce symptoms and just helps patients cope with disorder
  2. only works in highly populated areas where there is more schizo patients and staff is needed
  3. gilmory 2002- says clients loose all responsibility for caring for themselves
• evaluating ACT


  ACT is used for severe cases of mental health- not only schizo

  ACT seemed to work on all ages groups, genders and cultures

  • however Golmory suggests that ACT is paternalised and doesnt allow patients to go to surgery
• Strengths of ACT


  it is thought to be good for those who have many relapses and also good for social skills as family therapy and training can improve social interactions

  Treatments based on improving individual to function in society and have shown to help and can be incorapated into ACT programme

  • Bond et al found that ACT was extremely effective in most mental health disorder
• weaknesses of ACT


  although therapies such as ACT help to prevent relapses- they do not have function in reducing positive and negative symptoms

  ACT only works in heavily populated areas

  • areas of deprived amount of staff would not work- ACT invalid
• biological treatment- drug therapy

  if dopamine is linked to schizo then drugs that target dopamine transmission should reduce symptoms

  • if abnormal behaviour is caused by chemical imbalance or genetic predispostion then treatment is biological
  • drugs are used to change chemical balance or level of neurotransmitters
• typical and atypical antipsychotic drugs

  typical antipsychotic drugs- introduced in 1950s and is 1st treatment for schizo, drugs are neuroleptics as they act at the neuron but cause large side effects

  atypical antipsychotic drugs- they are newer and more powerful and taken at 'last resort'
• Drug therapy- Meltzer 2004


  carried out study to look at effectiveness of drug treatment

  481 people were assigned into groups

  groups were given a placebo( new anti-psycotic drug or haloperidal)

  study found that haloperidal gave significant improvements and some new drugs show improvements over placebo
• Drug therapy- Guo et al 


  was conducted to look at effectiveness of atypical and typical antipsycotic drug for those with early schizo

  drug therapy only works on people with negative symptoms