interactionist approach

• What does the interactionist approach say?

  An approach that acknowledges that schizophrenia results form a combination of biological, social and environmental factors. Acknowledges the complexity of the disorder
• What is the diathesis-stress model?

  The idea that schizophrenia is the result of the combination of a vulnerability to the illness and the stress needed for it to become a reality. The interaction is key

  
• Meehl's model (original diathesis-stress model)


  Diathesis entirely genetic as a result of a single 'schizogene' which led to a biologically based schizotypal personality. States that people without the gene cannot develop schizophrenia. A person who has the gene is vulnerable to the effects of chronic stress. The schizogene is necessary but not sufficient for the development of schizophrenia.
• Modern diathesis-stress model (neurodevelopmental model)

  Not one ‘schizogene’ but many genes. Suggest that there are other factors beyond just genetics, including psychological trauma could be the vulnerability (rather than just the stressor)-> Can cause changes to the Hypothalamic-pituitary adrenal (HPA) and systems can become overactive making people more vulnerable to later stress
• What are some external stressors that may trigger schizophrenia?

  Family dysfunction Critical life events (going to uni, divorce etc) Urban living (2.37x higher risk) Cannabis (increases risk to 7x)↳ cannabis interferes with your dopamine system however our understanding is still limited
• Ripke et al (2014)


  Meta-analysis of genome studies. Genetic make-up of 37,000 patients compared to 113,000 controls. Identified 108 genetic risk factors in schizophrenia ∴ schizophrenia is polygenetic ‘Schizogene’ too simplistic!!!
• Tienari et al (2004) - strength of interactionist approach


  Followed children of schizophrenic mothers who had been adopted in Finland 5.8% of children adopted by ‘healthy’ families developed schizophrenia 36.8% of children adopted by dysfunctional families developed schizophrenia. This shows that a combination of genetic vulnerability and family stress can lead to greatly increased risk of schizophrenia
• Murray (1996) - strength of interactionist approach


  Children born after flu epidemics where their mother to the flu whilst pregnant had an 88% increased chance of developing schizophrenia than those born @ the same time with non flu mothers. Flu in the 2nd trimester is suspected of causing neural development defects leading to increased vulnerability to schizophrenia (brain damage affects dopamine functioning)
• Jarvis and Okami (2019) - limitation of interactionist approach


  Suggest this argument is the same as claiming that because alcohol reduces shyness, shyness is caused by a lack of alcohol -the treatment causation fallacy∴ we cannot automatically assume that the success of combined therapies means interactionist explanations are correct
• Over-simplistic - limitation of the interactionist approach

  The original diathesis stress model is over simplistic. We used to see vulnerability as purely biological and stress as psychological. Recent events suggest that we early trauma causes vulnerability and that biological events like smoking can be environmental stressors. Houston et al(2008): Found that childhood sexual trauma was a diathesis and cannabis use a trigger.
• What is the interactionist approach to treating schizophrenia?

  Involves combining biological and psychological therapies↳ Antipsychotics and CBT. Biological therapies reduce severity of symptoms to increase engagement with cognitive therapy and allow for behavioural therapies to be effective. Which particular combination of treatments is best is affected by each patients individual circumstances and needs
• Guo et al (2010) - strength of interactionist treatments


  Randomised controlled trail of a clinical sample of 1,268 patients with early-stage schizophrenia. Patients randomly assigned to either:- Antipsychotics medication treatment only or Antipsychotic medication plus 12 months of CBT administered over 48 group sessions. Patients who had a combination of drugs and psychological therapy had improved insight, lower risk of relapse higher quality of life & increased social functioning
• Economic implication - limitation of interactionist treatments


  Combining therapies increase the cost of treatment CBT - multiple sessions. Drugs - for life. more expensive for the NHS and the taxpayer who funds the service↳ However, if it prevents hospitalisation etc it may be more cost effective in the long-run