Schizophrenia

• Positive symptoms


  Experiences that are in addition to normal experiences
• Negative symptoms


  Loss of normal experiences and abilities
• Avolition


  A lack of purposeful World Behavior
• Reliability


  Measures if two observers agree, or if the same doctor gives the same diagnosis over time
• Validity


  Questions if a person has a disorder when diagnosed, or if schizophrenia is a real disorder with clear and unique symptoms
• Back 1963 found 153 patients diagnosed by multiple doctors only had 54% concordance rate between the doctor's assessments, suggesting low inter-reliability in diagnosing schizophrenia
• Schizophrenia is often diagnosed with other disorders, which could lead to an inaccurate diagnosis
• Bipolar disorder also has hallucinations and delusions as a symptom, suggesting the two disorders may not be distinct
• Women's experience of schizophrenia is taken less seriously and underdiagnosed compared to men due to women's better social coping strategies
• People with African-Caribbean Heritage in the UK are up to nine times more likely to be diagnosed with schizophrenia, due to category failure when Western definition of mental illness are applied to people from non-western cultures
• Loring and Pal 1988 found overdiagnosis of the case study claimed to be of a black client and under diagnosis if the case study claimed it was of a female client, suggesting the existence of gender and cultural bias in psychiatrist diagnosis of schizophrenia
• Genes


  Code for biological processes including variations in neural brain structure and biochemistry
• Concordance rates


  Higher in families than found in the general population, with the closer the family member the higher the concordance
• Dopamine hypothesis


  Symptoms of schizophrenia are due to too much or an imbalance of the dopamine neurotransmitter across the brain
• Glutamate


  An excitatory neurotransmitter involved in learning, attention and memory, found in low quantities in people with schizophrenia
• Enlarged ventricles


  Voids in the brain filled with CSF, correlated with schizophrenia
• Gottesman 1991 found a concordance rate for schizophrenia of 48% for identical twins and 17% for non-identical twins, suggesting genetic factors
• Tienari 2004 found 5.8% of children adopted into psychologically Healthy Families develop schizophrenia compared to 36.8% of children raised in dysfunctional families, supporting the influence of biological and psychological factors
• Lett's meta-analysis found drug treatments that work via normalizing dopamine levels were more effective than placebo, supporting the dopamine hypothesis
• Cognitive-soft determinist perspective


  Clients can reconstruct irrational mental processes, empowering sufferers to control their disorder actively
• Diathesis-stress approach


  The root cause is a biological/genetic weakness, but an environmental stressor must be present to trigger the disorder
• Family dysfunction


  Schizophrenia symptoms are due to the interpersonal relationships within the family
• Double bind theory


  Due to mixed messages, the sufferer feels unable to do the correct thing, leading to disorganized thinking and paranoia
• Expressed emotion


  Verbal interactions exaggerated involvement, criticism and control of the sufferer's behavior, and emotional hostility towards the sufferer
• Attention deficit theory


  A faulty attention system cannot filter preconscious information, giving too much significance to information that would usually be filtered, overloading the mind
• Metarepresentation


  The ability to identify your thoughts and actions as your own
• Bebbington and Kuipers showed that relapse into schizophrenia is significantly more likely in families with issues of expressed emotion
• Tienari found only 5.8% of biological children of schizophrenic mothers adopted into psychologically Healthy Families develop schizophrenia compared to 36.8% of children adopted into dysfunctional families
• Lashley and Sterling 2006 found patients with schizophrenia took twice as long to name the color in the Stroop test as the controls, suggesting dysfunctional thought processing
• Typical antipsychotics


  First generation drug therapy used since the 1950s, work as dopamine antagonists to reduce positive symptoms but have severe side effects
• Atypical antipsychotics


  Second generation drug therapy from 1970s onwards, block dopamine receptors but also act on other neurotransmitters, addressing both positive and negative symptoms with fewer side effects
• Lashley's meta-analysis found drug treatments of symptoms were more effective than placebo, suggesting drugs targeting the dopamine system are effective in reducing symptoms
• Bagnall's review found atypical drugs were more effective than typical in treating overall symptoms, resulting in fewer movement disorder side effects and fewer people leaving the drug treatments early
• Tarrier's study found patients in combined drug and CBT treatment significantly improved the severity and number of positive symptoms and had fewer days in the hospital, suggesting an interactionist approach is more effective
• Cognitive Behavior Therapy (CBT)


  Assumes schizophrenia results from dysfunctional thought processes, the therapist role is to identify and challenge irrational beliefs
• Family therapy


  Attempts to improve the home situation of the person with schizophrenia, educating the family on symptoms and developing techniques to reduce conflict, stress and improve communication
• Token economies


  Designed to make Behavior more manageable, using tokens as positive reinforcement for predefined Target Behaviors
• Sensky found patients who had resisted drug treatments had a reduction in positive and negative symptoms when treated with 19 sessions of CBT
• Dickerson found token economies can effectively improve the Adaptive behavior of people with schizophrenia
• Diathesis-stress model


  A disorder is due to the interaction between a predisposed vulnerability and an environmental trigger or stressor