Schizophrenia

• schizophrenia

  Schizophrenia is a mental disorder. It is characterised by disruption in psychological functioning and loss of contact with reality.

  • Schizophrenia affects about 1% of the population. 
  • Symptoms first show in mid to late adolescence.
• key features of classification of features

  • ICD-10 and DSM-5 classify schizophrenia slightly differently. 
  • DSM-5 needs only one positive symptom (delusions, hallucinations) to be present for diagnosis.
  • ICD-10 needs two or more negative symptoms.
  • ICD-10 recognises sub-types of schizophrenia (paranoid schizophrenia, hebephrenic schizophrenia and catatonic schizophrenia).
  • These sub-types were omitted from the current edition of the DSM, even though they were present in previous editions.
• paranoid schizophrenia

  characterised by powerful delusions and hallucinations but relatively few other symptoms.
• hebephrenic schizophrenia 


  involves mainly negative symptoms.
• catatonic schizoprhrenia

  involves disturbance to movement, leaving the sufferer immobile or overactive.
• positive symptoms of schizophrenia

  • Positive symptoms of schizophrenia are those that are not present in non-schizophrenic individuals and include hallucinations and delusions.
  • Hallucinations are unusual sensory experiences, such as hearing voices, that are not present in the environment. These voices can be very critical. 
  • Hallucinations can also be visual, such as seeing people who aren’t there.
  • Delusions are irrational beliefs that can take many forms, such as believing you are a famous historical figure or under surveillance by the government.
• negative symptoms of schizophrenia

  • Negative symptoms of schizophrenia involve the loss of usual abilities and experiences. Symptoms include avolition (or apathy) and speech poverty.
  • Avolition includes difficulties with goal-directed behaviour, such as personal hygiene, lack of persistence and lack of energy.
  • Speech poverty involves changes in the pattern of speech.
• speech poverty interpretations

  • ICD-10 categorises speech poverty as a negative symptom because of the reduction in the amount and quality of speech, as well as a delay in verbal response during conversations.
  • DSM-5 places emphasis on speech disorganisation, rather than speech poverty. Speech can often become incoherent if the speaker changed topic mid-sentence. 
  • DSM-5 classifies disorganised speech as a positive symptom.
• reliability of diagnosis

  • Cheniaux et al. (2009) investigated the reliability of schizophrenia diagnosis. 
  • 100 patients were diagnosed by different psychiatrists using both ICD and DSM criteria.
• results of cheniaux et al

  • Results showed poor reliability.
  • One psychiatrist diagnosed 26 patients according to DSM and 44 according to ICD, while another psychiatrist diagnosed 13 (DSM) and 24 (ICD).
• validity issues in diagnosis

  • Co-morbidity.
  • Symptom overlap.
  • Gender bias. 
  • Cultural bias.
• co-morbidity

  • Comorbidity is the extent to which two or more conditions occur together, calling into question the validity of diagnosis.
  • Buckley et al. (2009) found that around half of all patients diagnosed with schizophrenia also had a diagnosis of depression. This factor called into question the ability to tell the difference between the two conditions and diagnose accurately. 
  • It could be that very severe depression can present as schizophrenia because it looks a lot like it.
• symptom overlap

  • Symptom overlap refers to the extent to which the symptoms of one disorder are also present in a different disorder. 
  • For example, schizophrenia and bipolar disorder both include symptoms such as delusions and avolition (lack of motivation to do tasks with an end goal).
  • Symptom overlap also calls into question the ability to accurately diagnose specific conditions.
  • Under ICD, a patient might be diagnosed with schizophrenia; while under DSM, they might be classified with bipolar disorder.
  • This might even mean that the two are actually the same disorder.
• Rosenhan - study of pseudopatients

  • The main study is an example of a field experiment. The IV was the made-up symptoms of the 8 pseudo (fake) patients, and the DV was the psychiatrists' admission and diagnostic label of the pseudo patient.
  • The study also involved participant observation, since, once admitted, the pseudo-patients kept written records of how the ward operated, as well as how they personally were treated. They telephoned hospitals for appointments and all reported the same symptom, ‘I hear a voice saying thud, empty or hollow’.
• rosenhan - psuedopatients - results

  • All were admitted and all except one given a diagnosis of schizophrenia. They remained in hospital for 7 to 52 days (average 19 days). Visitors to the pseudo patients observed “no serious behavioural consequences”. Although they were not detected by the staff, many of the other patients suspected their sanity (35 out of the 118 patients voiced their suspicions).
  • Some patients voiced their suspicions very vigorously for example ‘You’re not crazy. You’re a journalist, or a professor. You’re checking up on the hospital’.
• rosenhan - psuedopatients - conclusion

  The study demonstrates both the limitations of classification and, importantly, the appalling conditions in many psychiatric hospitals. This has stimulated much further research and has led to many institutions improving their philosophy of care.
• strength of rosenhan

  • Ecologically valid. 
  • Objective evidence from pseudo patients. 
  • Quantitative and qualitative data. 
  • Practical applications.
• limitations of rosenhan

  • Ethics. 
  • The pseudo patients experiences could differ from real patients as they knew they were not mentally ill.
• validity of diagnosis - gender bias - longenecker et al

  According to Longenecker et al., (2010), schizophrenia diagnosis might suffer from gender bias because of the disproportionate number of men diagnosed with disorder in comparison to women.
• validity of diagnosis - gender bias - cotton et al

  • While it could be that more men are diagnosed because they are more genetically vulnerable, it could also be because women are able to function better with the disorder than men.
  • According to Cotton et al. (2009), female patients appear to be more able to continue in work and have good family relationships. This better interpersonal functioning might lead to practitioners under-diagnosing schizophrenia in women.
• validity of diagnosis - culture bias

  Cultural bias might account for higher numbers of African American and others of Afro-Caribbean descent being diagnosed with schizophrenia compared to in Africa and the West Indies, where rates are not particularly high.
• validity of diagnosis - different cultural attitudes

  • Some African cultures have different attitudes to some positive symptoms, such as hearing voices, which can be more acceptable because of their beliefs about communicating with ancestors. 
  • This would mean that some symptoms seen as acceptable in some cultures would be seen as atypical in others.
• validity of diagnosis - culture bias - Escobar

  Escobar (2012) has suggested that, because the psychiatric profession is dominated by white people, psychiatrists might be over-interpreting symptoms and distrusting the honesty of black people during diagnosis.
• pinto et al (2017)

  Pinto et al (2017) studied schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England.
• pinto et al (2017)

  • Research aim
  • To investigate the increased risk of schizophrenia in Black Caribbean people and their descendants. 
  • Research method
  • A meta-analysis of databases from 1950-2013.
• pinto et al (2017)

  • Results
  • Statistically significant elevated incidence rates in the Black Caribbean group were found, present across all major psychotic disorders, including schizophrenia and bipolar disorder.
  • Conclusions
  • In the UK, Black Caribbean’s are more likely to be diagnosed with mental illness than their white counterparts.
• pinto et al (2017) - evaluation

  • Strengths
  • Large sample, reliable evidence. 
  • Limitations
  • Does not explain why. 
  • Evidence of racial bias in diagnosis.
• copeland et al (1971)

  Copeland et al (1971) studied American psychiatrist diagnoses vs British. The researchers wanted to investigate cultural variations in the diagnosis of schizophrenia. 
• copeland et al (1971)

  • Method
  • In an experiment, Copeland (1971) gave 134 US and 194 British psychiatrists a description of a patient.
  • Results
  • 69% of the US psychiatrists diagnosed schizophrenia, but only 2% of the British ones gave the same diagnosis.
  • Conclusion
  • Diagnosis of schizophrenia is not very reliable between cultures.
• copeland et al (1971) - evaluation

  • Strengths
  • Shows that mental illness can be a cultural construct. 
  • Limitations
  • Lacks ecological validity – giving a diagnosis from a description is different to seeing a patient in real life.
• family based explanations

  Psychological explanations focus on the psychological environment and abnormal cognitions, such as family relations, communication patterns, and thought processes involved in the experience of schizophrenia.
• family dysfunction

  Family dysfunction studies investigate the link between schizophrenia and childhood and adult experiences of living in a dysfunctional family.
• theory of expressed emotion

  • The theory of expressed emotion (EE) highlights the impact of negative environments (hostile or critical) on schizophrenic patients. 
  • If family/carers direct high levels of negative expressed emotion towards the patient, this can place the patient under a great deal of stress. 
  • This situation correlated to relapses in schizophrenic patients after being discharged. Vaughn and Leff (1967).
  • But stress might also be a contributory factor in the initial onset of schizophrenia.
• schizophrenogenic mother - Freida Fromm-reichmann

  • Frieda Fromm-Reichmann (1948) proposed the theory of the schizophrenogenic mother. 
  • The theory is based on reports from her own patients about their childhoods and their relationship with their mothers.
• Results of Fromm-Reichmann (1948) - schizophrenogenic mother

  • Many of Fromm-Reichmann’s (1948) patients spoke of cold, rejecting and controlling mothers and a family climate characterised by tension and secrecy.
  • She referred to these mothers as schizophrenogenic, meaning schizophrenia causing.
  • Schizophrenogenic mothering leads to distrust that can later develop into paranoid delusions and, ultimately, schizophrenia.
• double bind theory - Bateson et al

  • Bateson et al. (1972) proposed the double-bind theory.
  • They agreed with Fromm-Reichmann (1948) that the family climate was a factor in the development of schizophrenia.
  • But they placed greater emphasis on the role of communication patterns.
• double-bind theory - fear of wrong doing 


  Double-bind theory proposed that developing children often find themselves in situations where they fear doing the wrong thing, but receive mixed messages about what this is. They feel unable to comment on the unfairness of the situation or to seek clarification.
• double-bind theory - belief in a confusing world

  • Double-bind theory suggests that, when the child is punished for getting things wrong by the parent withdrawing love, the child is left with a belief in a world that is confusing and dangerous.
  • This results in symptoms such as disorganised thinking and paranoid delusions.
• double-bind theory - risk factor not cause

  Bateson (1972) emphasised that such patterns of communication were not the main type of communication, and that the double-bind represented a risk factor, not a cause of schizophrenia.
• evaluation of family based explanations

  There is little evidence for family-based explanations of schizophrenia, even though there is considerable evidence to support the principle that adverse childhood experiences within the family are associated with adult schizophrenia.