Schizophrenia

• Reliability refers to a diagnosis being repeatable, clinicians must be able to reach the same conclusion at two separate points in time
• According to Reiger, the diagnosis of schizophrenia has a Kappa Score of 0.46, which indicates sub par reliability
• Luhrmann et al (2015), found through interviewing schizophrenics from Ghana, India and the US that the 'harsh auditory hallucinations' that are characteristic of schizophrenia may not actually be a reliable method of classifying schizophrenia
• Validity refers to a diagnosis being valid, an issue with validity is gender bias
• Broverman (1970) found that clinicians in the US equate healthy behaviour as being healthy male behaviour, resulting in females being more likely to be pathologised
• Eliason and Ross found that people with dissociative identity disorder had more symptoms of schizophrenia than those with schizophrenia
• Comorbidity refers to the extent that two or more conditions occur simultaneously in a patient
• Buckley estimated that comorbid depression occurs in 50% of schizophrenic patient
• Mojabi and Nicholson (1995) found that 50 psychiatrists failed to differentiate between bizarre and non-bizarre delusions
• Rosenhan conducted a study in which pseudo patients were all given consistently the same incorrect diagnosis of schizophrenia
• Harrison (2001) found that 30% of patients showed improvement in some cases, but only 10% in others
• Loring and Powell found that 59% of case studies when male or no gender was given were given a diagnosis, compared to 20% when they were said to be female
• Joseph (2004) calculated that the concordance rate for mz twin is 40.4% compared to 7.4% for dz twins
• Dopamine hypothesis


  Dopamine is a neurotransmitter, when in excess seemingly causes the positive symptoms of schizophrenia
• Davis and Kahn proposed a revised dopamine hypothesis in which they suggested that the positive symptoms of schizophrenia are due to an excess of dopamine in subcortical regions of the brain, and the negative symptoms are due to a lack of dopamine in the mesolimbic pathway
• Gotto and Grace (2008) found that hippocampal dysfunction influences a reduction in dopamine release, affecting processing in the PFC and causing the cognitive symptoms of the disorder
• Noll (2009) claims there is evidence against the revised dopamine hypothesis as antipsychotics do not alleviate positive symptoms in a third of patients
• Addington et al (2015) completed a longitudinal study in which brain scans were done, suggesting that brain tissue can be predicted, allowing patients to be treated before symptoms develop
• Family dysfunction theory


  Particular family styles can cause or exacerbate schizophrenia in vulnerable individuals
• Double Bind theory


  Children who frequently receive contradictory information from their parents are likely to develop schizophrenia
• Expressed emotion


  Psychiatric patients have members who refer to them in a hostile/critical way, high levels of which are a key factor in increasing relapse rates
• Altorfer et al (1998) found that a quarter of their patients showed no response to the stressful comments made by their relatives
• Tienari et al (1994) found that adopted children with schizophrenic patients were only more likely to also receive a diagnosis if their family environment was described as disturbed
• Sarin and Warin (2014) found through reviewing research that the positive symptoms of schizophrenia may be caused by faulty thinking
• Typical antipsychotics


  Dopamine antagonists that bind to, but don't stimulate dopamine receptors, minimising positive symptoms
• Atypical antipsychotics


  Have a lower affinity for dopamine receptors and a higher affinity for serotonin receptors, leading to fewer side effects
• Leucht et al (2015) showed that patients who had been stabilised and continued with both atypical and typical antipsychotics had lower relapse rates than those who were given placebos
• Crossley found that atypical antipsychotics are just as effective as typical antipsychotics, but have side effects like headaches which are far less severe than tardive dyskinesia associated with typical antipsychotics
• Cognitive Behavioural Therapy for Psychosis (CBTp)


  Works by correcting the distorted beliefs that influence feelings and cause maladaptive behaviour
• NICE recommends that patients complete 10 sessions of CBTp
• Antipsychotics


  A preferred method of treatment, due to being effective and cheaper than other forms of treatment such as CBTp
• Antipsychotics


  Require less effort on the part of the patient, increasing the chances of them persisting in the treatment
• Cognitive Behavioural Therapy for Psychosis (CBTp)


  • Works by correcting the distorted beliefs that influence feelings, causing maladaptive behaviour
  • Recommended by NICE that patients complete 10 sessions
• CBTp

  1. Encouraging patients to find the origins of their symptoms

  2. Teaching patients to evaluate the content of their delusions, using the ABC model

  3. Setting behavioural assignments to improve functioning

  4. Developing alternatives to previous maladaptive beliefs
• During the more acute stages of the disorder


  CBTp is not effective - it is only after drugs have been taken that it is useful
• CBTp is time consuming and requires a great deal of effort on the part of the clients, making them less likely to persist in it</b>
• Only 1 in 10 of people in the UK who could potentially benefit from CBTp get access to it
• Family therapy


  Offered for 3-12 months for at least 10 sessions, in an attempt to reduce the level of expressed emotion within the family
• Family therapy


  • Involves psychoeducation, alliance formation, maintaining reasonable expectations, and encouraging more effective communication amongst family to reduce expressed emotion
• Family therapy has been shown to improve the mental state of patients, as well as increase their compliance with medication