Schizophrenia

• Schizophrenia

  A severe mental health disorder where contact with reality and insight are impaired, an example of psychosis.
• Positive symptoms

  Atypical symptoms experienced in addition to normal experiences, including hallucinations and delusions.
• Hallucinations


  Sensory experiences that have either no basis in reality or are distorted perceptions of things there.
• Delusions


  Beliefs that have no basis in reality.
• Negative symptoms

  Atypical symptoms which involve the loss of normal experience, including speech poverty and abolition.
• Co-morbidity


  The occurrence of two or more disorders together, which questions the validity of classifying the disorders separately.
• Limitation of classification of sz.

  There is cultural bias. For example, some African tribes believe they are blessed by their ancestors if they hear voices as they are communicating with them. However, in other cultures this could be seen as an hallucination, leading to incorrect diagnosis of sz as the criteria may differ between the uk and other cultures.
• Limitation of classification of sz

  There is symptom overlap with other conditions. For example, both sz and bipolar involve positive symptoms such as delusions and negative symptoms such as avolition. This suggests that these may not be separate but variations of one condition. So people may be treated for a condition they don’t have.
• Strength of classification of sz

  Diagnosis is reliable, so different clinicians are able to reach the same diagnosis for an individual. For example, Osorio reported inter-rater reliability of +0.97 when using the DSM-5.
• Genetic basis of sz

  • 108 genetic variations associated with an increased risk of sz.
  • mutation of parental DNA can lead to sz: Brown et al found positive correlation between paternal age (increased sperm mutation) and risk of sz.
• Dopamine hypothesis


  DA is important in the functioning of brain areas related to symptoms of sz. May be a result of high DA (hyperdopaminergia) in subcortex- e.g. excess of DA receptors in pathway to Broca’s area may explain speech poverty.

  May be result of low DA (hypodopaminergia) in cortex - e.g. low DA in prefrontal cortex may explain cognitive symptoms. This can lead to high DA in subcortex.
• Strength of genetic explanation

  Supporting evidence. For example, Gottesman found that risk of sz increases with genetic similarity - 9% for siblings but 48% for identical twins. Other evidence from Tienari - found that biological children of parents with sz have an increased risk even if they are adopted. This increases the validity. However, these studies often involve small sample as sz is uncommon, limiting the generalisability. Also difficult to separate nature and nurture, such as in twin studies.
• Limitation of genetic explanation

  Environmental factors increase risk. For example, Morgan found birth complications increase risk, and Forti et al linked sz to using cannabis containing THC. Psychological factors include childhood trauma (67% with sz). So genetic explanation doesn’t provide a complete explanation for sz.
• Limitation of genetic explanation

  Evidence for role of glutamate. Studies involving brain scanning and post-mortem have found increased glutamate level in brains of those with sz. and candidate genes are involved in the production of glutamate. So other neurotransmitters may be involved in sz. so the DA hypothesis is reductionist.
• Family dysfunction 


  Refers to processes within a family such as poor communication, cold parenting and high levels of expressed emotion. These may be risk factors for both the development and maintenance of sz.
• Schizophrenogenic mother

  • suggested by Fromm-reichmann
  • cold and controlling mother
  • creates tension and secrecy
  • leading to mistrust and paranoia -> delusions
• Double-bind theory

  • suggested by Bateson et al.
  • children receive mixed messages from parents and communication is contradictory
  • children are punished frequently and don’t understand what they did wrong (don’t have power to seek clarification)
  • leads to paranoia-> disorganised thinking
• Expressed emotion

  • High levels involve:
  • critical comments
  • hostility
  • emotional over involvement (needless self-sacrifice)
  • leads to avolition
• Strength & limitation of psychol expl (family dys)

  There is supporting evidence. For example, Berger found that people with sz. reported a higher recall of double bind statements by their mothers than non-schizophrenics. However, Liem found no difference in parental communication in families with a sz child and ‘normal’ families. This shows that the theory lacks reliable evidence as there is a mix of supporting and contradicting evidence, undermining the theory and reducing validity.
• Limitation of psychol expl (family dys)

  Family-based explanations have lead to parent blaming. Parents who have already suffered at seeing their child develop sz and who will likely be responsible for their care, feel responsible for their child’s illness, causing even more stress and anxiety. Therefore, this expl is socially sensitive so can have negative implications on society.
• Strength of psychol expl (family dys)

  There is supporting evidence. For example, Garety estimatate that relapse rates for those who receive family therapy is 25% compared to 50% for those who only receive standard care. However, other factors may influence relapse rates such as severity of sz, so cannot necessarily conclude the affect of family therapy.
• Dysfunctional thought processing 


  Cognitive habits or beliefs that cause the individual to evaluate information inappropriately, leading to undesirable consequences.
• Metarepresentation


  The cognitive ability to reflect on thoughts and behaviour which allow insight into our intentions & goals. Dysfunction disrupts this, explaining hallucinations and thought insertion.
• Central control


  The cognitive ability to suppress automatic responses while we perform deliberate actions instead. Dysfunction disrupts this, explaining disorganised speech and derailment of thoughts.
• Strength of cognitive explanation

  There is supporting evidence. For example, Stirling compared performance in cognitive tasks including the stoop test (name font colour of colour words), and found that people with sz took twice as long as the control, suggesting their cognitive processes are impaired.
• Limitation of cognitive explanation

  Only explain proximal origins of symptoms. For example, they only explain what is happening now to produce symptoms, whereas distal explanations focus on the initial cause of the condition. It is also not clear how genetics or childhood trauma lead to impaired cognitive processing, so this theory only provides a partial explanation of sz.
• Typical antipsychotics


  E.g chlorpromazine

  Act as dopamine antagonists by blocking DA receptors in synapses, initially increase DA but then decrease, normalising transmission to reduce symptoms. Given in up to 800mg doses. These antipsychotics have a sedative effect, so can be used to calm people with other conditions.
• Atypical antipsychotics


  Aimed to improve effectiveness is suppressing symptoms while minimising side effects. E.g. Clozapine - can cause blood condition, given in smaller doses (up to 450mg), is a DA, serotonin & glutamate antagonist, improves mood and cognitive functioning so is prescribes to suicidal patients.
• Strength of antipsychotics for sz

  There is supporting evidence. For example, Thornley conducted a meta-analysis and found better overall functioning and reduced symptoms taking chlorpromazine compared to control. Meltzer found that clozapine is more effective than typical antipsychotics (in 50% of cases where other drugs have failed). This shows that antipsychotics (especially atypical) are effective.
• Limitation of antipsychotics

  There are flaws with supporting evidence. For example, most studies only look at short-term use and can exaggerate the size of the evidence base. As these drugs have calming effects they may have the same positive effect on people without sz, so cannot determine whether they reduce severity of psychosis.
• Limitation of antipsychotics

  They are associated with side effects. For example, dizziness & itchy skin. Long-term use can lead to involuntary facial movements due to DA supersensitivity, and neuroleptic syndrome - due to blocked DA in hypothalamus, causes delerium and coma, can be fatal. Therefore, antipsychotics may do more harm than good so individuals experiencing side effects may avoid treatment, making it ineffective.
• Token economies used to manage sz

  Reward systems used to manage behaviour of people with sz, in particular tho who developed patterns of maladaptive behaviour due to spending time in psychiatric hospitals. Use has declined over time due to more community-based care & ethical issues of restricting rewards to people with mental disorders.
• Ayllon & Azrin (1968)


  Trialled token economy in a group of female sz patients. They found that positive behaviour increased significantly.
• Matson et al (2016)


  Identified behaviour tackled by token economy: personal care, condition-related behaviours, social behaviours. Major benefits: improves quality of life within hospital and normalises behaviour & makes it easier to adapt to life back in community.
• Strength of token economy for sz

  There is supporting evidence. For example, Glowacki did a analysed evidence from 7 studies and found a decrease in negative symptoms and unwanted behaviours. However, this involved a small sample. This can lead to a ‘file drawer problem’ resulting in bias towards positive published findings because undesirable findings have been ‘filed away’. This questions the integrity of the evidence.
• Limitation of token economy for sz

  There are ethical issues. For example, this gives professionals power to control behaviour of patients, imposing their norms onto others, which can be problematic if target behaviours are not chosen sensitively. Restricting the availability of pleasures to patients not behaving as desired means that those with distressing symptoms may feel worse. So the impact on patient freedom and quality of life may outweigh the benefits.
• Limitation of token economy for sz

  There are more pleasant and ethically sound alternatives. For example, art therapy may be beneficial - despite a small evidence base, this can be regarded as high gain Low risk to managing sz.
• CBT for sz

  Can help a patient understand how their irrational cognitions impact their feelings and behaviour - just understand the root of their symptoms can reduce distress and help them cope. Normalisation = teach them that hearing voices is an extension of ordinarily thinking words. Challenge delusions by examining how likely it is that their belief is true.
• Family therapy

  Carried out with family members and patient, aims to improve communication in family and reduce stress, by reducing levels of expressed emotion. It improves the family’s ability to help by improving their beliefs about sz. Also ensures a balance is maintained between caring for patient and maintaining their own lives.
• Burbach model for family therapy

  1. share information
  2. identify what different family members can offer
  3. encourage mutual understanding and safe space to express feelings
  4. identify unhelpful patterns of interaction
  5. skills training
  6. relapse prevention planning
  7. maintenance for future