Schizophrenia

• classifications of schizophrenia, schizophrenia is a type of psychosis characterised by a profound disruption of cognition and emotion so that contacts with external reality is impaired. it affects 1% of the population at some time in their lifetime. there are positive (in addition to normal experience) and negative (loss of normal experience) symptoms. The ICD-10 (EU) requires 2 or more negative symptoms or 1 positive symptoms whilst the DSM-5 (USA) requires 2 positive symptoms and a disturbance for more than 6 months.
• Positive symptoms:

  Hallucinations- disturbances in perception that have no basis in reality, most common are auditory.

  Delusions- firmly held irrational beliefs, include delusions of persecution, grandeur, control and reference.

  Disorganised speech- hard time to organise thoughts so have difficulty following along with conversation, jump between topics.

  Catatonic behaviour- dress or act in a way that is bizarre to other people, there is a reduced reaction to the immediate environment.
• negative symptoms=

  Avolition- lack of goal orientated behaviour often due to a lack of motivation

  Alogia- speech poverty which is a limited output of speech often with repetitive content.

  Affective Flattening- unresponsive and immobile facial expressions with little body movement.

  Anhedonia- inability of pleasure

  Asociality- lack of desire for company
• reliability (schizophrenia) is the consistency of diagnosis from different psychologists across time and culture.
• validity (schizophrenia) extent that schizophrenia is a unique syndrome with unique characteristics.
• Symptom overlap is when schizophrenia has the same symptoms of other conditions e.g. schizophrenia and bi-polar disorder share hallucinations which calls into question that validity of schizophrenia as a distinct disorder and hence its classifications.
• co-morbidity is the extent to which 2 or more conditions occur together. in terms of diagnosis this may make it difficult to tell the difference between the two conditions e.g. depression and schizophrenia. so it might better be seen as one condition hence calling into question the validity.
• Gender bias is the accuracy of diagnosis is dependent on the gender of the individual. often because women are better at masking or stereotyped beliefs about gender. Loring and Powell asked 290 male and female psychiatrists to diagnosis a male or female patient and found the male was diagnosed 56% of the time whilst female was 20%. gender bias was less evident in female psychiatrists.
• cultural differences affects both validity and reliability of diagnosis and classification. research suggests that there is a significant variation between cultures when it comes to diagnosing schizophrenia. e.g. african Americans are 9x more likely to be diagnosed, this is perhaps because positive symptoms are more acceptable in African cultures but this is odd to psychiatrists. this questions the validity as psychiatrists may have imposed etic. the reliability is also questioned as there may not be agreement on the diagnosis across cultures. (same symptoms different diagnosis)
• evaluation symptom overlap:

  it is possible to separate illnesses which increases the validity e.g. research has found despite schizophrenia and cocaine abuse being co-morbid it is possible to make accurate diagnosis so symptom overlap may not be a massive issue for validity.
• co-morbidity evaluation:

  supporting evidence that co-morbidity does occur within real-life and therefore is a threat to the validity of diagnosis and classification e.g. 50% of schizophrenics also have a depression diagnosis and 47% had substance abuse problems. hence if these conditions often occur together it may be best to view them as one illness.
• cultural bias evaluation:

  evidence of culture bias in the diagnosis of schizophrenia. Copeland found when a description of a patient of a ethnic minority was given to US and UK psychiatrists 69% of the US diagnosed schizophrenia whilst 2% of the British gave the diagnosis. this suggest that their symptoms were misinterpreted. hence this calls into question the reliability as it shows a lack of consistency across culture.
• Gender bias evaluation:

  Evidence from Loring and Powell that male patients are 36% more likely to be diagnosed than female symptoms but that this difference was not evident in female psychiatrists. hence proving that gender bias does pose a threat to validity of diagnosis.
• biological explanation for schizophrenia argues that genetics and neural correlates/ dopamine hypothesis are the most likely to explain schizophrenia.
• Genetic explanation for schizophrenia: schizophrenia is through to be polygenetic with over 108 genetic variations thought to be involved with an increased risk. Gottesman conducted a large scale family study and found higher concordance rates (48%) in MZ twins compared to (17%) in DZ twins. Hence it can be argued that schizophrenia runs in families.
• Neural correlates explanation of schizophrenia. Neural correlates are measurement of the structure and function of the brain that occur in conjunction with symptoms of schizophrenia. imaging studies have found reduced grey matter volume in the pre-frontal cortex in patients. a link has also be found between the amount of pre-frontal thinning and negative symptom severity.
• the dopamine hypothesis suggests that unusually high levels of dopamine (excitatory affect associated with pleasure) are related to schizophrenia especially positive symptoms. this may be because they have abnormally high levels of D2 receptors on the post-synaptic neuron resulting in more dopamine binding and hence more firing. this is thought to lead to delusions and hallucinations. The revised hypothesis suggests that instead positive symptoms are caused by hyperdopaminergeria in the sub-cortex and high and low levels in different parts of the brain.
• evaluation of the biological explanation of schizophrenia:

  -reductionist as other factors are being ignored.

  -unable to determine cause and effect in the dopamine hypothesis

  +much of the evidence is from successful drug treatments

  +supporting evidence from Vita that shows significant grey matter loss over time in patients.
• Drug therapy for schizophrenia:

  drug therapy is done through antipsychotic medication which attempts to reduce the symptoms. they work by reducing dopaminergic transmissions which is reducing the actions of dopamine. there are two types typical and atypical.
• typical anti-psychotics were developed in the 1950's and are dopamine antagonists so bind to dopamine receptors and don't stimulate them. initially dopamine levels build up but then production is reduced which reduces positive symptoms. several weeks is needed for improvement. antipsychotics block dopamine receptors across the brain which leads to undesirable side effects such as fatigue. there are also extrapyramidal side effects such as tardive dyskinesia (involuntary muscle movement) from long term usage.
• atypical anti-psychotics have been used since the 1970's in order to improve the effectiveness of the drug and minimise side effects. atypical anti-psychotics block dopamine receptors but only temporarily and then rapidly dissociate hence having little effect on dopamine symptoms in other areas e.g. movement. however there is also side effects, the most severe being agranulocytosis. Atypical side effects act on both negative and positive symptoms.
• evaluation of drug therapies.

  +antipsychotics enhance quality of life for patients as they can live independently hence they are an effective tool.

  +atypical antipsychotic have advantages over typical due to their reduced side effects because of the way they work.

  -ethical issues to consider when prescribing because those with severe symptoms cannot give informed consent.

  -mixed evidence for how effective atypical is for treating negative symptoms as they may just be improving ''secondary'' negative symptoms via improvements in positive symptoms.
• psychological explanation of schizophrenia suggests that it is either due to family dysfunction or faulty informational processing.
• the family dysfunction model, family experience of interpersonal conflict, communication issue cause schizophrenia. Schizophreno-genic mother, mum is cold and controlling dad is passive, leads to a tense family climate and excessive stress triggering delusions. Double-bind theory, the child receives mixed messages, cannot do the right thing, they are punished =withdrawal of love leading to understand world as confusing triggers disorganised thinking. expressed emotion, family have high levels they have exaggerated involvement (needless self-sacrifice)causing stress triggers relapse/ onset.
• the cognitive explanation for schizophrenia- schizophrenia is caused by abnormal informational processing due to dysfunctional through processing (evaluate info inappropriately). everyone has meta representation and central control, these are faulty in schizophrenics. meta-representation is ability to reflect on thoughts and behaviour, schizophrenics cannot recognise their own actions explaining hallucinations/ delusions. Central control is ability to supress automatic responses. Dysfunction leads to disorganised speech e.g. derailment of speech.
• evaluation of psychological explanation:

  -ethical implications

  -cannot explain all cases

  +supporting evidence patients with schizophrenia took twice as long to carry out the stroop test (cognitive)

  +use of CBTp to treat schizophrenia
• CBTp aims to help patients identify irrational thoughts and challenge them and reality testing them to reduce distress. it helps patients to establish links between thoughts, feelings and actions with symptoms allowing them to cope more effectivey. The NICE guide recommends 16 sessions. It uses the ABCDE model. It does not get rid of schizophrenia. CBTp uses normalisation saying many people have unusual experiences reducing anxiety and sets behavioural assignments to create goals such as shower everyday.
• evaluation of CBTp:

  -requires motivation

  -expensive

  -ethical implications if we challenge paranoia do we interfere with freedom of thought.

  +CBTp has been found to be effective in reducing rehospitalisation rates and improving social functioning.
• Family therapy for schizophrenia is interventions aim to improve the functioning of family. aiming improve the quality of communication, reduce stress of living = reduce rehospitalisation. conjuction with other resources. the patient talks to family about what they find helpful, collectively agree on solutions. strategies include: therapeutic alliance between members, improving knowledge about schizophrenia, maintaining reasonable expectations and achieving balance between caring + individual life. Pharoah reviewed 53 studies, increased medication compliance, did not improve concrete outcome.
• evaluation of family therapy as treatment for schizophrenia:

  +only aims to make schizophrenia manageable, not a cure. CA may reduce number of MH crisis'

  +evidence from pharoah

  +positive economic implications as cost of treatment is offset by cost of rehospitalisation CA- expensive to train therapists to do this.
• token economy is a way of managing schizophrenia, it is used to shape and control behaviour so long hospital stays can be managed. it is based on operant conditioning as desirable behaviours are rewarded through selective reinforcement. rewards are given immediately as a secondary reinforcer (no value) which can then be swapped for more tangible rewards such as sweets/ privileges these are the primary reinforcers (give pleasure/ drive behaviour). this encorages desirable behaviour to be repeated and improves QOL
• selective reinforcement is a type of behavioural modification which seeks to increase desirable behaviours and extinguish undesirable behaviours.
• evaluation of token economy as schizophrenia management:

  -only seek to make it manageable and more socially acceptable CA-allows them to return to some form of normality

  -ethical issues as it could lead to human rights violations e.g. controlling food

  -difficult to administer to outpatient care
• interactionalist approach to schizophrenia such as the diathesis stress model suggests that an underlying vulnerability paired with and environmental stressor can lead to schizophrenia. Meehl suggested that if a persons does not have a genetic vulnerability they will not develop schizophrenia and that both are needed. Gottesman found that over 50% of MZ schizophrenia is not accounted for and hence the environment must play a role. Tierney found that child-rearing style with high levels of criticism and low empathy were implicated but only in high-genetic risk group.
• evaluation of interactionalist approach:

  +combine several treatments making it likely to be more effective

  +evidence both are important as seen in Tierney's research

  -may be other diathesis factors other than stress e.g. brain damage, schizophrenia was 4x more likely if their was a long labour.