schizophrenia

• Describe the classification of schizophrenia.

  1. Positive symptoms: hallucinations & delusions; Negative symptoms: abolition, speech poverty (alogia) & catatonia.​
• What is the key study on the reliability and validity of the diagnosis and classification of Sz?  Rosenhan & 7/8 pseudo patients being admitted and taking 7-52 days to be released from psychiatric hospital. Proved reliability diagnosed as insane, but not reliable as diagnosing sanity (as shown in Experiment 2 when psychiatrists identified a large number as “fake/sane” when none were pseudopatients. Questions whether the diagnosis of Sz is even valid.
• Name the reasons why the classification of Sz is unreliable and invalid. Unreliability = poor inter-rater reliability & cultural bias; Invalid = comorbidity, gender bias & symptom overlap.
• What are the biological explanations of Schizophrenia? Genetics, neural correlates & dopamine hypothesis.
• What is the key study on the genetic explanation of Sz? Gottesman, family & twin study (48% MZ & 17% DZ)
• Give 3 evaluation points for the genetic explanation of Sz. Research support through twin studies, however MZ reared similarly, e.g., MZ same gender are likely to suffer the same family dysfunction than DZ. Research support through adoption studies,  Sz biological mothers = 17% concordance compared to 0% for adoptive non Sz mothers. Though this could be trauma from the adoption process or adoptive demonstrating family dysfunction due to child having a Sz mother. More likely an interaction between environment and genetics (DSM). However, maybe more modern DSM.​
• What would you put in the question if it said “describe the neural correlate explanation of Sz”? Dopamine hypothesis and areas of the brain (neural correlates).​
• Describe the dopamine hypothesis explanation of Sz. High dopamine (hyperdopaminergic) in mesolimbic = positive symptoms; low dopamine (hypodopaminergia) in mesocortical area = negative symptoms.​
• Describe the neural correlates explanation of Sz. Mesolimbic (amygdala = overactive fear response (delusions) & hippocampus = halluncinations as fearful memories lacking time sequencing seem like present day experience); mesocortical (PFC (lack of goals & motivation – avolition), motor cortex (catatonic) & Broca’s area (speech poverty). Enlarged ventricles (lack of grey matter in PFC and temporal lobes). Lack of ventral striatum, Sz cannot anticipate rewards, lack motivation – avolition. 
• What are the psychological explanations of Schizophrenia? Family dysfunction (double bind, high expressed emotion & schizophrenogenic mother), cognitive explanations (hypervigilance, egocentric bias, loss of central control & meta-representation).
• How does double bind cause Sz? Stress from a no win situation, as the mothers paralinguistics do not match her verbal message. Child is confused over the right course of action to please their mother. They retreat into their psychosis (hallucinations & delusions) to explain the mixed messages and cope with the stress caused.
• What are the elements of high expressed emotion and how do they cause Sz? Hostility, emotional over involvement & critical comments. They cause significant stress and feel guilt about the stress they are perceived as causing the family. They retreat into a psychosis to avoid the stress and guilt felt.​
• How does a schizophrenogenic mother cause Sz? They are cold, aloof, rejectional and controlling. The child has feelings of distrust towards their mother leading to paranoid delusions.​
• Family dysfunction explanation of Schizophrenia

  • Research supports high expressed emotion (HEE) - 4x more likely to relapse than low expressed emotion (LEE) families
  • Research supports double bind - Schizophrenia mothers gave more double bind statements than non-Schizophrenia mothers
  • Methodological issues as self-report
• Individual differences


  Not all Schizophrenia patients have a stress response to critical comments (25%)
• The family dysfunction theory is socially sensitive, placing blame on mothers, increasing stigma on families and preventing them seeking help
• Family dysfunction

  Could be more a response to Schizophrenia than causing it, and is more involved in relapse than cause
• The family dysfunction theory could be biological, as per Gottesman's twin study, hence mothers may have Schizophrenia symptoms or traits
• Explain how cognitive explanations cause Sz symptoms. Hypervigilance – excessive attention to auditory stimuli (hallucinations), egocentric bias – think irrelevant events are about them & arrive at false conclusions (delusions), loss of central control – difficulty with selective attention (disorganized speech), meta-representation – cannot recognize own thoughts and feelings as their own, seems external to them (hallucinations & delusions).​
• Give 3 evaluation points for the cognitive explanation of Sz. Support for cognitive deficits (e.g., egocentric bias & meta-representation difficulties & CBTp is effective which challenges these thoughts. However, it cannot explain negative symptoms. Research support for loss of central control through strop test. Though inferences are being made as cannot empirically see central control processes. Cognitive explanation is also machine reductionist ignores environment (family dysfunction), chicken & egg – does it cause Sz or a symptom of another cause (family dysfunction). ​
• Describe the interactionist explanation for Sz. Original DSM and modern DSM (epigenetics)
• Give 3 evaluation points for the interactionist explanation of Sz Research support for DSM, however oversimplified, original DSM not fully explanation, modern is, can never separate nature from nurture, research support from interactionist treatments, however treatment fallacy.​
• What are the treatments for Sz? Drugs, CBTp & family therapy.
• What are the 3 drug treatments for Sz & how do they work? Chlorpromazine (typical, blocks D2 receptors), Clozapine (atypical – blocks D2 receptors, serotonin & glutamate), Risperidone (atypical, blocks D2 & serotonin receptors)
• Give 3 evaluation points for the use of drugs to treat Sz. Effectiveness of anti-psychotics v relapse rates, side effects of chlorpromazine v atypicals, ethical issues (COSH argument) & short or long term effects.​
• Describe how CBTp is used as a treatment for Sz. Assessment, engagement, ABC Model, Normalisation, Critical collaborative analysis.​
• Give 3 evaluation points for the use of CBTp to treat Sz. Effectiveness v when initial acute phase, effectiveness overstated (therapists analyzing the effectiveness (biased), could be more the level of competence of the therapist, however lack of availability in Uk (large waiting lists) v duty of care and votes.​
• Describe how family therapy treats Sz. Person’s home, 3-12 months, 2-4 weeks, 10 sessions, 2 therapists. Relatives educated on Sz and encouraged to get Sz perception of their condition (asking questions), practical coping strategies given by therapists, therapist help with more effective communication (LEE), family and patient trained to spot signs of relapse.​
• Give 3 evaluation points for the use of family therapy to treat Sz. Effectiveness as lower relapse rate than drugs. Issues comparing family therapy to drugs as CBTp and drugs, cannot do just CBTp (unethical). Treatment is more helping to deal with Sz symptoms of the patient than treating the cause of the Sz (hence lower relapse). Economic implications of family therapy compared to drugs.
• Describe how token economy systems are used to manage schizophrenia. Classical conditioning (NS = token), operant conditioning (positive reinforcement from exchanging the token, punishment from taking away tokens for bizarre behaviour), behavior shaping = given tokens for more complex behaviors.​
• Give 3 evaluation points for the use of token economy systems to manage schizophrenia. Usefulness of TES however meta-analysis so used different methodologies and varying degrees of consistency in TES. Not effective long term, only works whilst in the TES so not a permanent behavior changer (extrinsic reward, rather than intrinsic). Could be considered to make them hide their symptoms to avoid punishment and gain a reward but not actually curing Sz symptoms (hence unethical). ​
• Describe the interactionist method of treating Sz. CBTp, drugs, family therapy & TES whilst in a psychiatric hospital. Hence a combination of treatments used together. TES needed in hospital for the acute phase, then drugs to reduce symptoms, enabling them to access the CBTp to reduce the cognition and family to lower relapse rates. ​
• Give 3 evaluation points for the interactionist method of treating Sz. Effectiveness of CBT, drugs & counselling has lowest readmissions into hospital. However, original DSM assumes that it is a genetic vulnerability which  is brought out by environment, environment may play a larger role (modern DSM). Interactionist treatments lower relapse rates (0%), however practical issues with using interactionist treatments (economic implications & waiting lists). ​