Interactionist approach

• What does the interactionist approach say?

  An approach that acknowledges thatschizophrenia results form acombinationof biological, social and environmental factorsAckonwleges thecomplexityof the disorder
• What is the diathesis-stress model?

  The idea that schizophrenia is the result of the combination of a vulnerability to the illness and the stress needed for it to become a realityThe interaction is key

  
• Meehl's model (original diathesis-stress model)


  Diathesis entirely genetic as a result of a single 'schizogene' which led to a biologically based schizotypal personalityStates that people without the gene cannot develop scchizophreniaThe schizogene is necessary but not sufficient for the development of schizophreniaOriginally the stressor was only psychological (typically related to parenting; schizophrenogenic mother)
• Modern diathesis-stress model (neurodevelopmental model)


  Not one ‘schizogene’ but many genes (polygenetic)- Suggest that there areother factors beyond just genetics, including psychological trauma (e.g. childhood trauma which affects brain development) could be the vulnerability (rather than just the stressor)↳ Can cause changes to the Hypothalamic-pituitary adrenal (HPA) and systems can become overactive making people more vulnerable to later stress
• What are some external stressors that may trigger schizophrenia?

  - Family dysfunction- Critical life events (going to uni, divorce etc)- Urban living (2.37xhigher risk)- Cannabis (increases risk to7xrelative to dose)↳ cannabis interferes with your dopamine system however our understanding is still limited
• Ripke et al (2014)


  Meta-analysis of genome studies. Genetic make-up of 37,000 patients compared to 113,000 controlsIdentified 108 genetic risk factors in schizophrenia ∴ schizophrenia ispolygenetic‘Schizogene’ too simplistic!!!
• Tienari et al (2004) - strength of interactionist approach


  Followed children of schizophrenic mothers who had been adopted in Finland5.8% of children adopted by ‘healthy’ families developed schizophrenia36.8% of children adopted by dysfunctional families developed schizophreniaThis shows that a combination of genetic vulnerability and family stress can lead to greatly increased risk of schizophrenia
• Murray (1996) - strength of interactionist approach


  Children born after flu epidemics where their mother to the flu whilst pregnant (especially in the 2nd trimester) had an88%increased chance of developing schizophrenia than those born @ the same time w/ non flu mothersFlu in the 2nd trimester is suspected of causing neural development defects leading to increased vulnerability to schizophrenia (brain damage affects dopamine functioning)
• Jarvis and Okami (2019) - limitation of interactionist approach


  Suggest this argument is the same as claiming that because alcohol reduces shyness, shyness is caused by a lack of alcohol -the treatment causation fallacy∴ we cannot automatically assume that the success of combined therapies means interactionist explanations are correct
• Over-simplistic - limitation of the interactionist approach


  The original diathesis stress model is over simplisticWe used to see vulnerability as purely biological and stress as psychologicalRecent events suggest that we early trauma causes vulnerability and that biological events like smoking can be environmental stressorsHouston et al(2008): Found that childhood sexual trauma was a diathesis and cannabis use a trigger.
• What is the interactionist approach to treating schizophrenia?

  - Involves combining biological and psychological therapies↳ Antipsychotics and CBT- Biological therapies reduceseverityof symptoms to increase engagement with cognitive therapy and allow for behavioural therapies to be effective- Which particular combination of treatments is best is affected by each patients individual circumstances and needs
• Guo et al (2010) - strength of interactionist treatments


  Randomised controlled trail of a clinical sample of 1,268 patients with early-stage schizophreniaPatients randomly assigned to either:- Antipsychotics medication treatment only- Antipsychotic medicationplus12 months of CBT administered over 48 group sessionsPatients who had a combination of drugs and psychological therapy hadimproved insight,lower risk of relapsehigher quality of lifeandincreased social functioning
• Hogarty et al (1986) - strength of interactionist treatments


  Assessed replaces rates of 103 schizophrenics from high EE families receiving various treatmentsFound these relapse rates;41% w/ just drugs20% social support therapy and drugs19% family therapy and drugs0% social support therapy, family therapy and drugsCombined more effective!↳However, further study suggests that combined treatments only delay relapses not prevent
• Economic implication - limitation of interactionist treatments


  Combining therapies increase the cost of treatmentCBT - multiple sessionsDrugs - for life $$$More expensive for the NHS and the taxpayer who funds the service↳ However, if it prevents hospitalisation etc it may be more cost effective in the long-run