schizophrenia
schizophrenia
A psychotic disorder where the patient experiences a loss of touch with reality
positive symptoms of schizophrenia
Hallucinations: Disturbances in perception (types- Auditory, Olfactory, Tactile, Visual)
Delusions: false or irrational beliefs (types- Delusions of grandeur (Believe you are supreme), Delusions of persecution (Belief others are trying to cause you harm), delusions of control (Belief external forces of controlling your behaviour)
Incoherent speech: Speech disorganisation, Changes topic mid sentence
negative symptoms of schizophrenia
speech poverty: Inability to speak properly, lack of ability to produce fluent words
avolition: Difficulty to start and continue with goal-directed behaviour, Reduce motivation to carry out activities
Anhedonia: Lack of interest, enjoyment or pleasure from life's experiences
Flat effect (emotional blunting): A lack of outward emotional expression, diminished ability to recognise emotions in others
classification and diagnosis of schizophrenia
To diagnose, we need to distinguish one disorder from another
Identifying clusters of symptoms that occur together
Two major systems: IDC – 11, DSM – 5
issues of reliability and diagnosis and classification
Interrater: Consistency between clinicians, independently reach same diagnosis
Test retest: Consistency overtime, Same person, same test, different time
threats of reliability
Classification tools used in UK and USA differ
Diagnosis is reliant upon accurate information from patient or carer
issues of validity in diagnosis and classification
Predictive validity: If treatment works, presume diagnosis was accurate
Descriptive validity: When symptoms are dissimilar to other conditions
aetiological validity: Symptomatic behaviours impatience is like other people with same diagnosis
Concurrent validity: Extent which test correlates with established benchmark
threats of issues with validity
Comorbidity: Patient presents with more than one condition
Overlapping symptoms: Many symptoms are similar
Gender bias: More men diagnosed than women
Cultural bias: More Afro-Americans diagnosed
Studies concerning validity- rosenhan (1973)
Investigated reliability
Sent eight pseudo patients who falsely reported hearing voices to psychiatric hospitals
Most diagnosed with schizophrenia
After discharge, were labelled 'in remission'- Let them to incorrectly identify real patients as impostors
Poor diagnostic reliability, powerful influence of labels, Raises ethical issues about validity
reliability ao3
strength- Good reliability: Diagnosis of using DSM – 5, Pair of interviewers achieved interrater reliability of +.97 and test retest of +.92
limitations- why do implications with Inconsistent diagnoses: Can have negative effect on accuracy of a diagnosis, If there is no reliability amongst clinicians, the needle impact the treatment and recovery of patients, Problematic when we consider that diagnosing someone schizophrenic when they're not can have a lasting impact and implications for their life
validity ao3
limitation- Symptom overlap: both schizophrenia and bipolar disorder involve positive symptoms and negative symptoms, Suggest both may not be two different conditions but variations of a single condition, Schizophrenia is hard to distinguish from bipolar
genetic explanations of schizophrenia
Hereditary
Genetic factors could increase the risk such as genetic closeness or combination of genes not functioning
Family studies
Risk of genetic closeness to someone else in the family who has schizophrenia, e.g. parents
gottesman (1991)- Risk of schizophrenia increases in line with genetic similarity, children= 13%, mz twins= 48%
twin studies
Compared to concordance rates in MZ and DZ twins
genain quadruplets: Higher concordance rates found in identical twins
adoption studies
Investigate children adopted away from the biological family
hesston (1996)- If schizophrenia is genetic, children will develop it even though they have no contact with their biological parents
candidate gene
Schizophrenia is polygenic
Certain candidate genes such as PCMI have been linked to abnormal neural transmission
ripke et al (2014)- 37,000 people with schizophrenia diagnosis compared to 113,000 without diagnosis, 108 genetic variations were associated with slightly increased risk of schizophrenia
The dopamine hypothesis (Neural correlates)
Higher level levels of dopamine is associated with schizophrenia
Receptor sites may be more sensitive causing excessive binding of dopamine
Reuptake process: Access dopamine remains in synaptic theft and continues to bind but is inhibited
High dopamine levels: Associated with Positive symptoms
Low dopamine levels: Negative symptoms
neural correlates
Brain structure and function
enlarged ventricles
reduced grey matter density in prefrontal cortex
Associated with schizophrenia
genetic explanation ao3
Strength: Twin studies and adoption studies
Limitation: Biologically deterministic- Criticised, Assumes that we are determined by our genetics, Does no room for free will to reduce their risk of developing schizophrenia
neural correlates ao3
strength- High scientific credibility: Objective view of schizophrenia such as dopamine can be measured in a controlled way
strength- Practical implications: Antipsychotic medicines, e.g. clozapine and Chlorpromazine reduce dopamine levels, helps many sufferers manage their symptoms and live more functional lives
limitation- Biologically reductionist: Criticised, Assumes behaviour can be best understood when broken down into smaller parts such as chemicals in the brain, Dopamine hypothesis fails to acknowledge the influence of nurture overlooking family dysfunction or stress
drug therapy- Biological treatment treatments for schizophrenia
Antipsychotic drugs
Reduced symptoms
Short or long-term
typical antipsychotics
Aim to block dopamine activity in the brain
Target dopamine
Block receptor sites
Reduced positive symptoms
1950s
Tablet, syrups or injection
Maximum 400 to 800 mg
typical antipsychotic example
chlorpromazine
Act as antagonist to reduce actions of neurotransmitter dopamine by blocking receptors in synapses of brain
initially when taking, Dopamine levels buildup, but then production is reduced
Normalises neurotransmission
atypical antipsychotics
Aim to block some dopamine activity in brain
Targets dopamine, serotonin and glutamate
Do not completely block receptor sites
Reduce positive and negative symptoms
1970s
Minimise side effects
atypical antipsychotic example
clozapine
More effective than typical
Potentially fatal side effects- Not available as a injection
Typically 300 to 450 mg a day
Can cause agranulocytosis (Severe lack of wbcs)
Improve mood and reduces depression and anxiety
Risperidone
1990s
As effective as as a pen, but without serious side effects
Daily 4 to 8 mg
biological treatments for schizophrenia ao3
Strength: Accessible and available- More accessible unavailable than other treatments (cbt), Quicker treatment for those who are at risk of endangering themselves or others, However, not appropriate to assume that they will be able to take responsibility for taking their medication safely and regularly
Limitation: Serious side effects- Typical- Dizziness, weight gain, involuntary facial movements, coma, death, Atypical- Agranulocytosis
unethical when misused- concerns that institutions may use to control the individual and keep them sedated, Described as a 'chemical straitjacket' impacting the clarity of thought in patience
Psychological explanations: Family dysfunction
According to the theory, the condition is rooted with the family and home
Focuses on ways in which an individual is communicated with at home and as well as mood and environment of home life
The schizophrenogenic mother
fromm-reichman (1948)
Proposed explanation based on accounts about patients childhood
According to fromm-reichman, Schizophrenogenic mother is cold, rejecting and controlling
Characterised by tension and secrecy
Develops into paranoid delusions
double bind theory
bateson (1956)
Refers to children who frequently receive mixed, conflicting or confusing messages
E.g. parent tells child they love them in a shouting tone
Experiencing double bind communication- will not be able to develop an accurate perception of their own reality
Leads to flat effect, hallucinations, delusions and disorganised thinking
expressed emotion (ee)
high ee: Critical, hostile, secretive= Patients are more likely to relapse
Whatever causes a relapse is likely to have been the cause of the condition
Negative emotion expressed towards family members
psychological explanations: family dysfunction ao3
strength- Positive implications for treatment: The other therapy programs for the whole family to reduce levels of ee at home + To coach them to use more supportive and positive communication, Addressing it as a family will help to reduce symptoms and severity
Limitation- Parent blaming is socially sensitive: Criticised, Offers controversial view of how schizophrenia develops placing blame onto the family and the upbringing of children, If family dysfunction is the cause of schizophrenia then blaming them will exaggerate the EE at home, contributing further to the disorder
psychological explanations: Cognitive explanations: Dysfunctional thinking
Disruption of normal thought processing
reduced thought processing is associated with negative symptoms
Reduced processing of information associated with hallucinations
psychological explanations: Cognitive explanations: cognitive faults
Faults may lie in person's ability to selectively attend to information
Anyone who is not able to filter out irrelevant stimuli is likely to experience sensory overload and become overwhelmed
frith (1992) identify two further kinds of dysfunctional thought processing:
Metarepresentations dysfunction- The ability to reflect on thoughts and behaviour, allows us insight into our own intentions, The inability to do this may lead to people experiencing delusions of control, believing that their thoughts or behaviours are not their own
Central control dysfunction- Issues with cognitive ability to suppress automatic responses, An inability to do this mainly to incoherent speech with derailed communication
psychological explanations: cognitive explanations ao3
strength: The cognitive approach provides an excellent explanations for the symptoms of schizophrenia, There is therefore an argument for seeing schizophrenia primarily as a psychological condition
limitation: Explanation lack scientific credibility- Not compatible with the aims of science, Researchers are only able to make inferences about cognitions rather than established and causing effect, Theory doesn't have high scientific credibility
limitation: A reductionist explanation- Assumes schizophrenia is caused by cognitive faults and reject the possibility that other fact this like biology and learning contributes to the development, not able to explain everyone with schizophrenia
psychological treatment for schizophrenia: cbt
Aims to correct irrational or dysfunctional cognition and behaviours
Therapist develops strategies to change the way they think and behave
Makes sense of how ireational cognitions impact feelings and behaviours
therapist convinced them the voice comes from the malfunctioning speech centre in their brain- make better to cope
Provide evidence the challenges that original thoughts
Reduces distress, anxiety and depression
Psychological treatments: Family therapy
pharoah et al (2010)
Aims to improve the quality of communication and interaction
Educating family members on the condition so they informed and can identify triggers and relapse
Psychoeducation
Reduces level levels of EE, stress and rise of relapse
Reduces blame and family tension
psychological treatments: CBT ao3
Strength- Highly effective in collaboration with drug therapies: However, this does suggest that CBT alone may not be the best treatment, Medication is only treatment that can be used on its own so suggest that CBT is not superior to drug therapies
Limitations- Not the most appropriate treatment: People struggling with severe symptoms, Those too paranoid to form trusting alliances may be experiencing solutions of persecution, CBT may be a threatening experience and would hinder their progress and recovery
psychological treatments: family therapy ao3
strength- Benefits for the family: by strengthening the functions of a whole family, family therapy lessens the negative impact of schizophrenia on other members and strengthens aibility of family to support
Limitation- high drop out rate: As therapy requires regular attendance of all family members, Ethical issues with sharing sensitive information, patients may not feel comfortable
management of schizophrenia: Token economies
Reward systems used to manage the behaviour of people
Especially those institutionalised and have maladaptive behaviour
Method of helping patients cope
Rewarded with tokens making behaviour more likely to be repeated and become normalised (operant conditioning and positive reinforcement)
token economy procedure
1. Devise a set of goals and behaviour e.g. making their bed
2. Give a token every time they perform one of the agreed desirable behaviours
3. Tokens are then exchanged for privileges
developing token economies
ayllon + azrin (1968)
Plastic tokens swapped for ward privileges, e.g. watch movie
1960s and 70s
use has now declined because of growth in community based care and ethical issues
rationale for token economies
Institutionalisation develops-> Prolonged hospitalisation
Improves persons quality of life
Normalise behaviour
management of schizophrenia ao3
Strength: Research support for effectiveness- monagle + sultana (2000) Reviewed to token economies over 15 year period, Found it did reduce negative symptoms
lImitation: ethical issues with controlling behaviour- Gives professionals considerable power to control the behaviour of people in the role of the patient, Restricts availability of pleasures, Problematic, if target behaviours are not identified sensitively
Limitation: Socially sensitive- Promote the idea that patients who deserve rewards can have rewards, Privileges are withheld from earning tokens, Most severe symptoms are likely to be less successful in earning tokens
The interactionist approach to schizophrenia
Combination of influences are responsible for the condition
Proposes that people may have a biological vulnerability or predisposition to developing schizophrenia E.g. a specific gene
Schizophrenia might be the result of a psychological trigger, e.g. stress Or an environmental and social trigger, e.g. trauma
The approach strongly claims that biological vulnerability alone is not likely to lead to the condition
The diathesis-stress model
Internal vulnerability and external trigger
Both vulnerability and stress are necessary to develop the order
Suggest schizophrenia doesn't need to be biological as trauma can change a persons biology
meehls Original diathesis stress model
Suggested diathesis (vulnerability) was entirely genetic- A single schizogene
Biologically reductionist- Reduced schizophrenia down to a single gene
modern understanding of diathesis + stress
Many genes appear to increase genetic vulnerability
Modern views include a range of factors beyond the genetic
Includes anything that risks schizophrenia, e.g. cannabis use
Cannabis is a stressor which increases the risk up to 7 times
The interactionist approach to schizophrenia ao3
Strength: Significant theoretical advantages- Avoid reductionism of purely biological explanations, Acknowledges the complex interplay Between genes, environment and cognition, Makes it more holistic view
Limitation: Nomothetic view- Makes assumptions that everyone who has a predisposition and an experience that could trigger schizophrenia, will develop it, Suggest these general laws can be applied to everyone in the same way, Would be more appropriate to take an ideographic approach