AQA PSYA4 Schizophrenia

paranoid = delusions of persecution, usually agitated, angry, argumentative and suspicious of to others

disorganised = severs disentergration of personality including eratic speech and childish manerisms

catatonic = episodes of extreme behaviour, long periods immobile, uncontrollable motor movement

type 1 = consists mainly of positive symptoms e.g. halluncinations

type 2 = consists mainly of negative symptoms e.g. poverty of speech

Halluncinations - hear or see things that don't exist can be audiotory of visual

delusions - mistaken interpretations of actual objects

Behavioural disturbances - may be a reaction to a hallucination/delusion

Disorderd thinking and speech - inability to concentrate, lack of logical sequence

Disturbed emotions - unexpected emotions e.g. laughing when inappropriate

Classification

DSM-IV:

duration = 2 or more positive symptoms present for at least a month

socail/occupational dysfunction = effects the persons ability to function properly

Exclusion of mood & organic disorders = must be excluded, not caused by drugs or brain disorders

Reliability (consistency of results over time)

DSM was developed to provide a more reliable system for classifying disorders

Carson claimed it fixed the problem or reliability as psychologists had better agreement when diagnosing

However there are different classification systems used for diagnosis -> USA = DSM, UK = IC

describe schizophrenia in different ways which causes problems when assessing reliability

Unreliable Diagnosis/symptoms

Klosterkotter assessed 489 admissions to a psychiatric hospital in Germany to determine whether positive or negative symptoms were better for diagnosing, showed that positive symptoms better

Diagnosis to weak -> impossible for people to get the same diagnosis when they have different behaviours 50 senior psychologists were asked to differentiate between bizarre and non bizarre delusions -> produced inter rater reliability of 0.4 -> DSM lacks sufficient evidence to be good at diagnosing

Validity

if scientists can't agree who has schizophrenia then the questions of what it actually is become essentially meaningless

Schnieder, listed symptoms that distinguished schizophrenia from other disorders and called them first rank symptoms e.g. hallucinations

-> made diagnosis more reliable

However Elason & Ross, found that people who have dissociative identity disorder have more schizophrenic symptoms than people with schizophrenia

Validity of Prognosis

same way that schizophrenics don't share the same symptoms, no evidence to suggest they have the same outcomes

Bleuer, 20% recover, 10% achieve significant long lasting improvement, 30% relapse, 40% don't recover

-> some recover some don't

Genetics

family history studies

shows that it tends to run in families due to greater genetic relatedness-> evidence from concordance rates:

among general population = 1%

2 schizophrenic parents = 46%

one parent = 13%

sibling = 9%

AO2/3

+ Kety et al, 207 offspring from mothers with schizophrenia matched with 104 healthy pp's, found strong support for familial link, schiz diagnosed at 16% compared to 2%.

- heritable traits that are maladaptive should be selected out during the process of natural selection so schizophrenia should no longer exist -> suggest that it has a survival advantage  -> influence group members to follow and create a new group

Twin studies

MZ twins more similar genetically then DZ twins, comparing concordance rates can see if genetics plays an important part in the development of schizophrenia

Gottesman & Shields, used the Maudsley twin register, found 58% of MZ twins reared apart were concordant for schizophrenia

Cadno et al, used Maudsley twin register and found 40% concordance rate for MZ twins and 5.3% for DZ twins

AO2/3

- assumed that higher concordance rated for MZ twins is due to genetics rather than greater environmental similarity

-> Joseph, claimed that MZ twins tend to be treated the same and expereince 'identity confusion'

therefore difference in concordance rates just reflects the environmental differences distinguishing the two types of twin

Adoption studies

help to disentangle genetic and environmental influences

Tienari et al, found that adoptees whose biological mothers had been diagnosed with schizophrenia, 6.7% developed the disorder compared to 2% of adoptees born to healthy mothers

AO2/3

- chances are never 100% -> other factors must be involved

- MZ twins still share the same womb for 9 months

+ nature vs nurture

Dopamine Hypothesis

chemical imbalance of the neurotransmitter dopamine in the brain, thought that an excess or super sensitivity of D2 receptors causes symptoms of schizophrenia

schizophrenics have an abnormally high amount of D2 receptors

dopamine responsible for guiding attention -> disturbances might lead to problem with perception and thoughts

evidence

phenothiazies (antagonists) found to inhibit dopamine activity and reduce symptoms

L-dopa (agonist) induces symptoms resembling acute schizophrenia -> Randrup & Munkvad, behaviour similar to schizophrenia induced in rats by administering amphetamines.

- chicken or the egg?? high dopamine cause schizophrenia or does schizophrenia cause high dopmaine levels

-> post mortem studies (Harcaz) found that those who had elevated dopamine level before death had received antipsychotic drugs

- reductionist -> if schiz caused by excess dopmaine that antipsychotic drugs would be effective for all schizophrenics however this is not the case -> evidence for more than one type??

- effectiveness of drug treatments -> alleviate positive symptoms, less effective for negative symptoms

+ development of PET scans has led to more accurate measurement

-> Copolov & Crook, but has failed to provide evidence of altered dopamine activity in brains of schizophrenics

Socio cultural factors

double bind theory

Bateson et al, suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia

Children are given conflicting messages from family members e.g. mother may say they love them but then turn their head away in digust, this confuses the child and leads to self doubt

they grow up without a secure sense of self and as a result later develop schizophrenia

AO2/3

 + Berger, schizophrenics reported higher recall for double bind statements from mother than non schizophrenics -> however evidence is not reliable as recall maybe effected by schizophrenia

 - Liem, measured patterns of parental communication in families with a schizophrenic child, found no difference when compared to ‘normal’ families

expressed emotion

Expressed emotion is a family communication style that involves criticism, hostility and emotional over involvement.

High levels of EE are most likely to cause high relapse rates -> 4 times more likely than low EE families

The negative emotional climate causes stress for the schizophrenic -> they already have impaired coping mechanisms which triggers the schizophrenic behaviour

AO2/3

+ lead to effective form of therapy -> high EE patients are shown to reduce levels of expressed emotion -> Hogarty et al, such therapy significantly reduced relapse rates

- Cause or effect of schizophrenia??

Psychodynamic explanation

 žFreud, believed schizophrenia was the result of 2 related processes:

 Regression to a pre-ego state & Attempts to re-establish ego control

If parents were cold and uncaring a person may regress to a stage where they had little awareness of the world e.g. infancy (regression to pre-ego state)

žThey then try to re-establish ego control from the infantile state, when this fails it can lead to symptoms of schizophrenia

AO2/3

+Fromm & Reichmann, described schizophrenic mothers or families who are rejecting, over protective, dominant and moralistic as important contributory influences in the development of schizophrenia.

- Oltmann et al, parents of schizophrenics behave differently from other parents particularly in presence of their offspring -> likely to be a consequence of the child’s problems

ECT

Idea that inducing a seizure will reduce symptoms, high electrical current passed through the temples and into the brain via scalp electrodes for about half a second

Patient is ‘knocked out’ and given a nerve blocker to reduce the risk of injury, patient typically needs 3-15 treatments

AO2/3

+ Tharyan & Adams, meta analysis of 26 studies (798pp’s) assess if ECT is a beneficial treatment, ECT compared to placebo condition (dummy shocks), people improved in ECT condition however no lasting effects, when compared to drugs, drugs were better

+ works when other treatments have failed BUT  Little is known about how the treatment works

- Risk of memory dysfunction, brain damage and personality change -> decline in use if treatment by 59% between 70s and 90s (read)

-Relapse rates of up to 60%

Antipsychotic drugs

Usually the first line of treatment -> block effect dopamine has on the brain, reduce feelings of anxiety and aggression

Conventional -> bind to dopamine receptors to block action, eliminates positive symptoms, lead to the dopamine hypothesis

Atypical -> act on the dopamine system and blocks serotonin receptors, effective at reducing positive symptoms, therapeutic effects unknown

AO2/3

+  Davis et al, meta analysis of 29 studies or relapse rates, found 55% relapsed when drugs where replaced by a placebo compared to 19% who stayed on the drugs

+ receiving a prescription may trigger a realisation of schizophrenia -> help with the treatment

- Ross & Read, being prescribed medication reinforces the view that something is wrong with you -> can effect treatment

CBT - Based on the idea they have irrational ways of thinking and have distorted beliefs

Initially thought it would fail -> schizophrenics are unable to distinguish own behaviour from reality and fantasy

Techniques:

Encouraged to trace origins of symptoms to understand how they developed

‘belief modification’ evaluate the content of delusions by testing their validity

‘reattribution therapy’ look at maladaptive responses and make them healthy

Doing this builds coping strategies that can be used in the future

AO2/3

+ Gould et al, meta analysis of 7 studies, found statistically significant decrease in positive symptoms after treatment

+ Most widely used therapy -> structured and has clear goals that are measurable

Psychoanalysis

 Based on the assumption that individuals are unaware of the influence of unconscious conflicts on their psychological state

 Requires establishing a close relationship with the therapist to avoid anxiety

Therapy requires adult forms of communication and they need to understand how the past has influenced their current problems -> do this by examining the patients life history

AO2/3

- Takes a long time to complete -> very expensive

+ Gottdiner, meta analysis of 37 studies, concluded it was an effective from of treatment

-Can be traumatic -> causes psychological harm (ethics)

- Cure rate is between 30% - 60% -> implies that it maybe biological as the treatment is not very successful