Schizophrenia- PSYB3

'Split mind'

It is a split in the psche;

Disorganised thought processes

Split between intellect and emotion

Split between intellect and external reality.

Positive-

Hallucinations

Delusions

Negative-

Lack of communication and emotional expression

No universal agreement

The term 'Schiziophrenia' can be misleading.

Primary

Hallucinations

Delusions

Secondary 

Social

Unemployment

Social drift

Insitutionlisation 

Psychological

Poor coping

No motivation.

Paranoid

Only delusions and hallucinations

Catatonic

Only immobility, mutisim, echolia, grimacing etc

Disorganised

Only disorganised speech/behaviour and flat effect

Undifferentiated 

Criteria not met for other types

Residual

Absence of delusions, hallucinations, disorganised speech and catonic behaviour.

Family studies

Gottesman and Shields

Relative                                                                       Percentage of lifetime                                                                                                   expectancy 

Parent                                                                         5.6%

Siblings                                                                       10.1%

Sibling with one parent with S                                    12.9%

Children with two parents with S                                 46.3%

Grandchildren                                                              3.7%

Twin studies

Gottesman and Shields

Concordance rate of MZ 46% and DZ 14%

Adoption studies

Heston

47 mothers with S whose children were adopted within days by Psychiatrically well mothers. Found the incidence of S in the adopted children to be 16%.

Limitations

Twin studies contain small samples

Family and Twin studies need to consider enviorment more

Strengths

46% concordance rate suggests genotype is a major contribution

Findings show inheritence may play a huge part.

Main idea: Those with S have excessive dopamine activity in the brain. (The Dopamine Hypothesis).

Seeman et al

Using PET scans, found six times the density of D4 receptors in the brains of people with Schiziophrenia. 

Limitations

Problems of cause and effect

Not clear how nerotransmitters interact 

Strengths

Neuroimaging studies by Pearlson et al were carried out on patients not exposed to neuroleptic drugs which rules out problem of cause and effect

Structure of brain can be effected in those with Schiziophrenia.

Limbic system

Jerangon et al

Found significant cell loss in patients with S

Corpus Callosum

Nasrallah et al

Gender differences in the thickening of these fibres are reversed in patients with S

Brain imaging studies

Raz and Raz

Significant increase in size over half the samples and on overall effect size of 0.6 in vectricular volume. This is a significant effect and can be linked to major functional abnormalties. 

Aim: To investigate twin pairs for structural abnormalities that could account for S in one of each pair.

Method: 15 MZ twin pairs- one of each pair had S. Given MRI scans. 

Results: Co-twin with S had a smaller bilateral hippo-campus  and larger ventricles than twin without S in 14 out of 15 pairs. 

Conclusion: When genotype is controlled- significant diminished brain volume in twin with S.

Evaluation: Difficult to establish cause and effect. 

Limitations

Issue of cause and effect

Doesn't consider environmental contributions

Lewis- Attempts to link structural changes have not shown consistent findings.

Strengths

Good evidence from Jerangon et al, Nasrallah et al and Raz and Raz.

Szasz

Labelling is the medicalisation of madness and using medical forms such as 'illness' and 'treatment' is a form of control that robs the indvidual of their liberity.

Scheff

Self fullfilling prophecy- this occurs when a S patient is labelled

Rosenhan's key study

8 patients told to show symptom of S and 7 diagnosed as S (1 as suffering from a mood disorder) and put into an insitution. Could not leave until weeks later when in fact all were psychologically well.

Led to changes in the diagnostic system but had many ethical issues.

Limitations

Does not explain cause of S

Ignores genetic evidence

Criticised for trivalising a very serious disorder.

Strengths

Rosenhans study lead to changes in the diagnostic criteria- improved the reliablity of this diagnostic system.

Double bind (Bateson et al)- This is when a parent says one thing but their body language says another.

Family socialisation theory (Lidz et al)-

Schismatic families- Conflicts result in competition for affection of family members.

Skewed families- One partner is subsmissive and the other dominant. Children are encouraged to follow the dominant partner. This impairs cognitive and social development. 

Limitations

Difficult to prove a causal relationship 

Not possible to untangle cause and effect

Brown et al- People with S who were discharged from hospital and returned to parents/spouses fared worse than those returning to lodgings.

High levels of face to face contact were found to increase the risk of relapse. This was attributed to high emotional over-involvement and included hostility, critical comments (tone/content) and negative/positive emotion. Patients more likely to relapse if EE is high. 

Bebbington and Kuipers

52% of families were high in EE. The relapse rate for thes families was 50% where as for low EE families it was at 21%.

Limitations

Issue of cause and effect

Problem with how EE is measured

Strengths

Ability to predict relapse rate of people with Schiziophrenia from the EE is measure is good

Anti-psychotic drugs 

Increase or decrease synaptic activity

eg. Chlorpromazine reduces postive symptoms of S by reducing dopamine levels

Newer drugs

Clozapine found to be effective for 80-85% of S sufferers. Able to treat negative symptoms and has fewer side effects. 

Cole et al

344 patients from 9 different hospitals into two groups. One group given drug treatment and other placebo. 75% from drug group improved compared to 25% in placebo group. 

Limitations

Many bad side effects

No evidence for older neuroleptic drugs being effective for negative symptoms

Strengths 

Newer drugs eg. Risperidone do not lead to distressing side effects

Neuroleptics have become popular as biomonthly injections which help to prevent relapse.

Cognitive Behavioural treatments-

Focused on delusions and hallucinations.

Tarrier-

Investigated coping strategies during psychotic episodes... 25 patients with S were interviewed. In their psychotic episodes.. 1/3 reported 'triggers' to their symptoms eg. feeling anxious and 75% reported major distress. 1/3 also reported disruption to their thinking and behaviour. 75% disclosed the use of coping strategies eg. distraction, positive self talk and relaxation. These coping strategies helped the indviduals to cope with their symptoms..

Therefore CSE (Coping Strategy Enchancement) was introduced.. it taught indviduals to use coping strategies to reduce the intensity/ frequencey of psychotic symptoms. 

Asses content, asses emotional response, asses person's thoughts, prior warning and then asses the indviduals coping strategies. The indvidual then rates each strategy on effectiveness. 

Limitations

Tarrier's study had a high drop out rate

Intensive therapy; not suitable for all

Strengths

Tarriers study good evidence and showed that CSE can be effective

Can be very effective if individual cooperates.

Psychotherapy

Relies on talking/listening

Includes cognitive and Psychodynamic therapies..

Cognitive Therapy-

Start with least important belief and work with evidence for that belief. Thoughts put through 'reality testing'.

Aim: You verbally challenge that belief, which causes a reducation in conviction and then is put through reality testing.

Chadwick et al-

Nigel believed he could predict what people could say before they said it- put through reality testing using video tapes. He could not predict what the person on the video tape said before they said it- concluded that he did not have this power.

Limitations-

Not always suitable for all

Strengths-

Faster response to treatment than drugs (Drury et al)

Research trials show a 40% reduction rate in Psychotic symptoms (Kuipers et al)

Community care is resdential care, home care etc...

Stein and Test

Group of 65 people. One group receiving inpatient care plus aftercare. One other receiving training in 'community living'. During the first 12 months= 58 of control group readmitted to hospital while only 12 of 'community living' were readmitted.

Community care

Better alternative to institutionalization as it can be more effective

Helps person adapt to life                           More ethical

Makes patient feel part of society

High staff turnover- hard for relationship to develop between patient and carer

High cost- very underfunded

Disastrous effects

Institutionalization 

Stable routine                     Protects community from harm

Better funded                      Can cause relapse/symptoms to occur

Withdrawal symptoms/ become dependent on drugs