Paper 3 Schizophrenia

Question 1

Schizophrenia?

Answer 1

• mental disorder affecting 1% of population
• usually diagnosed in males, city-dwellers or low socio-economic status

Question 2

Classification?

Answer 2

This is when symptoms are identified to be associated with a specific disorder
How?
the use of DSM-5 requires one positive symptom whereas ICD-10 requires 2 or more negative symptoms

Question 3

Diagnosis?

Answer 3

This is when the symptoms are to be identified and a classification system is used to identify the disorder

Question 4

Describe what positive symptoms are and give detailed examples

Answer 4

These are additional experiences of ordinary experiences that affect daily life.
e.g.
Hallucinations are unusual sensory experiences that are distorted perception of real things
Delusions are beliefs that have no basis of reality

Question 5

Describe what negative symptoms are ad give detailed examples

Answer 5

These are a loss of usual abilities in ordinary experiences that affect daily life.
e.g.
Avolition is the severe loss of motivation to carry out daily lifestyle (apathy). low activity levels
Speech poverty is the reduction in the quality and amount of speech (delay in speech production during conversation)

Question 6

Evaluate research relevant to diagnosis of schizophrenia

Answer 6

Who? Osorio et al 2019
What? testing reliabilty of DSM-5
how? excellent reliability and consistent diagnosis using DSM-5 as reports shows inter-rater R at 0.97+ and test-retest at 0.92+.
So? displays good reliabilty and consistent applicatiion when using ONE CLASSIFICATION SYSTEM (link to below)

Who? Cheniaux et al 2009
What? testing criterion validity (reach same diagnosis) between both classification systems
How? use of 2 psychriatrists indepedently assessing the same 100 Ps. 68 diagnosed with ICD compared to 39 DSM.
so? suggests the use of different classification systems could lead to over/underdiagnosis of sz.

Question 7

Evaluate culture bias concerning schizophrenia

Answer 7

What? symptoms such as auditory hallucinations are accepted in other cultures such as Afro-carribean.
How? this leads to Afro-carribean males being up to ten times more likey to be diagnosed due to overinterpretation of symptoms.
So? This leads to discrimination against such communities by this culturally biased diagnostic system and could be deemed as an etic approach.

Question 8

Compare and evaluate symptom overlay and comorbidity in relation to schizophrenia

Answer 8

Symptom overlap is when there is an overlap between symptoms of 2 or more disorders where as comorbidity is when two or more disorders co-exist as the same time within an individual.
Who? Buckley et al
What? found that 50% of sz cases are co-morbid with depression
So? suggests sz common diagonosis with other disorders may mean it is not a distinct condition
What? both sz and bipolar disorder involve delusions and avolition. when using classification systems particularly ICD-10 may be hard to distinguish conditions
So? suggests sz may not exist as one condition and can be harder to diagnose. (costly, time consuming, weigh up diff class sys)

Question 9

Describe the genetic basis of sz

Answer 9

Family studies
- strong relationship between genetic makeup and risk of sz
Who? Gottesman 1991
What? large-scale study looking at family members and shared risk for sz
How? found 48% risk in MZ twins for developing sz
so? support for genetic view
Candidate genes
- sz is polygenic and aetiologically heterogeneous
Who? Ripke et al
What? looked at GWAS (genome wide association studies) to identify genes causing sz
so? found 108 seperate genes with increased risk of sz

Question 10

Describe neural correlates of sz

Answer 10

What? specific brain structures/activities that correspond to a specific behaviour/experience seen in sz
e.g.
Original DA hypothesis - high levels of activity in subcortex can be associated with speech poverty as there are pathwyas linked to broca’s area
Updated DA hypothesis - low levels of activity in prefrontal cortex can be associated with negative symptoms.
How? early experiences of stress may cause individuals to be more sensitive to high levels of DA

Question 11

Evaluate biological explanations of sz

Answer 11

Genetic Basis:
- ignores influence shared enviroment of MZ twins and the tendency to be treated the same due to the identical look. So? could suggest a limited explanation.
CP: Tienari et al 2004, adoption studies show children with biological sz parents are at greater risk even with an adoptive family. So? supports influence of genetic makeup onto sz vunerability
+ RS ripke et al 108 genes
Neural Correlates:
- evidence from post-mortem examinations Who? McCutcheon et al What? raiseed levels of glutamate found. So? suggest other neurotransmitters such as glutamate may have a role in sz
+ lead to treatments of sz via drug therapy. e.g. chlorpromazine so? RWA and beneficial, effective treatment
- cause and effect relationship

Question 12

State components involved in psychological explanations for sz

Answer 12

Family dysfunction:
- schizophrenogenic mother
- double bind theory
- expressed emotion
Cognitive dysfunction:
- meta representation

Question 13

Describe research into psychological explanations for sz

Answer 13

Who? Fromm-Reichmann 1948
What? Schizophrenogenic mother
How? they are rejecting cold and create a climate of tension and secrecy
so? leads to distrust and paraniod delusions

Who? Bateson et al 1972
What? Double-bind theory
How? child receives conflicting communictaion from parents about what is perceived wrong leading to regular situations where they are wrong
So? child is punished with a withdrawl of love and cannot express their feelings leading to disorganised thinking

Question 14

Expressed emotion?

Answer 14

What? The level of emotion expressed within a family environment
How?
- Verbal criticism
- hostility
So? could lead to relaspe of SZ due to stress

Question 15

Describe cognitive explanations for sz

Answer 15

What? dysfunctional thought processing due to lower levels of information processing leading to impaired cognition.
How? disruption of meta representation (ability to reflect on self thought/behaviour) can lead to hallucinations. disruption of central control can’t suppress automatic responses while performing deliberate actions
So? could explain speech poverty

Question 16

Evaluate psychological explanations for sz

Answer 16

+ RS Who? Read et al 2005 What? reported a correlation between insecure attachment types and sz individuals. How? more likely to have type D or C. So? supports family dysfunction and suggests a greater vunerablity to sz.
- Parent blaming What? use of family dysfunction explanation could lead to additional stress for parents who are responsible and caring for a sz child. so? controversial and socially insensitive
- Proximal origins of symptoms What? cognitive explanations are only able to explain what is occuring now rather than the intial cause like distal explanations (bio) so? partial explanation and reductionist
+ lead to development of CBTp and family therapy So? more effective in treating symptoms and beneficial for both sz and family (wider application)
- cause and effect relationship

Question 17

Describe Biological therapy for sz

Answer 17

Typical antipsychotics:
What? dopamine antagonists that block dopamine receptors in the synapse to reduce action of dopamine on post synaptic neurone
e.g. chlorpromazine
How? normalises neurotransmission in specific areas of the brain to reduce symptoms. also has a sedation effect.

Atypical antipsychotics:
What? Newer drugs in aim to improve effectiveness, reduce side effects and target additional neurotransmitters
e.g. Clozapine
How? target Glutamate, dopamine and serotonin pathways to also reduce depression (comorbidity). and improve mood and cognitive functioning

Question 18

Evaluate Biological therapy for sz

Answer 18

• side effects What? dizziness, weight gain. So? can be more severe that symptoms, detering patients from taking treament and reducing overall effectivesness
• evidence of better alternatives Who? Anderson et al What found relapse rates where at 40% compared to 5% with combined treatment of drugs and Family therapy So? may not be as effective alone
  + RS Who? Crossley et al 2010 What meta analysis showing reducing in positive symptoms however 25% of patients showed no improvement. so? could be efective against reducing positve symptoms

Question 19

Describe psychological therapy for sz

Answer 19

CBTp:
What? aim to identify and change irrational thoughts to reduce positive symptoms like hallucinations and delusions
How? 5-20 sessions
1. Assessment
2. Engagement (build rapport)
3. ABC model
4. Normalisation (explaining behaviour as ordinary)
5. Gentle question and construction of coping strategies

Family therapy:
What? aim to reduce expressed emotion and negative symptoms
How? expressed emotion such as anger and guilt can cause stress and trigger sz so family is put through family to support individual whilst maintaining their own lifestyle
phase 1&2: Sharing of information and resources to support
phase 3&4: mutual understanding between family members and looking out for unhelpful patterns of interaction
phase 5,6&7! skill training, relapse prevention and maintainence

Question 20

Evaluate psychological therapy for sz

Answer 20

+ RS Who? NICE (National Institute for Health and Care Excellence) What? concludes that CBTp is more effective in reducing symptom severity so? effective applicable treatment
- casual effect what hard to determine as when paired with drugs, treatment is most effective
+ therapeutic and economic benefits as treats multiple individuals enabling them to intergrate back into society (increase economy as more ppl back in work+ less costly) so? wider benefits and positive impact beyond patient
+ RS anderson et al What? relapse rates at 5% with combined treatment of drugs and Family therapy. so? effective treatment supporting for cognitive basis

Question 21

Describe Token economies as a management of sz

Answer 21

Who? Ayllon and Azrin 1968
What? system that used a gift token as a ‘secondary reinforcer’ of behaviour
How? operant conditioning
3 categories of industrialised behaviour that need to be tackled: personal care, condition-related and social behaviours
tokens can be exchnaged for rewards (primary reinforces) and given IMMEDIATELY after performing desirable behaviour.
So? improves quality of life with hospital setting and normalises behaviour that easily adapts back into communities

Question 22

Evaluate token economies

Answer 22

• Hard to maintain outside hospital setting What? only modifies behaviours and does not cure actual condition so? not generalisable lacking ecological validity and may not be worth i due to economic implications
• ethical concerns What? around quality of life and power imbalance may cause psychologiccal or even physical harm. So? restriction of pleasures and freedom
• RS Who? Paul and Lentz What? improvents in self-care and pro social behaviour. So? positive economic implications to hospital costs

Question 23

Diathesis stress model?

Answer 23

‘diathesis’ means vunerability so this model displays how the interaction between stress factors and environment can trigger vunerability to developing a condition.
e.g. stress can be psychological or biological

Question 24

How can diathesis stress model be applied to treatment?

Answer 24

through the use of both antipsychotics and CBTp (mostly seen in UK)

Question 25

Evaluate the diathesis stress model in relation to sz

Answer 25

- meehl's model can be seen as oversimplistic What? RS from ripke shows multiple genes being the cause of sz. biological stress factors like cannabis have also been identified So? multiple biological and psychological factors effecting sz + RS Who? Anderson et al so? supports application to treatment hypothesis + Rs for dual role of vunerability and stress Who? Tienari et al 2004 What? studied parenting styles of a control group of adoptees with no genetic risk and group with adoptees with biological sz mothers . those with parenting styles of high levels of criticism and conflict saw implications in development of sz in adoptees with genetic risk. So? supports hypothesis that combination of vunerability and stress can lead to increased rick of sz

Question 26

Compare the understanding of the modern diathesis stress model to meehl's

Answer 26

Meehl: sz is monogenic, 'schizogene' Modern sz is polygenic diathesis can be psychological (trauma to brain development) stress can be psychological or biological