Define schizophrenia
Type of psychosis
Disruption of cognition and emotion
Loss of contact from reality
1% of population have SZ
What is the difference between positive and negative symptoms?
Positive is an excessive of normal functioning, whereas negative is a loss of normal functions
Name the three positive symptoms
Delusions- beliefs that make sense to them but bizarre to others
Persecution= being watched/followed by one/agency
Grandeur- prominent position of power/ heal others
Hallucinations- bizarre, unreal perceptions of the environment (auditory, visual, olfactory, tactile)
Disorganised thinking and speech- problems organising thoughts- incoherence
neologisms-make up new words no meaning
word salad-jumbled up
clang- sound same/ rhyme together but mean different
Name the two negative symptoms
Alogia (speech poverty)- reduction in amount and quality, produce fewer words, difficulty spontaneously producing them
Avolition- reduction of interests and desires, inability to persist in goal directed behaviour, reduction in involvement in activities available
How does DSM-V criteria diagnose SZ?
Requires two or more symptoms for at least six months
One if particularly problematic
What are the two issues surrounding classification and diagnosis of SZ?
Validity- needs to be accurate and a real diagnosis, distinct from other disorders, extent that DSM measures as intended
Reliability- consistency, using inter-observer (2 assessors give same diagnosis) and test-retest (on different occasions)
What are the issues surrounding validity?
Gender bias- dependent on gender of individual, biased criteria, clinicians judge on stereotypical beliefs
Symptom overlap- SZ symptoms found in other disorders, difficult to accurately distinguish eg avolition in bipolar
Comorbidity- two or more conditions occur, difficult to separate out conditions and decide treatments eg SZs can suffer from depression too
Give three evaluation points for the validity of diagnosis
Loring and Powell- randomly selected male and female psychiatrists given case described as male 56% diagnosed and as female 20%
Subjectivity- gender stereotypes not just symptoms
Ellason and Ross- Dissociative Identity Disorder patients have more symptoms of SZ
SZ and DID on same spectrum or separate?
Buckley- comorbid depression in 50% patients and 47% have comorbid substance abuse,
overlap between disorders
What type of bias is involved with reliability of diagnosing SZ?
Culture bias- psychiatrists influenced by own cultures values and expectations - inconsistent diagnosis
What are the three evaluation points for the reliability of diagnosis?
British and American psychiatrists given description of 1 patient
69% Americans diagnosed, 2% British diagnosed
Low inter-observer reliability between cultures
Certain cultural groups more likely to be diagnosed
African-Caribbean 8x more likely than white
Misinterpretating differences as bizarre behaviour
Reduces validity
However- may be genuine differences due to genetic inheritance
Social stigma- incorrectly labelled
Inaccuracy has long lasting negative impact
So allows professionals to share same common language
Better understanding
Describe genetic explanations as a biological explanation of SZ
Passed through generations due to genetic inheritance
More closely related= more likely to develop
Polygenic (caused by more than one gene)
Evidence- family, adoption, twin studies)
Uses concordance rates to establish genetics or environment
Give three evaluation points for genetic explanations
Family studies- Varma
16% first degree relatives vs 7% control SZs developed
More related= more likely to develop
However- increased rate of SZ with parents may be due to environment
Twin research by Joseph
Concordance rate 40% MZ vs 7% DZ twins
Partly genetic not 100%
However- MZ high due to treated similarly so ruling out environment is difficult
Adoption supports research
Tienari- adopted children with bio SZ mother/ control with no genetic risk
Higher rate with SZ bio mothers
Environment influence removed but still genetic risk
However- healthy adoptive family protects the risk
Describe neural correlates as a biological explanation
association between brain structure/function and development of SZ
Structure- enlarged ventricles (fluid-filled gaps between brain areas) associated with damage in pre-frontal cortex= +ve symptoms
Function- biochemical- dopamine hypothesis- excessive dopamine transmission (thoughts, attention, movements) by abnormally high density D2 receptors on recieving neuron, more binds and more neurons fire=issues with attention and perception
What is the revised dopamine hypothesis?
increased dopamine in mesolimbic pathway= +ve symptoms
low levels in mesocortical pathway= -ve symptoms
Evaluate neural correlates explanation as a biological explanation
Drug research
L-dopa for Parkinsons= +ve symptoms
Prac apps= Typical antipsychotics (dopamine antagonists) blocks receptors reaching +ve symptoms
Atypical more effective (30-50% treatment resistant patients) at reducing symptom severity
Explain family dysfunction as a psychological explanation
-Abnormal communication within the family
Double-bind theory- contradictory messages from parents eg hugging and turning away= more likely to develop
Schizophrenogenic mother- cold, rejecting, controlling= tension, secrecy= paranoid delusions
Expressed emotion- verbal criticisms and overbearing
High levels in carers= higher relapse rates
Evaluate family dysfunction as a psychological explanation
Double-bind support, higher recall of double-blind statements from their mothers than non szs= contradictory messages increase risk
Role of EE- adopted with SZ bio mum/control- parenting style with low empathy= increased risk- healthy prevents
Prac apps- family therapy 26% relapse vs 50% standard care
Explain the cognitive explanation as a psychological explanation
dysfunctional thought processing
Egocentric bias- rely too heavily on own pov not others, external events have personal significance eg do something embarrassing- overestimate degree go notice =paranoia, flaahes of light= signal from God (hallucinations)
Central control- inability to suppress/override automatic thoughts=disorganised speech (word thought and triggered next one)- see button and press it, unable to suppress urge
Evaluate cognitive explanation as a psychological explanation
+prac apps, CBTp effective, NICE compared with antipsychotic drugs and more effective
-doesnt account for biological factors, genes and neurotransmitters, holism should be considered eg interactionist approach
-research into recent evidence into delusional patients, biases in info processing-jump to conclusions, wide support into cognitive disruption
Explain CBTp as a psychological therapy
5-20 sessions group/indiv
distorted beliefs= negative feelings
1 identify+correct faulty interpretations
2 reality testing irrational beliefs
3 consider+ dispute rational
4 patient realises impact of +ve symptoms
5challenge irrational thoughts to have +_ve effect
Evaluate CBTp as a psychological therapy
Effectiveness overstated- as sole treatment and no meds so difficult to assess just CBT
More effective in reducing symptom severity as range of treatments compared
Dependent on stage- efffective when given at specific stages, initial self reflection phase not always appropriate- needs adaption
Describe family therapy as a psychological therapy
institutionalised patients returning home more likely to relapse in high EE family
Educate families= anger reduction
Set more reasonable expectations
Taught warning signs
Part of treatment package with drugs
Evaluate family therapy as a psychological therapy
relapse rates 26% vs standard care 50%
Meta-analysis on medication compliance- higher than standard due to meeting individual needs
Address symptoms not the cause- could be a dopamine imbalance
What are typical and atypical antipsychotics as examples of biological therapies?
They are used when… excessive dopamine transmission and increased density of D2 receptors
typical- 1950s, Chlorpromazine
reduces +ve only
binding which blocks D2 receptors
reducing sz thoughts, attention, movements
Atypical- 1980s, Clozapine
both +ve and _ve symptoms
temporarily blocks D2 receptors increasing dopamine in some pathways
works on serotonin levels
