Schizophrenia

Question 1

What is the definition of schizophrenia

Answer 1

Schizophrenia is along-term mental health condition that causes a range of different psychological symptoms, including; hallucinations, delusions, muddled thoughts, changes in behaviour, withdrawal from reality.

Question 2

What are the positive and negative symptoms of schizophrenia

Answer 2

Positive symptoms (in addition to ‘normal’ feelings or experiences)
Hallucinations: Unusual sensory experiences
Delusions: Irrational beliefs
Speech disorganisation: Incoherant speech

Negative symptoms (a lack of ‘normal’ feelings or experiences)
Avolition: Inability to keep up with goal directed activity
Speech Poverty (alogia): Reduction in amount or quality of speech
Flat affect: Lack of normal emotion

Question 3

Reliability & validity of the classification of schizophrenia (key study)

Answer 3

Key Study: Rosenhan

Sample: 8 pseudopatients = (confederates!)
11 hospitals (1 hospital recognised Rosenhan) = participants

Procedure: Complained of hearing voices saying ‘empty’, ‘thud’ & ‘hollow’ but otherwise acted normally. They were honest and genuine when answering all other assessment questions.

Results:
All were admitted to hospitals and diagnosed with Sz
Invalid diagnosis but reliably diagnosed (as all psychiatrists came to same diagnosis).

Results:
The pseudopatients spend 7-52 days in hospital.
Poor inter-rater reliability (diagnosing sane) as all 7 would have been released at the same time but were not.

Part 2:
Psychiatrists professionally embarrassed & doubted his findings. They asked Rosenhan to send in pseudo-patients over 3 months.
23 patients were rated as pseudopatients by at least 1 psychiatrist. 1 member of staff identified 41 patients as pseudopatients. None were sent. Poor validity.

Question 4

Reliability & validity of the classification of schizophrenia AO1

Answer 4

Inter-rater reliability
Study found a 0.11 correlation for inter-rater reliability amongst psychiatrists when diagnosing Sz.
Questions whether psychiatrists can reliably classify people consistently when they have the same symptoms.

Culture Bias
Greater chance of being diagnosed with Sz as a black ethnicity than a white ethnicity living in the UK, due to cultural differences.
Questions the reliability of the diagnosis as not everyone with the same symptoms is classified in the same way.

Co-morbidity
When two or more disorders are diagnosed together, e.g., 60% of Sz patients also have a diagnosis of depression.
Questions the validity of the classification & diagnosis as maybe they are too similar and hence really one diagnosis.

Gender Bias
There is a higher % of males (56%) diagnosed with Sz than females (20%) despite that psychiatrists were given the same symptoms. Also depended on the gender of the psychiatrist.
Questions the reliability of the diagnosis as not everyone with the same symptoms is classified in the same way.

Symptom Overlap
There is an overlap of symptoms with other disorders, e.g., delusions are also found in depression & OCD, flat affect is shown in depression & ASD as well as Sz.
Questions the validity of the diagnosis. If these are in fact 2 separate disorders or the same one.

Question 5

Biological explanation of schizophrenia: genetic ao1

Answer 5

Sz is innate and inherited through genes
Research found 108 separate genetic variations that might result in Sz
Therefore, Sz is polygenic; and is not caused by one single gene, but many genes interacting together
In particular, the genes associated with increased risk were the genes which coded for the function of neurotransmitters including dopamine.
It is aetiologically heterogenous; the many different combinations of genes may result in different types of schizophrenia
It might be more Diathesis-Stress model-genetic vulnerability plus environmental stressor

Question 6

Biological explanation of schizophrenia key study

Answer 6

Key Study: Gottesman (family & twin study) (2011)
Gathered secondary data from Danish Civil Register & Danish Psychiatric Central Register for over 3.4 million people, between1970 & 2007.

Gottesman (2011)
Both parents had sz: child 27.3% sz
One parent had sz: child 7%
Neither parent had sz: child 0.86%

Gottesman (1991)
Twin study: found 48% concordance rate for Sz in MZ & 17% for DZ.
Therefore, the more genetically similar, the higher the concordance rate of both family members having Sz. This suggests that Sz is genetic.

Question 7

Biological explanations of schizophrenia: Dopamine hypothesis (AO1)

Answer 7

Hyperdopaminergia
Higher levels of dopamine and more D2 receptors = more excitatory neuronal firing on the post synapse.
Linked to positive symptoms of Sz
Linked to mesolimbic areas of the brain (e.g., amygdala & hippocampus)

Hypodopaminergia
Lower levels of dopamine and fewer D2 receptors = less excitatory neuronal firing on the post synapse.
Linked to negative symptoms of Sz
Linked to mesocortical areas of the brain (e.g., PFC)

Research of drugs that increase dopaminergic activity (agonists)
Amphetamines (speed) is a dopamine agonist (floods neuron with dopamine) causes hallucinations and delusions similar to a Sz episode in ‘typical’ pps.
Those with Parkinson’s disease who take L-Dopa (increases dopamine) develop similar side effects to positive symptoms of Sz.

Research of drugs that decrease dopaminergic activity (antagonists)
Anti-psychotics (e.g. chlorpromazine) block D2 receptors, reducing the effects of excess dopamine.
They reduce the positive symptoms of Sz, e.g., hallucinations & delusions.

Question 8

What are neural correlates

Answer 8

There is a correlation between brain structure and function and symptoms of schizophrenia.

Question 9

Biological explanations of schizophrenia: neural correlates (AO1

Answer 9

Mesolimbic system=Pos
Hyperdopaminergia causes overactivity in the:
Amygdala (fear) = delusions
Hippocampus (memory) = hallucinations
Anterior Cingulate Gyrus = emotional processing & vocalizing speech = hallucinations
Broca’s Area (speech production) = speech disorganisation

Mesocortical system = Neg
Hypodopaminergia causes underactivity in the:
PFC (problem solving, motivation) = avolition
Broca’s Area (speech production) = speech poverty
Motor Cortex (voluntary motor movements) = catatonia

Deficits in other neural areas
Enlarged ventricles (fluid filled cavities)
15% larger in those with Sz, linked to negative symptoms
Positive correlation: Increased ventricles, increased negative symptoms

Deficits in other neural areas
Lack of activity in the ventral striatum (Responsible for anticipating reward from behaviour.)
Sz do not anticipate reward = avolition.
Negative correlation: Decreased activity, increased negative symptoms

Question 10

Psychological explanations of schizophrenia: family dysfunction ao1
Key features

Answer 10

Double Blind
Family dysfunction
Schizophrenogenic mother

Question 11

Explain double blind as key feature

Answer 11

Where there is a conflict between the paralinguistics (body language) which does not match the verbal message given.
93% of our communication is from paralinguistics.
It puts the Sz person into a bind – cannot win. They cannot respond to their parent in a way that will not cause offence.
The Sz person retreats into their psychosis to avoid the stress caused, e.g., delusions help to explain the mothers confusing communication or avolition to withdraw from the parent.

Question 12

Explain family dysfunction as key feature

Answer 12

High Expressed Emotion(relapse)

Hostility
Where the Sz is blamed for family’s problems, including anger & rejection

Emotional Over-involvement (EOI)
Where the mother blames herself for the Sz, needlessly self-sacrifices, creating guilt in Sz.

Critical Comments
Combination of hostility & EOI. Criticism of Sz but openness not entirely their fault.

Question 13

Explain schizophrenogenic mother as key feature

Answer 13

Cold, rejecting, controlling & unresponsive to the child = distrust leads to paranoid delusions

Question 14

Psychological explanations of schizophrenia: cognitive explanations key features

Answer 14

Hypervigilance (hallucinations)
Egocentric Bias (delusions)
Loss of Central Control (disorganised speech)
Dysfunctional meta-representation (hallucinations & delusions)

Question 15

Explain Hypervigilance (hallucinations) as key feature

Answer 15

Sz give excessive attention to auditory stimuli. This leads to a higher expectation of a voice occurring in their environment than a normal person.
They struggle to see the difference between imagination and real sensory perception, e.g., “What will other people think of me?” turns into a voice saying, “He is not a good person”.
A hallucinating Sz person is more likely to misattribute the source of a self generated auditory thought as an externa source than non hallucinating Sz.

Question 16

Explain Egocentric Bias (delusions) as key feature

Answer 16

Sz perceives themselves as the central component to events. They attribute irrelevant events to themselves & arrive at false conclusions.
Creates delusions e.g., muffled voices are people criticising them.
The delusions are resistant to reality testing as they have ‘impaired insight’ to recognise the cognitive distortions and give rational alternatives.

Question 17

Explain Loss of Central Control (disorganised speech) as key feature

Answer 17

Inability to suppress automatic responses, whilst performing deliberate actions.
Tested through Stroop Test. Sz perform poorly on this compared to ‘normal’ controls.
Sz = disorganised speech (word salad) due to inability to suppress thoughts and speech triggered by another thought.

Question 18

Explain Dysfunctional meta-representation (hallucinations & delusions) as key feature

Answer 18

Cognitive ability to reflect on thoughts and feelings; having insight into our own intentions and goals & those of others.
Sz = cannot recognize own thoughts and actions as being ourselves. Seems to be someone external.
Explains auditory hallucinations & delusions (e.g., thought insertion).

Question 19

What are Anti-psychotics

Answer 19

Anti-psychotics are dopamine antagonists. They decrease the amount of dopamine.

Question 20

Examples of Typical and Atypical antipsychotics

Answer 20

Typical- Chlorpromazine
Atypical- Clozapine, Risperidone

Question 21

CBT therapy for schizophrenia key features

Answer 21

Assessment
Engagement
The ABC Model
Normalisation
Critical Collaborative Analysis

Question 22

Explain Assessment as key feature

Answer 22

The client expresses their experiences and symptoms to the therapist.
Goals and expectations of therapy can be established here.

Question 23

Explain Engagement as key feature

Answer 23

The therapist provides a therapeutic environment
This includes the therapist empathising with the patient’s perspective, feelings of distress etc.
The therapist must also stress that explanations for the patients’ distress can be developed together.

Question 24

Explain Normalisation as key feature

Answer 24

Knowing that there are other people who experience the same things as you can help to greatly reduce feelings of isolation and anxiety.
Placing psychotic experiences on a continuum of ‘normal’ experiences can help patients feel less stigmatised.

Question 25

Explain Critical Collaborative Analysis as key feature

Answer 25

Gentle questioning is used by the therapist Questioning can be used in a non-threatening way. This means there needs to be trust between therapist and patient. The core conditions of empathy and UPR must also be present.

Question 26

The ABC Model

Answer 26

Patient describes (A)ctivating event that is the cause of their irrational thoughts or behaviour Identify their (B)eliefs about the activating event. The therapist then asks how they felt and acted as a (C)onsequence. These beliefs can then be challenged or (D)isputed using the group as well as the Sz patient.

Question 27

How does family therapy work for schizophrenia

Answer 27

Family therapy works by reducing levels of stress and expressed emotion, whilst increasing the chances of patient’s compliance with medication. This combination of benefits tends to result in a reduced likelihood of relapse and re-admission to hospital.

Question 28

family therapy for schizophrenia AO1 ( 6 stages)

Answer 28

Takes places in people’s homes and typically two family therapists will work with the relatives and patient. It lasts between 3-12 months with sessions every 2-4 weeks. A minimum of 10 sessions are recommended by NICE. The relatives are made more aware of the information regarding psychosis and the particular diagnosis their relative has been given. The therapist encourages the relatives to ask questions and learn more about the disorder Provides the whole family with practical coping skills which enables them to manage the everyday difficulties arising from having Sz in the family. Family members learn more constructive ways of communicating and are encouraged to concentrate on any good things that happen rather than negative events. Lastly, the family and the patient are trained to recognise the early signs of relapse so that they can respond rapidly to reduce the severity of it.