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Schizophrenia – Treby
‘Schizophrenia is characterised by Psychosis – a loss of contact with
reality’
Clinical Characteristics of Schizophrenia:
• Prevalence = 1% of the population(prevalence = The percentage of a population that is affected with a particular disease at a given time.)
Broken down into Positive Symptoms (Type I) and Negative Symptoms (Type II)
Symptoms:
Positive Symptoms:Where something is added to your personality.e.g.• Delusions – beliefs that seem
real, but aren’t.• Feeling they’re controlled by
something.• Hallucinations – either
auditory or visual.• Disordered thinking – the idea
that thoughts have been inserted into your mind.
Negative Symptoms:Where something is removed from your personality.e.g.• Affective flattening –
lack of emotion.• Alogia – poverty of
speech.• Avolition – having no
drive to do anything.
First Rank Symptoms – Schneider 1959
Schneider believed that first rank symptoms (Type I) such as:Delusions, feeling controlled by someone else, and hallucinationsWere only associated with schizophrenia.(However, these symptoms have also been linked with depression and bipolar.)SYNOPTICITY! Randy Gardener (1964) also experienced Type 1 symptoms, from sleep deprivation.
Different types of schizophrenia:1. Paranoid – Delusions &
hallucinations2. Catatonic – unusual motor
activity, extreme negativism, peculiar posturing. V. Rare.
3. Hebephrenic (ICD) or Disorganised (DSM) early age, disorganised speech, flat affect, some hallucinations & delusions.
4. Undifferentiated – Schizophrenic symptoms that don’t neatly fit a diagnosis.
5. Residual – At least one episode of schizophrenia experienced in the past. But no longer exhibiting signs of the disorder.
The ICD-10 also contains 2 other subtypes:Post-schizophrenic depression (a depressive episode after a schizophrenic illness.Simple schizophrenia (progressive development of negative symptoms, with no history of psychosis)
Classifying Mental Health Disorders:Diagnostic and Statistical Manual (DSM):• Published in America• English only• Predominantly used in the UK• Classifies 5 sub-types of schizophrenia• Looks after 6 months of symptoms• Used by professionalse.g. psychiatrists, psychologists, social workers.• Contains mental health statistics• Multi-axial approach – as it notes that
mental illness rarely exists without the influence of other factors in an individuals life:
Such as…1. Clinical syndromes2. Personality disorders3. Physical conditions4. Severity of psychosocial factors5. Highest level of functioning
International Classification of Diseases and related health problems (ICD): • Published by the WHO• International – multiple languages• Collection of health statistics• Classifies 7 sub-types of
schizophrenia• Looks after 1 month of symptoms• Mainly for disease – only chapter 5
is for mental health • Does NOT look at social factors• 10 categories of mental disorders
are identified• Looks mainly at positive symptoms
Evaluating classification systems:
Beck (1967) – RELIABILITYFour psychiatrists used the DSM to diagnose 153 patients.Each patient was interviewed separately with 2 psychologists.There was 54% agreement on diagnoses of schizophrenia, even less agreement on sub-types.• Small sample, not necessarily representative. (though,
mental health is not that prevalent)• People must be trained to understand DSM• Subjective• Lacks inter-rater reliability
Evaluating classification systems:
Cooper et al (1972) – CULTURAL RELATIVISMWhen patients (with identical symptoms) presented themselves. Schizophrenia was TWICE as likely to be diagnosed by New Yorker psychiatrists using the DSM than Londoner psychiatrists using the ICD.
The opposite was true of depression.• Unreliable • Cultural relativism – NY & L diagnose differently• Subjective
Evaluating classification systems:
Temperline (1970) – VALIDITYInterview with an actor was recorded. 7 groups were asked to assess his mental health.Groups consisted of professionals: e.g. psychiatrists, psychologists and law students.5/7 groups heard that the man being interviewed was interesting as he looks neurotic, but is actually psychotic. The 6th group heard nothing, and the 7th group heard he was healthy.
Temperline – continued!With those that heard he was neurotic, a majority of them said that he was neuroticAnd there was further disagreement amongst professionalsGroup that heard he was mentally healthy: 100% said healthyThis shows that the DSM and ICD may lack validity as some diagnoses may already be formed from existing preconceptions rather than using the manuals themselves
Temperline – evaluation:• People look at the labels rather their own
opinion• Groups are all from different backgrounds
(extraneous variable)• Individual differences amongst professionals –
subjective
Evaluating classification systems:
Rosenhan (1973) – LABELLINGEight people with no history of mental illness rocked up at a psychiatric hospital; claiming to be hearing voices in their head.Other than this, they answered further questions as mentally healthy individuals.They were all admitted, once in, they acted completely normally.Staff reported normal behaviour as if it were abnormal.One patient kept notes in a diary. This was described as ‘excessive note taking’.After, Rosenhan told a hospital about the study, and warned there would be more pseudo-patients. He never sent any. But staff recorded that 43 of the 93 admitted patients were pseudo-patients.• Ethical Issues – sending healthy people to a place for mentally ill• Self fulfilling prophecy could have caused these people to get ill• ‘labelling’ caused the nurses to act differently, which could cause long-term
damage where people may be unable to get a job• Shows diagnosis should be more rigorous
Biological:
Nature: genetics, brain damage, biochemistry, infection
They differ from your nurture i.e. peers, upbringing, culture, friends, environment
Biological – Genetics:
Definitions!Word Definition
Schizophrenia Psychosis… Loss of contact with reality
Monozygotic twin (MZ) Identical twin (same genetics)
Dizygotic twin (DZ) Non-identical (different genetics)
Concordance rate Likelihood of one twin getting same illness as the other twin
Twin studies Studies involving twins, if they’re MZ then they have same genes, so we can see if they were influenced by nature (genes) or nurture (upbringing)
Adoption studies Studies involving adopted children to see whether or not they have same genetic disorders as their real parents to see if illnesses are inherited
Twin study - Cardno et al (2002):
• Diagnosed schizophrenia in twins• Used ‘Maudsley Twin Register’ to get
strict diagnosis• Showed 26.5% concordance rates in MZ
twins• 0% concordance rates in DZ twins
This shows that it is your genetics (nature) that affects schizophrenia rather than your environment (nurture).
2002
Evaluation – Cardno et al (2002):
• MZ twins are relatively rare, out of all, schizophrenia only has a prevalence of 1%... Always will be small sample size.
Adoption study – Kety (1994):
• High rates of schizophrenia in individuals who’s parents had schizophrenia, but had been adopted by psychologically healthy parents.
Shows that genetics are more important than your environment. Supports Cardno et al (2002)
1994
Adoption study -Tienari (1991):
(in the Finnish Adoption Study)
• Matched groups, each with 155 adopted kids• Group one = schizophrenic mother’s (10%
developed schizophrenia)
• Group two = psychologically healthy mother’s (1% developed schizophrenia)
1991
Strengths & weaknesses (A02):Strengths Weaknesses
Twin Studies: MZ have same genetic makeup, so you can test Nature vs Nurture
Objective (quant data)
Twins are rare
Different criteria for different twin studies (so, Cardno used Maudsley, but other people use others)
Concordance rates measured differently = subjective
Adoption Studies: Nature vs nurture
Objective (quant data)
Bigger sample sizes possible than twin = more generalisable
Individual differences (life events)
Extraneous variables e.g. life events…
Biological – Biochemistry:
Dopamine Hypothesis:The dopamine hypothesis suggests that
messages from neurons that transmit dopamine fire either too often, or too regularly. Is is thought that schizophrenics have high numbers of the D2 receptors on the receiving neurons, therefore more dopamine binds to the cell.
Comer (2003): Dopamine plays a role in attention. Disturbances may lead to problems with focussing, and the perception problems found in schizophrenia.
Supports hypothesis – Grilly (2002):
Parkinson’s disease:- Degenerative neurological condition - Low levels of dopamine- Prescribed ‘L-Dopa’ to raise dopamine in brain- Some individuals went on to develop
schizophrenic-type symptoms
Ethical issues – protection from harm
Supports hypothesis – Anti-psychotic drugs:
• Anti-psychotic drugs block activity of dopamine in brain
• By doing so, schizophrenic symptoms (e.g. hallucinations and delusions) are alleviates
• They are known as dopamine antagonists
Supports hypothesis – Amphetamines (like speed):
• Drugs that act as dopamine agonists • Means that synapses get flooded with
dopamine• Large doses can cause hallucinations and
delusions (characteristics of schizophrenia)
Hard to test – ethical issues – protection from harm and … Drugs are illegal’n’ting
Supports hypothesis and contradicts hypothesis – PET Scans:
• Wong et al (1986) used PET Scans and found dopamine activity was greater in schizophrenics compared to a control
• However, Copolov and Crook (2000) have not found evidence of altered dopamine activity in schizophrenic’s brains.
Dopamine hypothesis – evaluation:
• Objective – Quantitative data, scientific
• PET Scans (Wong et al 1986)
• Hormonal• Reliable • Deterministic – no
blame
• Reductionist – no consideration for social events, may ignore actual cause
• Nature vs Nurture –NATURE, good as no blame. BUT, could lead to passive patients
Psychodynamic approach:
Freud (1924):
• Believed schizophrenia was a result of TWO processes:
1) Regression to a pre-ego state2) Attempts to re-establish ego control
Freud (1924):
Freud believed that schizophrenia came from:- Parents being cold/uncaring- Causing child to regress back into infantile state- Where the ego is not yet properly formed- Symptoms include: Delusions of grandeur
(believing you can fly etc)- But also, auditory hallucinations could be seen as
an individual’s attempt to re-establish ego control
Supporting Freud – Fromm-Reichmann (1948):
• Overprotective, rejecting, dominant, and moralistic mothers can contribute to children developing schizophrenia
• Supports Freud in that the condition stems from childhood
Supports Freud – Bateson et al (1956):
• Children who get mixed-messages from their parents are more likely to develop schizophrenia
• For example, if a mother was to tell her child she loved them, but look away in disgust if the child did something wrong. = mixed messages
• Prolonged exposure disrupts a child’s internally coherent construction of reality (perception of reality)
DOUBLE-BIND THEORY
Argues Freud – Oltmanns et al (1991):
• Parents act differently once their child has been labelled as schizophrenic
• Not prior to• Therefore it is not parental influence
and it argues Freud
• (SYNOPTIC: kinda like in Rosenhan’s 1973 pseudo-patients study as the nurses reacted to them differently once they had been labelled)
Psychodynamic approach AO2:
• Supporting research – Fromm-Reichmann (1948) (use other two in AO1)
• Considers social influences such as upbringing
• Individual differences
• Subjective
• Simplistic – biology not considered
Cognitive for schizophrenia:
Cognitive:
• Cognitive approach looks at biological factors for schizophrenia, says Type I/positive symptoms come from biology
• But further symptoms stem from people trying to make sense of their symptoms
• They reject feedback from others and believe that their beliefs are manipulated by others
Cognitive – Frith (1979):
• Argues schizophrenia comes from faulty attention systems
• with an inability to filter out unnecessary info that they have gathered through their senses
• This leads to illusion of distorted thoughts
Does not consider individual differences
Cognitive – Bentall (1994):
• Schizophrenics have trouble with processing information• Shown in Stroop tests: Colour words (red and green) are
substituted for emotional words (death and laughter), • Schizophrenics take longer than non-schizophrenics to
name the words.• Automatic subconscious processing – may account for
positive symptomsStroop tests may be unreliableIndividual differences
What have we learnt thus far…?
• Cognitive psychology is concerned with thought processes such as memory and attention.
• The cognitive approach to psychology recognises that biological factors contribute to the positive symptoms of schizophrenia. Other symptoms, such as negative symptoms develop from the individual attempting to make sense of an experience.
More stuff we’ve learnt…
• People provide information they need to maintain a grasp on reality and if this does not happen, psychosis may occur (loss of contact with reality) and people may become paranoid they are being controlled by someone else.
• A faulty attention system is blame as the reason for schizophrenia (Frith, 1979) as they can not filter out unnecessary information which leads to problems with attention.
Even more…
• This is shown further by Bentall (1994) who used the Stroop test to show problems with how people with schizophrenia process information, showing disruption with the processing of emotional words.
Supports cognitive – Meyer-Lindenberg et al (2002):
• Excessive dopamine in the prefrontal cortex has direct impact on the working memory.
• Where the schizophrenia stems from a disbelief in others(Synoptic – links to dopamine hypothesis)Objective (hormones)
lindenberg&
Supports cognitive – Yellowleese et al (2002):
• Developed a virtual hallucination machine• E.g. hearing a TV telling you to kill yourself• These were shown to schizophrenics to show
their own hallucinations were unreal & irrational
Ethical issues – protection from harm
Argues Cognitive – McKenna (1994):
• Schizophrenics aren’t more easily distracted than non-schizophrenics in cognitive tasks
Historical validity Lab study may affect results Distraction = subjective
Cognitive AO2:
• Yellowleese et al (2002)
• Free will
• Application to real life: treatments
• More holistic – approach believes that positive symptoms have a biological influence
• McKenna (1994)
• Individual differences
Treatment of schizophrenia:
Antipsychotic drugs:
• Chemotherapy (chemical treatments) used to treat symptoms of psychotic disorders such as schizophrenia and manic depression
• Two types of antipsychotic drugs:
Conventional and atypical…
Antipsychotic drugs:
Conventional:• E.g. ChlorPROmazine (pro –
treats positive symptoms)• Such as hallucinations and
delusions• Reduces the effects of
dopamine by blocking receptors
• Dopamine antagonists• Side effects
Atypical antipsychotic drugs:• E.g. Clozapine• Works on both positive and
negative symptoms (depression & apathy)
• Acts on dopamine & serotonin receptors
• Side effects include tardive dyskinesia (involuntary movement of mouth and tongue)
• Less side effects
Effectiveness and appropriateness of conventional and atypical drugs:
Conventional:• Luft B (2006) Found that
conventional drugs are associated with sudden death whereas atypicals are not
• Hill (1986) found that 30% of people taking conventional develop Tardive Dyskinesia
• Ross and Read (2004) – Motivational deficits, such as labelling, reinforcing ‘something’s wrong with you’ which is unethical
Atypical:• Leucht et al (1999) - Meta-
analysis showed that atypical are only a little better.
• Jeste et al (1999) - Side effects. Less chance of Tardive Dyskinesia (5% of people)
• Davis et al (1980) – Relapse. Placebo = 55% relapsedAtypicals = 2-22% relapsed
Individual differences etc etc
Antipsychotic drugs AO2
• Biological
• Objective
• Real life application
• Deterministic
• Reductionist – individual differences
Psychological therapies for schizophrenia:
Psychoanalysis:
• Getting to your subconscious to see if your childhood affected you – usually associated with Freud’s psychodynamic approach
• Freud believed that this approach would not work as schizophrenics are unable to form a transference with the analyst
• This is when the emotions of a patient are unconsciously shifted onto the analyst
SubjectiveCheapQuickCan combine with medicine
Appropriateness of psychoanalysis – Gottdiener (2000):
• Meta-analysis of 37 studies• Covering 2642 patients• 66% of them improved after
treatment using psychotherapy/psyschoanalysis
Effectiveness of psychoanalysis: Malmberg and Fenton (2001)
• It is impossible to draw a definite conclusion for or against the effectiveness of psychoanalysis.
• In fact the schizophrenia patient outcome research team (PORT) has even argued that psychoanalysis may be harmful to schizophrenics
Effectiveness of psychoanalysis:
• Therapists are expensive
• Patients often treated over a long time
• Prevents it being adopted on a large scale
• Costly & time consuming
Cognitive behavioural therapy:
• Caused by faulty thinking. Trying to find root of the problem to prove irrational thoughts are irrational
• Look at alternative explanations for maladaptive beliefs
• Treats symptoms rather than causeFocuses on ‘negative behaviours’ which are also deemed the ‘safest behaviours’
• People need to be trained to do it
Appropriateness of CBT - Kingdon and Kirschen (2006):
• 142 patients were tested, and found that many patients were not suitable for CBT as they would not fully engage with it.
• In general, it was less effective on older folk than younger ones
Effectiveness of CBT: Gould et al (2001):
• Meta-analysis of 7 studies• Reported that there was a
statistically significant decrease in the positive symptoms of schizophrenia after treatment
7 studiespositive symptoms
Evaluation for psychological therapies of schizophrenia – AO2:
• Comment on effectiveness and appropriateness for each
• Can be used along side drug therapies
• Comment on effectiveness and appropriateness for each
• Simplistic – only treating thoughts even though cognitive theory suggests that positive symptoms derive from biological influences
• People have to be trained to do CBT and psychoanalysis which is expensive, time consuming
• Individual differences – some people might not respond as well to drug treatment as others
Key words:Word Definition
Psychosis Loss of contact with reality
Positive symptoms Added to personality e.g. delusions and hallucinations
Negative symptoms Something removed from your personality, such as alogia = loss of speech
Biochemistry Hormones and neurotransmitters
Chemotherapy Treatments based on chemicals
Serotonin A neurotransmitter, low levels of this have been linked to depression
Dopamine A neurotransmitter, high levels have been linked to schizophrenia in the dopamine hypothesis
MOAAARR definitions!Word Definition
Dopamine antagonist Chemical which inhibits effect of dopamine
Placebo ‘fake’ version of a drug which tests whether the drug has biological impacts
Relapse When you lose your symptoms of abnormality, but then they come back
Neurotransmitter Chemicals that transmit impulses across a synapse causing a change in behaviour