PsychExchange.co.uk Shared Resource

1

Schizophrenia

Characteristics of Schizophrenia

Positive symptomsNegative symptomsMisconceptions

Biological explanations Psychological

Genetic BehaviouralViral Infection PsychodynamicBrain dysfunction CognitiveBiochemical

Sociocultural

Life events Family relationshipsSocial Labelling

DSM IV diagnostic criteria are A Characteristic Schizophrenia symptoms Two (or more) of the following each present for a significant portion of time during a 1-month period (or less if successfully treated)Delusions - false beliefs strongly held in spite of invalidating evidence especially as a symptom of mental illness for example Paranoid delusions or delusions of persecution for example believing that people are out to get you or the thought that people are doing things when there is no external evidence that such things are taking place Delusions of reference - when things in the environment seem to be directly related to you even though they are not For example it may seem as if people are talking about you or special personal messages are being communicated to you through the TV radio or other media Somatic Delusions are false beliefs about your body - for example that a terrible physical illness exists or that something foreign is inside or passing through your body Delusions of grandeur - for example when you believe that you are very special or have special powers or abilities An example of a grandiose delusion is thinking you are a famous rock star Hallucinations - Hallucinations can take a number of different forms - they can be Visual (seeing things that are not there or that other people cannot see) Auditory (hearing voices that other people cant hear Tactile (feeling things that other people dont feel or something touching your skin that isnt there) Olfactory (smelling things that other people cannot smell or not smelling the same thing that other people do smell) Disorganized speech (eg frequent derailment or incoherence) - these are also called word salads Ongoing disjointed or rambling monologues - in which a person seems to talking to himselfherself or imagined people or voices Grossly disorganized or catatonic behavior (An abnormal condition variously characterized by stuporinnactivity mania and either rigidity or extreme flexibility of the limbs)

Negative symptoms of Schizophrenia these symptoms are the lack of important abilities productivity thought to reflect slowing or blocked thoughts and often manifested as short empty replies to questions

B Disturbance must last for 6 months (including 1 month of the above symptoms)

C The symptoms must have produced a mark deterioration in functioning at work in social relations and in self care

Schizophrenia is one of the most serious psychiatric disorders It is classified as a psychotic disorder characterised by severe symptoms (that many would refer to as ldquoabnormalitiesrdquo) in the areas of judgement emotions perceptions and behaviour The name itself implies some kind of split not as popular opinion would suggest a split personality but a split between the mind and reality It was the psychiatrist Bleuler who first labelled the disorder schizophrenia deriving it from two Greek words meaning split (schizo-) and mind (-phrenia) The schizophrenic appears to retreat from reality into his or her own private world Schizophrenia is most commonly characterised by both positive symptoms (those additional to normal experience and behaviour) and negative symptoms (the lack or decline in normal experience or behaviour)

2

The onset is typically in late adolescence and early adulthoodonset- Men 18ndash25 years women 25ndash35 yearsPrevalence The lifetime prevalence of schizophrenia is commonly given at 1 The incidence of schizophrenia was given as a range of between 75 and 163 cases per 100000 of the population (See figure 141)Men are more likely to suffer than females

Schneiderrsquos (1959) first rank symptoms

Task Complete SCHIZOPHRENIA SYMPTOMS-SORTING ACTIVITY Schneider (1959)ACUTE Type 1- Positive symptoms = addition to normal behaviour (+)Slater amp Roth (1969)CHRONIC Type 2-Negative symptoms = absence of normal behaviour (-)

3

TASK1 What is the word lsquoschizophreniarsquo derived from2 What is the prevalence rate of schizophrenia 3 Give two examples of the symptoms that need to be present for a significant portion of time during a 1-

month period (or less if successfully treated) for diagnosing schizophrenia4 Which areas of functioning must the symptoms have disturbed

Delusions are firmly held erroneous beliefs due to distortions or exaggerations of reasoning andor misinterpretations of perceptions or experiences Delusions of being followed or watched are common as are beliefs that comments radio or TV programs etc are directing special messages directly to himherHallucinations are distortions or exaggerations of perception in any of the senses although auditory hallucinations (hearing voices within distinct from onersquos own thoughts) are the most common followed by visual hallucinations

Alogia or poverty of speech is the lessening of speech fluency and productivity thought to reflect slowing or blocked thoughts and often manifested as short empty replies to questions

Disorganized speechthinking also described as thought disorder or loosening of associations is a key aspect of schizophrenia Disorganized thinking is usually assessed primarily based on the personrsquos speech Therefore tangential loosely associated or incoherent speech severe enough to substantially impair effective communication is used as an indicator of thought disorder by the DSM-IV

Affective flattening is the reduction in the range and intensity of emotional expression including facial expression voice tone eye contact and body language

Grossly disorganized behavior includes difficulty in goal-directed behavior (leading to difficulties in activities in daily living) unpredictable agitation or silliness social disinhibition or behaviors that are bizarre to onlookers Their purposelessness distinguishes them from unusual behavior prompted by delusional beliefs

Catatonic behaviors are characterized by a marked decrease in reaction to the immediate surrounding environment sometimes taking the form of motionless and apparent unawareness rigid or bizarre postures or aimless excess motor activityOther symptoms sometimes present in schizophrenia but not often enough to be definitional alone include affect inappropriate to the situation or stimuli unusual motor behavior (pacing rocking) depersonalization derealization and somatic preoccupationsAvolition is the reduction difficulty or inability to initiate and persist in goal-directed behavior it is often mistaken for apparent disinterest (examples of avolition include no longer interested in going out and meeting with friends no longer interested in activities that the person used to show enthusiasm for no longer interested in much of anything sitting in the house for many hours a day doing nothing)

________________False beliefs (incompatible with reality persecution of grandeur)

______________________________voices are heard discussing thoughts and behaviour may be obscene and order patient to do things

_______________________thoughts are controlled by external forces ie Martians government etc

Schizophrenia is usually an episodic illness as it consists of periods of acute disturbance (+) interpersed with periods of better functioning (-)

Ideas about the disorder we now term schizophrenia crystallized towards the end of the last century The concept of this disorder has evolved during this century Important landmarks in the definition of this disorder are

4

Emil Kraepelin separated affective psychoses (eg mania) from non-affective psychoses he gave the term lsquodementia praecoxrsquo to clinical conditions resembling the main forms of schizophrenia

Eugen Bleuler coined the term lsquoschizophreniarsquo (lsquosplitting of the mindrsquo) his description placed more emphasis on thought disorder and negative symptoms than on positive symptoms

the main international classification systems ICD-10 and DSM-IV have further clarified the diagnostic criteriaThe main distinction between ICD-10 and DSM-IV is that the latter specifies a 6-month duration of symptoms and places a large emphasis on social or occupational dysfunction

Kurt Schneider defined first-rank symptoms which now comprise criteria(a)ndash(d) of the ICD-10 classification

1893 1911 1959 1970 to the present

MISCONCEPTIONSThere are many misunderstandings about schizophrenia

Is schizophrenia lsquosplit personalityrsquo or like a lsquoJekyll and Hydersquo character

Are people with schizophrenia violent

5

CASE STUDY SchizophreniaJohn was referred to a psychiatrist at the age of 22 after leaving home to go to college Prior to that he had lived at home with his mother and sister and had always had problems making friends Living in a shared house with other students proved to be difficult and he spent increasing amounts of time in his room He began to think that the other people in the house were plotting against him and imagined that they were standing outside his door and shouting abuse As his work began to suffer he began to have paranoid thoughts about his college lecturers This eventually extended to the belief that MI5 had bugged the house with microphones hidden in the walls After he left college and returned to the family home he had little energy and no interests He remained unemployed and continued to avoid contact with anyone outside the home (Based on Lavender 2000)Reference Lavender T (2000) Schizophrenia In L Champion amp M Power (Eds) Adult Psychological Problems Hove UK Psychology Press

TaskSchizophrenia screening quiz httppsychcentralcomquizzesschizophreniahtm

No Schizophrenia is a complex illness affecting a personrsquos whole being their moods feelings perceptions thoughts behaviour and ability to communicate It is a severe and disabling condition which is characterised by a profound disruption of cognition and emotion which affects a persons language thought perception affect and even sense of self

No Sufferers are usually withdrawn and prefer to be left alone People with schizophrenia are not especially prone to violence particularly if they had no record of violent behaviour before being diagnosed with mental illness Unfortunately rare cases attract media attention and dominate peoplersquos perceptions of schizophrenia The main danger for people suffering from schizophrenia is violence to themselves and an increased risk of suicide

TaskAnswer the following questions after reading the article ldquoSchizophrenia-Destiny in your genesrdquo-Neil Ingram

1 Why is schizophrenia very hard to diagnose2 Highlight the difference between positive and negative schizophrenic symptoms3 State the concordance rate for identical twins developing schizophrenia4 Highlight why genetic factors are not the only possible cause for schizophrenia5 According to the article what was the first life stress event that Corven experienced that Michael

did not6 At which stage in pregnancy did Maureen develop the flu and what effect did this have on the

unborn twins

6

EVIDENCE FORTWIN STUDIES Gottesman (1991) found that closer the degree of genetic relatedness the higher the incidence of schizophrenia than the general populace (See graph) 48 concordance for MZ FAMILY STUDIES Gottesman (1991) reviewed concordance rate between family members Both parents (46) one parent (16) and sibling (9) whereas general population have 1 chance of schizophrenia onsetSome argue MZ twins may have same environmental treatment than DZ soADOPTION STUDIES allow the clearest separation between genetic and environmental factors They look at adopted children who later develop schizophrenia and compare to their biological and adoptive parentsKety (1988) foundhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellipGENE-MAPPING STUDIES Sherrington (1988) a gene located on chromosome 5 has been linked to schizophreniaMiyakawa (2003) schizophrenics have a defective version of a gene called PPP3CC

The fact the schizophrenia tends to run in families (20 chance if one parent is schizophrenic and 50 chance if both parents schizophrenic) led to the inference that it has a g____________ basis According to the genetic hypothesis the more closely related the f____________ member is to the schizophrenic the greater their chance of developing the disorder

These explanations can be split into 4 cateogries

GENETICBIOCHEMICAL

NEUROLOGICAL (Brain DYSFUNCTION) VIRAL

A01

Mainly look at family twin and adoption studies

A02

KEY STUDY Heston LL (1966) ldquoPsychiatric disorders in foster home reared children of schizophrenic mothersrdquo British Journal of Psychiatry vol 112 819-825AIM To investigate the extent to which genetic factors play a part in the development of schizophreniaMETHOD A longitudinal study on 47 people who had been born between 1915 and 1945 to women with schizophrenia in a state mental hospital The infants were separated from their mothers at birth and raised by foster or adoptive parents A control group of 50 participants were selected from the same childrenrsquos homes both were assessed in 1964RESULTS The following main findings are significant 31 47 children of schizophrenic mothers had a mental health diagnosis

(66) compared to 9 50 of the controls (18) 5 (166) had a diagnosis of schizophreniaThe lsquoschizophreniarsquo group had been more involved in criminal activity and had more often been discharged from the armed services for psychiatric problemsCONCLUSIONS Provides strong support for the importance of genetic factors in the development of schizophrenia Children reared without contact with their schizophrenic mothers were still more likely to become schizophrenic than the controlsEVALUATION The data was gathered from a time span of over 40 years Earlier interpretations of symptoms were differentless uniform from today

EVIDENCE AGAINST-NOT 100-Concordance rate between MZ twins is not 100 and therefore genetics cannot offer a complete explanation-ELICITED TREATMENT-The higher concordance rate in MZ than DZ may be due to the fact that they are treated the same so NURTURE may explain the concordance rate not NATURE -NOT 100-Fewer than 50 of children where both parents have schizophrenia develop the disorder which is evidence against a genetic link-SHARE SIMILAR ENVIRONMENTS- High degree of genetic similarity between family members often fund themselves spending more time together too so environmental factors could also affect them-HETEROGENEITY OF SCHIZOPHRENIA- Farmer (1987) have found that the concordance depends on different symptoms Concordance rate of MZ was 0 for FRMs but 50 for the broader criteria

A02

Evaluation of the genetic basis of Schizophreniastrengths Weaknesses

7

EXTENSION TASK Research The Genain quadruplets who suffered schizophrenia(Rosenthal 1963)

DIATHESIS-STRESS MODELThis states that an individual has a G____________ P_________________ to develop schizophrenia but that it is only triggered by STRESSFUL EVENTS IN THE E_______________________

EVIDENCE Tienari (1987) FINNISH ADOPTION STUDYHigh risk + healthy environment = low schizophreniaLow risk + disturbed environment = low schizophrenia

What is a NEUROTRANSMITTER (NT)

Within a neuron information is conveyed by electrical impulses But for transmission BETWEEN neurons NTs are needed When an electrical impulse arrives at the end of neuron a NT is released into a tiny gap (synaptic cleft) between it amp the beginning of the next neuronThe sending neuron = PRE-SYNAPTIC NEURON amp receiving neuron = POST-SYNAPTIC NEURONThe released NT attaches to the receptor site on the post-synaptic neuron and this triggers another electrical impulse Once its done its job the NT is recycled in one of two waysa) it may be taken back by the neuron that released it (RE-UPTAKE)b) it may be broken down chemically in the synapse gap into smaller compounds by MONOAMINE OXIDASE (MAO)Serotonin (5-HT) noradrenaline and domapine (D2) are major NTs - known as MAO transmitters

The DOPAMINE HYPOTHESIS ptcc pg 196

A01

Evaluation of the biochemical basis of Schizophrenia

Strengths+

Weaknesses-

8

EVIDENCE FOR Anti-psychotic drugs

Parkinsonrsquos Disease (have low dopamine levels) so they are given drug L-DOPA to raise their dopamine levels (this can produce symptoms very similar to schizophrenia Grilly 2002) Parkinsons type symptoms are also side effects of anti-psychotic drugs which reduce dopamine levels What does this tell youPost Mortems and PET scans post mortems on schizophrenics show high levels of dopamine in the brain especially the limbic system (Iversen 1979) (see graph)

A02

Evidence supporting1048707 L-DOPA (used in the treatment of PARKINSONrsquoS DISEASE) whichINCREASES the amount of dopamine can produce symptoms of schizophrenia1048707Amphetamines which STMULATE dopamine release also produce schizoid type behaviour This can be seen in studies on rats such as research by (RANDRUPamp MUNKVAD 1966)1048707 Specific studies (eg OWEN 1978) have found increased dopamine receptor density in the brains of schizophrenics (both PET scans amp postmortems) Further refinements of the hypothesis show that schizophrenics have excess D2 receptors and D2 receptors are oversensitive (Davidson and Neale 2001)

There is contradictory evidence Some studies show that schizophrenics have lower levels of dopamine in certain areas of their brainTo be effective antipsychotics have to reduce dopamine activity to below their normal levels If the theory is true then reducing dopamine levels to normal should be sufficient

9

EXTENSION TASK 1 Read the article on the link between cannabis and schizophrenia

EXTENSION TASK 2 You may want to read through the lsquodopamine extra informationrsquo sheet to get more A02 evaluative points

There is a growing body of evidence which suggests that schizophrenia may be caused by abnormalities to b____________ structureIn particular the following brain areas have been implicated in the development of schizophrenia

(i) BRAIN VOLUME- Enlarged ________________(appears to be associated with negative symptoms) This is fluid filled cavities due to the loss of subcortical brain cellsThe ventricles of a person with schizophrenia are on average about 15 bigger than normal

This implies that the brain areas around the border of the ventricles have shrunk or decreased in volume the ventricular space becoming larger as a result and also decrease in brain weight

Picture MRI scans of 28 year old male identical twins showing an enlarged brain ventricles in the twin with schizophrenia (left) compared with his well brother (right) Torrey (2002)The enlarged ventricles may be the result of poor brain development or tissue damage

(ii) SPECIFIC BRAIN AREAS- Many brain regions and systems operate abnormally in schizophrenia Buchsbaum (1990) found abnormalities in the _________________ cortex (frontal lobe) the ___________________ the __________________ and the ____________________

A01

10

Hippocampus Mediates learning and memory formation these functions are impaired in Schizophrenia

Frontal LobeCritical to problem solving insight and other high level functioning Low frontal lobe activation when engaging in mentally challenging tasksIn schizophrenia this leads to difficulty in planning actions and organising thoughts

Evidence For

Enlarged Ventricles Brown et al (1986) found decreased brain weight and enlarged ventriclesMRI (Magnetic Resonance Imaging) showed that in MZ twins where one had schizophrenia and the other didnrsquot the schizophrenic twin had more enlarged ventricles (Suddath Torrey et al 1990)Abnormalities in Specific Brain Regions Cannon et al (1998) found that the pre-frontal area does not kick into action when patients perform complex tasks (like Wisconsin Card sorting)People with Sz show abnormality in cognitive behavioural social and emotional development before the onset of the disorder which is consistent with the neurodevelopment hypothesis Walker (1994) analysed clips of home movies of pre-schizophrenic children and found they showed more unusual hand movements than their healthy siblingsMyer-Lindenberg et al (2002) examined brain activity in schizophrenics engaged on a working memory task They found 2 key brain abnormalities in schizophrenia (see PTCC PAGE 196)1)

2)

A02

Basal Ganglia involved in movement and emotions and integrating sensory information Abnormality can contribute to hallucinations and paranoia

Limbic System (Amygdala) involved in emotion Disturbances are thought to contribute to the agitation frequently seen in schizophrenia

Where do these abnormalities originate Consider the next hypothesis

Viral infection and Complications during pregnancy

11

Evidence Against

Enlarged Ventricles The differences in the MZ twins brains show that genetics or neurodevelopmental factors are not solely responsible as only environmental factors can account for such differences

Research has shown that enlarged ventricles are found in non-schizophrenics which contradicts this as a physical cause

Specific Brain regions Whilst MRI studies appear to provide conclusive evidence of structural abnormalities it is worth noting that they do not always agree on the regions of the brain affected For example Flaum (1995) found no abnormalities in the temporal lobe regions whereas Woodruff (1997) found quite significant reductions in the temporal lobe compared with controls

A02

EVALUATION1) Causality -C______________ and E___________ This can be seen in two ways-

(a) MEDICATION(b) SCHIZOPHRENIA rarr BRAIN CHANGES

2) Reliability ndashlack of consistency in the nature of brain abnormalities across different research3) Nature or Nurture- brain abnormalities could be genetic but differences in MZ twins suggest nurture4) Generalisability- Brain dysfunction is linked to negative symptoms only

The Viral Theory

WINTER BIRTH- Torrey (2000)

VIRAL INFECTION during pregnancy De Messias et al (1998)

IMPORTANCE OF THE 2ND TRIMESTER in PREGNANCY-Van Os et al (1997) Comer (2003)

EVIDENCE FOR ptcc 196

A01A012

12

Brain abnormalities are caused by exposure to viruses before birthVIRAL INFECTIONS such as measles pneumonia and Influenza A DURING PREGNANCY especially the 2nd trimester (when the developing brain is forming crucial interconnections)SEASONALITY EFFECT high proportion of Sz are born in the winter months (when flursquos are most prevalent) Viral infection enters brain and is dormant until it is activated by hormones at

StrengthsExplainswhy Sz appears in individuals with no family history of the disorder

Karlsson (2001) 3rd of those who recently developed Sz had high levels of retrovirus (virus binds to DNA and can be passed on to the next generation) in their cerebrospinal fluid cf none in normal conditions

WeaknessesMethodological problems-studies such as those of Torrey were based on correlational data and so caution should be observed when attempting to infer causation

EVALUATION


1) Psychological-Psychodynamic Behavioural and Cognitive

2) Socio-culturalLife Events Family relationships and Social Labelling

TRY THIS ESSAY AND APPLY YOUR KNOWLEDGE Describe amp evaluate 2 or more biological explanations of schizophrenia (24 marks)

EXAM TIP although we have covered a lot of biological explanations you may not be able to cover all of these in the time given so make sure you provide QUALITY (describe explanations in depth) than QUANTITY (list many explanations but not in detail

Freud believed that schizophrenia involves a two-part psychological process1 Regression to pre-ego stage2 Attempts to re-establish ego controlHe believed that it stems from a basic conflict between a personrsquos self-gratifying impulses and the demands of the real world When the real world is difficult stressful anxiety-producing then the person will regress to an early part of the oral stage called primary narcissism (where the ego has not separated from the id AND great self-interest) The lack of ego functioning results in loss of contact with reality When they reach this stage the schizophrenic will then try to re-establish ego control and try to interact with reality

A02

A01

Overall evaluation of bio explanation of SzBiological explanations are deterministic ie assume that some individuals will inevitably develop Sz Patient is seen as passive and bio cause = bio treatmentIGNORES SOCIAL FACTORS

DESCRIPTION (A01) DESCRIPTION (A01)O____________ C________________ has been used to explain schizophrenia (eg Liberman 1982- FAULTY LEARNING) The idea is that most people learn from their environment to respond to s_________ c__________ When the response is socially acceptable then it will be reinforced Some people however do not receive these r______________ and they will stop attending to these social cues and focus instead on other often irrelevant cues As they do this more and more their behaviour will become more and more

1) The schizophrenic will have some b_______________ abnormality which will lead to strange sensory experiences

2)Then according to Comer (1995) the schizophrenia when first confronted by voices or visions will turn to r__________ f______________ etc to help them understand what is happening

3) When these people d___________ the existence of these visions or voices that the schizophrenic knows they are experiencing then they will come to believe that their

13

EVALUATIONLACK OF RESEARCH EVIDENCE (except the alternatives)SPECULATIVE impossible to test empirically concepts such as ego regression etcDATED conducted in the Victorian era and so may lack temporal validitySAMPLE BIAS He used his own patients upper-class Viennese women so population validity lowEMPHASIS ON THE PAST focus on the past means present problems are negelectedFreudrsquos Research may have little relevance to schizophrenics today as the research may be era-dependent and context boundCAUSALITY

Schizophrenic symptomsRegressive- delusions of self-importance (grandiosity) regress to the PRIMARY NARCISSISM (focus on self)RestorativeRestitutional- Hallucinations and delusions (as fantasies get mixed with reality) ALTERNATIVE Psychodynamic

Explanation-SCHIZOPHRENOGENIC MOTHER Fromm-Reichmann (1948) ptcc page 199

A02

A02

TASK Read through the A01 points on the behavioural and cognitive explanations of Sz and then complete the A02 section for each explanation (see PTCC page 199)

bizarre which means that their behaviour will eventually receive a lot of attention this attention will act as a r_____________ for the behaviour There has been some support for this because it has been shown that schizophrenics can learn appropriate responses if they are rewarded with cigarettes food attention etc (eg Belcher 1988)

friends and relatives are trying to h_______ the truth from them and

4) they will eventually r__________ all feedback from others

5) They will eventually believe that they are being m_______________ or persecuted (Garety 1991)-FAULTY THINKING

COMMENTARY- evidence and evaluation

A02


A02NATURE OR NURTURE DESCRIPTIVE RATHER THAN

EXPLANATORY Describe symptoms but do not explain in order to explain the origins of Sz they need to be combined with biological models EXPLAINING SYMPTOMS cannot offer a full explanation of Sz but accounts for some symptoms like hallucinations and delusions

14

15

EXAMPLES OF DISCRETE STRESSES Death of a close relative

SOCIAL ECONOMIC STATUSSome studies (eg Srole et al 1962) have suggested that schizophrenia is not evenly distributed throughout the population and that the lower socio-economic status (SES) you investigate then the more likely you are to find schizophrenics Clark (1948) showed that low status occupations have much higher rates of schizophrenia than high status Kohn (1973) suggests that this could be something to do with personal strategies for coping with stress He argues that working class people emphasise conformity more than middle class people and that this might mean that they have fewer personal resources when faced with stresses Of course these ideas have caused a great deal of controversy Evaluation- There is a great deal of argument about whether schizophrenia is the cause of social disadvantage (the social drift hypothesis) or whether

DESCRIPTION

EVIDENCE FORhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

EVIDENCE AGAINSTVan Os et al (1994) reported no link between life events amp onset of Sz Equal likelihood of having or not having major life event in the 3 months prior to onset of Sz

CONSIDER Module 2- Abnormality Can you think of cultures which would not consider hallucinations as being abnormal(See case study below to help you)

DESCRIPTION In 1962 Szasz claimed that Sz as a disorder did not exist and believed it was societyrsquos way of classifying individuals who did not follow societyrsquos controls on behaviour and instead demonstrated bizarre behaviour According to Szasz lsquoMental Illnessrsquo is simply a lable used to exclude individuals from as they are not lsquoclassedrsquo as lsquonormalrsquo In 1966 Scheff developed a theory that argued that Sz may be largely a social role which on receiving a psychiatric diagnosis this creates a stigma or mark of social disgrace This label of lsquomental illnessrsquo then creates expectations from the patient and others as a result sufferers then conform to this role and in turn create a SELF-FULFILLING PROPHECYAccording to Scheff (84) some deviant behaviour gets labelled as mental illness which then leads to rejection by others and to self-identification as mentally ill Individuals then take on this identity and behave in a way that

Teachers at a Minneapolis school in were convinced that one of their pupils had a psychological disorder The pupil a Chippewa boy kept seeing thunderbirds ndash mythical birds Unfortunately for him nobody else at the school could see them The boyrsquos parents were called in and said they were delighted with their sonrsquos sightings A psychiatrist was asked to examine the boy He was concerned about the visions ndash they are often seen as a symptom of schizophrenia in Western psychiatry ndash but admitted that the boy seemed normal in every other respect Luckily a member of the anthropology department at the university who had studied the Chippewa was contacted He explained that there was nothing wrong with the boy in fact just the opposite In traditional Chippewa culture the thunderbird is a supernatural being and it is a great honour to have such visions Far from seeing his behaviour as psychologically abnormal the boy and his parents saw it as something to be proud of In terms of American culture- the boyrsquos behaviour is abnormal and may well indicate a psychological disorder Chippewa culture- it indicates psychological wellbeing

16

EVIDENCE FORIn lsquoOn being sane in insane placesrsquo-Rosenhan (1973) claims that psychiatric (diagnostic) labels tend to become self-fulfilling prophecies Psychiatric labels stick in a way that other medical labels donrsquot More seriously everything the patient says and does is interpreted in accordance with the diagnostic label once its been applied For example after admission the pseudo-patients kept a written record of how the ward was run This was documented by the nursing staff as lsquopatient engages in writing behaviourrsquo In other words the writing was seen as a symptom of their pathological behaviour See SUMMARY SHEET

According to Scheff the Label influencesa) how the person will continue to behave

ARGUMENTS AGAINSTKimble et al (1980) PTCC pg 199

DESCRIPTION- DESCRIPTION

EVIDENCE FORExample a mother induces her son to give her a hug but when he does she tells him lsquonot to be such a babyrsquo

17

EVIDENCE FOR

ARGUMENTS AGAINSTMischler amp Waxler (1968) found significant differences in the way mothers spoke to their schizophrenic daughters compared to their normal daughters which suggest that dysfunctional communication may be a result of living with the schizophrenic rather than the cause of the disordersETHICAL IMPLICATIONS blaming the familyLACK OF EVIDENCE there is research evidence that dysfunctional communication characterises all family interactions to some extent Can you think of a time when

ARGUMENTS AGAINSTEXPLAINS MAINTENANCE NOT CAUSE High EE has been well supported as a factor in relapse (ie a factor in maintenance rather than the cause) as individuals are 4x more likely to relapse if EE high (Kavanagh 1992) MULTI-DIMENSIONAL APPROACH not all siblings develop schizophrenia which challenges the family environment as the cause It is more likely to be explained by differences in genetic vulnerability cognition and unconscious motivationsCAUSE OR EFFECT the family is seen as lsquoschizophrenicrsquo and one member becomes a scapegoat for the whole familyrsquos pathology OR patient is already ill and part of the familyrsquos way of dealing with this is to develop abnormal (schizophrenic) forms of

1 According to Bateson what are the three defining characterisitics of a double bind

helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip2 What important issue within the family did Laing

amp the anti-psychiatry movement highlighthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3 What is meant by a relapse into psychoseshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4 Highlight the two goals of family therapy

helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

5 What is meant by the term expressed emotion (EE)

helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6 Highlight the effect high negative EE has on the

schizophrenic patient compared to high levels of positive EE

helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

18

Task READ THE ARTICLE lsquoLiving with Schizophreniarsquo (David Putwain) and answer the questions below

helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip7 Outline how Sarason and Sarason have

suggested that the findings about EE has been misinterpreted


19

The factors in Schizophrenia can be organised into those that create a vulnerability (Predisposing) those that trigger the disorder (precipitating) and those that maintain it (perpetuating)

re-disposing recipitating erpetuating

20

Task Considering the theories we have looked at organise the following in the table below If you are not sure write it in pencil Note certain factors could go in more than 1

1 Life events 7 Neurodevelopment Hypothesis2 Family conflict 8Dysfuncitonal family dynamics3 Genetics 9Biochemistry4 Expressed emotion5 Faulty cognition6 Reinforcement HINT There are 3 in each

DSM IV diagnostic criteria are A Characteristic Schizophrenia symptoms Two (or more) of the following each present for a significant portion of time during a 1-month period (or less if successfully treated)Delusions - false beliefs strongly held in spite of invalidating evidence especially as a symptom of mental illness for example Paranoid delusions or delusions of persecution for example believing that people are out to get you or the thought that people are doing things when there is no external evidence that such things are taking place Delusions of reference - when things in the environment seem to be directly related to you even though they are not For example it may seem as if people are talking about you or special personal messages are being communicated to you through the TV radio or other media Somatic Delusions are false beliefs about your body - for example that a terrible physical illness exists or that something foreign is inside or passing through your body Delusions of grandeur - for example when you believe that you are very special or have special powers or abilities An example of a grandiose delusion is thinking you are a famous rock star Hallucinations - Hallucinations can take a number of different forms - they can be Visual (seeing things that are not there or that other people cannot see) Auditory (hearing voices that other people cant hear Tactile (feeling things that other people dont feel or something touching your skin that isnt there) Olfactory (smelling things that other people cannot smell or not smelling the same thing that other people do smell) Disorganized speech (eg frequent derailment or incoherence) - these are also called word salads Ongoing disjointed or rambling monologues - in which a person seems to talking to himselfherself or imagined people or voices Grossly disorganized or catatonic behavior (An abnormal condition variously characterized by stuporinnactivity mania and either rigidity or extreme flexibility of the limbs)

Negative symptoms of Schizophrenia these symptoms are the lack of important abilities productivity thought to reflect slowing or blocked thoughts and often manifested as short empty replies to questions

B Disturbance must last for 6 months (including 1 month of the above symptoms)

C The symptoms must have produced a mark deterioration in functioning at work in social relations and in self care

Schizophrenia is one of the most serious psychiatric disorders It is classified as a psychotic disorder characterised by severe symptoms (that many would refer to as ldquoabnormalitiesrdquo) in the areas of judgement emotions perceptions and behaviour The name itself implies some kind of split not as popular opinion would suggest a split personality but a split between the mind and reality It was the psychiatrist Bleuler who first labelled the disorder schizophrenia deriving it from two Greek words meaning split (schizo-) and mind (-phrenia) The schizophrenic appears to retreat from reality into his or her own private world Schizophrenia is most commonly characterised by both positive symptoms (those additional to normal experience and behaviour) and negative symptoms (the lack or decline in normal experience or behaviour)

2

The onset is typically in late adolescence and early adulthoodonset- Men 18ndash25 years women 25ndash35 yearsPrevalence The lifetime prevalence of schizophrenia is commonly given at 1 The incidence of schizophrenia was given as a range of between 75 and 163 cases per 100000 of the population (See figure 141)Men are more likely to suffer than females



3














4





1893 1911 1959 1970 to the present




5








unborn twins

6




GENETICBIOCHEMICAL


A01


A02




A02


7







A01


Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20





3














4





1893 1911 1959 1970 to the present




5








unborn twins

6




GENETICBIOCHEMICAL


A01


A02




A02


7







A01


Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20




4





1893 1911 1959 1970 to the present




5








unborn twins

6




GENETICBIOCHEMICAL


A01


A02




A02


7







A01


Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20






5








unborn twins

6




GENETICBIOCHEMICAL


A01


A02




A02


7







A01


Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20



6




GENETICBIOCHEMICAL


A01


A02




A02


7







A01


Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20




7







A01


Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20




Strengths+

Weaknesses-

8



A02



9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20





9








A01

10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20



10



Evidence For


2)

A02





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20





11

Evidence Against




A02




The Viral Theory





A01A012

12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20



12





EVALUATION







A02

A01






13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20







13




A02

A02







A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20








A02




14

15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20



15



DESCRIPTION






16






17

EVIDENCE FOR











18





19



20



16






17

EVIDENCE FOR











18





19



20



17

EVIDENCE FOR











18





19



20











18





19



20






19



20





20



Date post:	25-Jun-2015
Category:	Documents
Upload:	psychexchangecouk
View:	455 times
Download:	0 times

PsychExchange.co.uk Shared Resource

Documents