schizophrenia ao3s

strength of schizophrenia diagnosis

RELIABLE - a diagnosis is reliable when diff diagnosing clinicians reach the same diagnosis for the same individual (inter-rater) and when the same clinician reaches the same diagnosis for the same person on two diff occasions (test-retest). OSARIO et al found excellent reliability in the diagnosis of 180 individuals using DSM-5 where pairs of interviewers achieved inter-rater (+0.97%), test-retest (+0.92%)

L - diagnosis of SZ is likely consistently applied

weakness of the diagnosis of schizophrenia

Cheniaux et al had two psychiatrists assess the same 100 clients using ICM and DSM-5 and found that 68 were diagnosed w SZ (ICD) compared to 39 diagnosed (DSM-5). ICD requires two or more negative systems for diagnosis whereas DSM requires only one positive symptom. An issue could be that the negative symptoms of SZ are less specific to SZ, making it easier to meet the threshold

L - SZ is either over (ICD) or under (DSM) diagnosed according to the diagnostic system - the criterion validity is therefore low.

weakness 2 of diagnosis of schizophrenia

gender bias - men have been diagnosed more frequently than women (1.4 to 1 ratio). women usually have closer relationships and hence get more support which is why they might be under-diagnosed. LORING AND POWELL asked male and female psychiatrists to diagnose patients using the DSM and found that when no gender info was given 56% were diagnosed with SZ, vs. when patients were described as female, 20% were diagnosed

L - lack of consistency reduces inter-rater reliability + reduces the validity of diagnosis through gender bias as women won’t receive the treatment they might benefit from

weakness 3 of diagnosis of schizophrenia

culture bias - hearing voices (positive symptom of SZ) in Afro-Caribbean cultures is seen as communication from ancestors. British ACs are 9x as likely to receive SZ diagnosis than white British. This shows cultural bias in the diagnosis of clients in a diff cultural background to the psychiatrist. White psychiatrists tend to over-interpret symptoms and distrust the honesty of POC during diagnosis (ESCOBAR) and when the given the same description of patients, 69% of US psychiatrists diagnosed SZ vs. 2% of UK psychiatrists (COPELAND)

L - there is a lack of consistency between cultures and the same diagnosis should be given regardless of culture (as it reduces reliability) OR

L - this suggests issues with the validity of diagnosis as individuals from some cultures are more likely to be diagnosed due to bias.

weakness 4 of the diagnosis of schizophrenia

symptom overlap - both SZ and BPD share positive symptoms of delusions as well as negative symptoms such as avolition - this questions the validity of classifying them as two diff disorders as there may be variation of a single condition. in terms of diagnosis it means that SZ is hard to distinguish from BPD

L - this decreases the validity of diagnosis as it could lead to incorrect diagnosis and leads to low reliability as as diagnoses can become inconsistent

weakness 5 of diagnosis of schizophrenia

co-morbidity - if conditions occur together, this questions the validity of the diagnosis and classification as they may be a single condition. SZ is commonly diagnosed with other conditions e.g. BUCKLEY’s review found that 50% of those w/ SZ also had depression, 47% had co-morbidity w/ substance abuse and 23% w/ OCD

L - this decreases the validity of diagnosis as it could lead to incorrect diagnosis (unusual case of depression rather than SZ) which could lead to incorrect treatments, impacting recovery, employment and family life etc.

strength of the psychological SZ explanation

evidence linking FD to SZ - READ ET AL found that adults w/ SZ = type C or D attachment (disinhibited). 69% of women + 59% men suffered physical/sexual abuse history b4 SZ diagnosis. Mørkved et al found that most adults w/ SZ reported at least one childhood trauma event, most often abuse

L - strongly suggests that FD makes ppl more vulnerable to SZ

weakness of the psychological SZ explanation

weak evidence to support FD - little to no evidence on importance of schizophrenogenic mother or double-bind theory. both theories are based on outdated concepts (e.g. assessing personality of mothers for contributing to child’s disorders). socially sensitive research leads to parent blaming as well

L - undermine the appropriateness and credibility of the family-based explanation

strength of the the cognitive SZ explanation 2

strong evidence for cognitive explanation (dysfunctional info processing) - STIRLING ET AL compared 30 SZ ppl to control group on diff cognitive tasks including stroop test and found ppl w/ SZ took twice as long on stroop test vs. control

L - shows poorer cognition, supporting concept of central control as they were unable to suppress non-essential processes such as urge to read words aloud rather than colour.

weakness 2 of the cognitive SZ explanation

cognitive only explains proximal rather than distal explanations - cog explanation = descriptive not explanatory. focus is placed on present symptoms (proximal) rather than distal causes (genetic/FD) which causes cause-and-effect issues. unclear if cog dysfunction drives neurological changes or results from them

L - cog theories are partial explanations, describing how symptoms occur but not why SZ develops

strength of psychological therapy (CBT) for SZ

effectiveness evidence - Jauhar et al reviewed 34 studies using CBT with SZ and found small but significant effects on positive and negative symptoms. Pontillo et al found reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE (national institute for health and care excellence) recommends CBT for SZ

L - both research and clinical experience support benefits of CBT on SZ

weakness of psychological therapy (CBT) for SZ

wide range of techniques and symptoms included - CBT techniques and SZ symptoms vary widely from one case to another. THOMAS points out that diff studies have involved the use of diff techniques and ppl w diff combos of symptoms. the modest benefits of CBT are prolly concealing a wide variety of effects of diff CBT techniques on symptoms.

L - therefore hard to say how effective CBT is for particular people

weakness 2 of psychological therapy (CBT) for SZ

no cure - CBT may improve quality of life but fails to consider the distal causes (individual biology) As the condition is largely biological, psych therapies only improve the ppt’s ability to cope with SZ, not curing it.

strength of psychological therapy (Family) for SZ

effectiveness - McFarlane concluded that FT was a consistently effective treatment for SZ, with reduced relapse rates by 50-60%. using FT as mental health starts to decline helps its effectiveness. Clinical advice also recommends FT for everyone diagnosed w/ SZ

L - FT is likely to benefit ppl with both early and full-blown SZ

strength 2 of psychological therapy (family) for SZ

benefits whole family - families often carry the bulk of care provided for the SZ individual. Lobban and Barrowclough concluded that the effects are important as strengthening the functioning of a whole family, there are less negative impacts of SZ on other family members and strengthens the ability of the family to support the person with SZ

L - FT has wider benefits beyond obvious positive impact on identified patient

strength of bio therapy for SZ

effectiveness - both typical and atypical antipsychotics are moderately effective in tackling SZ symptoms. THORNLEY et al reviewed 13 trials of chlorpromazine and found it was associated w/ better overall functioning and reduced symptom severity vs. placebo. MELTZER concluded clozapine = more effective than typical and other atypical antipsychotics and that it’s effective in 30-50% of treatment-resistant cases where typicals have fails.

L - effectiveness is high as proven by studies

C/A - HEALY argues serious flaws w/ effectiveness evidence as most studies = short term effects only and data republication exaggerates the size of the evidence base

weakness of bio therapy for SZ

side effects - typical antipsychotics = dizziness, sleepiness, weight gain and itchy skin. long term use can result in tardive dyskinesia, caused by dopamine super-sensitivity (involuntary facial movements) the most serious side effects of antipsychotics = neuroleptic malignant syndrome (NMS) which could be fatle to over 2% of SZ individuals

L - they do just as much harm as good, making it ineffective as ppl might avoid them

weakness 2 of bio therapy for SZ

unclear mechanism - antipsychotics mechanism is heavily tied with dopamine hypothesis but the OG hypothesis isn’t a complete explanation for SZ. symptoms are reduced without understanding of how or why disorder occurs (acts as chemical strait jacket)

given that there are questions over the effectiveness of antipsychotics anyways this adds to the argument that they are in fact ineffective

L - some may not be the best treatments to opt for - maybe other factors influence the success of these drugs

strength of psych explanations (FD) of SZ

evidence linking family dysfunction to SZ - READ ET AL found that adults w/ SZ = mostly type C or D attachment. 69% of women and 59% men w/ SZ has history of physical and/or sexual abuse

Mørkved et al found that adults w/ SZ had at least one childhood trauma, most likely abuse

L - strong support for FD explanation of SZ vulnerability

C/A - retrospective evidence which could’ve been distorted by SZ symptoms of patient, making the explanation lack validity

weakness of psych explanation (FD) for SZ

weak evidence for SZ-causing mother and DB theory - little to no evidence supports the SZCM and DBT, as both are based on outdated concepts e.g. assessing personality of mothers for contributing to making their children ‘crazy’

socially sensitive research has led to parent blaming - creates stigma and strain in families and undermines family’s ability to support SZ patient

L - both these issues undermine the appropriateness and credibility of the explanation

strength of psych explanations (cog) of SZ

strong evidence for dysfunctional info processing - STIRLING ET AL conducted a stroop test, plus other cognitive tasks with 30 ppl w/ SZ and found they took 2x longer (123s) vs control group (58s). deficits in central control lead to lowered ability to suppress automatic responses

L - SZ ppl = poorer cognition which supports concept of central control, as they were unable to suppress non-essential processes

weakness of psych explanation (cog) of SZ

provides only proximal rather than distal explanations of SZ - cog explanation = descriptive rather than explanatory. only focuses on proximal processes that produce present symptoms, rather than distal causes like genetics or FD.

this creates cause and effect issues as it’s unclear whether cognitive dysfunction drives neurochemical changes, such as dopamine imbalance, or results from them

C/A cog explanations have practical application through use of CBT to help reduce symptoms in SZ patients

strength of psych therapy for SZ (CBT)

RS - JAHUAR reviewed 34 studies and found clear evidence of small but significant effects on positive and negative symptoms

PONTILLO ET AL found noteworthy reductions of frequency + severity of auditory hallucinations following CBT - CBT is also recommended by NICE showing clinical guidelines and research support its effectiveness

L - valuable and well supported intervention for SZ for addressing symptoms and increasing quality of life

limitation of psych therapy for SZ (CBT)

unsuitable for some - CBT requires self-awareness and willingness to engage w process (positive symptoms = low self-awareness/negative symptoms = inability to engage)

CBT is also impractical due to the length of the therapy (higher attrition rates) and some ppts don’t want vigorous confrontation - unethical due to ‘interfering’ with ppt’s freedom of thought

L - success varies between individuals, making CBT less valid

strength 2 of psych therapy for SZ (CBT)

long term benefits - enhances ability to ignore auditory hallucinations and therefore experience less anxiety (more able to function adequately)

CBT improves quality of life and effectiveness in multiple areas due to active role of patient in therapy

L - CBT = partial cure for SZ

C/A helping symptoms not = eliminating symptoms - cure is unlikely as it’s largely a biological condition so core symptoms may not respond to psych therapy

strength of psych therapy (FT)

RS - MCFARLANE ET AL reviewed studies and found FT = consistently effective + reduced relapse rates by 50-60%, esp when offered early. it’s recommended by NICE and the effectiveness = partly from increased medication compliance as families = more involved in supporting SZ individual

higher socio-economic benefits by lowering relapse rates + reliance on hospitals, reducing financial burden on healthcare services

L - FT = effective for both early and full blown SZ patients + effective intervention for society

strength of psych therapy (FT)

issues with implementing FT - willingness of family members to commit to effort required = varied. accessibility of these therapies = limited due to financial constraints esp considering higher prevalence of SZ in lower socio-economic groups (only applicable in community settings)

SZ ppts may still have paranoid beliefs (collusions betw. family and therapist) → hinders efficacy of therapeutic process

L - while FT = beneficial, successful implementation requires careful consideration of various factors

strength 2 of psych therapy (FT)

long term benefits to whole family - LOBBAN AND BARROWCLOUGH found about 60% of studies on family intervention had signitifcant positive outcomes, including reduced stress + better coping. FT enables families to provide consistent support which benefits patients and caregiving network - promotes recovery and improves wellbeing of relatives

L - FT supports sustained improvements in both patient recovery and family functioning, making it effective and durable

strength of management of SZ

effectiveness - GLOWACKI ET AL identified 7 high quality studies that examined tocken economy effectiveness for ppl w/ chronic MH issues like SZ, and found reductions in negative symptoms in ALL studies + decline in frequency of unwanted behaviours

L - supports value of TEs + effectiveness in improving behaviours

C/A - 7 studies = small evidence base - causes issue to due ‘file drawer problem’ which leads to bias towards positive published findings as undesirable findings = filed away

L - questions validity + strength for effectiveness of TEs

weakness of management of SZ

ethical issues - TEs give pros more power to control behaviour of patients and impose ‘norms’ onto them e.g. loss of personal freedom + basic rights for people who like looking ‘scruffy’ if forced to maintain ‘good hygiene’ to their standards

limiting pleasures to the non-conformist patients worsens experience in seriously ill individuals w/ distressing symptoms

L - benefits may be outweighed by the impact on personal freedom and short-term reduction in quality of life

C/A other approaches = under researched e.g. art therapy recommended by NICE but unclear effectiveness

weakness 2 of management of SZ

limited benefits - TEs = difficult to maintain outside of a hospital setting as behaviours can’t be as closely monitored + tokens can’t be administered immediately

as they only work in institutions, this shows a lack of ecological validity in the systems. KAZDIN ET AL found changes in behaviour don’t remain when tokens = removed (short-term) although they provide modest negative symptom reduction, TEs = less effective for positive symptoms

L - TEs are limited as they only address effects of SZ, not causes

weakness of the interactionist approach

original model = overly reductionist - MEEHL’s model reduced vulnerability to a single ‘schizogene’ and stress to one factor (SZ causing parenting) modern research shows this is TOO SIMPLISTIC, vulnerability implicates multiple genes, neurodevelopmental issues and psych trauma, while stress can include cannabis use, life events or other bio/psych triggers

reducing diathesis and stress to single factors fails to capture complexity of SZ

L - modern approach = more valid by recognising multiple interacting influences on SZ

strength of interactionist approach

RS for combined role of ‘diathesis’ and stress - TIENARI ET AL conducted a large-scale adoption study of 19,000 Finnish children w bio SZ mothers. in adulthood, those w/ high genetic risk = compared to adoptees w/o SZ family history. high criticism, hostility and low empathy from adoptive parents = linked to SZ but ONLY in high-risk group

L - findings show that neither genes nor environment alone = sufficient to trigger SZ - interaction of the two increase the risk of SZ significantly therefore supporting diathesis-stress model

C/A - supporting evidence = weak, culture bias (only Finnish children) in western context, dysfunctional parenting = hard to measure across cultures - age at adoption = CV

L - not fully valid

strength 2 of interactionist approach

practical application - combined bio/psych treatments (drug and CBT therapy) enhances effectiveness. TARRIER randomly allocated 315 ppts to 1) medication + CBT 2) meds + counselling or 3) control (meds only) ppt in 2 combo groups showed lowered symptoms following trials vs control group

L - shows superior treatment outcomes w IA

C/A JARVIS ET AL caution that assuming success of treatment confirms explanation is a logical error (treatment-causation fallacy)

therefore, effectiveness of treatments doesn’t automatically validate IA of SZ