Schizophrenia

Schizophrenia

A severe mental disorder where contact with reality and insight is impaired. It affects how someone thinks, feels and behave. It is linked with episodes of psychosis

Positive symptoms

Atypical symptoms experienced in addition to normal experiences

negative symptoms

symptoms that represent a loss of normal experiences

How is schizophrenia diagnosed?

• First, a disorder needs to be classified

• Diagnosis then involves either use of ICD-10 or the DSM-5

• they differ slightly (i.e. DSM-5 requires one positive symptom whereas the ICD-10 say two negative are sufficient)

• Both have dropped the sub-types of schizophrenia due to inconsistency

Who is more likely to suffer from schizophrenia ?

• Men

• those living in rural areas

• those with a lower socio-economic status

Positive symptoms of SZ

• Hallucinations - unusual sensory experiences which may be related to events in the environment, whereas others are completely unrelated

• Delusions- the irrational belief that commonly involves feeling persecuted by the government or aliens. It involves the sufferer believing they are being controlled by someone or something else

Negative symptoms of SZ

• Speech poverty - sufferers experiences changes in patterns of their speech (e.g. a reduction in the amount or quality of speech). Speech may lack coherence

• Avolition - finding it difficult to begin or keep up with goal-directed activities. Sufferers have drastically reduced motivation

family studies of SZ

family studies have confirmed that the risk of SZ increases as the amount of DNA you share with a family member increases. This is a clear indicator that there may be a genetic basis to SZ. Looking at Gottesmans’ results, sharing 25% of DNA with someone with SZ results in a 2-6% chance, sharing 50% of DNA results in a 6-17% chance yet sharing 100% of DNA results in a 48% chance

candidate genes definition

a gene believed to be related to a specific trait

polygenic in terms of SZ

multiple genes are implicated with SZ

candidate genes

• they have been studied in early SZ research that focused on finding one single gene responsible. However, it appears that SZ is polygenic. This typically appears to be genes that are linked to the production and regulation of dopamine.

Ripke’s research on candidate genes

• They compared all previous data from genome-wide studies. The genetic makeup of 37,000 people with SZ and 113,00 controls was compared. Ripke identified 108 separate genetic variations that were linked to a slightly increased risk of SZ

• as a result of different studies finding different candidate genes, it appears that SZ is aetiologically heterogenous (different combinations of genetic variations can lead to the condition in different people)

neural correlates

patterns or structures of the brain that occur alongside an experience which are then perceived to be the cause of an experience

hyperdopaminergia

refers to excessive amounts of dopamine

hypodopaminergia

refers to lack of dopamine

the original dopamine hypothesis

• drugs that decrease dopamine were found to decrease symptoms of SZ. It was therefore concluded that SZ might be as a result of excessive levels of dopamine.

• For example, excessive levels of dopamine in Broca’s area might lead to speech poverty

the revised dopamine hypothesis

• It has been found that some SZ sufferers experience abnormally low dopamine levels

• they might be localised: hyperdomaminergia in the subcortex and hypodopaminergia in the cortex

• abnormal levels of dopamine might be due to genetic variations or early experiences

Schizophrenogenic mother

Fromm-Reichmann interviewed several SZ patients and found that a specific group of mothers ‘caused’ schizophrenia. Cold and and emotionally distant behaviour towards their child caused the child to develop paranoid delusions and ultimately, schizophrenia.

Double-bind theory

Bateson found that family dynamics were important in the development of SZ. Mixed emotions from family members causes a child to act in fear that they are doing the wrong thing, which will lead to a withdrawal of love. This causes the child to view the world as confusing and develop symptoms of disorganised thinking and delusions.

Expressed emotion

Research shows that high levels of negative emotion displayed towards the sufferer makes it more likely for the sufferer to relapse and can also be a risk factor in the development of SZ

dysfunctional thinking

Many symptoms of SZ involved a disruption to normal thought processing. People with SZ have been found to have an impairment in thought processing in the ventral striatum and also in the temporal and cingulate gyri. This lower than normal level of information processing in these areas suggests that cognition of the individual is likely to be impaired, causing them to suffer things such as faulty auditory processing and a lack of motivation

meta-representation dysfunction

Frith argued that a person with SZ suffer with an inability to reflect on their own thoughts and behaviours, which allows us to match them to our own intentions and goals. Dysfunction in metarepresentation disrupts our ability to recognise our own thoughts and actions as being carried out by ourselves rather than someone else. This would explains why hallucinations and delusions occur

central control dysfunction

Frith found that sufferers of SZ had issues with the cognitive ability to suppress automatic responses. Speech poverty and thought disorders might result from this inability to suppress automatic thoughts and speech triggered by those thoughts

antipsychotics

drug used to reduce the intensity of symptoms, especially positive symptoms of SZ

typical antipsychotics

first generation of drugs for SZ

dopamine antagonist

second generation of drugs for sz. They target dopamine and serotonin

atypical antipsychotics

reduce the action of NTs. They block dopamine receptors on the postsynaptic neuron, reducing the chance of dopamine being passed through

what does the most common treatment of SZ involve?

the use of antipsychotic drugs. A person with psychosis experiences a loss of contact with reality and therefore an antipsychotic is given to relieve psychotic symptoms.

typical chlorpromazine

• Can be taken as tablets, syrup or by injection

• maximum dosage of 1000mg

• act as antagonists, which decrease the action of a NT

atypical clozapine

• can be taken as tablets or syrup

• it was withdrawn because it caused deaths by inducing a blood condition, however it was reintroduced. Because it can cause severe, life-threatening side effects, it requires strict, mandatory blood monitoring

Atypical risperidone

• can be used as tablets or injection

• recently developed in an attempt to work as effectively as clozapine

• binds to dopamine and serotonin receptors more strongly, so smaller doses are sufficient

• fewer side effects than other AP’s

family therapy

a psychological therapy carried out with all or some members of a family with the aim of improving communications within the family and reducing the stress collectively

CBT

A method of treating mental disorders based on both cognitive and behavioural techniques. It aims to deal with challenging negative thoughts and uses behavioural techniques

how does family therapy help SZ patients?

• helps members achieve balance between their own lives and the sufferers

• improves families’ beliefs about SZ

• reduces the stress of caring for a relative with sz

• reduces anger and guilt among members

how does CBT help SZ patients?

• aims to identify irrational thoughts and challenge them - therapist might argue to discuss how irrational beliefs aren’t true

• CBT also tackles positive symptoms and how they impact feelings/behaviour

• Anxiety can be reduced if the individual learns their beliefs (delusions) are not true

token economies

A form of behaviour modification where desirable behaviours are encouraged through selective reinforcement. People are given tokens when the display desirable behaviour

• the token (secondary reinforcer) can be exchanged for primary reinforcers (food etc.)

token economies with reference to SZ

• a way of ‘managing’ SZ symptoms - the aim is to make behaviour more socially acceptable

• typically used among sufferers who have developed maladaptive behaviour (i.e. poor hygiene, social withdrawal etc.) when staying in a psychiatric hospital for a long period of time

origin of token economies

Alloyn and Azrin trialled a token economy system in a female schizophrenia ward by giving them plastic tokens for completing tasks like making their beds. These tokens could be swapped out for rewards like watching a movie. The number of tasks completed increased significantly and was implemented within many psychiatric units in the 1970s

why has the use of token economies decrease?

because community-based care is used where possible. There are also some ethical concerns raised around restricting rewards for those who have lost touch with reality

Why use token economies?

• individuals often develop poor habits (i.e. bad hygiene, social withdrawal) as a result of prolonged hospitalisation. Matson identified three categories of behaviour that token economies can tackle: personal care, condition-related behaviours (i.e avolition) and social behaviour

main purposes of token economies

1. improving a person’s quality of life within the hospital setting

2. ‘normalises’ behaviour, making it easier to do upon release

what is involved in token economies?

• token is given immediately when someone completes target behaviour

• rewards might include watching a film, sweets etc.

How does the token economy system work?

• based on OC techniques

• tokens are secondary reinforcers - they only hold value to obtain primary reinforcers

• primary reinforcers are the meaningful rewards that can be purchased with the tokens

interactionist approach

a way to explain the development of behaviours in terms of a range of factors, including biological and psychological ones. It agrees that they don’t simply add together but instead combine in a way that can’t be predicted separately

Diathesis-stress model

• an interactionist approach to explaining behavior. SZ is explained a the result of an underlying vulnerability (diathesis) and a trigger (stress). Both are needed for SZ to occur.

• both genes and trauma can be diathesis and stress can be psychological or biological in nature

Meehl’s original diathesis-stress model

• the diathesis was entirely genetic and no amount of stress would lead to SZ if a person did not have the schizogene

• chronic stress (e.g. schizophrenogenic mother) could trigger SZ

modern understanding of the diathesis-stress model

• many genes are implicated in the genetic vulnerability of SZ

• Diathesis can also be psychological

• anything that risks triggering SZ is now a ‘stressor’

• recent research has found that cannabis use increases the risk of SZ by 7 times - interferes with dopamine system

how should we treat SZ according to the interactionist approach?

The interactionist approach treats schizophrenia by combining biological and psychological therapies, typically pairing antipsychotic medications with CBT or family therapy. This model acknowledges that both biological and psychological factors drive the condition, proving that even biologically rooted symptoms can be managed with therapy