Schizophrenia

classification of schizophrenia

classification of schizophrenia

• severe mental illness with contact with reality and insight are impaired

• 1% of the world

• men more likely to suffer

• 1 in 10 commit suicide

• commonly develops in teens/early 20s

schizophrenia symptoms

• positive: delusions, hallucinations, racing thoughts

• negative: apathy, avolition, speech poverty and poor/non-existent social functioning

DSM-5 diagnosis

• 2+ criteria A symptoms for 1 month or mixture of any for 6 months

• Criteria A: delusions, hallucinations, disorganised speech, abnormal motor behaviour

• Criteria B: functioning at work, interpersonal or self care level is well below the premorbid level

ICD-11 diagnosis

• 1 or more symptoms for majority of 1 month

• delusions, hallucinations, incoherent speech, negative symptoms

6 main issues with classification and diagnosis

• gender bias

• culture bias

• symptoms overlap

• comorbidity - 2+ conditions at once

• reliability - inter rater and test-retest

• validity - concurrent

classification and diagnosis AO3

• Questioning validity - 2 psychiatrists diagnose 100 patients with DSM-4 and ICD, 1st = 26 with DSM and 44 with ICD, 2nd = 13 with DSM and 24 with ICD - lacks interrater, low concurrent, leads to over and under diagnosis. C/A: DSM-5 achieved greater agreement of +97

• culture bias - hearing voices in Africa seen as sign from god not a mental health issue, ethnocentric, over diagnosis/ discrimination, negative ethical implications

• gender bias - men: women diagnosis = 4:1, women mask symptoms so underdiagnosed or given wrong treatment, alpha bias

biological explanation AO1

• Genetics - polygenic and aetiologically heterogenous, 108 candidate genes found with 37000PT vs 113,000 control, neuregulin gene found in all 163PT, prevalence rates 10% higher among genetic vs adoptive children.

• Neural correlates - structure and activity of brain

1. Dopamine hypothesis = hyperdopaminergia in subcortex leads to positive symptoms, hypodopminergia in prefrontal cortex leads to negative symptoms

2. Areas of brain = prefrontal cortex responsible for logical thinking - racing thoughts and speech poverty, visual cortex = hallucinations, auditory cortex = hallucinations, basal ganglia responsible for movement and thinking = apathy, avolition, racing thoughts

biological explanation AO3

• RS - twin studies show 48% identical twins vs 17% non identical twins, reliability. C/A: not 100% so bio reductionist, best to take interactionist approach as shared/unshared environment plays a role

• Practical application - genetic counselling, RLA, positive ethical implication. C/A: ethical issues as new parents can test baby leading to not wanting the child despite only have genetic predisposition which might not develop

• Conflicting evidence - fMRI scan shows damage to the frontal lobe which worsens 3 years later, cant establish cause and effect as SZ may have caused the damage, low internal validity

biological treatments AO1

• Typical antipsychotics - 1950s, positive symptoms

chlorpromazine = blocks dopamine receptors, increase HR and weight gain

• Atypical antipsychotics - less side effects and both positive and negative symptoms

1. clozapine = regulates glutamate, dopamine and serotonin, increases memory, 85% reduction in suicidal thoughts - seizures and heart issues as thins blood

2. risperidone = regulates serotonin and dopamine, prevents disorganised thoughts and lowered mood - akathisia, unresponsive to insulin

• tablets, liquids and injections

biological treatments AO3

• RS typical - chlorpromazine > placebo in 1211 pp, more effective and less relapse, large sample, reliable, positive ethical implication. C/A: side effects

• RS atypical - clozapine more effective than typical drugs, effective in 30-50% resistant cases, positive ethical implications. C/A: low reliability

• lack of knowledge - cant establish cause and effect, new evidence disproves, reductionist stance as only treat hallucinations, better to take holistic stance and treat all

• conflicting evidence into effectiveness - exaggerates success for purpose of funding companies, short term, ignores relapse, negative ethical implications, socially sensitive research ,bio reductionist, better to be holistic and combine drugs and therapy

psychological explanations AO1

• Environment:

1. schizophregenic mother - cold, rejecting, controlling, father is passive

2. Double blind theory - child receives mixed messages, doesn’t know what right thing is, punished, child is conflicted and confused with the world = racing thoughts, speech poverty and delusions

3. Expressed emotion - PT exposed to negativity = verbal criticism, hostility, emotional over-involvement

• Cognitive: abnormal mental processes linked to language, thinking and attention

1. metarepresentation - ability to recognise own thoughts and actions carried out by ourselves, can understand own thoughts and intentions

2. central control - can supress automatic responses while performing deliberate actions instead - Stroop test

psychological explanations AO3

• conflicting evidence -  breadth of evidence showing links between genetics and the levels of dopamine in parts of a person’s brain to sz, reductionist. C/A: interactionist approach best, stress diathesis model. C/A: cognitive theories explain both positive and negative symptoms, generalisable.

• RS - 46 studies of child abuse and sz and concluded that 69% of adult women and 59% of men in-patients with a diagnosis of sz had a history of physical abuse, sexual abuse or both in childhood. C/A: Information about childhood experiences are often taken after the onset of sz and this may have distorted the view of childhood for those with sz & lack of evidence for double blind or schizophregenic mother.

• Flaws in method - Evidence regarding family dysfunction comes from clinical observations by psychiatrists, subjective, lacks scientific credibility, potential bias, small sample, cant produce nomothetic law

• RS - compared 30 patients with sz with 18 non-patients on  a range of cognitive tasks e.g. stroop test. Stirling found patients took twice as long to name the ink colours in the stroop test than the control group. C/A: some argue this evidence simply tells us about symptoms of sz rather than the causes of sz.

CBT AO1

• identifying dysfunctional thoughts, change into functional thoughts by talking, set PT homework

• 5-20 sessions, once every 10 days

• improves quality of life through conversation

• both positive and negative symptoms

• Personal therapy - involves detailed evaluation of problems, experiences, triggers and consequences to create coping strategies

• Rational emotive therapy - used to teach PT muscle relaxation techniques to detect gradual anger build ups and apply relaxation skills

• STRATEGIES:

• cognitive strategies - thinking of specific tasks that focuses on PT mind in order to help distract them from delusional thinking such as counting back from 10

• positive self talk - responding to negative voices and thoughts with positivity

• behavioural strategies - what could be done to drown out negative voices that are hears such as diaries and pleasant activity calendars

CBT AO3

• Flaws in method - can’t be suitable for all, those disorientated so cant generalise to all PT as they are needed to play an active role, cant produce a nomothetic law

• RS - CBT more effective that drugs and counselling, 50% in personal therapy vs 15% in counselling reduction in symptoms. C/A: 2 years later no difference so not long term, expensive as £100-£150 each, negative economic implications. C/A: cheaper than counselling and less side effects than drugs

• Conflicting evidence - CBT doesn’t treat symptoms merely masks them by producing coping strategies. C/A: does improve quality of life. C/A: better to take holistic approach and use CBT and drugs

Family therapy AO1

• Family dysfunction - aims to improve communication, focuses on EE, increases tolerance, decreases criticism levels, guilt and responsibility for causing SZ

• consent form - emphasis on openness so requires consent, details will be confidential and boundaries will be set

• 9-12 months

• Research - compares family therapy vs routine therapy, 9 months- 50% relapse routine vs 8% relapse family. 2 years - 75% relapse routine vs 50% relapse family.

Family therapy AO3

• Considers all PT - who lack insight into their illness or cannot speak coherently about it. Family members may be able to assist here. holistic, positive ethical and economic implications. C/A: 2 years, 50% relapse still, reductionist, still needs drugs so interactionist approach better

• not applicable if family is reluctant, can’t generalise, could cause relapse due to further family tensions, negative ethical implications

• less hospitalisation, lower relapse compared to other treatments and family therapy is cheaper than standard care by £1,004 per patient over three years

Token economies AO1

• operant conditioning - positive reinforcement, long term hospitalisation, negative symptoms

• aims to change unwanted behaviour by awarding token

• desired behaviours - self care, social interactions, regularly take medicine

• research - TE successful for females SZ PT who were hospitalised for 16 years, completed chores increased from 9 to 42 a week such as brushing hair and making bed in order to receive token to exchange for film, trip to canteen etc.

Token economies AO3

• improves hospital conditions - less staff abuse= less staff absences, better PT care, positive ethical and economic implications. C/A: not all hospital uses as can lead to segregation/humiliation = ethical issues, better to use individualistic treatments so cant produce nomothetic law

• negative outcomes - PT can form dependency and addictions, can’t function without so only works short term as in real life immediate gratification doesn’t exist, CBT or FT better, cant justify cost, negative economic implications

• Applicable to all PT - tailored to individual, holistic and idiographic. No specialist is required so positive economic implications for NHS, cheaper than CBT

stress-diathesis model AO1

• Diathesis - predisposition

• stress - any triggering environment factor

• meehls model - diathesis was completely genetic

• modern model - diathesis - genes, psych trauma, issues at birth/ conception & stress - psychological, dysfunctional family, cannabis

• model + treatment - antipsychotics and CBT as have to accept psychologicAL role in SZ

stress-diathesis model AO3

• RS - 315 PT, drugs + CBT, drugs + counselling, only drugs. Combination groups had lower symptoms, RLA, reliability, holistic. C/A: no difference in relapse so only short term, causation fallacy not always correct, cant establish cause + effect, lacks validity. C/A: both still work

• RLA - SZ more diagnosed in city areas than rural as more stressful, ecological validity. C/A: rural lack resources to diagnose, no cause and effect.

• RS - combination of genes and parenting style in 19,000 finish mothers with SZ children adopted, if family was critical and conflicting there was high risk of developing SZ compared to control with no gene predisposition, interactionist approach