Psychology - Schizophrenia

What is Schizophrenia?

Scizophrenia is a serious mental disorder affecting around 1% of the global population. Often the disorder appears in late adolecence and found it people who are male, working class, and live in cities

In what two ways is Schizophrenia classified?

There is no single defining feature of Schizophrenia, often it is a cluster of symptoms that are both positive and negative

• DSM-5 (diagnostic statistical manual) from the American Pyschological association APA

• Also ICD-10 (International and classification of disease) from the world health organisation WHO

The DSM believes that a positive symptom must be present in order to diagnose Schizophrenia, whilst the ICD believe that there needs to be two or more negative symptoms

What is criterion validity?

The extent to which two different measures of the same variable are measuring the same thing

What are the positive symptoms of Schizophrenia?

Positive experiences are described as an additional experience that is beyond ordinanary experiences

• Hallucinations, are unusual sensory experiences that have no basis in reality or distorted perceptions of real things. They are experienced in relation to any sense e.g voices

• Delusions (paranoia), irrational beliefs that have no rational basis in reality. e.g believing you are jesus or being watched by the government

What are the negative symptoms of Schizophrenia?

Often they involve a loss of usual activities

• Avolition/apathy/loss of motivation, the idea of completing a task with multiple steps is tricky meaning people suffering with Schizophrenia may lack hygiene or not feed themselves. Andreason in 1982 identified three types of avolition, poor hygiene, lack of work, lack of energy

• Speech poverty, change in patterns of speech, the ICD sees this as a negative symptom with the reduction in speech quality. This, accompanied by a delay in response could indicate a symptom of schizophrenia

How is reliability a positive feature of the classification and diagnosis of Schizophrenia?

Reliability is generally good in diagnosis, Flavia Osorio et al 2019 found reliaiblity in the diagnosis in 180 individuals using DSM-5. Pairs achieved inter-rater reliabilty of +.97 and test retest of +.92 which is near perfect. Therefore by using DSM-5 we can be confident that diagnosis of OCD is reliable

What are two studies of showing how Scizophrenia diagnosis is poor?

• One way we are able to assess the validity is criterion validity, Cheniaux et al 2009 had two clinicians assess the same 100 clients. One used DSM-5 and another used ICD-10. 68 were diagnosed by ICD whilst 39 were under DSM. Therfore meaning it is either undrdiagnosed by DSM or criterion validity is very low

• Another example of showing poor validtity of schizophrenia diagnosis is Rosenhans study, He sent 12 Pseudo patients to different hospitals and asked them to act schizophrenic saying they kept hearing the same 3 words, thud, hollow, and empty, once they were in hospital they were asked to act normally. It was found that 11 were diagnosed with Schizophrenia and 1 was diagnosed with manic depression. This shows errors within diagnosis meaning it has lower validity

How are there limitations in the method of diagnosis in schizophrenia in regards to co-morbidity and overlapping of symptoms?

• Peter Buckly et al in 2009 found that disorders were often found with schizophrenia, e.g depression 50%, OCD 23%. This could show that Schizophrenia is maybe just an extreme variation of other conditions

• There is also considerable overlap between symptoms of Schizophrenia and other conditions, Both bipolar disorder and schizophrenia show avilition 

What issues are there with Gender bias and culture bias based on the diagnosis of schizophrenia?

• Longenecker et al in 2010 found that since the 1980s woman have been diagnosed less than men. This could be due to the fact woman are better at masking, they have a high level of interpersonal functioning so it seems schizoprenia appears less

• Escobar in 2010 argued that psychistrists over interpret symptoms of black people and don’t trust their honesty. It has been found that black people of afro-caribean decent are more likely to be diagnosed with schizophrenia. This isn’t about genetics as levels are the same in African countries. Therefore it could be cultural bias as we misunderstand culture of speaking to relatives no longer here.

How can the role of the schizophrenogenic mother (family dysfunction) cause Schizophrenia?

Fromm-Reichman in 1948 proposed a psychodynamic explanation based on previous accounts of schizophrenic patients. She noted that many spoke of a schizophrenogenic mother which demonstrated traits like coldness, rejection, and being controlling. This type of mother creates a tense environment that leads to schizophrenia in patients

How is double bind theory (family dysfunction) an example of the psychological explanation for schizophrenia?

Batesman in 1972 argued that the communications in family are important in the risk factor of developing schizophrenia

Children who find themselves unsure about if what they are doing is right or wrong who have no clarification or fairness may recieve mixed signals. He argued that if they get something wrong they are punished with a withdrawal of love. This means they grow up seeing the world as confusing and dangerous and show symptoms of disorganised thinking. As a result, poor communication within the family leads to an increased risk of schizophrenia

How is expressed emotion (family dysfunction) an example of psychological explanations for schizophrenia?

This is theorised as a level of emotion towards patients by their carers. It contains several elements

• Verbal critiscm, accompanied by violence

• hostility towards patient

• emotional over-involvement like needless self sacrifice

Higher levels of expressed emotion cause stress for the patient causing them to relapse

Also this stress can onset schizophrenia in a person who is vunerable due to their genetic makeup

How can we evaluate family dysfunction theories about the cause of schizophrenia?

• One strength of these theories is that there is supporting evidence. Read in 2005 reviewed 46 studies of child abuse and schizophrenia. 69% of schizophrenic women had experienced sexual and physical abuse. 59% for men. Also adults with insecure attachments were more likely to develop schizophrenia

• However, overall evidence supporting is weak. Both schizophrenogenic mother and double bind theory were based on controlled observations and assessing the personality of mothers by creating ‘crazy making’ characteristics. This is also socially sensitive as it leads to parent blaming, parents having the blame is unfair after experiencing the trauma of their child having schizophrenia

• Their accounts of childhood may be distorted as the patients would have already acquired schizophrenia, therefore this lacks internal validity

What is the basis of cognitive explanations into schizophrenia?

They focus on the role of mental processes. Schizophrenia is linked to abnormal information processing and characterised by disruption to normal thought processes

How are meta-representations an example of psychological explanations for schizophrenia?

This is the idea of our cognitive ability to reflect on our own thoughts and behaviours allowing insight of our interactions and goals, also allowing us to predict the actions of others. Dysfunction would disrupt our ability to recognise our own thoughts actions and for us to believe these our caused by someone else. This would explain hearing voices

How is the central control an example of psychological explanations for schizophrenia?

our cognitive ability to surpress automatic responses while we preform deliberate actions. Disorganised speech and thought disorders could result in an inability to surpress automatic thoughts and speech triggered by others. e.g schizophrenic patients may have a derailment of thoughts because words trigger our associations and a patient cannot supress a response to this

How can we evaluate cognitive explanations from the psychological perspective about schizophrenia?

• They tell us little about the origins of schizophrenia, they explain proximal causes rather than direct causes

• Supporting evidence, sterling in 2006 compared 30 schizophrenics to 18 controls in cognitive tasks like the stroop test. patients with schizophrenia took twice as long as the control group

How are genetics argued to be a biological cause for schizophrenia, what is a study that supports this?

It is argued that genetics are a cause of schizophrenia and that it is passed down from family members, the closer related you are to someone with sz, the more likely you are to develop the condition.

Ripke in 2014 found that 108 seperate variations were associated with sz, Gene mapping has depicted a large number of gene candidate combonations, one gene PCM1 is found to be 15% of the root cause for schizophrenia. sz could be polygenic meaning it is caused by multiple candidate genes increasing the risk

What did Grottesman find about genetic cause of schizophrenia? How can we evaluate this research?

Found that 48% of identical twins both developed schizophrenia, this demonstrates that as genetic likeness increases, so does the probability to develop the disorder. However it is clear that it is not completely genetic. Shared genes but also shared environment could play a factor. Additionally with Shields, Grottesman found that although when mz twins were reared apart, there was a 58% concordance rate for sz.

• Both studies show that many cases of sz could be related to genetics making the theory stronger

• However, the rate still isn’t 100% so there may be other factors

How was the case study of Genain quadruplets (rosenthal 1963) a good example of genetic causes of schizophrenia?

4 mz quadruplets had all went on to develop sz but to different extents, some experienced positive symptoms and others didn’. It also want’t concorded as the quadruplets contracted sz at different times. Both their father and mother were unstable

• Their case study is positive as it shows that there is a link between genetics and sz

• Overall, case studies have low pop validity

How can we evaluate the ideas that schizophrenia is caused by genetics?

• One limitation is that the idea is both reductionist and deterministic

• It is also limited in the fact that it is socially sensitive, knowing that sz runs in families could lead to arent blaming and create an unhealthy relationship.

• However it could have the opposite effect and remove stigma as environmental factors aren’t as significant

• led to practical application of genetic councilling, we can help people understand the risk of their children developing conditions if they have a family history. It can also provide support for adults who choose to have children even with the risks

What is a likely theory that explains both genetics and environmental issues as a cause of conditions like schizophrenia?

The diathesis stress model explains how our genetics interact with our environment, childhood trauma acting as a stresser could onset conditions like sz or OCD

What is the idea of The dopamine hypothesis acting as a cause for schizophrenia?

symptoms of sz could be caused by abnormal levels of dopamine. dopamine acts in a way that increases the firing across the synapse 

What are two possible effects of dopamine?

• Hyperdopaminergia - explains a higher level of dopamine in the subcortex in areas like brocas. there are positive symptoms of hallucinations

• Hypodopaminergia - explains a lower level of dopamine in the cortex (outer part) including the pre-frontal cortex, where less dopamine is transmitted, this includes negative symptoms like avolition

What was Tenn et al study into dopamine’s involvement in schizophrenia?

Tenn et al in 2003 found that giving amphetimines (which increase dopamine) leads to positive symptoms of schizophrenia

• This study supports theories of as increasing dp levels leads to induced symptoms of sz

• However, we can’t generalise humans and rats and humans may respond differently