Schizophrenia AO3

Discuss reliability and validity in relation to the diagnosis and / or classification of schizophrenia 

Rosenhan > ‘Sane in Insane Places’ > 8 patients pretended to have speech poverty > Admitted to hospital > Took clinicians between 7-52 to realise diagnoses were incorrect > Poor validity in diagnosis 

Gender bias > Loring and Powell > Describe same SZ symptoms > Only difference was gender stated > Males more likely to be diagnosed (56% vs 20%) > Indicates there may be an alpha bias in diagnosing SZ patients > Women have more support so easier to cope with symptoms (Cotton) > Women may be underdiagnosed 

Culture bias > Cochrane > Found that those from Carribean were 7x more likely to be diagnosed when living in Britain compared to country of origin > Due to bias of British Doctors > Escobar > Hospital records found that most of those admitted with SZ were of Afro-Caribbean origin 

Difficulty distinguishing > Ellason and Ross > Symptom overlap > Those with DID have more SZ symptoms than those with SZ > Buckley > Co-morbidity (2 or more illnesses occurring together) > Depression – 50%, Addiction – 47%, OCD - 23% 

Describe and evaluate biological explanations for schizophrenia 

Research support > Strong evidence base > Gottesman (Risk increases with genetic similarity to family member with SZ > Tienari (Biological children of those with SZ are more likely to have SZ, even when adopted) > Hilker (Twin study concordance (23% vs 7%) 

Environmental factors are also involved > Nina Morkved > 67% of people with SZ and psychotic mental health issues reported childhood trauma compared to a control group of non-psychotic mental health PPTs with only 38% > Other environmental factors have been found to increase SZ risk like birth complications or cannabis use  

Support for the role of dopamine > Amphetamines increase DA and worsen symptoms for those already with SZ and induce symptoms in those without (Curran) > Antipsychotic drugs reduce DA activity so reduce symptom intensity (Tauscher) > Candidate genes associated with SZ have been found to impact DA production 

Real-life applications > Genetic counselling > If one or more potential parents have a relative with SZ, child is more likely to develop > More informed choices > Predictions of genetic risk is just an average figure as the environment exposed to will impact (diathesis-stress) 

Describe and evaluate psychological theories of schizophrenia

Support from meta-analysis > Butzlaff and Hooley > Meta-analysis of 27 studies > Relapse into SZ is more likely in families with high degrees of EE 

Support from adoption studies > Tienari > Observed SZ rate in biological children of SZ mother who had been adopted > 5.8% compared to 36.8% raised in dysfunctional families > Interpersonal family environment impacts those with SZ vulnerability 

Support from brain imaging studies > Firth > PET scans showed reduction in blood flow to frontal cortex in SZ patients with negative symptoms and inability to suppress automatic thoughts > Increased temporal lobe activity in those with reality distortion > Suggests that there is a difference in the way people with SZ process thoughts 

Support for central control > Sterling > Stroop test > SZ vs control PPTs > Naming ink colours on words without saying the word > Those with SZ had a harder time not saying the word itself (took twice as long) > Suggests those with SZ have dysfunctional though processing 

Describe and evaluate antipsychotics as a treatment for schizophrenia 

Evidence for effectiveness > Thornley et al. > Study review showed chlorpromazine (TYPICAL) was associated with better functioning and reduced symptoms compared to a placebo > Meltzer > Clozapine is more effective than typical antipsychotics and most atypical > Healy > Repeated published findings and not many long-term effects studied > Suggests not as effective as it seems 

Likelihood of severe side effects > Side effects can be severe > Most severe is NMS > Dopamine action is blocked in hypothalamus > Symptoms include coma and delirium, can be fatal > May do more harm than good 

Unclear mechanisms > Most of our understanding is tied with dopamine hypothesis > High levels of dopamine in mesolimbic > However SZ also caused by low levels > If antipsychotics reduce dopamine action, then most APs shouldn’t work which is not the case > We do not fully know how they work and perhaps they aren’t as effective as we think they are, other factors involved 

The chemical cosh > Moncrieff > APs may not be for the benefit of the patient but rather for the staff to make them easier to work with > CP Helpful for engagement > Calming people by removing hallucinations and delusions can help them engage more effectively in CBT > APs can be used to control behaviour rather than for main treatment 

Discuss psychological therapies for schizophrenia 

Evidence for effectiveness > Sensky > Patients with no drug therapy had reduction in positive and negative symptoms after 19 sessions of CBT > Continued to improve even months after the CBT sessions ended > Target underlying> CBT is an improvement on drug therapies where effects are only short-term 

Wide range of techniques and symptoms included in studies > Neil Thomas > Different studies have used different CBT techniques on patients with varying symptoms > Although CBT helps SZ, studies conceal effects of CBT for certain symptoms > Hard to determine how effective a certain type of CBT will be for a patient

Evidence for effectiveness > McFarlane > Review of studies found family therapy was one of the most consistent treatments > Relapse rates reduced by 50-60% > Particularly effective for those whose SZ symptoms begin to emerge > Suggests FT is helpful for both early and long-established SZ 

Benefits to the whole family > Therapy also helps those who are taking care of the identified patient > Especially useful for teenagers or young adults who are more likely to be still living with their families > Helps the functioning of the entire family by reducing impact of SZ on other members and providing support for the SZ individual > Suggests FT has wider benefits beyond identified patient 

Discuss token economies as used in the management of schizophrenia 

Evidence for effectiveness > Glowacki et al > Identified 7 studies which showed a reduction in negative symptoms / unwanted behaviours of SZ when token economies were used in a hospital > CP ‘file-drawer’ problem > Bias towards positive finds, others ‘filed away’ > Evidence can be questioned 

Ethical issues > Restricting availability of everyday pleasures could be seen as cruel > Those who are already displaying symptoms of distress are experiencing a worse time > Restricts personal freedom as ‘adaptive’ and ‘maladaptive’ behaviours are set by institution may not align with preference of PPT > Benefits may be outweighed by ethical issues 

Existence of better approaches > Chiang > Art therapy > High-gain low risk approach > Even if benefits are modest, this is true for many therapies > Art therapy doesn’t have major side effects or ethical abuses > Supported by NICE guidelines > Suggests AT is a better alternative 

Difficult to continue outside > Once outside hospital, hard to monitor and reward behaviours > Over-reliance on tokens > Once tokens are removed, person may not continue behaviour > Therefore TEs may only be a temporary solution 

Describe and evaluate the interactionist approach to both explaining and treating schizophrenia 

Support for vulnerability and triggers > Tienari > Discovered that adoptive parents with a harsh, critical child-rearing style was strongly associated with SZ development, but only in children with a genetic risk (biological parent with SZ) 

Oversimplicity of original diathesis-stress model > Original model claimed the only diathesis was a single ‘schizogene’ and no amount of stress could trigger SZ without it (Meehl) > Now shown many genes in different combinations exist as diathesis > Diathesis not always bio (childhood abuse) / Stressor not always psychological (cannabis) (Houston) 

Real-world application > Tarrier > Combining drug treatment with either CBT or counselling is more effective than medication alone > CP (Jarvis and Okami) > Treatment-causation fallacy, success of combined therapies does not mean that Interactionist explanations are automatically correct 

Urbanisation > SZ more diagnosed in urban over rural areas > Urban living is more stressful, so city living is a trigger > CP > Could be that SZ more diagnosed in big cities > Or those with diathesis (like abuse) migrate to cities