schizophrenia (cambridge a level psychology)

What are the positive symptoms of schizophrenia?

1) persistent delusions,

2) persistent hallucinations,

3) disorganized thought, and

4) experiences of influence, passivity or control (the belief that your thoughts or actions are being influenced or controlled by someone/something external)

What are the negative symptoms of schizophrenia?

1) avolition (lack of motivation),

2) flattened affect (blunted emotional expression),

3) impaired cognitive function (reduced memory or attention), 4) catatonia (lack of movement & speech)

What was Aneja et al.'s study about?

Aneja et al was about individuals who all developed early onset schizophrenia before the age of 18. Core study 1 was about a boy who showed a decline academically & behaviour before the age of 10. The trigger was the divorce of his parents, when he and his mother moved with his grandparents & he had to change schools. From age 12 he started hearing voices, which he believed his mom and other people to be communicating with. He barely slept and his self-care declined dramatically. He was then admitted to the hospital to have his aggressive symptoms under control. When the boy was released, he still suffered from negative symptoms such as apathy, social withdrawal, and a resistance to going to school.

What are the types of delusion?

1) Persecutory delusion: a strongly held belief that you are in danger, that you are being conspired against & that others are pursuing you to to try to do you harm

2) Grandiose delusion: a strongly held belief that you are someone with special abilities or special powers, for example the belief that you are a superhero

3) Delusions of reference: a strongly held belief that events in the environment are related to you, for example the belief that a television program is talking about you

What is the context that Freeman et al. (2003) is based on?

Context:

* Research by Rothbaum et al. shows that people suffering from a range of phobias have been successful treated using VR

* In this case, VR was used to conduct exposure therapy, where an individual is gradually exposed to more fearful instances of their phobic until they no longer fear the stimulus

What are the main theories and explanations Freeman et al. (2003) is based on

* Persecutory ideation is the belief (without any evidence) that other people are being hostile towards you, or that they have negative feelings towards you

* Persecutory ideation can have a profoundly negative impact in someone's life (can lead to social withdrawal & inability to maintain social activities due to a fear of hostilities from others

* since persecutory ideation as a symptom of schizophrenia is hard to understand due to it being a complex disorder, VR could be used to achieve a greater understanding it in individuals without schizophrenia

What are the aims and hypothesises of Freeman et al.?

The aim was to investigate whether participants without a history of mental illness have thoughts of a persecutory nature in VR.

Researchers also aimed to find out whether cognitive or emotional factors predict the likelihood of persecutory ideation being shown in VR

Hypothesis: that a small number of participants would have thoughts of a persecutory nature, and that these would be people with higher levels of emotional distress & paranoia

What was the sample used in Freeman et al.?

The sample consisted of 12 male and 12 female participants, all students, or administrative staff from UCL, with an average age of 26 years old. All participants had no history of mental illness.

What was the design of Freeman et al. 's study?

1) a lab experiment was used where participants were trained on how to use VR equipment

2) the participants were asked to enter a virtual environment (library scene) for 5 minutes

3) there was 5 avatars: 3 set on one desk, 2 sat at another desk

4) the avatars displayed ambiguous behaviour, such as smiling, looking, & talking to each other

5) after leaving the VR environment, participants did a range of questionnaires:

a) Brief Symptom Inventory (BSI): 53 item self-report measure designed to assess 9 symptoms over the past week (interpersonal sensitivity, unipolar symptoms, hostility, & psychosis)

6) the questionnaires had closed questions where participants answered on a numerical scale - 20 items from 1-4

7) to prevent demand characteristics, half the participants did the questionnaire before the VR experience, and half after

8) semi-structured interviews were also carried out to probe participants' thoughts & feelings

What were the results & conclusions of Freeman et al.?

1) There's significant correlation between scores on the paranoia questionnaire & the score given in the interview

2) Most participants had positive attitudes, but some ideas of persecution

3) Higher levels of interpersonal sensitivity & higher levels of anxiety were significantly correlated with higher levels of persecutory thoughts in VR

4) CONCLUSION: People are more likely to show persecutory ideation if they show high levels of interpersonal sensitivity or anxiety

What are the strengths of Freeman et al. ?

1) the study uses specially designed VR that is standardised which increases the reliability of measurement

2) through the use of a combinations of numerical scales & semi-structured interviews, the researchers were able to gather a combination of quantitative and qualitative data

3) the use of a control by having half the participants do the questionnaire before the VR experience and after the VR experience increased the validity by ensuring the questionnaires themselves were not eliciting feelings of persecution

4) applicability to everyday life was high because the study could be used to gain a greater understanding of factors that may predict persecutory ideation

What are the weaknesses of Freeman et al. ?

1) Ecological validity was compromised because a stimulated environment in VR is different from real life

2) the sample was also relatively small (24 people) who were all from the same university (UCL) means generalisability is limited

3) application to daily life may also be compromised because the study used VR and not an actual real life situation

What is the genetic explanation for schizophrenia?

1) one biological explanation for schizophrenia is that genes or a particular combination of genes are passed on to offspring which may cause disorders to develop

2) three ways to investigate the genetic explanation: family studies, twin studies, & adoption studies

a) family studies show a general trend in the development of a disorder for individuals who have close family members with that disorder

b) Gottesman (1991) found the likelihood of developing schizophrenia went from 1% in the general population all the way to 48%, if you had an identical twin with schizophrenia

c) research tends to show that the concordance of schizophrenia is higher in identical (monozygotic) twins

d) Hilker's study concludes that the heritability of schizophrenia is 79%

3) adoption studies enables us to separate the influence of genetics & focus on the influence of environment: however Tienari et al proved that in line with family & twin studies, that there's a genetic influence in the development of schizophrenia

What is the dopamine hypothesis that serves as a biochemical explanation for schizophrenia?

* The dopamine hypothesis is that brains of people with schizophrenia produce more dopamine than the average person

* Dopamine is a neurotransmitter, meaning a chemical substance that enables communication between two neurones

* so basically, the dopamine hypothesis identifies a link between excessive amounts of dopamine/dopamine receptors AND positive symptoms of schizophrenia

* research suggests that an excess of dopamine in certain brain regions can be linked to certain symptoms: e.g. an increase of dopamine in the Broca's region, which's responsible for the formation of language can impair logical speech, which is a classic symptom of schizophrenia

-> evidence to this comes from drug trials using people w/ schizophrenia & people w/o the disorder: large increases in dopamine production are correlated w/ an increase in the positive symptoms of schizophrenia: drugs that increase dopamine include cocaine & amphetamines - large increases in dopamine production correlate with reports of increased delusions & hallucinations

-> patients w/ Parkinson's disease are often treated with a synthetic form of dopamine, L-dopa. If the dosage is too high, it also creates symptoms in those with schizophrenia, such as hallucinations.

What types of scans help us understand the biochemical explanations for schizophrenia?

* Post-mortem studies: helped find that brains of deceased individuals w/ schizophrenia have a larger number of dopamine receptors than those w/o the disorder

* Positron emission tomography (PET): measured the amount of dopamine activity in the brain & indicated that there was a high amount of dopamine receptors in the striatum, limbic symptom, and cortex of the brain in those w/ schizophrenia than those without

-> some research also indicated that negative symptoms of schizophrenia correlated with decreased dopamine activity in the prefrontal cortex

How does Frith (2015) explain schizophrenia from a cognitive perspective?

Frith views schizophrenia as involving a faulty mental process, describing it as an "abnormality of self-monitoring", which occurs when patients fail to recognise that their perceived hallucinations are just in fact inner speech (the kind of self talk people usually experience)

-> this leads them to attribute what they are hearing to someone else (e.g. a voice speaking to them from an external source

How does Frith (2015) explain positive symptoms of schizophrenia?

-> Frith suggests that another symptom, delusional thinking, may also arise from a misinterpretation of perception, by applying logical reasoning to their self-generated hallucinations, thinking they're coming from an external sources.

-> These failures in monitoring can thus lead to delusions of alien control

-> additionally, the inability to monitor the thoughts of others can lead to delusions of paranoia & incoherence

How does Frith (2015) explain negative symptoms of schizophrenia?

-> Frith explains that those experiencing negative symptoms such as a-volition have difficulty generating spontaneous actions (this means they find it difficult to make decisions on how to behave and what to do without a prompt from someone/something)

-> THIS may happen due to an impaired theory of mind, which creates problems trying to recognise the intentions of others

-> A flattening of affect, lack of speech, & social withdrawal all result in difficulties monitoring their own mental state & the states of others

What are the differences between typical & atypical psychotic drugs?

Developed in the 1950s, typical antipsychotic drugs worked by reducing the effects of dopamine, therefore reducing the positive symptoms of schizophrenia, mainly delusions & hallucinations. This makes them dopamine antagonists, blocking dopamine receptors. However, there are too many undesirable side effects

On the other hand, atypical antipsychotics were developed in the 1990s, and have a comparatively lower risk of side effect , and they also have a beneficial effect on negative symptoms of schizophrenia as well as positive symptoms.

The main difference is that atypical psychotics work by rapid dissociation, blocking dopamine receptors for a short period of time. By allowing normal dopamine transmission to take place, this leads to less side effects

What are the downsides of antipsychotics on schizophrenic patients?

Relapse rates using antipsychotics can be quite high, unfortunately. The main reason for this is that patients are told to take medication during periods of remission. But because medication can have a lot of undesirable side effects, patients think because the symptoms have reduced they can non-adhere to medication.

Side effects are often severe on typical antipsychotics, as it includes conditions that both affect motor control & involuntary spasms + abnormal facial & body movements. Although side effects on atypical antipsychotics are less severe, they still include weight gain, drowsiness, & difficulties in concentration.

What is electro-convulsive therapy & why is it not used anymore?

Modern ECT involves the passing of electricity through the brain to illicit a seizure; the seizure is the treatment rather than the electricity. Modern ECT is applied unilaterally to the non-dominant hemisphere only to prevent memory loss. Despite the improvements compared to when it was introduced in the 1930s, it still carries significant risks, as it affects the central nervous system & cardiovascular systems. Memory loss remains a common side effect, but the more serious ones include lasting neurological damage & even death. Because of these side effects and the fact that there is no accepted explanation that ECT is helpful with mental disorders, ECT is rarely used to treat schizophrenia because it hasn't been proven to be more effective than antipsychotics/CBT

What is a psychological treatment for schizophrenia?

Cognitive behavioural therapy (CBT) is an approach to the treatment of mental disorders which incorporates both the cognitive & behaviourist approaches to psychology. CBT is a talking therapy designed to help people change through recognising & challenging the thoughts that underlie their behaviours. Patients with schizophrenia usually have to be stabilised with antipsychotics to be able to engage in therapy.

What was Sensky et al. (2000)'s study about?

Sensky et. al conducted a randomised control trial to investigate the effectiveness of CBT with a control group that engaged in 'befriending'. This comparison was to test whether CBT itself is effective, or rather than JUST the experience of talking to others. Sample consisted of 90 patients between 16-60 with a diagnosis of treatment-resistant schizophrenia. Patients received an average of 19 sessions of either CBT/befriending. Results showed immediately following the treatment period that both groups showed a significant overall reduction of both negative & positive symptoms of schizophrenia. At the following up stage 9 months later, improvements only remained with the CBT group. This is where Sensky concludes that CBT is an effective treatment for reducing the positive & negative symptoms of schizophrenia, and the benefits continue for at least another 9 months after treatment