SZ EXPLANATIONS

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  • EXPLANATIONS FOR SZ
    • PSYCHOLOGICAL
      • PSYCHODYNAMIC EXPLANATION - FREUD
        • PARENTS COLD & UNCARING, person REGRESSES to earlier stage of development BEFORE EGO - may be DUE TO WORLD of SZ being PARTICULARLY HARSH
          • LITTLE EVIDENCE - H/E PARENTS SHOWN TO BEHAVE DIFF - CONSEQUENCE OR CAUSE?
          • REDUCTIONIST - CAN'T empirically TEST EGO - internal valid - genetic factors
        • SZ seen as infantile state - result of attempts to ESTABLISH EGO CONTROL. Some symptoms .e.g dellusions of grandeur reflect PRIMITIVE CONDITION. ALL SYMPTOMS suggest PRODUCT of WEAK & CONFUSED EGO
          • LACK OF RESEARCH SUPPORT - H/E claims of distorted family patterns as cause of sz - FROMM - REICHMANN - 'sz mothers' rejecting, overprotective as development factors - support
          • SUPPORT from SUCCESS OF PSYC THERAPY - meta-analysis GOTTDIENER 37 studies, effective treat. support claim psy origins
      • SOCIO-CULTURAL FACTORS
        • LIFE EVENTS - STRESSORS associated with higher RISK of sz EPISODES - BROWN & BIRLEY found prior to sz episode, patients reported TWICE as many STRESSFUL LIFE EVENTS compared to healthy control grp.
          • LACK OF RESEARCH SUPPORT - VAS OS ET AL - NO LINK between sz & life events - retrospective part of study - patients not more likely to have had experience makor life event 3 months prior to sz episode. Prospective - major life event - lower relapse rates!
          • CORRELATIONAL RESEARCH - NO CAUSE - May be that EARLY SYMPTOMS CAUSE OF MAJOR LIFE EVENTS - major life events in sz lifes - consequence
        • FAMILY RELATIONSHIPS - DOUBLE-BLIND THEORY - BATESON ET AL - CHILDREN who RECIEVE CONTRADICTORY MESSAGES from parents more likely to develop sz. PREVENTS DEVELOPMENT OF INTERNALLY CONSISTENT CONSTRUCTION OF REALITY - can manifest itself as sz symptoms
          • SUPPORT - TINARI et al adopted children who had sz bio parents more likely to develop sz but ONLY WHEN ADOPTED FAMILY RATED AS DISTURBED - ILLNESS MANIFESTED UNDER APPROPRIATE ENVIROMENTAL CONDITIONS
          • double blind theory has MIXED SUPPORT - lack reliability - BERGER found sz reported higher double blind statements than non-sz h/w LIEM - no difference in patterns of parental communcation in families of sz's and nonsz's
    • BIOLOGICAL
      • GENETIC FACTORS - TWIN & ADOPTION STUDIES
        • TWIN STUDIES - JOSEPH, meta-analysis, CONCORDANCE RATE of 40% for mz, over 7% for dz. SUPPORTs bio exp.
          • CONC rates may oncly REFLECT ENVIROMENTAL DIFFERENCES - JOSEPH - SZ treated similarly - experience more 'IDENTITY CONFUSION'
          • Methodologically sound, recent studies - blind tech - reported lower conc rates for mz. h/w still higher than dz.
        • ADOPTION STUDIES - TIENARI ET AL - bio mothers with sz, 6.7% adoptees developed sz, only 2% developed sz born to non-sz mothers.  SUPPORTS BIO EXP.
          • SELECTIVE PLACEMENT - adoptees know child born to sz - TREATED DIFFERENTLY - who would adopt them?
          • METHODOLOGICAL PRBLMS - research only finding differences when children born to sz parents 'sz spectrum disorder' validity
      • DOPAMINE HYPOTHESIS
        • MESSAGES from NEURONS that TRANSMIT DOPAMINE FIRE TOO EASILY/OFTEN leading to sz symptoms. SZ'S have ABNORMALLY HIGH numbers of D2 RECEPTORS, resulting in more dopamine neurons firing
          • REDUCTIONIST - DOP ALONE DOES NOT CAUSE SZ - psyc factors (expressed emotion) influence development/ recovery. BIOLOGICAL VULNERABILITY. only develops in presence of sig stressors
          • HIGH DOP LEVELS - CONSEQUENCE rather than cause. review POST-MORTEM studies (HARACZ) found elevated dop levels in those who received antipsychotics shortly before death - consequence of treatment
        • EVIDENCE for DOP HYP - use of AMPHETAMINES - dopamine agonists, causing SYNAPSES to be FLOODED WITH DOPAMINE. LARGE DOES CAUSE HALLUCINATIONS - support - symptom of sz
          • IF caused by solely dop - ANTIPSYCHOTICS should work for every1 - NOT CASE - cannot explain development of sz
          • INCONCLUSIVE EVIDENCE from NEUROIMAGING. CHALLANGES DOP HYP - DEVELOPMENT OF PET SCANS - SHOWN NOW ALTERED DOP LEVELS IN SZ - COPOLOV & CROOK

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