Schizophrenia

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  • Created by: Maya98
  • Created on: 01-06-17 09:53
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  • Schizophrenia
    • Characteristics
      • Negative symptoms
        • Symptoms of behaviour that prevent the individual from expressing normal behavioral patterns
        • Alogia - poverty of speech, lack of speech, lack of meaning. Even short sentences can be problematic
        • Avolition - individual appears to be indifferent or unconcerned with their surroundings
          • To someone unaware of the diagnostic the individual would just appear disinterested
        • Anhedonia - individual does not react appropriately to pleasurable experiences
        • Flatness - appear to have no emotion. Little or no facial emotion
          • Speech patterns can be very monotonous
        • Catatonic behaviour - can range from fast repetitive movements to little or no movement at all.
          • Echopraxia may also occur here, where the individual mimics the behavior of those around them
        • Many of the negative symptoms are seen in someone with depression, and so those with shcizophrniea can go on to develop depression also
      • Positive symptoms
        • Hallucinations - perceptions that aren't real.
          • Can be voices, sounds. Or can be visual or physical
          • Estimated that 20% of people with schiz have tactile hallucinations (Lewandowski et al)
        • Symptoms of behaviour that are in addition to normal behaviour
        • Formication - sensation that resembles small insects crawling on or under the skin.
        • Delusions - beliefs that are unreal, no evidence to support the belief.
          • Delusions of persecution - based on the idea that a person, group or organisation want to harm the individual.
          • Delusions of grandiosity - suggest that the individual is special in some way; believes they are powerful.
      • Disordered thinking - persons thoughts and discourse move from one topic to another without reason
    • Biology
      • Dopamine Hypothesis
        • Individuals with schiz had too much of the neurotransmitter dopamine in their brains.
        • J.J.Griffiths induced psychosis in non schizophrenic volunteers by giving them a drug that increased dopamine levels.
          • volunteers demonstrated abrupt onset of paranoia, delusions and showed a cold and detached emotional response
        • Of particular interest is the D2 receptors in the brain found primarily in sub-cortical regions of the brain in the limbic system.
        • limbic system engaged in emotions, memory formation and arousal.
          • Mesolimbic pathway - too much dopamine here can cause overstimulation and explains the positive symptoms
          • Mesocortical pathway - vital in emotional responses, motivation and cognition
            • Kenneth Davis et al - too little dopamine is evident in D1 receptors of the frontal lobe of many individuals with cognitive impairments and negative symptoms
        • Evaluation
          • May be linked to genes
            • Gottesman - looked at schiz in family members,As genetic similarity increased so did the probability of both individuals having schiz
          • not easy to measure neurotransmitters.
            • Majority of the research is based on metaolites
          • Ignores the role of serotonin
          • Unsure whether dopamine abnormalities is due to schiz or a result
          • Useful in terms of treatment. Abnormal dopamine levels can be treated with drugs
      • Structural Abnormalities
        • Enlarged ventricles
          • Schiz have larger ventricles than individuals without schiz
          • Weinberger - used CAT scans and found greater ventricle size in schiz when compared to control group
          • Andereasen - studied MRI scans of individuals with and without schiz. Found that those with schiz had ventricles 20% to 50% larger
        • Cortical atrophy
          • loss of neurons in the cerebral cortex.
          • can occur all over the brain (making it appear shrunk) or in a specific area
          • Affects cognitive functions of the brain
        • Reversed cerebral asymmetry
          • In individuals without schiz the left hemisphere is larger than the right
            • However in schizophrenics the right hemisphere is larger
          • Relevant as language function is found in left hem
          • Luchins - compared CAT scans of right handed people with schiz and right handed people with.
            • found that there was an increase in reversals of those with schiz
        • Evaluation
          • McCarley - argues that it is the most reliable finding in research that uses brain scans
            • Explained that the way in which researchers measured the brain differences may be responsible for any differences in results
            • Also explained that age, sex and strength of symptoms may affect results.
          • Unsure whether it is a cause or effect. May be that schizophrenic behaviour has caused the brain abnormalities not the other way around
          • Brain abnormalities not unique to schiz
          • Doesn't provide an explanation
          • Doesn't take into consideration the social aspects
          • Is scientific
    • Individual differences
      • Psychodynamic Approach
        • Fixation
          • occurs during oral stage of psycho sexual development
          • if infant receives too much or too little stimulation at this stage they may become fixated
        • regression
          • if individual experiences excessive amounts of stress they may regress back to oral stage
          • it is an ego defense mechanism
          • may be temporary or long term
        • losing touch with reality
          • during oral stage the ego is not fully developed
            • role of the ego is to control the ids impulses and find balance between id and super ego
          • without ego the id can take full control which become hallucinations and delusions
            • individual then struggles to distinguish between reality and fantasy.
          • this state is the same as if they were a new born baby - and the individual can be classed as narcissistic
        • schizophrenogenic mother
          • the mother child relationship is most important to the psychodynamic theorists
          • states that mothers of schizophrenics are over protecting and controlling
            • whilst at the same time being rejecting and distant
            • the over protection stifles the childs emotional development
        • Evaluation
          • This Freudian theory is outdated
            • it is unscientific and hard to prove or disprove
          • could not produce a treatment
            • Freud himself stated that psychoanalysis was not suitable for those with schizophrenia
            • Strupp et al - stated that psychoanalysis could actually be more destructive and harmful for individuals
          • not much research to support the schizophrenogenic mother theory
            • kasanin found that one third of schizophrenic patients didn't have maternal over protection
          • overlooks roles of genetics.
            • focuses on nurture rather than nature
            • Hetosn found that 10.6% of adoptees who had schiz mother also developed the illness. Whereas 0% of adoptees without shciz developed it
      • Cognitive
        • Morrison proposed that triggers (e.g. sleep deprivation) can cause some individuals to hear maladaptive voices
          • These voices cause anti social behaviour such as social withdrawal or self harm
          • they promote emotions of shame and embarrassment and the individual becomes stuck in a cycle
        • Negative symptoms
          • Beck et al - used his cognitive triad (that is used to describe depression) to explain the negative symptoms
          • Beck proposes that the individual has dysfunctional beleifs about their performance and ability to seek pleasure
            • in addicition the individual holds a gloomy view of the future
          • the individuals with schiz only see the negative side to everything, as their cognitive deficits filter out everything else
          • explains the flatness and avolition  and anhedonia
        • lack of pre-conscious filters
          • Firth - proposed that core positive symptoms of schiz could be due to pre conscious filters
          • normally our brains receive thousands of different stimuli and information from environment
            • best fit of information gets pushed ino our consciousness - letting us make sense of what we are observing
          • Firth believes that those with schizophrenia do not filter correctly and are over loaded with all the information at once.
            • therefore the delusions and hallucinations are methodsof protection
          • Compromised theory of mind
            • Firth - individuals with schiz are working with compromised theory of mind
              • 1. disorders of voluntary behaviour can explain negative and disordered symptoms
              • 2. disorders of self-monitoring can explain symptoms such as delusions and alien control and vocal hallucinations
              • 3. disorders of monitoring other peoples thoughts and intentions can lead to symptoms such as delusions of persecution
        • Evaluation
          • lots of scientific research
            • e.g. Barch et al found that schiz preformed poorer on stroop tests than non schiz
          • reductionist - only looks at brain deficits.
          • only explains cognitive theories
            • does not explain origin of symptoms
          • Howes and Murray - propose that it is genes or early factors in life combine with social stressors
            • this combines with dopamine system to release more dopamine.
              • increased dopamine causes cognitive issues.
    • Social
      • dysfunctional families
        • double bind theory
          • Gregory Bateson - proposed that symptoms of schiz are caused because of communication difficulties within the family
          • may develop schiz when repeatedly exposed to conflicting messages
            • in which the child does not have the opportunity to ignore them or respond
            • e.g. a father asking how their child's day was whilst focusing on the TV and not listening
              • child receives two conflicting messages
            • these conflicting messages incapacitate the child's ability to respond effectively
          • it was explained that long-term exposure to these contradictions means that the child learns to perceive the world in terms of contradictory input
            • leads to manifestation of schizophrenia e.g. hallucinations and delusions as an escape mechanism
        • Expressed Emotion
          • George Brown found that relapse in schiz was connected to the type of home they were discharged to
          • When they stayed with parents or wives they were more likely to relapse than those who stayed in lodgings or with siblings
          • connection between amount of expressed emotion and likelihood of relapse
          • Critical comments e.g. 'they are too lazy' were made by high EE caregivers
            • low EE acknowledged that it was the illness
          • Hostility - present in high EE. thought to be result of unmanageable anger, irritation and rejection of parent
          • emotional over involvement - parents reported feeling guilty and so over involved themselves
          • warmth - measured in vocal qualities and empathy. Evident in low EE caregivers

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