Schizophrenia
- Created by: Natalie867
- Created on: 06-05-15 14:31
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- Schizophrenia
- Nature of SZ
- A disorder of thought, language and emotion (affect).
- A 'splitting' of the mind into fragments-not into different personalities.
- Symptoms come and go.
- There are many types and people with the diagnosis of SZ may share no symptoms.
- Symptoms:
- Positive:
- Delusions: bizarre beliefs that seem real, sometimes these can be paranoid in nature (e.g. grandeur, nihilism, paranoia).
- Hallucination: bizarre, unreal perceptions of the environment that are usually auditory but also visual, olfactory (hearing) or tactile (feeling bugs on your skin.
- Experiences of control: believing that you are under the control of aliens.
- Disordered thinking: thoughts have been inserted or withdrawn from the mind.
- Negative:
- Affective flattening: a reduction in the range and intensity of emotioinal expression (i.e.facial expressions, body language and voice tone).
- Avolition: a reduction of goal-directed behaviour, its often mistaken for apparent disinterest (i.e. sitting in the house doing nothing).
- Alogia: poverty of speech-not speaking much.
- Catatonia: maintaining an unusual posture for hours or a day in a catatonic stupor.
- Positive:
- Issues: diagnosis and classification
- Reliability
- Beck (1961)-2 psychiatricts, 164 patients. inter-rater reliability was as low as 54%.
- Whaley (2001)- inter-rater reliability corelations are as low as 11%.
- Hard to diagnose SZ - they have different symptoms, similar to other diseases/dis-orders. May be categorised differently.
- Reliability is difficult because..
- Patients give different info.
- behaviour is subjective
- Which behaviors constitute a symptom?What is a hallu-cination?
- Mild SZ or severe mood swing?
- Limited time/ resources, blurring of boundaries between SZ and mood disorder.
- Validity
- Does our system of diagnosis reflect the true nature of the problems that the patient is suffering?
- Types of SZ: hebephrenic, simple, catatonic, paranoid, atypical.
- Co-morbidity- Ellison and Rose (DID sufferers- a multiple personality disorder) had more SZ symptoms than SZ's.
- Predictive validity (PV): accurately predicting the course of the disorder and response treatment.
- Bleuer(1978)Studied SZ patients progress-20%: full recovery, 10%: significant improve-ments, 30%: some improve-ments, 40%: no recovery.
- PV in patients with SZ is very low. there is so much variablity.
- Bleuer(1978)Studied SZ patients progress-20%: full recovery, 10%: significant improve-ments, 30%: some improve-ments, 40%: no recovery.
- Labelling
- The label sticks even if the symptoms were there years ago (e.g job application).
- Stigma-no recovery, no cure.
- "In remission"-could go back to being SZ.
- Social Stigma
- Labelling Theory-miscon-ception of link between SZ and violence has doubled since the 1950's. (Phelan et al.)
- Kim and Berrios- only 20% of people with SZ in Japan are diagnosed.
- Cultural Bias
- Arabic culture- an outpouring of emotion is normal, but its abnormal in Western cultures.
- What is normal in one culture is not normal in another.
- What culture you are in affects your diagnosis.
- Copeland et al (1971)- 69% of US psychiatrists, 2% of UK psychiatrists diagnosed SZ on basis of desciption.
- Reliability
- Biological explanations
- Gottesman (1991)-Meta-analysis of 40 family studies.
- Chance of getting SZ: 44% if both your parents have it. 6% if one parent has it.
- MZ twins have a 42% concordance rate for SZ.
- Small sample size.
- Kety et al (1975)-SZ prevalence was higher in children with biological relatives with the disorder.
- Correlation not causation.
- Gottesman (1991)-Meta-analysis of 40 family studies.
- Bio-chemical explanations
- The Dopamine hypothesis.
- SZ is an excess of Dopamine
- Comer (2003)- Dopamine neurons play a role in guiding attention. So this could lead to the problems of attention and thought in SZ.
- Evidence for:
- Traditional Antipsy-chotics (Pheno-thiazines) block dopamine and reduce symptoms of SZ.
- Parkinsons disease-sufferes have low levels of dopamine.
- Grilly (2002)- take L-Dopa to raise their dopamine levels-taking too much caused SZ symptoms (e.g hallu-cinations).
- Amphet-amines-raises dopamine levels, high doeses can cause psychosis + SZ symtoms.
- Post-mortems/PET scans- Wong et al (1986)- found (doing PET scans) that SZ sufferers had higher dopamine receptors.
- Evaluation
- Anti-psychotic drugs are only effective for positive symtoms
- L-Dopa and amphet-amines dont worsen symtoms at all.
- New A-typical APs have proved more effective. these affect dopamine as well as othe neuro-transmitters. (Kasper et al, 1999).
- Reductionist.
- No cause and effect.
- Is dopamine a cause and effect?
- DOESNT SUPPORT: After AP's your dopamine levels drop but your symtoms do not immediately reduce (therapeutic delay)
- Cant explain why SZ patients go into lengthy periods of remission.
- Could dopamine be related to all mental disorders, not just SZ?
- The Dopamine hypothesis.
- Psychological explanations
- Freud (1924)-SZ was... 1. a regression to a pre-ego stage, 2.Attempt to re-establish ego control.
- AO2
- SZ is not that similar to pre-ego infantile behaviour.
- Diagnosis has changed a lot-how we describe it is different to how he described it.
- Lack or scientific evidence.
- Based on a small no. of case studies.
- Deterministic-based on upbringing.
- Unfalsifiable.
- 20th C, middle class, Viennese.
- AO2
- Id-what I want now, pleasure principle.
- Ego-looking at long-term goals.
- Super ego-mediating the other two.
- Ego-looking at long-term goals.
- SZ is an infantile state-the ego is trying to take back control.
- Evidence for:
- V. little supporting evidence.
- Fromm-Reichmann (1948)-"Schizogenic mothers".
- Normal baby.
- Raised by a schizogenic mother
- Child has a weak and fragile ego.
- Ego is broken apart.
- Person loses control of psyche.
- S/he loses contact with reality-cant distinguish between desires and fantasies, themselves and others.
- Normal baby.
- Raised by a schizogenic mother
- Child has a weak and fragile ego.
- Ego is broken apart.
- Person loses control of psyche.
- S/he loses contact with reality-cant distinguish between desires and fantasies, themselves and others.
- S/he loses contact with reality-cant distinguish between desires and fantasies, themselves and others.
- Person loses control of psyche.
- Ego is broken apart.
- Child has a weak and fragile ego.
- Raised by a schizogenic mother
- Normal baby.
- S/he loses contact with reality-cant distinguish between desires and fantasies, themselves and others.
- Person loses control of psyche.
- Ego is broken apart.
- Child has a weak and fragile ego.
- Raised by a schizogenic mother
- Normal baby.
- Oltmanns et al (1999)-SZ patients said that their parents behaved differently.
- Cognitive explanations
- SZ is caused by faulty thinking.
- Frith (1979)-SZ is the result of a faulty attention system, the pre-conscious goes into the conscious filter, this breaks down in SZ
- This is why SZ's withdraw (they begin hearing things etc.), their conscious filter doesn't really work-irrelevant thoughts become important (delusions)
- The cause is functional brain abnormalites-specifically dopamin pathways.
- This is why SZ's withdraw (they begin hearing things etc.), their conscious filter doesn't really work-irrelevant thoughts become important (delusions)
- Evaluation (AO2)
- Doesnt acknowledge environ-mental factors.
- DOES acknowledge biology.
- Disordered thoughts-cause or effect?
- Doesnt explain negative symptoms
- Freud (1924)-SZ was... 1. a regression to a pre-ego stage, 2.Attempt to re-establish ego control.
- Sociocultural factors
- Life events
- Stressful life events -> higher risk of SZ.
- Brown and Birley (1968)- 50% of SZ have stressful life events in 3 weeks before an episode.
- AO2-Retrospective (unrelable memories), low %.
- Hirsch et al (1996)- life events made a significant contribution in the 12 months preceding relapse.
- AO2-lontitudinal, correlation not causation.
- Evaluation (AO2)
- Not all evidence supports the link.
- Correlation evidence.
- The beginnings of SZ could have caused life events.
- Family dysfunction
- Double Bind theory (Bateson et al, 1956)-a contradictory message where an individual cannot 'win'.
- Growing up with Double Binds all the time could lead to learned patterns of commun-ication.
- Evaluation
- Berger (1965)-SZ patients reported more double bind statements. (self-report).
- Liem (1974)-measured patterns of parental communication in SZ's families-found NO abnormalities.
- Hall and Levin (1980)-meta-analysis-found NO difference.
- Expressed emotions (EE)
- (e.g. criticism, hostility and emotion over-involvement).
- Linzen et al (1997)-a person returning to a family with high expressed emotions is 4X more likely to relapse.
- Evalutation
- Better supported than double bind.
- Cause or effect?
- Has led to an effective EE-reducing therapy for families.
- Evaluation of family relationships
- Tenari et al (1994)-adoptees with SZ biological parents are more likely to become ill.
- But this difference only emerged when the adopted family was rated as disturbed
- (Diathesis-stress model)
- Social labelling
- Labeling theory (Schaff,1999)-social groups create the concept of psychiatric deviance by constructing rules
- Those displaying symptoms are considered deviant and labelled SZ.
- Self-fufiling prophecy-start acting SZ as you have been labelled as such.
- Evaluation
- Draws attention away from the v. real and disabling symptoms of SZ.
- Life events
- Nature of SZ
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