Schizophrenia

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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        • Disordered thinking:  thoughts have been inserted or withdrawn from the mind.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.
    • 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.
      • 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.
    • 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.
    • 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?
    • 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.
      • Id-what I want now, pleasure principle.
        • Ego-looking at long-term goals.
          • Super ego-mediating the other two.
      • 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.
          • 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.
          • Evaluation (AO2)
            • Doesnt acknowledge environ-mental factors.
            • DOES acknowledge biology.
            • Disordered thoughts-cause or effect?
            • Doesnt explain negative symptoms
      • 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.

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