Schizophrenia essay plans

These are some plans I've made for the main schizophrenia essay questions. Lighter coloured boxes contain AO1 points, darker boxes provide commentary (AO2/AO3).

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  • Schizophrenia essay plans
    • Reliability and validity issues
      • Reliability - consistency of measure
        • Inter-rater high = high +ve correlation
          • Whaley (2001) low +ve (+0.11) with DSM
            • Further revisions needed so patients who need help can receive it
          • Copeland et al. (1971) cross-cultural 2% UK diagnosed, 69% US
            • Improvements since 1971
              • Still an issue in ensuring patients receive necessary treatment
        • Diagnosis
          • Rosenhan (1973)
            • Suggested that situation more important than characteristics so reliability is low
            • Study - 8 pseudopatients claimed to hear voices, all diagnosed
              • Follow-up - 21% detection rate when no pseudopatients sent
                • Psychiatrists didn't trust own diagnoses
                  • Diagnosis unreliable, so unhelpful for patients
                • Rosenhan (1973)
                  • Suggested that situation more important than characteristics so reliability is low
                  • Study - 8 pseudopatients claimed to hear voices, all diagnosed
                    • Follow-up - 21% detection rate when no pseudopatients sent
                      • Psychiatrists didn't trust own diagnoses
                        • Diagnosis unreliable, so unhelpful for patients
                    • Professionals unable to distinguish fakes from those who truly need help
              • Professionals unable to distinguish fakes from those who truly need help
    • Biological explanations
      • Genetics
        • Gottesman (1991) MZ= 48% DZ=17%
        • Kety et al. (1978) more common in bio than adoptive relatives
        • MZ environments more similar
        • Gottesman and Bertelsen (1989) MZ parent = 17% parent's MZ = 17%
          • Diathesis-stress model useful to explain why both MZs weren't schizophrenic
      • Brain structure
        • Torrey (2002) 15% larger ventricles
        • Inconsistent findings
          • May be  due to variety of symptoms
        • Cause or effect?
          • Harrison (1995) brain damage doesn't worsen
      • Neurotransmitters
        • High dopamine levels/ sensitivity
        • Deterministic - high dope leads to sz
        • Antipsychotics increase dopamine and are effective
          • Doesn't mean dopamine was the cause
        • Only linked to positive symptoms
          • Other factors for negative symptoms
    • Psychological explanations
      • Cognitive
        • Frith (1992) faulty filter model
          • Meyer-Lindenberg et al. (2002) physical basis of cognitive functions
          • Yellowlees et al. (2002) virtual hallucinations treatment
          • Not a full explanation (relies on bio)
      • Socio-cultural
        • Life events
          • Brown and Birley (1968) 50% life event 3 weeks prior
            • Retrospective & self-report - symptoms may influence recall
              • Hirsch et al. (1996) prospective
        • Expressed emotion
          • Linszen et al. (1997) 4x more relapse
            • Correlational - symptoms may cause high EE
            • Hogarty et al. (2001) EE reduction therapy effective
      • Conclusion
        • Bio evidence - diathesis-stress model more suitable
    • Biological therapies
      • Antipsychotic drugs
        • Conventional
          • Bind to/block dopamine receptors
          • Effective Davis et al. (1980) relapse 19% (meds), 55% (placebo)
          • Inappropriate Hill (1986) 30% tardive dyskinesia
        • Atypical
          • Temporarily bind to dop. receptors, delaying release
          • More appropriate Jeste et al. (1999) 5% side effects
          • Leucht et al. (1999) Slightly more effective on negative symptoms
        • Reduce dopamine in brain
        • Patient doesn't have an active role in recovery
        • Placebos may not provide a fair complarison
      • Electro-convulsive therapy
        • 0.6 amp current between 2 electrodes to elicit seizure
        • APA (2001) ECT+meds no more effective than meds alone
        • Sarita et al. (1998) ECT impairs memory
          • Use declined by 59% between 1979 & 1999 due to risks
      • Conclusion
        • Antipsychotics still used widely, Drury et al. (1996) best with psychotherapy e.g. CBT
    • Psychological therapies
      • Cognitive behavioural therapy
        • Identify and correct faulty interpretation of events
          • e.g. delusions of control
        • Develop alternatives & practise with behavioural assignments
        • Drury et al. (1996) CBT+meds reduce +ve symptoms & recovery time
          • Can't easily separate out effects of CBT & meds
        • Kuipers et al. (1997) CBT+meds = fewer patient dropouts
        • Kingdon and Kirschen (2006) many patients unsuitable
      • Psychodynamic therapy (psychoanalysis)
        • Form alliance - offer help for perceived problem    e.g. that someone's in control of their behaviour
        • Replace punishing conscience w/ supportive one
        • Help ego regain control in non-symptomatic ways (not hallucinations)
        • Gottdiener (2000) 66% improved w/ psychotherapy
          • Not 100% - not effective on all
        • Sz Patient Outcome Team - can be harmful (inappropriate?)
        • Expensive so not widely available
          • Karon and VandenBos (1981) overall cost decreases
            • Require less inpatient treatment, have better prospects

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