AQA psychology schizophrenia revision notes

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Classification and Diagnosis
Classification ­ Emil Kraepelin
1. Dementia praecox (his term for what we now call schizophrenia), caused by a chemical imbalance
2. Manic-depressive psychosis (now known as bipolar disorder), caused by a faulty metabolism
Kraepelin's classification helped to establish the organic or somatic (bodily) nature of mental disorders. It also
provided the basis for the two classification systems: DSM and ICD
Both DSM and ICD use the term `mental disorder' BUT they have both dropped the traditional distinction
between `neurosis' (e.g. phobic disorders, OCD) and `psychosis' (e.g. schizophrenia and depression). However,
ICD-10 retains the term `neurotic' and DSM-IV-TR still uses `psychotic'
Psychosis is the technical term for what the lay person calls madness. Psychotic symptoms include ­ delusions,
hallucinations and thought disorder. These account for why `crazy' people are seen as `out of their head' or `in
another world'. Unlike neurotic symptoms (such as anxiety, including panic attacks and phobias), psychotic
symptoms are outside the normal realm of experience. This means that they're also outside our common-sense
powers of understanding and empathy. Schizophrenia is by far the most common of the psychoses, and is
considered to be one of the most serious of all mental disorders.
Reliability of psychiatric diagnosis
The classic study examining the reliability of psychiatric diagnosis is Rosenhan's `Being sane in insane places'
Reliability of psychiatric diagnosis
Although Rosenhan's conclusions have been questioned, the study highlights the issue of reliability, as well as the
related issue of validity.
If psychiatrists cannot agree among themselves about a particular patient's diagnosis, then it's impossible to
know whether any diagnosis that's made is correct ­ i.e. valid ­ that is, that this is the disorder the patient
`actually' has.
Reliability of psychiatric diagnosis
Diagnosis is the process of identifying a disease and allocating it to a category on the basis of symptoms and
signs. Clearly, any system of classification will be of little value unless psychiatrists can agree with one another
when trying to reach a diagnosis ­ inter-rater/inter-judge reliability.
Davidson et al: despite some categories still having greater reliability than others, reliability has improved
significantly since the publication of DSM-III in 1980 and is now acceptable for most of the major categories.
However, problems remain. Specifying a particular number of symptoms from a longer list that must be evident
before a particular diagnosis can be made seems very arbitrary. For example, DSM-IV-TR insists on depressed
mood plus four other symptoms to be present to diagnose major depression ­ But why four?
There's still room for subjective interpretation on the part of the psychiatrist. For example, in relation to mania,
the elevated mood must be `abnormally and persistently elevated' for a diagnosis of mania to be made.
Likewise, one of the five axes of DSM requires comparison between the patient and an `average person'. These
examples beg all sorts of questions.
Davison et al: `Such judgements set the stage for the insertion of cultural biases as well as the clinician's own
personal ideas of what the average person should be doing at a given stage of life.'
Validity of psychiatric diagnosis
Validity implies a degree of `objectivity', but it is actually more difficult to assess than reliability - this is because
for most disorders there's no absolute standard against which diagnosis can be compared.
However much we improve reliability, this is no guarantee that the patient has received the `correct' diagnosis.

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Predictive validity
The primary purpose of making a diagnosis is to enable a suitable treatment programme to be selected.
Treatment cannot be chosen randomly, but is aimed at eliminating the underlying cause of the disorder (where
it's known). But in psychiatry there's only a 50% chance of predicting correctly what treatment a patient will
receive on the basis of diagnosis. One reason for this seems to be that factors other than diagnosis may be
equally important in determining a particular treatment.…read more

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Crow has found it useful to distinguish between so-called positive and negative symptoms.
Positive symptoms
These are symptoms added on to the individual's personality ­ hallucinations, delusions, disorganised speech.
Delusions: bizarre beliefs that seem real. They are sometimes paranoid in nature and may also involve beliefs
relating to grandiosity. Belief behavior/comments of others are specifically meant for the individual alone (who is
suffering from Schizophrenia).
Experiences of Control: believe they are under control of an alien force that has invaded their mind or body.…read more

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Are they `types' or states? Subjective accounts of psychotic experience suggest that it's doubtful whether
negative symptoms define a type of schizophrenia. It's more likely that positive and negative symptoms
represent alternating states occurring at different times within the same individual.
Are negative symptoms unique to schizophrenia? If a diagnosis of schizophrenia is based on an initial
episode that consists solely of negative symptoms, it won't be very convincing.…read more

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Describe symptoms included in the ICD or DSM manuals eg: thought control, delusions, hallucinatory voices, other persistent hallucinations, incoherent/irrelevant
speech, catatonic behaviour, and negative symptoms (such as lack of drive/motivation, flat affect, inappropriate emotional response and sudden mood swings).
Clinical characteristics of schizophrenia could also legitimately include factors such as the prevalence, course and outcome of the disorder. However, causal
explanations and evaluative commentary, eg, on the difficulty of diagnosis, are not creditworthy.…read more

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Pilgrim argues that calling madness `schizophrenia' or misery `depression' merely technicalises ordinary
judgements - What do we add by calling someone who communicates unintelligibly `schizophrenic'?
Winter also argues that `diagnostic systems are only aids to understanding, not necessarily descriptions of
real disease entities'.…read more

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Biological Explanations
Genetic explanation:
There is some evidence that schizophrenia runs in families. This may be because they share the same
disadvantaged environments. However evidence from family, twin and adoption studies does provide some
genetic link:
Family studies:
1st degree relatives (parents, siblings) share 50% of their genes 2nd degree relatives about 25% of their genes
Evidence suggests the closer the biological relationship, the greater the risk of developing schizophrenia (or a
related psychotic disorder).…read more

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The study reported that 7% of the index adoptees
developed schizophrenia, compared to 1.5% of the controls.
Kety et al - `The Danish Adoption Study'
Taking a national sample from across Denmark, Kety et al found high rates of diagnosis for chronic schizophrenia
in adoptees whose biological parents had the same diagnosis, even though they had been adopted by `healthy'
The evidence provided by these prospective studies have so far, indicated a strong genetic link for
schizophrenia.…read more

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Biochemical explanations
There may be structural or biochemical abnormalities in schizophrenics' brains. Research has focused on the
action of certain neurotransmitters or chemical messengers.
The Dopamine Hypothesis:
Interest in the neurotransmitter dopamine arose when it was found that phenothiazine's (neuroleptic,
anti-psychotic drugs which reduce the symptoms of schizophrenia) work by inhibiting dopamine activity and that
L-dopa (a synthetic dopamine-releasing drug) can induce symptoms resembling acute schizophrenia in
non-psychotic people.…read more

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Neuroanatomical explanations:
Technological advances have enabled the medical profession to examine the live brains of people with
schizophrenia. MRI studies have shown definite structural abnormalities in the brains of many patients with
Evidence for neuroanatomical explanations:
Brown et al- found decreased brain weight and enlarged ventricles.
Flaum et al- also found enlarged ventricles, along with smaller thalamic, hippocampal and superior temporal
Buchsbaum- found abnormalities in the frontal and pre-frontal cortex, the basal ganglia, the hippocampus and
the amygdala.…read more




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