AQA: Schizophrenia

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  • Created on: 22-01-13 17:50
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Schizophrenia
Sz is a disorder characterised by a profound disruption of cognition and emotion which affects a person's
language, thought, perception and sense of self.
Criticisms
Support
Classification and Diagnosis:
DSM & ICD:
Reliability:
The publication of DSMIII in 1980 was specifically designed to provide a more reliable system
A review of DSMIII claimed to have fixed the reliability problem
Beck et al (1961): looked at interrater reliability between 2 psychiatrists when considering the cases of 154
patients. The reliability was only 54%they only agreed on 54% of 154 patients.
Whaley (2001): found interrater reliability correlations of Sz as low as 0.11
Klosterkötter et al (1994): interrater reliability correlations in diagnosis of only about 0.4
Harrison et al (1984): diagnosis may be affected by cultural biasan overdiagnosis of Sz in West Indian
psychiatric patients in Bristol
Rosenhan et al: sent pseudopatients to a psychiatric ward. They were successful in admission and were
diagnosed as Sz patients. Rosenhan then said that there were more pseudopatients coming but there was
actually none. However, 41 genuine patients were judged to be pseudopatients.
Evaluation: not possible to control all variables and so results lose some reliability. Staff would not
normally expect `normal' people to try to get admission to a psychiatric hospital. Better to admit
someone even if there's a small chance of them being at risk to someone or to themselves. 'Sz
remission' is a rare diagnosispsychiatrists may not have believed they had Sz.
Ethical issues: freedom was taken away, mentally healthy people may have had treatments,
professionals were deceived and genuine patients were not treated.
The existence of 2 books shows that its inconsistent
Validity:
Rosenhan et al: the pseudopatients were labelled with their disorderthey tried telling medical staff that they
had faked their symptoms but this was seen as a symptom itself
Concerns for what Sz really is
Firstrank symptoms distinguish Sz from other disorders, but some of these are also found in other symptoms
Scheff (1966): people labelled with a diagnosis will conform to the label and therefore becomes a
selffulfilling prophecy
Biological Explanations
Genetics:
Twin studies:
Gottesman (1991): a review of over 40 studies found: monozygotic twins48% concordance rate, dizygotic
twins17% concordance rate
Rich dataresearchers have the opportunity to study rare phenomena in a lot of detail
High ecological validityvariables aren't manipulated so the findings should be true to real life
Use of `blind' diagnosis produces lower concordance rates for MZ twins but still much higher than DZ twins
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Marshall (1990): the better controlled the study, the lower the concordance rate
Difference in concordance rates may reflect environmental similarity rather than role of genetic
factorsenvironments for MZ twins may be more similar than for DZ twins
MZ twins share 100% of their genes but concordance rate is not 100%other factors involved
MZ twins are relatively rare in the population and of these, only 1% would be expected to have Szsample
sizes are small
In the past, it was more difficult to distinguish between MZ…read more

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Neuroanatomical Factors:
Torrey (2002): the ventricles of a person with Sz are about 15% bigger than normal
Andreasen et al (1990): conducted a CT scan study and found significant enlargement of the ventricles in
Sz patients compared to controls
Szesko et al (1995): the asymmetry found in normal brains in the prefrontal cortex is absent in people with
Sz
Castner et al (1998): damaged monkeys' brains during the foetal periodduring childhood they were fine,
however at puberty they developed symptoms of Sz
Buchsbaum (1990): carried…read more

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ElectroConvulsive Therapy (ECT):
Tharyan and Adams (2005): a review on 26 studies, studies that compared ECT vs simulated ECT
(placebo)more people improved in the real ECT
Can produce positive results when no other treatments work
Sarita et al (1998): found no difference in symptom reduction between ECT vs simulated ECT
Significant risks: memory dysfunction, brain damage and even death
Only temporarily effective
Difficult to gain informed consent
Psychological Explanations
Psychodynamic Theory:
Freud (1924): Sz is the result of regression to preego stage and attempts to…read more

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Evidence only correlational, not causal
Labelling Theory:
Scheff (1999):13 of 18 studies consistent with predictions of labelling theory
Rosenhan (1973): pseudopatients were labelled
Family Models:
Doublebind Theory:
Bateson (1956): doublebind theory: if a child repeatedly receives contradictory messages, the child
will end up with a false sense of reality and inability to communicate properly
Berger (1965): Sz patients recall more doublebind statements from mothersmay not be reliable as
patient's recall may be affected by Sz
Liem (1974): measured patterns of parental communication in families with…read more

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Freud: impossible to establish an appropriate therapeutic relationship with psychotic patients, the
nature of their symptoms (e.g.…read more

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