Psychology AQA A2 Detailed Schizoprenia Notes

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Schizophrenia is a serious mental disorder characterized by severe disruptions in psychological
functioning and a loss of contact with reality. There are two main classification systems in current use
which are ICD-10 and DSM-IV-TR. It is important to have a classification system because it enables
clinicians to organise data, to provide a summary of the main syndromes, to keep statistics and as the
first step in treatment. The two classification systems have now become very similar, but not entirely
Reliability refers to the consistency of a measuring instrument such as questionnaire or scale, to
assess, for example schizophrenic symptoms. Inter-rater reliability is the degree of agreement
among rater. The publication of DSM-III in 1980 was specifically designed to provide a much more
reliable system for classifying psychiatric disorders which was done by fixing the problem of
inter-rater reliability.
However, despite the claims for increased reliability in DSM-III there is still little evidence that DSM is
used with high reliability by mental health clinicians. Recent studies have found inter-rater reliability
correlations in the diagnosis of schizophrenia as low as +0.11.
CHENIAX ET AL (2009) investigated the inter-rater reliability of the diagnosis of schizophrenia
according to both DSM and ICD-10. Although the inter-rater reliability was above +0.50 for both
classificatory systems, schizophrenia was more frequently diagnosed to ICD-10 than DSM-1V criteria
Another aspect of reliability is test-retest reliability. Test-retest reliability is whether tests used for
diagnoses are consistent over time. WILKS ET AL administered these alternate forms of the test to
schizophrenic patients over interval varying from 1-134 days. The test-retest reliability was high at
PRESCOTT ET AL analysed the test-retest reliability of several measures of attentions and
information processing in 14 chronic schizophrenics performance on these measures was stable over
a 6 month period. Despite there being a small sample size, this study shows that test-retest reliability
was high.
COPELAND gave 134 US and 194 British psychiatrists a description of a patient. 69% of the US
psychiatrists diagnosed schizophrenia but only 2% of the British psychiatrists gave the same
diagnosis. This shows that there is a great culture difference in diagnosing schizophrenia therefore
reducing the reliability of diagnosis in schizophrenia.
Validity refers to the extent that a diagnosis represents something that is real and distinct from other
disorders and the extent that a classification system measures what it claims to measure.
Comorbidity is an important issue for the diagnoses of mental illness. It refers to the extent that two
more conditions co-occur. Psychiatrics comorbidites are common among schizophrenic patients.
These include substance abuse, anxiety and depression.

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SCHNEIDER in an attempt to make decision more reliable he identified a group of symptoms which
are specific for schizophrenia and not other disorders. He called this `first-rank symptoms'. ICD makes
more of an emphasis on the first-rank symptoms.
Using first-rank symptoms of schizophrenia when diagnosing is a way of avoid the issue of
comorbidity. However, RENTALL ET AL claim that many of the first-rank symptoms of schizophrenia
are also found in other disorders.…read more

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But since it is not it suggest that there are other factors too.
A more effective way of separating genetic and environmental factors is to look at adopted children
who later develop schizophrenia and compare them to their biological and adoptive parents. KETY ET
AL found high rates of diagnosis for chronic schizophrenia in adoptees whose biological parents had
the same diagnosis despite being adopted by healthy parents.…read more

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Drugs tend to be effective at alleviating positive symptoms of schizophrenia, but not negative
symptoms, suggesting that all of the symptoms of schizophrenia may not be directly related to
Since late 1920s, it's been noticed that an overwhelming high proportion of people diagnosed with
schizophrenia were brown in winter and early spring.
Birthing complications has also been linked to schizophrenias. DALMAN ET AL conducted a
longitudinal study and found links between birth complications and later developments of
schizophrenia.…read more

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There is a lot of research supporting drug therapies. For example JULIEN found that Clozapine has
been an effective treatment of schizophrenia. DELIME found that serotonin moderating drugs such as
Clozapine can alleviate negative symptoms.
RZEWUSKA (2002) found that symptoms often retuned if patients stop taking the drugs and
patients sometimes had to be kept on maintenance doses for long periods of time. This increases the
risk of serious side effects.
DAVIS ET AL.…read more

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An APA (American Psychiatric Association) review in 2001 listed 19 studies that had compared ECT
with `simulated ECT' (patients are given general anaesthesia but no ECT.) It concluded that ECT
produced results that were no different from or worse than antipsychotic medication. However, an
Indian study by SARITA ET AL, 1998, found no difference in symptom reduction between 36
schizophrenia patients given either ECT or simulated ECT.
There are significant risks associated with ECT, including memory dysfunction, brain damage and
even death.…read more

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Hemsley found tentative research in animals has found a neurological relationship between problems
in the hippocampus and schema activation failure. Genetic support has been found where Park found
working memory deficits in people with schizophrenia and in their first-degree non-schizophrenia
PET scans show under-activity in the frontal lobe of the brain, which is linked to self-monitoring and
so provides biological support for this explanation.…read more

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The social explanation can be criticised for putting too much emphasis on social factors and ignoring
biological factors, when there is strong evidence that the latter do have a significant effect. And
therefore even an interaction of both hypotheses will be a reductionist
Disturbed communications with family might be a factor in the development of schizophrenia. The
term `Schizophrenogenic families' was coined by Fromm-Reichmann in 1948 and was used to
describe families with high emotional tension, many secrets, close alliance and conspiracies.…read more

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In an Israeli study, psychologists looked at children with a schizophrenic parent. They found that those
children who had good parenting did not develop schizophrenia. However those who had poor
parenting were more likely to develop schizophrenia.
Patients suffering from schizophrenia despite taking their medication a significant proportion still
suffer from distressing symptom. Some, therefore, believe that additional psychological therapies
are also needed. Cognitive-behavioural therapy and psychoanalysis are the main forms of
psychotherapy.…read more

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It seems that not everyone will benefit from cognitive behavioural therapy. For example in a study of
142 schizophrenia patients, it was found that many patients were not deemed suitable for cognitive
behavioural therapy because psychiatrists believed they would not fully engaged with the therapy.
There are many aspects of cognitive behavioural therapy and it is unknown as to which has the most
effect. This limits effectiveness as the therapy could be made more effective if we knew which
aspect has most benefits.…read more


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