Schizophrenia revision guide

classification - clinical characteristics of schizophrenia, issues surrounding the classification and diagnosis of schizophrenia (reliability and validity). 

explanations - biological (genetics and biochemicals), psychological (behavioural, cognitive, psychodynamic)

therapy - biological therapies (drugs and ECT), psychological therapies (Psychodynamic and family therapy)

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Classification and diagnosis of schizophrenia:
Schizophrenia means split mind because there is a loss of contact with reality, disturbances of thought
process and disturbances of emotion/behaviour. There are two types of symptoms: positive and negative.
Positive symptoms is an excess distortion of a normal function (exaggeration) and a negative symptom is a
loss of normal function. The two major classificatory systems for psychological disorders are DSM-IV
(American psychiatric association) and ICD-10 (world health organisation).
The diagnostic criteria from the DSM-IV:
Control of thoughts. (+)
Delusions of control. (+)
Hallucinatory voices. (+)
Other persistent delusions and hallucinations. (+)
Breaks in train of thought. (-)
Catatonic behaviour. (-)
Change in personal behaviour (-)
The possibility of a mood disorder or organic causes (e.g. drug abuse or a brain tumour) must be excluded.
Both classifications identify a number of subtypes of schizophrenia. The DSM-IV lists five subtypes:
1. Paranoid schizophrenia: the main features are delusions, particularly delusions of prosecution and
hallucinations. They are usually agitated, angry, argumentative and highly suspicious of others.
2. Disorganised schizophrenia: once called hebephrenic schizophrenia (silly mind). Symptoms include
giggling, pulling faces and flat or inappropriate affect. Disorganised speech is common as is
disorganised behaviour such as not washing or brushing teeth.
3. Catatonic schizophrenia: some people in this category spend long periods immobile, in catatonic
stupors. Others exhibit catatonic excitement with wild, uncontrollable motor movements.
4. Undifferentiated schizophrenia: people who don't fit into any of the sub categories.
5. Residual schizophrenia: the symptoms are reduced in number and intensity but signs of the disorder
are still present.
Reliability of diagnosis:
Reliability is the extent to which different psychiatrics can agree on the same diagnoses when assessing
patients. Existence of classification systems (e.g. DSM) is claimed to lead to a much greater agreement in
diagnosis of schizophrenia. There are different classification systems used for diagnosis. In the US the DSM is
used and in the UK the ICD is also used. The issue with this is that they describe schizophrenia in different
ways, which creates problems in assessing reliability. Whalley found that inter-rater reliability (how similar
are people diagnosis) correlations for the diagnosis of schizophrenia was as low as 0.11.
Rosenhan demonstrated the unreliability of diagnoses by arranging for pseudopatients to present
themselves to psychiatric hospitals claiming to be hearing voices. All were diagnoses with schizophrenia and
admitted, despite the fact they displayed no further symptoms during their hospitalisation. Throughout their
stay none of the staff recognised that they were actually normal.

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Everyone that displays symptoms gets the diagnosis of schizophrenia and not another disorder. Furthermore
there is little consistency in diagnosis over the 30 years: USA: 20% diagnosed in the 1930's and 80%
diagnosed in the 1950's however in the UK it was 20% for 1930's ­ 1950's.…read more

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Adoption studies: adoption studies mainly compare adoptees with biological and adoptive parents
as similarities with biological parents would indicate genetic influences. Kety's Danish adoption
study found higher rates of schizophrenia in adoptees whose biological parent/parents had
schizophrenia even though they had been adopted by someone who doesn't have schizophrenia.
However there is a major problem with diagnostic criteria as it is changing all the time.
3.…read more

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Research methods: cause or effect? It is very difficult to establish whether the excessive dopamine
causes schizophrenia or is it an effect of schizophrenia drug treatment. This is a huge obstacle to
overcome. Psychologists have come up with a solution in terms of regularly scanning brains of
schizophrenics continuously. However this is extremely expensive and unethical as it does not offer
them help and just uses them as test subjects.
Individual differences: drugs don't work for everyone.…read more

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Socio-cultural factors ­ life events:
Life events are major events such as getting married. High levels of physiological arousal associated with
neurotransmitter changes are thought to be involved (Faloon). Cortisol damages nerve cells in the
hippocampus (memory) resulting in impaired memory which means you are not able to coordinate and carry
out tasks.…read more

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Appropriateness: "revolving door syndrome" and side effects: both drugs have side effects. These
drugs only have temporarily sort out symptoms and doesn't solve the symptoms. Relapses are
common and then they are given more drugs so its like a revolving door. Perhaps they also need
psychological therapies as well to prevent a relapse.
Ethical issues: there is problems with obtaining informed consent.…read more

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Freud claimed that psychoanalysis was inappropriate when treating schizophrenia as many have
communication problems and they cannot understand their disorder. Now, thinking has changed as they
have drugs and these enable the symptoms to reduce and they are capable of talking about the disorder.
Free association allows the client to talk freely and the idea is that the analyst is meant to pick up clues and
hints to determine the cause of schizophrenia, things such as traumatic experiences. This brings the
unconscious to the conscious.…read more

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The treatment involves and education about schizophrenia and its nature, offers advice, support and
problems solving. In the beginning they measure the level of EE (expressed emotion) through structured
interviews and continue to measure it on a regular basis to try and prevent a relapse. In sessions the
therapist comes up with solutions to problems they may have. By discussing problems, everything is out in
the open and encourages everyone to talk, develop and learn to cope.…read more



Really helpful thanks, so much detail. 

Erika Pickard

Very Helpful- Which syllabus is this for?


Possibly AQA A specification. This book is really good with A* model essay answers for Psya4 Schizophrenia too - the guy that wrote it scored 100% for both A2 papers:

:) PurpleJaguar (: - Team GR

Really helpful, thanks! :)

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