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Introduction to Schizophrenia
Bleuler (1911) was the first person to use the word schizophrenia, which literally means `split mind'. He used it to
describe a general class of disorders that are characterised by a number of similar symptoms associated with a split
Main Symptoms Diagnosing Schizophrenia.
Auditory Hallucinations - usually voices in the persons The current specific diagnostic criteria is set out in the DSM IVR
Delusions - false beliefs that can take many forms CHARCTERISTIC SYMTPOMS
Disordered Thinking - thinks there thoughts have been This is 2 or more of the following occurring for one month period (or more)
inserted or withdrawn from the mind. delusions
Control - lack of self control hallucinations
Emotional and Volitional Changes - emotions are flat. disorganised speech
negative symptoms
catatonic behaviour
WING 1992 has argued for a distinction between the primary
impairments which are intrinsic to the disorder, and SOCIAL/OCCUPATIONAL DYSFUNCTION
secondary impairments which result from the primary. Functioning at work, self care, interpersonal relations markedly below the level normally achieved before the onset.
The above are all primary impairments, secondary DURATION
impairments are divided into social and psychological. Social Continual signs for 6 months including the 1 month of symptoms found in A. The sings must persist.
include employment and rejection and prejudice whereas
psychological refer to dependancy, self esteem and no
motivation Types That Appear in the DSM-IVR
ANDERSON ET AL found that there were two general
patterns that are visible in schizophrenics symptoms.
Preoccupation with delusions and auditory hallucinations. disorganised speech or behaviour, even catatonic not
(negative and positive).
Related to this is type 1 and type 2 schizophrenia. Type 1
Immobility, excessive motor activity, extreme negativism, stereotyped movements.
refers to a response to the drug treatments but also
abnormalities in their limbic systems. Type 2 is where they
Disorganised speech, flat affect, disorganised behaviours.
don't respond to the drug treatments with abnormalities in
the frontal lobes with the enlargement of ventricles.
Characteristic symptoms present, but does not meet catatonic, paranoid or disorganised.
The term schizophrenia may be convenient but can also be
Absence of prominent delusions, hallucinations. 2 or more negative symptoms seen in CA.
very misleading. For example, it is more than likely that there
are several different types of severe mental disorders that we
Occurs after bout of schizophrenia, low level symptoms can occur.
currently call `schizophrenia', all of which has loss on contact
with reality in common.
No past history of psychotic episodes
Only negative effects which have been developmental.…read more

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Socio-Cultural Explanation of Schizophrenia
This explanation, instead of looking at the individual, looks at the wider social context in which the individual exists.
For example, abnormal behaviour is due to societal or family interactions.
Labelling Theory Rosenhan 1973
His work helped improve the diagnosis of schizophrenia, and the reliability of it.
Thomas Szasz stated that labelling someone with a
mental illness is nothing more than `medicalisation of Investigate the reliability of diagnosing mental illness.
madness'. An individual is robbed of their liberty when
words such as `treating' `diagnosis' and `illness' are A group of 8 non mentally ill participants said they could hear auditory hallucinations and were suffering
used. from delusions, in order to gain admission to various mental hospitals around the US.
7 of those were classes as schizophrenic. They sensed the feelings of powerlessness and fear once
Giving individuals the label of `schizophrenic' or inside and behaving normally.
`mentally ill' is just a way of excluding those who do not
form to our social and cultural norms. From admission into the hospitals, the PP had difficulty convincing the staff that they were sane, they
were on average hospitalised for 19 days. When released they were given the title `schizophrenia in
Scheff has proposed that schizophrenia is a learned
social role that is determined by the process of labelling.
His theory believes that an individual who breaks one or
more residual rules and is labelled schizophrenia, acts The unreliability of diagnosing mental illness is clearly evident. Patients were perceived in accordance to
upon this label, behaving in a way that fits the the labels they had been given.
It also often effects the way others react to the
behaviour of the individual questioned.
Labelling Evaluation
Once diagnosed it is hard to fit back into society, and if
The work of Rosenhan, helped us to improve our reliability of diagnosing mental illness along with the revision of the DSM - III. It
people find out, then it can be hard to find work, and demonstrated that psychiatric labels tend to become self fulfilling prophecies.
makes the whole idea of recovery a lot harder. We begin to interpret behaviour in a way which fits in with out pre-existing assumptions and beliefs.
A self fulfilling prophecy is created. The labelling theory only accounts for how the symptoms of schizophrenia are maintain, it does not explain the cause, nor does it
An expectation that a person will behave in a certain offer any kind of treatment.
way, as a result of which the person's behaviour turns
It ignored compelling genetic evidence which has been discussed in the biological explanation of schizophrenia. Gottesman and
out as expected because they begin to act in a way that Shields meta analysis showing how the % risk of schizophrenia increases in accordance to whether certain family members have the
will optimise the expected outcome. illness.
Seriously ill individuals with severe symptoms exist and require the help of professionals, and the labelling theory has been accused
of trivialising a very serious disorder.…read more

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Socio-Cultural Explanation of Schizophrenia
This explanation, instead of looking at the individual, looks at the wider social context in which the individual exists.
For example, abnormal behaviour is due to societal or family interactions.
Early Studies Into Family Evaluation of Early Studies
Patterns and Styles Even though links have been made between family patterns and schizophrenia, it has been difficult to unravel the cause and
This looked a the nature and style of communication. effects. It could be that a particularly difficult child causes the family problems, instead of the family problems creating difficult
Batesman et al - suggested that communication
between parents and their children is sometimes Expressed Emotion Explanation
contradictory, `double blind'. This is seen when a parent
Brown et al found that those released back to families rather than lodgings were more likely to relapse.
is saying something, but there body language is saying
something different.
High face to face contact between the individual in remission and their family was found to increase the risk of
From the children learn not to trust their own feelings
relapse. This was known as emotional over involvement, including
and perceptions, because they cannot trust those of
Emotions (+ and -), Hostility and Critical Comments. Where the EE is high patients were at a higher risk of
others, growing up to mistrust all communication.
relapse compared to low EE.
This is sometimes shown with people with paranoid
Lidz et al stated that families sometime fail to provide a Bebbington and Kuipers Evaluation of EE
stable and supportive environment as well as the
appropriate role models for the developing child. (family Cross cultural meta analysis of 26 studies The a ability to predict the relapse rate of people with
socialisation theory) looking at the relationship between EE families schizophrenia from the EE measure up to 12 months following
and rate of relapse. UK JAPAN SWITZERLAND discharge is a wrong indicator of the predictive validity.
SCHISMATIC FAMILIES - conflicts between parents USA.
results in competition for the affection of family Kanter Et Al - if the condition of a person with schizophrenia
members, and a desire to take control and undermine begins to deteriorate, family involvement is likely to increase,
1,346 patients used. along with family criticisms and efforts to control the situation.
the other parent. 52% were High EE (of which relapse averaged at
50%) Kavanagh - High EE is not specific to schizophrenia but also
SKEWED FAMILIES - 1 partner is abnormally dominant, Low families 48% (relapse average = 21%) seen in those with eating disorders and depressive illnesses.
and the other is submissive. The children are Difference was highly statistically significant.
encouraged to follow the dominant partner, this impairs Leff et al found that this type of communication pattern was
their cognitive and social development. Expressed emotion is a RISK FACTOR in relapse more evident in western communities.
rates of schizophrenia.
In both types of family, parents fail to act in role- There is a problem with the measurement of EE, which is
Difficult to establish cause and effects.
appropriate ways, which can cause anxiety and usually by interview. PP can give socially desirable answers
Does the EE cause the schizophrenia, or does
(therefore not reliable). It might not give an accurate picture of
schizophrenia may be a way of handling the family the schizophrenia cause the EE. family interaction patterns.
conflicts.…read more

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Biological Approach to Schizophrenia
The biological approach can also be known as the medical model. This is where mental disorders are said to have
physical causes. There are 3 explanations that are included, genetic, neurochemical and neuroanatomical.
Genetic Genetic Evaluation Neurochemical Explanation
The risk of schizophrenia in the general population is 1%. Studies have 46% of concordance rate in MZ twins suggests a major contribution from It was originally thought that schizophrenia was caused by an excessive amount
shown however, the greater the genetic relatedness the higher the individuals genotype. of dopamine in the brain.
concordance for schizophrenia. (aka family members are of an increased
risk). Concordance in MZ twins is about 3x of that in DZ, never the less, although high, This was because drugs like amphetamines cause schizophrenia like symptoms.
there is still a discordance rate of 40%. However, studies have shown about half They exacerbate psychotic symptoms.
This is supported by the META-ANALYSIS done by Gottesman and of the discordant group will go on to have schizoid disorders or something
Shields (1982). similar, and thus if the broader definition is schizophrenia is adopted, the MZ However, through research, over the years they have established that it is not
concordance rates with be even higher. excessive dopamine that causes schizophrenia, but excessive sensitivity towards
Finding twins with an incidence of schizophrenia, is extremely rare, therefore the
studies always use small sample sizes, this suggests that it is not representative. This is supported by post mortem that have show more D2 reception in the
SIBLINGS 10.1 However this is unavoidable. schizophrenic brains that normal brains, and PET SCANS (Pearlson et al)
Lytton 1977 suggests that Mz twins are reared in a more similar environment There is also scans to show 6x more D4 receptors (very similar to D2)
than DZ twins, and therefore nurture might partly explain the higher concordance Seeman et al.
rate found in MZ.
Neuroleptic drugs have been developed to block the dopaminergic neutrons and
The findings from adoption studies do support the idea that there is a genetic reduce the psychotic symptoms.
the extend to which this is due to genetic
3.7 or
predisposition for schizophrenia.
environmental influences is not clear.
MZ = 100% genes DZ = 50% genes
The concordance rates for twins with schizophrenia should be therefore
higher in MZ than DZ
Neurochemical Evaluation
It is not known whether these D2 receptors found in the brains of
MZ DZ people with schizophrenia at post mortem is the cause of the
pathology or an effect of the neuroleptic drugs taken, as it is
AVERAGE OF THE known that such drugs are attracted to this kind of receptor.
CONCORDANCE However, this was then ruled out by Pearlson et al as he
46 14
STUDIES conducted studies on patients who had not been exposed to
neuroleptic drugs.
However, the extend to which this is due to genetic or environmental
influences is not clear.
To infer from this explanation that the cause of schizophrenia is
mainly due to the hypersensitivity to dopamine, this would be
Adoptive oversimplifying. It is now clear that the neurotransmitter pathways
These types of studies are unique as they eliminate the environment from interact and that the mapping of these cortical pathways are only
genetics. just being explored.
An early adoption study by Heston 1966 of 47 mothers with schizophrenia,
whose children were adopted within days by psychiatrically well mothers,
found the incidence of schizophrenia in the children to be 16%.…read more

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Biological Approach to Schizophrenia
The biological approach can also be known as the medical model. This is where mental disorders are said to have
physical causes. There are 3 explanations that are included, genetic, neurochemical and neuroanatomical.
Neuroanatomical Explanation Suddath et al
It has been acknowledged for a long time that the brains of Investigate discordant twin pairs for structural abnormalities that might account for the incidence of
schizophrenics are different to that of normal brains. Some differences schizophrenia.
include the size of the anatomical structure, cell counts and hemisphere
differences. 15 twins were used, only 1 was actually diagnosed with schizophrenia, they were given MRI scans.
LIMBIC SYSTEM Smaller bilateral hippocampus found in twin with schizophrenia as well as larger ventricles. This
Located in the sub cortex, it includes both he hippocampus and
suggests that when the genotype is controlled for, there is significantly diminished brain volume in
the twin with schizophrenia.
Jernigan et al showed that through post mortars schizophrenics have
significant cell loss in the limbic system.
There is also evidence of unusual cell connections in the hippocampus. However, it is difficult to establish whether the enlarged hippocampus as being the cause of effect of
Large bundle of fibres connecting the hemispheres.
Nasrallah et al showed that gender difference in the thickening of these
fibres in normal individuals are revised in people with schizophrenia
A disorder in the brain main occur in the third trimester of pregnancy,
seen with neural dendrites are organisation of synapses.
Both post mortem's and imagery studies have shown that the normal
Evaluation of the Neuroanatomical Explanation
asymmetry (of hemispheres) is much less evidence in patients with
Attempts to link the structural changes to particular symptoms has not yet shown consistent findings.
Lewis 1990 looked at 18 studies and could not find an association between enlarged ventricles and
BRAIN IMAGING STUDIES negative symptoms associated with schizophrenia.
Significant differences found in both the structure and function of the
schizophrenic brain. A variety of brains structures seem to be implicated in schizophrenia but as of yet, there is still not
Raz and Raz - META ANALYSIS, comparing ventricular volume in both enough research to sufficiently say that there is a causal link.
exp and contr... reported a significant increase in size in over half the It could actually be the schizophrenia that changes the structure of the brain, and not the other way
samples and an overall effect size of 0.6. round!!
Liddle 1996 - at rest schizophrenics show under activity inside tempera-
It is likely that there are environmental factors that contribute to the onset of schizophrenia, and it is
frontal areas of the cortex compared with controls without
schizophrenia. This has become known as hypofrontality. and is
perhaps more realistic to propose that biological factors contribute towards an individuals liability to
particularly evident in chronic patients. develop schizophrenia.…read more

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