Explanations for psychotic disorder - Schizophrenia

Aim: To assess the extent to which schizophrenic patients lack social skills and to propose that social skill training should be part of treatment.

Background: Schizophrenic patients often have difficulty with social skills such as meeting and greeting, making eye contact, making conversation and expressing feelings. There are two types of communication : instrumental which means communication with a goal such as buying something in a shop, and social-emotional communication, such as asking someone how they feel.

Sample: Lots of pieces of research and case studies which looked at patients with psychotic illnesses are reviewed in the article..

Method: This was a review article whcih analysed the social skills of psychotic patients in 3 categories: 1. Their topographical social skills, which includes verbal and non verbal elements of communication; 2. A functional view of their social skills, which is about using communication to achieve a goal such as returning a defective item of clothing; 3. An information processing view of their social skills, which includes the correct recognition of gestures and postures as expressions of thoughts and feelings. Methods of assessment were self-report, interview, role play tests, naturalistic interactions and tangible evidence of completion of a task such as a ticket stub or job application.

Results: On all measures schizophrenic patients had difficulty. Institutionalisation led to loss of skills and faulty cognition meant they misinterpreted others peoples meanings. A new finding was that they had difficulty with attention, perception and information processing. A lack of social skills led to a lack of positive reinforcement in their lives which in turn led to social withdrawal.

Evaluation: Schizophrenic patients found filling out self-reports confusing and role-plays lack external validity and are beset by demand characteristics. The naturalistic interactions which are staged with stooges are possibly unethical as they involve deception. This is fairly reductionist approach although many different forms of communication difficulty are examined. This is very useful research whic can be used to formulate training programmes for psychotic patients.

Aim: To review research on fmaily, twin and adoption studies to test for evidence of a genetic cause.

Background: A dispute has arisen between those who believed that schizophrenia was caused by environmental factors such as schizophrenic or abnormal parenting and those who believed there was a genetic cause. Twin and adoption studies begun in the late 1960's attempted to resolve the issue.

Sample: In total there were 711 participants in the adoption studies and 210 monozygotic twins and 317 dizygotic twin sets studied.

Method: A review article of three adoption and five twin studies between 1967 and 1976.

Procedure: Concordance rates (how often both twins were diagnosed with schizophrenia) and incidence of schizophrenia in parents and children in biological and adoptive families were calculated in the studies.

Results: All three adoption studies showed increased incidence of schizophrenia in adopted children with a schizophrenic biological parent, but normal children fostered with a schizophrenic parent did not develop schizophrenia. In one study, the biological siblings of children with schizophrenia were found to have a 19.2% chance of also developing the condition. The twin studies, also supported the biological expanation, with monozygotic twins showing a 58% concordance rate compared to 12% in dizygotic twins.

Evaluation: Both genes and environment are each necessary but not sufficient for developing schizophrenia. There were disagreements on the diagnosis of schizophrenia across the studies. No single gene for schizophrenia has been identified.

Nature/nurture is a clear debate here with the use of twin studies which off the possibility to test genes against the enviornment. Once again, the reliability of diagonisis could be an issue here,

The usefulness of the research is questionable. The research suggests potential genetic cures but a need to isolate many genes first and also to investigate environmental causes, as yet unspecified, although cannabis is one suspect at the moment.

Aim: To develop a model to explain why some schizophrenic patients experience the positve symptoms of delusions and hearing voices.

Background: Recent research has sought to explain the mechanisms of the formation of delusions in more detail. 

Explanation of the formation of delusions: The emergence of symptoms comes from an interaction between vulnerability from genes, biologicaal, psychological and social factors and stress. Therefore the formation of the delusion will begin with a precipitator such as a life-stress event or drug misues. This causes arousal which creates an inner-outer confusion causing a strange experience, e.g. thoughts being unexperienced as voices, actions being explained as unintended or more subtle cognitive experiences such as perceptual anomalies, which in turn drive a search for meaning. In the search for meaning, pre existing beliefs are drawn upon, so if a person already has a negative self-image or belief that the world is hostile then they will tend to form persecutory delusions. The explanations considered in the search for meaning will be infuenced by cognitive biases associated with psychosis including the 'jumping to conclusions' bias,which may limit the amount of data gathered by the patient to support a conclusion. Patients have to make a choice between something being wrong with them or that something is wrong with the world. Believing they are going mad is more distressing than believing that they are being persecuted and so a persecution belief is created.

Evaluation:

There is a lot of evidence that it is socially anxious individuals with low self-esteem who are more likely to develop psychosis. Research needs to be done on exploring the types of explanations that patients have for their experiences to provide further support for the model.

Nature/nurture interactions are very much a part of this model. Is this a state or trait explanation? The beliefs are maintained because they provide the relief of an explanation for the patients of his strange experiences so this can lead to a line of therapy where alternative meanings for the delusions can be explored with the patient.