DELUSIONS: Misinterpretation of sensory information - Persecution (paranoia) or Grandeur ('God-like' impossible powers)
HALLUCINATIONS: Seeing/hearing in the absence of reality - Visual, Auditory or Tactile (feeling something that isn't there)
DISORGANISED SPEECH: Frequent derailment (going off track) or 'word salads' (inability to filter things out/lack of sentencing)
DISORGANISED BEHAVIOUR (CATATONIA): Violating social norms or muscular rigidity
NEGATIVE SYMPTOMS: Things that stop due to illness - Loss of language abilities or affective flattening (no extremes of emotions)
SOCIAL/OCCUPATIONAL DYSFUNCTION: Breakdown of relationships/employment
DURATION: Not temporary state of mind (symptoms have to last for 1-6 months)
1. Medicalised- SZ termed as a "brain disorder" or "physical, biological disorder". Less of a stigma associated with SZ
2. Drug Treatment - Diagnosis is the only way to receive medical treatment for the illness
3. Increases awareness - Helps us to understand what triggers "psychotic episodes".
Issues with Classification/Diagnosis - RELIABILITY
RELIABILITY - The same person, presenting with the same symptoms, may get a diagnosis of SZ from one disorder but not from another.
There isn't one agreed system of classification: DSM (USA) and ICD (UK and Europe)
These two systems vary: DSM - Duration is 6 months with 5 different types. ICD - Duration is 1 month with 7 different types.
RESEARCH - Cooper et al: Of 200 consecutive admissions to psychiatric institutions: 163 were diagnosed with DSM. 85 were diagnosed with ICD.
American psychiatrists diagnosed at twice the rate of British psychiatrists.
Issues with Classification/Diagnosis - VALIDITY
VALIDITY: SZ is difficult to diagnose accurately. Often people go misdiagnosed or undiagnosed.
Symptoms are easily confused with other disorders, especially bipolar. Co-morbidity - SZ is masked by other psychiatric problems, such as substance misuse and depression. There is also no definitive test for SZ (such as X-Rays etc). Clinicians are largely dependent on a person's ability to describe their symptoms, which is difficult to do.
RESEARCH - Rosenhan:
Psychiatric units were unable to identify genuine patients from psychologists. 1 - Believed them all to be patients (ALL psychologists) 2 - believed 41 to be imposters, when they were ALL genuine patients.
It is very difficult to diagnose SZ accurately.
Issues with Classification/Diagnosis - LABELLING
LABELLING: Having a diagnosis of schizophrenia can do more harm than good (CASL)
- An unscientific label, as there is a lack of validity and reliability in the diagnosis of SZ
- Very damaging as it is poorly misunderstood. Danger, craziness, unpredictability is how SZ is viewed in the public eye.
- Diagnosis doesn't neccessarily lead to a successful treatment - does more harm than good
RESEARCH: Farina et al
Stereotypes associated with mental illness devalue all aspects of a person.
Biological explanation - Genes
- The more genetically similar you are to someone with SZ, the higher your risk of developing the disorder.
- Concordance rates: 1% 'normal' population, 16% one SZ parent, 48% identical twin with SZ.
- Adoption studies - Tienari et al: When raised away from SZ birth mother, 10.3% developed SZ, compared to 1.1% of control group.
- The search for one SZ gene has been unsuccessful.
- A complex interaction of genes with each other and the environment is responsible for SZ.
- Phenotypic plasticity - no guarantee of inheriting the disorder if you are vulnerable
Biological explanation - Dopamine
- Medication known as antipsychotic medication - acts as a 'dopamine antagonist'
- Blocks the activity of dopamine at D2 receptor sites.
- L-Dopa used to treat Parkinsons disease. The brain converts L-Dopa into dopamine, but if someone receives too much dopamine, it can create symptoms of SZ.
- Amphetamines can also trigger SZ symptoms in either those who were already diagnosed, making the disorder worse, or those who were previously unaffected.
- Post-mortem examinations found an increase in dopamine for those with SZ compared to control groups - Seeman found an increase of 60-110%
Biological explanation - Dopamine (problems)
1. TREATMENT AETIOLOGY FALLACY - Anti-psychotic drugs (dopamine antagonists) which block D2 receptors to slow the transmission of dopamine. That doesn't mean the cause has been found just because these drugs work.
2. Not everyone who uses drugs..... develops SZ. This is very socially sensitive for people with SZ who are linked to drug use (which may not be the case)
3.Direction of causality - symptoms of SZ may lead to excess dopamine and vice versa.
Biological explanation - AO2 Strengths
- If a genetic link to the disorder can be found, it makes it easier to test for the disorder. Eventually, we may be able to eliminate the faulty gene through genetic engineering
- Biological explanations can be supported and tested using empirical, scientific evidence. They enjoy more scientific credibility than some psychological explanations which may be harder to test.
Biological explanation - AO2 Weaknesses
- Reductionist - It fails to recognise that the environment has an influence. We know this from Tienari - Being raised away from a SZ birth parent can reduce risk of SZ from 16% to 10%
- Determinist - If there is a genetic link to the disorder then the cause is out of anyone's control. We are controlled by our genes/environment, not ourselves. We know that there are things that can be controlled (family dynamics) which may trigger or contribute to the disorder.
Psychological explanation - Cognitive
- Focuses on distorted thinking that underpins many of the positive symptoms for SZ
- Memory and perception breaks down, leaving what are usually familiar surroundings to appear frightening
- Inability to filter out irrelevant information, resulting in a catatonic state.
- Lack of self-monitoring, where a person's inner voice appears to be alienated. May be used to explain auditory hallucinations.
- Attributional bias affects the way we determine who or what was responsible for an event or action, explaining positive symptoms of delusions, particularly delusions of grandeur.
Evaluation of Cognitive
- Supported by empirical evidence which gives scientific credibility - Johns et al found when people with SZ were experiencing auditory hallucinations, the voices they hear are actually their own "inner voice", but they fail to recognise that it isn't an alien voice.
- Practical applications - CBT can be used to teach patients a change of perception and check for cognitive errors
- Can give SZ patients some feeling of control over their symptoms, unlike purely biological approaches which are highly determinist.
- Prevents those diagnosed from becoming "passive recipients of care" as CBT is a more positive aspect and treatment.
Evaluation of Cognitive (2)
- The cognitive approach is limited in it's ability to explain exactly why there is a breakdown in functioning in the brain. It is therefore best used in conjunction with biological explanations such as genes or the dopamine hypothesis, which do explain why there is a breakdown in functioning in the brain, suggesting a more holistic approach.
Psychological explanation - Socio-Cultural Factors
SOCIAL CAUSATION HYPOTHESIS:
- Holding down a job is difficult if you have schizophrenia, meaning many schizophrenics live in poverty.
- One third of all homeless people in the UK and USA are thought to have a serious mental illness, most commonly schizophrenia. Poverty causes stress which is a causal factor in SZ (AO1)
- It is more likely that the symptoms of SZ make it difficult for people to maintain jobs and relationships, and this causes unemployment and homelessness, not the other way around.
- It is possible that the stress of not having enough money (because of symptoms) could trigger relapse. (AO2)
- Direction of causality makes research findings invalid, impossible to be sure that the IV (poverty) is causing the DV (symptoms) and not the other way around. Impossible to test in highly controlled conditions. (AO2)
Psychological explanation - Schizophrenogenic Fami
SCHIZOPHRENOGENIC FAMILIES (HIGH EE)
- It is difficult not to be controlling if your offspring do not appear to be able to cope by themselves.
- Higher relapse rates when schizophrenogenic adolescents are placed back into a dysfunctional family with high levels of EE compared to those who go to a hostel. (AO1)
- Not all offspring in the same families are schizophrenic, yet they share parents. It is likely that the high EE is a result of having a schizophrenic offspring, not the cause of the SZ. (AO2)
- IV (high EE) causing the DV (symptoms) or the other way around? Impossible to test in highly controlled conditions. (AO2)
Psychological explanation - Double Bind Theory
DOUBLE BIND THEORY (BATESON)
- Schizophrenics find it hard to interpret mixed messages, hence parents who send mixed messages can make things worse or trigger relapses
- Parents' negativity and tendency to be 'mystifying' (contradictory, paradoxical) increasing the likelihood of 'problem boys' going on to develop SZ in later life. Bateson supported his Double Bind Theory in observations of families with a schizophrenic child. (AO1)
- Parents who were 'guilty' of being 'mystifying' tended to communicate 'normally' with other offspring who were not schizophrenic, questioning the direction of causality. (AO2)
- IV (being mystifying) causing the DV (symptoms) or the other way around? Impossible to test in highly controlled conditions. Bateson accused of experimenter bias. (AO2)
Evaluation of Socio-Cultural
- We can use these ideas about families with SZ and offer help and suport, to help them deal with the illness (family therapy)
- Recognise that poverty/homelessness are a problem for people for people living with SZ - help improve their quality of life by offering any support we can
- Socially sensitive - these ideas could have done more harm than good. The stigmas associated are very negative
- Direction of causality - in all three socio-cultural explanations, D of C is challenged
- Impossible to test with accurate scientific credibility (empirical evidence)
Biological Therapies - Drug Treatment
- Three types - Typical, Less Typical and Atypical
- Typical and Less Typical work as dopamine antagonists, meaning that the molecules of the drug are shaped specifically to the dopamine receptors.
- This reduces the transmission of this transmitter which is believed to be responsible for many SZ symptoms, particularly positive symptoms.
- Atypical drugs work in similar ways , however it aims to have an effect on serotonin as well as dopamine - having an effect on both positive and negative symptoms.
Evaluation of Drug Treatment
- Weiden et al: Relapse rates for those who take antipsychotic medication as prescribed estimated at 3.5%, compared to 11% for those who are non-compliant.
- Remington & Kapur: Atypical drugs are helpful in relieving negative symptoms as well as positive symptoms - as newer drugs are developed, symptoms of SZ are treated more efficiently.
- People living with a diagnosis of SZ can live in their own homes amongst their own family - Use of medication can help reduce stigma because it medicalises the disorder.
- However, side effects are as bad as the symptoms of the disorder. Eg. If the dosage isn't measured correctly, symptoms of other disorders such as Parkinsons disease and/or tardive dyskinesia can occur
- For those who wish to have more control, drug therapy should be combined with other therapies such as CBT or family therapy, where more help is provided and making treatment less deterministic.
Biological Therapies - Electro Convulsive Therapy
- The development of better medications has largely replaced the use of ECT.
- NICE state that ECT has no advantages over drug therapy and therefore no longer recommends ECT as an appropriate therapy for SZ.
- However, it is sometimes used as a last resort for patients.
- Modern ECT involves general anaesthetic to limit the risk of injury, although it still carries a high risk of memory loss and brain damage.
- Champatana - ECT is effective over a short period of time and some SZ patients reported improvement in quality of lives.
- Royal College of Psychiatry reports that whilst ECT does appear more effective than placebo ECT, many patients in the placebo conditon also recovered, making it difficult to establish how much is down to placebo effect.
Psychological Therapies - CBT
- Recommended by NICE for the treatment of SZ.
- Involves to challenge some of the distorted thinking which underpins some of the positive symptoms, particularly hallucinations and delusions, as well as negative symptoms such as depression.
- CBT is not a cure, but it can help the patient to take control of their thoughts eg. command auditory hallucinations (out-ranking)
- CBT can challenge the client to replace negative thinking with more helpful thoughts.
Evaluation of CBT
- Morrison et al: CBT did reduce symptoms and improved personal and social function. CBT had a moderate effect which was roughly similar to the effect size of antipsychotics. Best used alongside antipsychotic medication, but when patients were non-compliant or the medication failed, CBT was better than nothing.
- Turkington et al: They used CBT effectively in terms of insight improvement and reduction in overall symptoms and depression. CBT appeared to be very acceptable to patients, with an average of drop-out across studies of just 12-15%.
- However........some data is contradictory and may lack scientific credibility. Unlike drug trials, most CBT trials are not carried out under blind conditions - may lead to bias
- Sensky et al and Lewis et al: No significant advantage for CBT
- Tarrier et al: Non-significant difference in favour of CBT to treat delusions and hallucinations, and no difference for negative symptoms.
- When results from all research are pooled, the effect size is close to zero.
Evaluation of CBT
- The National Institute for Clinical Excellence (NICE) recommends that patients diagnosed with SZ should be offered antipsychotic medication and CBT. However, CBT are not alternatives to medicines.
- They are used more effectively in addition with medication.
- NICE recommends up to 16 CBT sessions - studies have found that on average, CBT reduces the chance of being admitted or re-admitted to hospital, can reduce symptom severity and can improve social functioning.
- Offers hope to those who are unresponsive to medication or who are non-compliant
- Gives the client some control over their symptoms.
- A problem - It requires a more rational thought. When people have lost touch with reality, they will not be able to receive CBT.
Psychological Therapies - Family Therapy
- When families of people with SZ are helped to understand the patient's disorder and relieve the feelings of guilt.
- Families with high EE are more vulnerable to relapse rates so are therefore more likely to benefit from family therapy.
- Helps to modify the way that they communicate to manage conflicts.
- Falloon et al: Significantly fewer relapses in the family therapy group compared to the control group
- Leff et al: Significantly fewer relapse rates for the family therapy group after nine months.
Evaluation of Family Therapy
- Whilst high EE is not the cause of the schizophrenia, teaching families strategies that will help them show less negative emotion towards their schizophrenic family member will reduce stress at home and lower risk of relapse
- Family therapy aims to help families with any guilt (feelings of blame) that they may have, and can also improve communication between all family members, not the just with the schizophrenic
- Family therapy alone will not be a successful treatment for SZ since family relationships are not the underlying cause.
- When it is done at home
- When it occurs in 'blocks'
- When families feel supported by family therapy not threatened.