Schizophrenia is a severe mental disorder characterised by a deep disruption of cognition and emotion.
- This affects a person's language, thought, perception and even their sense of self. The schizophrenic tends to believe things that cannot be true - Delusions - and/or hears voices or sees visions when there is no present stimuli to create them - Hallucinations.
- Contrary to popular beliefs, schizophrenic people do not have 'split personalities', neither are they constantly incoherent or constantly displaying psychotic symptoms.
- However, displaying one of the characteristics (symptoms) of schizophrenia could be enough to land a person with a diagnosis for life.
Clinical Characteristics of Schizophrenia:
+ Symptoms - An excess of normal function
- Experiences of control - Person believes they are under control of some paranormal force
- Disordered thinking
- Symptoms - A loss of normal function
- Affective flattening - Reduction in range + intensity of emotion
- Alogia - Reduction in range of volcabulary
- Avolition - Inability to persist in goal-directed behaviour
Biological Explanation of Schizophrenia:
Family studies - Are biological relatives more similarly affected than non-biological = More common among biological. Closer the genetic material = greater the risk of developing.
Twin Studies - Contributions of genetic material vs. environmental = Monozygotic concordance rate higher than dizygotic = Supports genetic position.
Adoption studies - Genetically related individuals raised apart = Genetic role confirmed.
Dopamine Hypothesis: (Symptoms of S are caused by excess of dopamine in the brain)
For some schizophrenics too much of the neurotransmitter dopamine is present. May account for some symptoms (Eg. Hallucinations + strange motor movements) - as dopamine circuit is involved in perception + motor control + limbic system = Emotion changes. ...Amphetamines, Antipsychotic drugs + Parkinson's disease can all lead to dopamine overload = Schizophrenic symptoms.
(Think of D2 receptors as Bowls filling up with dopamine, sometimes schizophrenics have too many bowls = Too much dopamine being taken in = Symptoms)
Evaluation of Biological Explanations:
Family studies - Schizophrenia appears to run in families. However could be due to environmental/common rearing factors rather than heredity.
Twin studies - MZs treated more similarly than DZs - reflecting environmental differences.
Adoption studies - ??
Excess dopamine could be a result of having schizphrenia as opposed to the cause.
Studies have shown that this hypothesis also only applies to a certain sub-group of schizophrenics - suggesting that not all ** produce excess dopamine.
This reinforces the idea that schizophrenics are not all suffering from the same disorder.
Psychological Explanations of Schizophrenia:
Psychodynamic - World of S been harsh = Regress to early stage before ego + realistic view of world developed. Infantile state - Symptoms are attempts to control ego.
Cognitive - Acknowledges biology but features of disorder develop as S begins to experience symptoms - Friends not confirming reality of them = S rejects feedback = Delusional beliefs.
Life events - Major stress factor associated with episodes = Stressful life events. Eg. Death
Family relationships - 1. Double-bind theory - Conflicted messages = Confusion + misinterpreting. Eg. Mother says love while turning head in disgust. 2. Expressed emotion = - emotional climate = Impaired coping mechanisms
Labelling theory - Social groups make rules for members - Symptoms are deviant from rules = Label of schizophrenia applied. Label becomes self-fulfilling prophecy = other symptoms. (If called schizophrenic, treated as + then acts like)
Evaluation of Psychological Theories:
Psychodynamic explanations - No support except for other psychoanalysists claiming, like him, that disordered family patterns can cause S. Eg. Schizophrenogenic mothers.
Cognitive explanations - Much evidence of physical nature for cognitive deficits linked.
Life events - Not all evidence supports + evidence that does suggest link could be only correlational. Eg. Beginnings of disorder = Cause of major life event.
Family relationships - Importance supported. 1 - Some evidence only. 2 - Much more universal support. However, not sure if EE is cause or effect of S. Either way has led to effective form of therapy where high-EE relatives are shown how to reduce levels of EE. EE + culture = Much less common in families outside West - Less individualist - Less responsibility - Less likely to blame S for their actions.
Labelling theory - Lots of evidence support.
Diathesis Stress Model - Likely that only predisposed ** are affected by these factors.
Biological Therapies for Schizophrenia + Evaluatio
Biological Therapies for Schizophrenia + Evaluatio
Idea very new in early 20th century - followed reports that S was rare in epileptic people + seizures reduced S symptoms. First studies - Disappointing + low recovery rates.
What Happens in ECT?
Unconscious in procedure, given nerve-blocking agent to paralyse muscles against shock + prevent breakages. Small amount of electric current passes through brain for 1/2 second via 2 scalp electrodes - Seizure lasts for minute, affects entire brain. Requires 3-15 treatments.
Effectiveness of ECT:
Reveiw - ECT produced results no different or worse than antispychotic drugs. However, Indian study showed no symptom reduction in either ECT or simulated ECT - Ineffective?
Appropriateness of ECT:
Significant brain risks associated - Use of treatment has declined significantly in UK.
Psychological Therapies for Schizophrenia: CBT:
Cognitive-Behavioural Therapy (CBT):
- Basic assumption - Patients have distorted beliefs which influence their behaviour in maladaptive ways. Delusions thought to result from faulty interpretations of events. CBT goal = Help the patient identify + correct these.
- In CBT - Patients encouraged to trace back origins of symptoms to get better idea of how they might have developed. Encouraged to evaluate content of delusions + consider ways in which they might test validity of faulty beliefs. Might also be set behavioural assignments with aim of improving level of function.
- During CBT therapist lets patient develop own alternatives to previous maladaptive beliefs - Ideally by looking for the techniques already present in patient's mind.
- Outcome studies - Suggest patients who recieve CBT experience fewer hallucinations + delusions + recover functioning to greater extent than those who recieve drugs alone.
- Reduction of + symptoms + 25-50% recovery rate for patients given combination of CBT + antipsychotic drugs.
- Follow up - Confirmed above advantages + noted there were also lower patient drop- out rates + greater patient satisfaction rates when CBT was used in conjunction with antipsychotic medication.
Biological Therapies for Schizophrenia: Psychoanal
Psychodynamic Therapy: Psychoanalysis:
- Assumes that all symptoms are meaningful + a product of life history of patient.
- Based on assumption that individuals are often unaware of influence of unconscious conflicts on current psychological state.
- Aim - Bring into awareness conflicts where they can be dealt with.
- Therapist attempts to create alliance with patient by offering real help for percieved problem of patient.
- Freud believed schizophrenics could not be analysed because they could not form a transference with their analyst.
- However, other forms of psychodynamic therapy have been found successful in treating schizophrenia.
- These have in common with Freud's psychoanlysis - First task of any psychodynamic therapy is to win trust of of patient + to build relationship with them.
- Therapist achieves this by replacing the harsh + punishing conscience (often based on parents) with one that is less destructive + more supportive.
- As patient gets healthier they take more active role -and therefore therapist takes less active role- in own recovery.
Evaluation of Psychological Therapies:
CBT & Psychodynamic Therapy: