Schizophrenia

Type 1: more positive symptoms (responds better to treatment)

Type 2: more negative symptoms (responds less to treatment)

Positive symptoms:

• Hallucinations- preceptual disturbances
• Delusions (grandure, paranoia)- cognitive symptoms 

Negative symptoms:

• Avolitions (lack of personal care)
• Speech poverty (echolalia)
• psychomotor disturbances (no contro of muscles)

Test-retest reliability: on seperate visits diagnosis is the same 

Inter-rater reliability: diagnosis i sthe same for 2 different clinicians 

Causes of Unreliability in diagnosis:

• Client/ Patient factors: may not be able to talk about mental state, relative on behalf may want diagnosis to over-emphasise, atypical symptoms may make it difficult
• Clinician factors: how well they were trained, what approach they follow etc
• Classification factors: differences between DSM-V and ICD. Billing in DSM may lead to bias in dignosis 

+ clients get correct treatment 

+ using a classification system, diagnosis is more refined 

- getting the worng psychiatric label can be deeply damaging 

Predictive validity: correctly predicting the prognosis 

Descripitive validity: symptoms are differentiated from other illnesses

Aestiolpgical validity: all people w an illness experiencing it the same way 

*Rosenhan: put people in a hospital claimign to hear voices, but act normally. Released between 1-52 dyas as SZ in remission 

- unethical as staff were desieved

*Sugarman: Afro-Carabean siblings/ next generation sibligs where between 8 and 15 times more lkely to be diagnsoed w SZ than white siblings.

+ in many culturees its normal to claim to hear voices or even disirable 

- doesnt explain why black people are more liekly to be diagnosed. Sugessted it has to do w immigrants catching flu in pregnancy which can increse SZ chance by a quarter.

*Castle: such drastic differences between men and women could sugest 2 different disorders, women experince effective psychosis not SZ.

• Female: less severe, late onset, depressive, good prognosis 
• Male: severe, early onset, negative symptoms, chronic 

Research evidence:

Incidence: Castle- males made up twice as much of the SZ population

Age of onset: clear differences in age of onset

Hormones: female onset in late 50s (linked to menopause) 

- differnces have been ignores (beta bias) 

General pop. risk: 1%

Relatuve w SZ risk: 6-17%

*Gottesman and Shields: twin study

• MZ: 58%
• DZ: 12%

Varma and Sharma: 34% in first degree relatives 

SZ working group: identifies 128 genetic variations that contribute to SZ

- would be 100% if it was genetic

- cannot be certain is not contributing in twin studies 

Too much DP leads to onset of SZ.

Drugs that block DP receptor sites are effective in treating SZ. 

*Davis: high DP not in all SZ petients. Clazapine (dosnt block DP) is effective in treating SZ

- over simplistic and non-inclusive 

- ignores role of environment 

+ possibel to idirectly measure DP levels thru scanning

+ DP hypothesis has generted lots if reasearch and driven drug treatmets 

Grey matter: grey matter deteriorates t leave vesivles in the brain of mush 

Amygdala Differences: Li- bilateral amygdala is less active in SZ patients 

- not all patenients show these differences 

- bio deterministic

+ Ho: by rescannign patients, brain differences increase over time 

Batesons double bind: contradictiry actions and words 

• high levels of interpersonal conflic
• difficulty communicating 
• controlling of children

Stress is harmful as it realeses cortisol (activates fight or flight). Long term stress can lead to incresed chances of SZ

*Patino: large sample of children. Found family disfunction when family problems such as child abuse and overprotection were reported

*Tienari: high SZ risk adoptees living in either dysfunctional or normal families. 35% SZ in dysfunctinal compared 5%normal

- doesnt explain why some children in dsyfunctinal families dont  develope SZ

+ family therapy has been shown to be effective in achieveing more positive long term outcomes for patients, supporting theory

Maladaptive thoughts cause SZ. INdividuals cannot process information so are mispercieved as voices. 

Hallucinations created: by mispercieving thoughts as being inserted in the head by someone else

Delusions created: by an 'alien control system

Negative symptoms comes from overwhelimg emotional dsitress, so individuals 'flatten' to deal w suprluss

Typical

• Strong
• Sedative
• 1st gen
• Slows dopamine
• Block D2 receptors
• Reduce excitation
• Reduce +ve symptoms
• Erectile dysfunction
• Weight gain
• Haldol
• Clorporzine

• Weak
• Non-sedative
• 2nd gen
• Acts on dopamine as well as seretonin
• Effects -ve symptoms
• Clozapine
• Olanzapine

Applies Ellis' ABC model to identofy faulty cognitions, goal setting and normalising their psychological experineces, then developing alternatuve assumptions. 

*Sensky: compared CBT to non-specific befreinding methods. Found same level of immidiate improvemnt, but in follow up, CBT maintained their improvemtn while non-specific had lost some benefits 

+ works well in combo w drug therapies 

+ requires skilled therapist who is experenced w working w SZ patients 

- no suitable for all patients (e.g. extremely aggitated patient)