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  • Created on: 08-04-21 11:33


  • Suffered by approximately 1% of the global population
  • Most commonly diagnosed between 18-35 years old
  • Prevalence is very similar for males and females, although males tend to be diagnosed at a younger age
  • African-Caribbean men are particuarly likely to be diagnosed in the Uk -> psychiatrists with different cultural, religious or social experiences to patients leads to mistakes in diagnosis - ethnocentric
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Positive Symptoms

= involve additional experiences beyond those of ordinary existence.

Hallucinations -> unusual sensory experiences. Some are related to events in the environment, others have no relationship. Can be experienced in relation to any sense.

Delusions -> irrational beliefs. Common involve being an important figure. Another concerns the body - sufferers may believe part of them is under external control. Some delusions can lead to aggression.

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Negative Symptoms

= involve loss of usual abilities and experiences.

Avolition -> can be described as finding it difficult to begin or keep up with goal-directed acitivity. Often have sharply reduced motivation. 3 identifying signs: poor hygeine, lack of persistence in work, lack of energy.

Speech poverty -> changes in patterns of speech. Emphasis on speech disorganisation - speech becomes incoherent or the speaker changes topic mid-sentence. Sometimes accompanied by a delay in the sufferers verbal responses during a conversation.

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  • The diagnostic and statistical manual, published by the American Psychiatric Association.
  • One positive symptom must be present for diagnosis.


  • The international classification of diseases, edition 10, published by the World Health Organisation.
  • Two or more negative symptoms are sufficient for diagnosis.
  • Recognises a range of subtypes of schizophrenia.

Both require a minimum of 1 month of symptoms persisting.

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Paranoid schizophrenia -> characterised by powerful delusions and hallucinations but relatively few other symptoms.

Hebephrenic schizophrenia -> involves mainly negative symptoms - great disorganisation of behaviour including delusions, hallucinations, incoherent speech and large mood swings.

Catatonic schizoprenia -> involves disturbance to movement, leaving the sufferer immobile or overactivie.

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Diagnosis Evaluation

Experiences issues with reliability -> Longnecker et al. (2010) reviewed prevalence studies and concluded that since the 1980s men have been diagnosed with schizphrenia more often than women. Cotton et al. (2009) found an explanation for this which stated that female patients typically function better than men, being more likely to work and have positive family relationships  -> this creates problems with reliability as genders are viewed and diagnosed differently due to biological differences abd stereotypes in society - gender bias.

Cultural bias -> Escobar (2012) claimed that psychiatrists (who are overwhelmingly white) may tend to over-interpret symptoms and distrust the honesty of black people during diagnosis -> this is a limitation for diagnosis as it shows how psychiatrists may hold racist views without relaising, which will result in them altering their behaviour around these people. Black people will be treated differenltly which could lead to a false diagnosis - cultural bias - the tools are not a fair method.

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Diagnosis Evaluation

Based on individual psychiatrist opinion -> Cheniaux et al. (2009) - 2 seperate psychiatrists diagnosed 100 pateints using the DSM & ICD. 1 psychiatrist diagnosed 26 with schizophrenia according to the DSM and 44 according to the ICD. The other diagnosed 13 with the DSM and 24 according to ICD -> this is a limitation of both the DSM & ICD as it shows how diagnosis is based partly on psychiatrists subjective opinion. This can lead to problems with diagnosis where some people can be wrongly diagnosed & others can be missed out.

Symptom overlap -> e.g. a diagnosis of bipolar disorder will feature positive symptoms (delusions) and negative symptoms (avolition) -> this is a limitation of both DSM & ICD as it shows that psychiatrists can become confised when making a diagnosis and mistake symptoms for something that it isn't. This can lead to people being wronly diagnosed, which can lead to the wrong treatments being given which is a risk to the patient's health. Therefore, it is important that psychiatrists are extensively trained on the symptoms of all mental health disorders so than the correct diagnosis can be given.

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Diagnosis Evaluation

Co-morbility (the occurance of 2 conditions together) -> Buckley et al. (2009) found that half of patients diagnosed with schizophrenia also have a diagnosis of depression (50%) and substance abuse (47%). PTSD occured in 29% of cases and OCD occured in 23% of cases -> this means that psychiatrists become confused when making a diagnosis as they will not know which condition suits the patient best.

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Biological Explanations


  • General population = 1%
  • Nieces/nephews = 4%
  • Parents = 6%
  • Uncles/aunts = 2%
  • Fraternal twins = 17%
  • Siblings = 9%
  • First cousins = 2%
  • Grandchildren = 5%
  • Identical twins = 48%
  • Children = 13%
  • Half-siblings = 6%

Tells us that schizophrenia has a genetic basis HOWEVER identica twins still don't have 100% of a chance even though they share 100% of genes - environment plays an important role.

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Candidate Genes

  • Schizophrenia appears to be polygenic
  • Different combinations of factors can lead to schizophrenia - aetiologically heterogenous
  • RIPKE ET AL (2014) - conducted a meta-analysis using gerome-wide studies of schizophrenia
  • N = 37,000 (sz), N = 113,000 (controls)
  • 108 seperate genetic variations associated with increased sz risk
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Neural Correlates

Prefrontal cortex -> helps people think logically and organise their thoughts -> many schizophrenics have lower activity in this area, which could be linked to delusions and disorganised thoughts.

Visual cortex & auditory cortex -> process information from the eyes and the ears -> schizophrenics have the same activity in these areas when they hallucinate as some people do when they have genuine visual and auditory experiences.

Basal ganglia -> located deep inside the brain and affects movement and thinking skills -> research has shown that this structure is longer in schizophrenics, which could cause motor dysfunction.

Amygdala -> responsible for basic feelings such as fear, lust and hunger -> smaller in schizophrenics so can link to loss of emotion (affective flattening).

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Neural Correlates

Dopamine -> responsible for feelings of pleasure and also affects thinking and movement -> low levels in certain brain areas are linked to negative symptoms as these are linked to a loss of pleasure. High levels are linked to positive symptoms.

Broca's area -> responsible for speech production -> may be associated with poverty of speech and/or the experience of auditory hallucinations.

Cingulate gyrus -> helps regulate emotions and pain - involved in predicting and avoiding negative consequences -> smaller grey matter volumes - underline presence of negative symptoms.

Temporal gyrus -> responsible for processing sounds -> resported to be smaller in patients with schizophrenia - correlates negatively with severity of hallucinations and thought disorder.

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The Dopamine Hypothesis

States that schizophrenia is caused by abnormal dopamine transmission in the brain. Later versions of the hypothesis state that schizophrenic symptoms can be caused not only by too much dopamine activity in certain brain areas, but also by too little in other parts.


  • Research has shown that drugs that increase levels of dopamiine produce psychotic symptoms -> this is a strength as it shows how high levels of dopamine are associated with schizophrenia.
  • Clozapine is the most effective drug at reducing schizophrenic symptoms. It acts on serotonin as well as dopamine -> this is a limitation as it shows that the most effective method is to use a combination of drugs, not just dopamine, therefore it is a limited explanation.
  • High levels of dopamine could actually be a symptom of schizophrenia, not a cause -> problems with causal conclusions.
  • An excess number of dopamine receptors have been found in Broca's area, which is linked to speech production and auditory hallucinations -> this is a strength as it could be an explanation for the speech poverty that is linked to schizophrenia.
  • Antipsychotic drugs that reduce schizophrenia do so by blocking this neurotransmitter -> this is a strength as it shows that it is high levels of dopmaine that cause schizophrenia.
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Biological Explanations Evaluation

The environment also plays an important role in your risk of developing schizophrenia -> monozygotic twins share 100% of genes but concordance rates for schizophrenia are around 50% -> if the disorder was caused purely by genetic factors then this percentage should be 100%, as it is not this indicates that genes and biology are only partly responsible. This means that the biological explanation of schizophrenia is a limited explanation.

There are multiple sources of evidence for genetic susceptibility -> adoption studies such as that by Pekka Tienari et al. (2004) clearly show that children of schizophrenia sufferers are still at a heightened risk of schizophrenia if adopted into families with no history of schizophrenia -> this is a strength of the explanation as there is evidence for the idea that genetic factors make people much more vulnerable to developing schizophrenia than other - adds credibility.

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Biological Explanations Evaluation

Schizophrenia can take place in the absence of family history of the disorder -> mutation in parental DNA - can be caused by radiation, poison or viral infection. Evidence for the role of mutation comes from a study showing a correlation between parentak age and risk of schizophrenia, increasing from around 0.7% with fathers under 25 to over 2% in father over 50 (Brown et al. 2002) -> This suggests a biological cause of schizophrenia - adds credibility.

The correlation-causation problem -> There are a nuumver of neural correlates of schizophrenia symptoms. For example, the correlation between levels of activity in the ventral striatum and negative symptoms of schizophrenia. It may be possible that something wrong in the striatum is causing negative symptoms, however it could be possible that another factor influences both the negative symptoms and the ventral striatum activity -> Therefore, the existence of neural correlates in schizophrenia tells us rekatively little in itself. This is because correlations do not tell us a cause.

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Biological Therapies


Typical antipsychotics -> the first generation of antipsychotic drugs, having been used since the 1950s. They work as dopamine antagonists and include chlorpomazine.

Atypical antipsychotics -> developed after typical antipsychotics. They typically target a range of neurotransmitters such as dopamine and seratonin. Examples include clozapine and risperidone.

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Can be taken as tablets, syrups or by injection. If taken orally it is administered daily up to a maximum of 1000mg - intial doses are much smaller.


Work by acting as antagonsist in the dopamine system (chemicals which reduce the action of a neurotransmitter). Dopamine antagnists work by blocking dopamine receptors in the brain. Initially dopamine levels build up, but its production is reduced - reduces symptoms such as hallucinations. It is also an effective sedative.


Dizziness, blank facial expression, restlessness, uncontrolled movements of any part of the body, difficulty falling asleep or staying awake, increased appetite, weight gain, changes in skin colour.


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Not available as an injection. Daily dosage is lower than chlorpomazine, typically 300 to 450mg a day.


To be used when other treatments fail. Binds to dopamine receptors, but in addition acts on serotonin and glutamate receptors. It is believed that this helps improve mood and reduce depression and anxiety - may improve cognitive functioning. It is sometimes prescribed when a patient is considered at high risk for suicide.


Potentially fatal side effect of agranulocytosis - a blood condition. Also minor possible side effest of drowsiness, diziness, increased salivation, dry mouth, restlessness, headache.

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Can be taken in the form of tablets, syrup or an injection that lasts for around 2 weeks. Small dose is initially given - built up to a typical dose of 4-8mg and a maximum of 12mg.


Believed to bind to dopamine and serotonin recptors. Binds more strongly to dopamine receptors - effectove in much smaller doses than most antipsychotics.


Some evidence to suggest it leads to fewer side effects than is typical for antipsychotics. Can also cause minor side effects such as nausea, vomiting, diarrhea, constipation, heartburn, increased appetite, weight gain, stomach pain, anxiety, agitation, dreaming more than usual, etc.

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Biological Therapies Evaluation

  • All have side effects, some very bad - seen as worse than the symptoms they're meant to treat.
  • Possibly outdated - used since the 1950s.
  • Was discovered by accident - was not created for the purpose it is used for.
  • Expesnive.
  • Assume that psychosis is primarily a biological brain problem - limited explanation.
  • Dropout rates are high - may patients stop taking them so not useful long-term.
  • They don't work for everyone - individual differences.
  • 50% of those who do agree to take them end up either taking them haphazardly or not at all.
  • Argued that other treatments, such as CBT, are much safer and just as good.

There is confusion over how dopamine plays a role in schizophrenia -> orginally believed that schizophrenia involved high levels of dopamine in the brain. More recent research has revealed that schizophrenia could be due to low levels of dopamine in some parts of the brain, known as hypodopamingeria. Antipsychotics work by stopping the production of dopamine, but if a patient is experiencing low levels, this will actually make the symptoms worse -> This is a limitatiom as it means that there is a lot of confusion over the true cause, and therefore it will be too difficult to prescribe antipsychotics.

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Psychological Explanations


  • Double-bind theory
  • Expressed emotions
  • Schizophrenogenic mother


  • Metarepresentation
  • Central control
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Double-Bind Theory

Bateson et al. (1972) agreed that family climate is important in the development of schizophrenia, but emphasised the role of communication style within a family. 

The developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but recieve mixed messages about what this is, and feel unable to comment on the unfairness of this situation or seek clarification. When they 'get it wrong' (which is often) the child is punished by withdrawal of love.

This leaves them with an understanding of the world as confusing and dangerous, and this is reflected in the symptoms like disorganised thinking and paranoid delusions.

Bateson was clear in stating that this was a risk factor to schizophrenia, not the main factor.

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The Schizophrenogenic Mother

Fromm-Reichmann (1948) proposed a psychodynamic explanation for schizophrenia based on the accounts she heard from her patients about their childhoods. 

She noted that many of her patients spoke of a particular type of parent, which she called the schizophrenogenic mother (literally means 'schizophrenia causing).

According to Fromm-Reichman the schizophrenic mother is cold, rejecting and controlling and tends to create a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions (i.e. the belief that one is being persecuted by another person) and ultimately, schizophrenia.

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Expressed Emotion

EE relates to a negative emotional climate that is characterised by a family communication style of criticism, hostility and emotional over-involvement. Criticism relates to negative comments said between family members; hostility relates to any aggressive behaviour, whilst emotional involvement involves things such as over-protective parenting where parents spend too much time interfering in the affairs of other family members. These family members can also come over as overly moralistic (i.e. having a very strong sense of right and wrong).

High levels of EE are more likely to influence relapse rates of recovering schizophrenics who return to their families after treatment.

It is the high stress levels that this EE creates that trigger a schizophrenic episode.

These families also feature things such as secret alliances between members, which encourage paranoid symptoms such as delusions of persecution.

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Expressed Emotion

CRITICISM (negative comments)

Can't you do anything right?, Why do you always do things wrong?, You are the reason we are all so unhappy, You are the worst daughter in the world, I wish you had never been born.

HOSTILITY (aggressive comments such as threats)

If you do that again I will shout at you, Don't make me do something I may regret, If you look at me like that again I will never speak to you, This is going to end in tears.

EMOTIONAL OVER-INVOLVEMENTS (behaviour that involves interfering in other family members' affairs)

You can always come to me if you need to talk about your personal life, What did your father say about me when he was upset last night?, A parent going through their child's mobile phone, A parent logging into their child's email account, Why are you and your boyfriend having problems?

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Cognitive Explanations

Metarepresentation -> the cognitive ability to reflect on thoughts & behaviour. This allows us insight into our own intentions & goals, also allows us to interpret the actions of others. Dysfunction in metarepresentation would disrupt our ability to recognise our own actions & thoughts as being carried out by ourselves, rather than someone else. This would explain hallucinations of voices & delusions like thought insertion (the experience of having thoughts projected into the mind by others).

Central Control -> the cognitive ability to supress automatic responses while we perform deliberate actions instead. Disorganised speech and thought disorder could result from the inability to supress automatic thoughts & speech triggered by other thoughts. For example, sufferers with schizophrenia tend to experience derailment of thoughts & spoken sentences because each word triggers associations, and the patient cannot supress automatic responses to these.

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Psychological Explanations Evaluation

The cognitive explanation has supporting evidence -> Myer-Linderberg found reduced activity in the prefrontal cortex of schizophrenics as they did a task involving working memory -> This is a strength for the cognitive explanation as it shows the disruption of information processing when completing a task. This adds credibility to the pschological explanations.

Problems with causality for the cognitive explanation -> An issue is that dysfunctional thinking could be a consequence of schizophrenia rather than a cause -> This is a weakness as it means that the cognitive explanation is limited and unreliable as you do not know the true causes - reduces credibility. It means that the research cannot be replicated either which decreases reliability.

Problems with family dysfunction and causality -> Has been found that high expressed emotion amongst families could be a symptom rather than a cause -> This is a limitation as it creates confusion over the true causes of these symptoms - limited explanation which therefore reduces scientific credibility of the explanation.

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Psychological Explanations Evaluation

Assumptions of family dysfunction can be seen as unethical -> E.g. implies that parents are responsible for the problems of their children which places parents under a lot of emotional and psychological pressure -> Limitation as it is unethical to place so much pressure of a mother - will end up creating more issues for the mother's own mental health - has an impact on the development of schizophrenia as a mother may become too anxious around her child so may begin to retreat. The mother could also be too scared to get her child tested, which leads to many sufferers being unknown.

Research collection can be seen as unreliable -> E.g. info about childhood experiences was gathered after the development of symptoms and a formal diagnosis -> This is a limitation as it can be seen as unreliable as the info could have been exaggerated to try and prove that the theory was true. Also, the patient could have got confused when giving a recall and delusions could have had an impact on the accuracy of this recall - this method is unreliable.

Family dysfunction has supporting research -> Berger (1965) found that schizophrenics reported a higher recall of double blind statements by their mothers that non-schizophrenics -> Supports the conclusions made about the schizophrenogenic mother - theory has increased scientific credibilty and real-life application.

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Psychological Treatments


-> family therapy


-> cognitive behavioural therapy (CBT)


-> token economies

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Family Therapy

Most focused on reducing the stress within a family of a schizophrenia sufferer as minimising stress helps prevent relapse - proritises reducing levels of expressed emotion.

PHAROAH ET AL (2010) identified strategies a therapist would use to improve the functioning of a family:

  • Form a theraputic alliance with all family members
  • Improve the ability of the family to anticipate and solve problems
  • Reduce anger and guilt in family members
  • Help achieve a balance between caring for sufferer & maintaining their own lives
  • Challenge negative stereotypes about the disorder

This leads to reduced relapse and re-admission to hospital as patient is more likely to comply with medication.

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CBT - Traditional Approach

  • Can take anywhere from 5-20 sessions, group or individual based.
  • The steps involved: identify irrational thoughts, discuss/argue whether these are likely to be true & homework tasks gather evidence to challenge irrational thoughts.


  • Schizophrenia sufferers naturally develop their own coping strategies by identifying triggers
  • E.g. certain people (parents), being on their own, being put under stress
  • Typical coping stratgeies fit into 2 categories:
  • Behavioural -> relaxation, breathing techniques, music, doing something that distracts you, seeing more people or removing yourself from social situations
  • Cognitive -> positive self talk (reminding yourself it is not real), reasoning with themselves, focusing on something else, goal setting
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Token Economies

  • A reward system based on operant conditioning
  • Modifying bad habits developed in hospital improves a patient's quality of life and coping capabilities when discharged
  • Bad habits could include: relying on the institution, self-harm, fear of doctors
  • Patients receive a token immediately after demonstrating a desirable behaviour
  • Tokens are secondary reinforcers - they only have value once a patient learns that they can be traded for bigger rewards
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Psychological Treatments Evaluation

Meta-analysis in CBT can fail to consider sources of bias - leff effective -> Jauhar et al. (2014) conducted a systematic review & meta-analysis of the effectiveness of CBT for schizophrenia symptoms. Overall, CBT has a theraputic effect in schizophrenia sysptoms in the 'small' range. This reduces even further when bias is controlled -> Suggests that bias in CBT can be problematic, but when it is controlled it is a more effective treatment. Meta-analysis is a limitation as it increases the chance of more bias taking place.

Support for effectiveness of CBT -> Chadwick (1992) worked with a schizophrenic who had the delusion that he could influence the future. However, he failed to predict what would happen in 50 video clips shown to him which helped provide him with evidence to show that his delusional beliefs were false -> This is a strength of CBT as it shows how the treatment methods can be effective in reducing symptoms, allowing clarification between delusions and reality. Therefore, the patient is able to improve their own condition.

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Psychological Treatments Evaluation

Family dysfunction is proven to be an effective treatment -> Pharoah et al. (2010) conducted a systematic review from a random selection of studies that primarily focused on families of people with schizophrenia of schizoaffective disorder. It was found that family intervention could reduce the number of relapse events and the number of hospitalisations -> This is a strength for family dysfunction as there is evidence to suggest that it is effective in improving a schizophrenics condition.

Token economy is not very effective in improving symptoms -> Baker et al. (1997) conducted an 18-month controlled experiment into the effects of a token economy programme on the ward behaviour and symptoms of schronic schizophrenia patients. An experimental group received tokens dependent on appropriate behaviour, while a matched control group received tokens that were not dependent on their behaviour. It was found that over 12 months the experimental group improved no more than the control group -> This is a limitation of token economies as it suggests that other factors were more responsible for the main changes in patients - not effective as a treatment.

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Psychological Treatments Evaluation

Some experience ethical issues -> Token economies have proved controversial - major issue is that privileges become more available to patients with mild symptoms and less so for those with more severe symptoms that prevent them from complying with desirable behaviours. This means that the most severly ill patients suffer discrimination -> This is a weakness of the psychological treatments - has led to the reduce use of token economies in the psychiatric system as it is seen as unfair and unreliable.

Treatments improve quality of life but do not cure -> All psychological treatments aim to make schizophrenia more manageable and improve patient's quality of life. These treatments are all worth doing but should not be confused with curing schizophrenia -> This failure to cure is a weakness - the treatment could just be 'pushing back' the smptoms and making them less noticeable in the short-term, but there is still a risk of the symtoms reocurring.

There are alternative treatments -> NICE reccommends art therapy. Ruddy & Milnes (2005) stated that in addition to medication, creative therapies may be helpful. Art therapy allows exploration of the patient's inner world in a non-threatening  way -> This is a strenght of psychological treatments as it shows how they are constantly being updated and looked into - new treatments have positive results.

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Interactionist Approach


Diathesis = vulnerability

Stress = a negative psychological experience

The model says that both a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the condition.

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Meehl's Model (1962)

  • Diathesis (vulnerability) was entirely genetic - the result of a single 'schizogene'
  • Led to the development of a biologically schizotypic personality - one characteristic of which is sensitivity to stress
  • If the person does not have the schizogene then no amount of stress would lead to schizophrenia
  • However, in carriers of the gene chronic stress through childhood & adolescence (particuarly the schizophrenogenic mother) could result in the development of the contition
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Modern Diathesis-Stress

  • It is now clear that many genes appear to increase genetic vulnerability slightly - there is no single 'schizogene'
  • Include a range of factors beyond the genetic (including psychological trauma) - trauma becomes the diathesis rather than the stressor 
  • Read et al (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain
  • Early and severe enough trauma (such as child abuse) can seriously affect many aspects of brain development - e.g. HPA system can become over-active making the person more vulnerable to later stress
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Impact On Understanding

In the original model stress was seen as psychological in nature - in particular relating to parenting. This may still be important, but a modern definition of stress includes anything that risks triggering schizophrenia.

E.G. Cannabis - recent research has showed a relation as cannabis as a stressor because it increases the risk of schizophrenia up to 7x. But most people do not develop schizophrenia after smoking cannabis so there must also be 1 or more vulnerability factors.

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Interactionist Treatment

Compatiable with both biological and psychological treatments - the model is associated with combining antipsychotic medication and psychological therapies - most commonly CBT.

In Britain it is increasingly standard practice to treat patients with this combination - it is unusual to treat schizophrenia using psychological therapies alone.

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Interactionist Evaluation

Evidence for the role of vulnerability and triggers -> Tienari et al. (2004) - children adopted from 19,000 Finnish mothers with schizophrenia between 1960 & 1979 were followed up. Their adopted parents were assessed for child-rearing style, and the rates of schizophrenia were compared to those in a control group of adoptees without any gentic risk. Child-rearing style characterised by high levels of criticism & conflict and low levels of empathy was implicated in the development of schizophrenia, but only for th children with high genetic risk. Suggests that both genetic vulnerability and family realted stress are important - genetically vulnerable children are more sensitive to parenting behaviour -> This is very strog support for the importance of adopting an interactionist approach.

The original diathesis-stress model is over-simple -> The classic model of a single schizogene and schizophrenic parenting style as the major source of stress is now over-simple. Multiple genes increase vulnerability and stress can come in many forms - not one single source. It is now believed that vulnerability can be the result of early trauma as well as genetic make-up and stress can be biological -> This is a problem for the old idea of diathesis-stress but not for newer models.

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Interactionist Evaluation

Support for the effectiveness of combinations of treatments -> Turkington et al. (2006) points out that it is not really possible to use combination treatments without adopting an interactionist approach. Tarrier et al. (2004) - 315 patients were randomly allocated to a mdeication + CBT group, medication + supportive counselling or a control group. Patients in the 2 combination groups showed lower symptom levels, although there was no difference in rates of hospital readmission -> Studies like this show a clear practical advantage to adopting an interactionists approach in the form of superior treatment outcomes, and therefore highlight the importance of this approach.

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