Schizophrenia Researchers

DIAGNOSIS AND CLASSIFICATION

Reliability & Gender Bias

-> reviewed prevalence studies and concluded that since the 1980s men have been diagnosed with schizophrenia more often than women.

DIAGNOSIS & CLASSIFICATION

Reliability & Gender Bias

-> found an explanation which stated that female patients typically function better than men, being more likely to work and have positive family relationships.

DIAGNOSIS & CLASSIFICATION

Cultural Bias

-> claimed that psychiatrists (who are overwhelmingly white) may tend to over-interpret symptoms and distrust the honesty of black people during diagnosis.

DIAGNOSIS & CLASSIFICATION

Individual Differences

-> 2 seperate psychiatrists diagnosed 100 patients using the DSM & ICD. 1 psychiatrist diagnosed 26 with schizophrenia according to the DSM & 44 according to the ICD. The other diagnosed 13 with the DSM & 24 according to ICD.

DIAGNOSIS & CLASSIFICATION

Co-Morbility

-> 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 - leads to confusion when making a diagnosis.

BIOLOGICAL EXPLANATIONS

The risk of developing schizophrenia based on your relation to the sufferer

• 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%

-> schizophrenia has a genetic bases HOWEVER identical twisn still don't have 100% concordance even though they share 100% genes - environment must play an important role.

BIOLOGICAL EXPLANATIONS

Candidate Genes

-> conducted a meta-analysis using germone-wide studies of schizophrenia. N = 37,000 (sz), N = 113,000 (controls). 108 seperate genetic variations associated with increased sz risk.

BIOLOGICAL EXPLANATIONS

Genetic Susceptibility

-> clearly show that children of schizophrenia sufferers are still at a heightened risk of schizophrenia if adopted into families with no history of schizophrenia.

BIOLOGICAL EXPLANATIONS

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 - study showing correlation between parental age and risk of schizophrenia, increasing from around 0.7% with fathers under 25, to over 2% in fathers over 50.

PSYCHOLOGICAL EXPLANATIONS

Double-Bind Theory

-> agreed that family climate is important in the development of schizophrenia, but emphasised the role of communication style within a family. The developing child often finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what this is, and feel unable to comment on the unfariness 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 thoughts and paranoid delusions.

PSYCHOLOGICAL EXPLANATIONS

The Schizophrenogenic Mother

-> 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. The schziophrenogenic mother is cold, rejecting & controlling and tends to create a family climate characterised by tension & secrecy. This leads to distrust that later develops into paranoid delusions and ultiamtely schizophrenia.

PSYCHOLOGICAL EXPLANATIONS

Supporting evidence of the cognitive explanation

-> found reduced activity in the prefrontal cortex of schizophrenics as they did a task involving working memory - shows the disruption of information processing when completing a task.

PSYCHOLOGICAL EXPLANATIONS

Supporting research of family dysfunction

-> found that schizophrenics reported a higher recall of double-blind statements by their mothers than non-schizophrenics - supports the conclusions made about the schizophrenogenic mother.

PSYCHOLOGICAL TREATMENTS

Family Therapy

-> 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 the sufferer & maintaining their own lives
• Challenge negative stereotypes about the disorder

PSYCHOLOGICAL TREATMENTS

Coping strategy enhancement

-> schizophrenia sufferers naturally develop their own coping strategies by identifying triggers - e.g. certain people, being on their own, being put under stress. Typical coping strategies fit into 2 categories: behavioural - relaxation, breathing techniques, music, doing somehing that distracts you, seeing more people or removing yourslef from social situations. Cognitive - positive self talk, reasoning with themselves, focusing on something else, goal setting.

PSYCHOLOGICAL TREATMENTS

CBT & Bias

-> conducted a systematic review & meta-analysis of the effectiveness of CBT for shizophrenia symptoms. Overall, CBT has a theraputic effect in schizophrenia symptoms in the 'small' range - this reduces even further when bias is controlled.

PSYCHOLOGICAL TREATMENTS

Support for effectiveness of CBT

-> 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.

PSYCHOLOGICAL TREATMENTS

Effectiveness of family therapy

-> conducted a systematic review from a random selection of studies that primarily focused on families of people with schizophrenia and schizoaffective disorder. It was found that family intervention could reduce the number of relapse events and the number of hospitalisations.

PSYCHOLOGICAL TREATMENTS

Token economy not being effective at improving symptoms

-> conducted an 18-moth controlled experiment into the effects of a token economy programme on the ward behaviour and symptoms of chronic 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.

PSYCHOLOGICAL TREATMENTS

Alternative treatments

-> stated that in addition to medication, creative therapies may be helpful. Art therpay allows exploration of the patient's inner world in a non-threatening way - NICE reccommends art therapy.

INTERACTIONIST APPROACH

Diathesis-Stress Model

-> 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 & adolesence (particuarly the schizophrenogenic mother) could result in the development of the condition.

INTERACTIONIST APPROACH

Modern Diathesis-Stress

-> proposed a neurodevelopmental model in which early trauma alters the developing brain.

INTERACTIONIST APPROACH

Evidence for the role of vulnerability and triggers

-> 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 genetic risk. Child-rearing style characterised by high levels of criticism & conflict and low levels of empathy was implicted in the development of schizophrenia, but only for the children with high genetic risk. Suggests that both genetic vulnerability and family related stress are important - genetically vulnerable children are more sensitive to parenting behaviour.

INTERACTIONIST APPRAOCH

Support for effectiveness of combinations of treatments

-> points out that it is not really possible to use combination treatments without adopting an interactionist approach.

INTERACTIONIST APPROACH

Support for the effectiveness of combination treatments

-> 315 patients were randomly aloocated to a medication + 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.