Schizophrenia Revision Notes

Positive Symptoms - those where there is an additional or an excess to ognitive functioning

• Delusions - bizzare believes seem real, sometimes paranoid, grandiosity (I am God), reference (comments of others)
• Experiences of control - individuals believe they are under the control of someone else
• Auditory hallucinations - unreal perceptions of the environment, usually sound, may be visual, olfactory (smell), or tactile (feelinng things crawl on you)
• Disordered thinking - thoughts are being withdrawn or instered thoughts are being broadcast to everyone else

Negative Symptoms - where there is something taken away or a diminishment of normal functioning

• Affective flattening - emotional expression is reduced, facial, tone of voice and body language
• Alogia - speech becoming less clear, less fluent this is probably because of slowing or blocked thoughts
• Avolition - inability to take part in goal directed behaviour, appear to be disinterested
• Catatonia - this is where people stand in unusual positions for very long periods of time completely still

Schizophrenics generally have confused thinking, and often suffer from delusions. Many of these delusions involve what are known as 'ideas of reference, in which the schizophrenic patient attaches great personal significance to external objects or events. For example, a schizophrenic seeing his neighbours talking may be convinced that they are plotting to kill him.

Schizophrenics often suffer from hallucintions. Delusions arise from mistaken interpretations of actual objects and events, but hallucinations occur in the absence of any external stimulus. Most schizoprenics hallucinations consist of voices, usualyy saying something of personal reference to the patient.

McGuigan suggested that these auditory hallucinations occur because patients mistake their own inner speech for someone else's voice, He found that the patients' larynx was often inactive during the time that the auditory hallucinations was being experienced, More recent studies have confirmed this explanation of hallucinations - Frith

Language impairments characterise schizophrenia. Patients may repeat sounds (echolalia) or use invented words (neologisms). Their speech may seem illogical and involve abrupt shifts from one theme to another. This is described as 'knight's move thinking' because in chess, the knight is only permitted to move in an L shape. In some cases, the patient's speech can be so jumbled it is decribed as a 'word-salad'. The impairments of language has led to some theorists to suggest that there is a link between the evolution of language in humans and schizophrenia.

There are some schizophrenics whose behaviour is even ore bizarre. One of the most common behavioural abnormalities is to remain almost motionless for hours at a time. Some patients make strange grimaces or repeat an odd gesture over and over again.

Reliability

• Inter-rater reliability - would two practitioners arrive at the same diagnosis with the same individual?
• Extent to which psych's agree on same definiton - could be subjective/bias
• Beck - compared two psychiatrists and of 154 Ps, interrater reliability of 54% - LOW
• However each patient could have given different info - investigater effects, unpredicability of a patient
• Also they were relying on retrosprective data/some may exaggerating truth/lying 
• Rosenhan - being sane in insane places found that 'normal' people could get themselves diagnoses with schiz by just claiming they heard voices
• A follow up study to check reliability - they told a hospital to expect pseudo patients over the next 3 months, hospital staff said they recognised 19 pseudos but there was NONE

Reliability cont.

• Issues with cultural bias (DSM IV and ICD10)
• Futher development of classification systems (DSM 5 in development)
• Extent to suffering? do we need to label a person/ do they need to be hospitalised? all of these things are difficult to decide
• Some disorders are very similar and its hard to differentiate between the negative symptoms of schiz and depression for example
• Due to lack of funding in many mental health departments, diagnosis are often rushed
• However - if the drugs or treatment plans work this suggests reliability of diagnosis

Validity

• Is it measuring what it claims to measure?
• No, as classification systems are not consistent
• When people are labelled, psychiatrists are not objective when identifying the symptoms (social sigma of diagnosis - carry label for life)
• Difficult to define the disorder from others
• Organic problems like brain tumours can be brought about as part of another condition
• Validity of subtypes are questioned as some overlap
• Cultural relativism of diagnosis - 'lost in translation'

Dysfunctional Families/Family Relationships

This is the therory that family interactions are abnormal. Most of the theories start off with a psychoanalytical origin.

Laing and Esterson - 'Sanity, Madness and the Family' are a number of case studies of young schizophrenic women. Laing found clear and consistent abnormal patterns of parenting across the families.

Mystification - not making clear in speech within the family what you want them to do. If a child says they are unhappy, replaying that 'you cannot be unhappy we have given you everything you need' In otherwords the person is left mystified on the instructions.

Double Bind - is an emotionally distressing dilemma in communication in hich an indiviudal or group receives two or more conflicting message, and one message negates the other. If a mother tells her son that she loves him, while at the same time turning her head away in disgust, the child receives two conflicting messages about their relationship on different

Research Support

Bateson et al - suggests that the child's inability to respond to the mother is incapacitated by these contradicitons, because one message effectively invalidates the other. If there is a combination of these in parenting there will be disorders of thinking in the child. These processes tend to occur in secretive and overprotective families. Oftent the parents themselves are psychologically unstable.

Laing - suggests that schizophrenic is the sane response to a dysfunctional family

Berger - found schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrencs. However Ps recall may not be reliable.

Research Support cont.

Lidz - thought that two types of family could lead to children developing schiz

1) Schizmatic family - both parents have major private personal problems usually the marital relationship is poor. The child ends up being used as a pawn, with each parent competing for the child's affection and often being openly hostile about the other parent. The combination of emotional trauma and confusion could spark schizophrenai in their children

2) Skewed family - one parent is very dominant, the other is passive. The dominant parent is deeply disturbed. They impose their strange views on the entire family ignoring the needs of the children and intruding in their lives. The passive parent accepts this behaviour to help keep the family in tact. This reinforces it in the children's eyes and the whole family starts to think and act in the same strange way.

Stress - life events may cause so much emotional trauma that this is a cause. High level of physicological arousal associated with major neurotransmitters may occur. Brown et al found 50% of people experienced a major life event 3 weeks before a schizophrenic episode. Van Os et al found no link between life events and schizoohrenia. Cause and effect cannot be established, the start of the disorder could cause a major life event.

It is a result of faulty learning. If a child receives little or no reinforcement early on in life, the child will respond to inappropriate environment cues. The child's behaviour will appear to be strange , those who observe it will respond erratically which will reinforce bizarre behaviour. Hospital staff may accidentally reinforce schizophrenic behaviour by giving more attention to those with wacky behaviour, Others in the institution may see this behaviour and observe and learn by vicariour reinforcemet. This could also happen in schools where naughty children receive more attention. Social skills training/token economy have been used to help the behaviour of schizophrenics.

Schizophrenia is characteristed by disordered thinking patterns. Cogntive psychologists see this as the cause rather than a consequence of schizophrenia. Most people are able to filter an process incoming stimuli, yet it is thought that schizophrenics cannot focus attention selectively. They let in too much irrelevant information, they are inundated with inappropriate stimuli and so they experience the world very differently.

Frith says that positive symptoms are a result of inability to monitor own cognition and behaviour. They cannot differentiate between actions that are brought about by external forces and those that are brought about internally. Fault is due to a functional disconnection between frontal area of the brain concerned with action and those that control perception.

Hemsley - Failure to activate schemas

In schizophrenia there is a breakown in the relationship between information from memory and new information. Schemas are not activated so schizohrenics are subjeced to sensory overload and they can't ignore which aspects of a situation to attend to and whcih to ignore on the basis of a schema. Superficial incidents are seen as highly relevant and signifiant. Interal thoughts are often not recognised as arising from memory and so are thought to be from and external souce and experience as auditory hallucinations.

Evaluation

Positive - There is a lot of evidence for a physical basis for cognitive deficits, PET scans show under activity in the frontal lobe of the brain which is linked to self monitoring

Negative - The research being experimental, lacks mundane realism and so may lack genralisability to schizophrenic symptoms, Cause or effect?

Psychodynamic 

Freud said it is a result of two related processes

1) Regression to pre-ego state

2) Attempts to regain ego control

If the world is a harsh place (cold and uncaring parents) a child may regress to a stage of development before the ego was properly formed and the child has developed a realisitic awareness of the external world. So schizophrenis is an infantile state.

The ego may be upset by the demands of the id, or upset by the guilt placed by the superego. The ego may have returned to the oral state and this is why they experience hallucinations and delusions as fantasies ge confused with reality

Evaluations

Positves - May gain support by linking to the family relationships exaplanations

Negatives - Very little research support, it is impossible to test concepts of the unconscious mind, id, ego and superego. Dated, the researcg may be era dependant and context bound. Schizophrenia is not that similar to child like behaviour

Expressed Emotion

The idea that a negative climate is responsible. EE associated with hostility, criticism and emotional over-involvement. A patient returning to a home with high EE is 4 times likely to suffer relapse. Kalafi found that high prevalence of EE is Iranian culture was oe of the main caues of relapse. EE has more empirical studies in support than other family relationship ideas.

Research Support

Vaughna and Leff belived that expressed emotion was a strong predator of relapse rates among discharged patients. This was stimulated by an earlier study by Brown showing that patients with schizophrenia who returned to homes where a high level of emotion was expressed such as hostility, criticism, over involvement and over concern - showed a greater tendency to relapse than those returning to low expressed emotion homes. Vaughn and Leff found similar results, with 51% relapse in those in high expressed emotion home and only 13% relapse in those in low-expressed emotion homes. Face-to-face contact increased with high expressed emotion

Evaluation

Positive - Adoption studies show the importance of family relationships. Tiernari found that adopted children with schizophrenic biological parents were more likely to become ill themselves that children with non-schizophrenic parents, this seems to support genetics. However, this difference only emerged when the adopted family was rated as disturbed, i.e. the illness only manifested itself in appropriate environmental conditions. Genetic vulnerability alone was not sufficient.

Negative -  It is difficult to accurately test these theories - lack of evidence. They add guilt to an already disturbed family. Schizophrenics have often been brought up alongside healthy sibiling, it seems unlikely that parenting patterns should be consistently different across different children. Many children experience they schismatic family that Lidz describes yet do not develop schizophrenia. Klebanoff says a family of a schizophrenic shows these abnormal parenting patterns because of the behaviour of an unusual child, this reaction to the child's first sign of symptoms may in turn also have an influence on the illness. Doane found that recurrence of schizophrenia was reduced when parents reduced hostlity towards the children. Biological explanations.

Schizophrenis runs in families is mainly investigated by twin studies. If schizophrenia is genetic we would expecr to find a high concordance rate between known schizophrenic and their close relatives. 

Twin Studies

Gottesman summarised about 40 studies. The concordance rate is about 48% for MZ twins but only 17% for DZ twins.

Most striking suppor for genetics is by Rosenthal. He studies quadruplets, in which all four girls were identical to each other. Amazingly, all four of them developed schizophrenia, although they differed with age of onset and symptoms.  They were known as the Genain quadruplets as they also had a dreadful and aberrant childhood so, as with most evidence, the conclusion is not clear cut.

Twin Studies cont.

Gottesman and Shields looked at the history of 45,000 Ps between 1948 and 1964. They identified 57 schizophrenics with twins who could be located and agreed to be studies. They found MZ had a concordance of 42% and DZ had a 95 concordance. This suggests that genetics may play a role as the identical twins have a higher concordance rate.

Helsons proivdes futher support for genetics research and found a 90% concordance rate for MZ twins. Overall, studies on twins tend to show a concordance rate of 50% for identical and 15% for non identical twins.

Twin Studies Evaluation

Strong evidence of genetic factors in schizophrenia from the studies of twins. Concordance rates are not 100% snf therefore even the data does not exclude environmental input.

The problem is that twins presumably share a very similar environment, more so for identical twins as people will respons to them in the same way. The cause could therefore be environmental.

Another proble of the research is that you might expect peole with schizophrenia to be less likely to have children, yet the incidence rate is not vastly dropping.

First MZ twins elict more similar treatment from their parents than do DZ twins - Lytton, this suggests that the greater genetic similarity of identical twins may be a cause rather than an effect, of their more similarity parental treatment.

Schizophrenia concordance rate for MZ twins bought up apart is preumably not due to a high level of environmental similarity, although critics have suggested that some of the reared apart twins in Shielfs study had not always spent the whole of their childhood apart and some raised by relatives and even went to the same school.

Adoption Studies

These studies can separate the effects of the environment and genetic factors. Researchers look at adopted children who later develop schizophrenia and compare them with their biological and adoptive parents

Tiernari -  Finland. 155 schizoprenic mothers who had given up their children for adoption, compared against 155 adopted children not havig a schizophrenic parent. Large difference in the incedence of schizophrenia in these two groups when they were adults, 10.3% of those with schizophrenic mothers developed schiozphrenia compared with only 1.1% of those without schizophrenic mohers.

Kety - Danish adoption study, took a national sample from across denmark. They looked at the relatives of adopted children who had developed schizophrenia, they found that biological relatives had 14% occurence of schizophrenia an adoptive parents had 2% occurence of schizophrenia

Evaluation

This adoption study provides evidence of a genetic link for schizophrenia. A problem with the research is that these statistics were gathered from information over 70 years ago and the diagnostic criteria for schizophrenia are constantly being updates and changed. Earlier interpretations of symptoms were different from today and probably less uniform.

Family Studies

Gottesman - reviewed other concordance rates. If both parents have schizophrenia, then youhave a 46% chance of developing schizophenia as wel. The concordace rate is 16% if one of your parents have schizophrenia and it is 8% if a sibling had schizoprenia. These concordance rates should be compared against the 1% of someone selected at random suffering from schizophrenia

Gottesman and Bertelsen - reported some convincing findings on the importantce of genetic factors. One of their findings was that their parents had a 17% chance of being schizophrenic if they had a parent who was an identical twin and who has schizophrenic. This could be due to either heredity or envronment. They also studied participants with a parent who was an identical twin and did not have schizophrenia, but whose identical twin did. These participants also had a 17% chance of being schizophrenic. In other words, what are of most importance are the genes that are handed on by the parent

Conclusion

The evidence seems to suggest the individuals may have a genetic predisposition to schizophrenia. However, it may be that other factors trigger the schiophrenia. This is the Diathesis-Stress model. Schizophrenia occurs because of the biological vulnerability (diathesis) to a disorder interacting with personaly significant environment stresor. The environment may 'switch-on' this gene or not.

Evaluation of Genetics

Positive - Twin studies provide strong genetic evidence.

Negative - There is not 100% concordance so genes can not tell us the whole story. Less than 50% of children where both parents have schizophrnia develop the disorder. Nature vs nurture is difficult to separate, higher concordance of identical twins may be because of a more similar environment. Methodology, family studies are retrospective. Small sample size. Evidence of psychological factors can be used against

This is the idea that schizophrenics have abnormally high levels of the neurotransmitter dopamine in their brains. A slightly different view is that neurons in the brains of schizophrenic patients are over sensitive to dopamine, there are four pieces of evidence:

1) Autopsies of schizophrenics consistently show above normal levels of dopamine

2) Drugs that indivduals take for schizphrenia are believed to work because they block dopamine activity in the brain

3) Parkinson's disease Ps (impaired motor functioning) is believed to have abnormally low levels of dopamine. They are treated y being given L Dopa, a drug to increase dopamine levels. Often a side effect of this is schizophrenic like symptoms. At the same time, schizophrenics Ps can develop Parkinsonian like symptoms as a side effect of their drugs

4) Neuroleptic drugs (Phenothiazines) that block dopamine seem to reduce the symptoms of schizophrenia; this mainly has the most effect on positive symptoms

Futher evidence is from individuals who take hallucogenic drugs, as the experience is similar to the positive symptoms of schiozphrenia. Cocaine and amphetamines stimuate the receptors for dopamine and users report delusions of persecutions and hallucinations. Davies found that if you give Ps cocaine or amphetamines it exaggerates their symptoms

Evidence Against

• This doesn't tell us why dopamine levels are high and it is not possible to establish cause and effect. Maybe the schizphrenia comes before the change in dopamine levels.
• Drugs such as cocaine, increase levels of ther neurotransmitters too.
• Anti-Psychotic drugs block dopamine receptors very quickly, yet it can take days to change the behaviour of people with schizphrenia
• Barlow and Durand believe that neuroleptic drugs block dopaine fairly rapidly, but generally fail to reduce symptoms of schizophrenia for days or weeks thereafter. These puzzling high levels of dopamine are responsible for maintaining the symptoms What is also puzzling for the perspective of he dopamine hypothesis is that the fairly new drug, Clozapine, if frequently more effective than that of the neuroleptics in reducing schizophrenic symptoms. Clozapine blocks dopamine activity less than the neuroleptics, and so it should be less effective, according to the dopamine hypothesis

Evidence Against cont.

• How can we explain the effectiveness of Clozapine, according to Barlow and Durand, there is growing support for the view that the 2 neurotransmitters, dopamine and serotonin, both play a role in producing the symptoms of schizophrenia. Clozapine blocks both of these neurotransmitters, which is not the case with neuroleptics
• The evidence on the relationship between schizophrenia and dopamine levels is mostly correlation in nature. As a result, we do not know whether the changed dopamine activity in schizophrenics occurs before or after onset of the disorder. If it occurs after, then clearly dopamine play a part in causing schizophrenic symptoms

Recent advances in brain scanning have shown that the brains of schizophrenics appear to be different to those of healthy people. In particular many of the ventricles (fluid filled cavities) in the brain seem enlarged. There are two explanations:

1) Damage at birth - children in a difficult labour are more likely than babies born without complications to develop schizophrenia

2) Damage to the unborn foetus - research has shown that pregnant mothers who contract flu during the middle of their pregnancy are more likely to produce children who will develop schizophrenia. However there is contradictory evidence eg. they found this to be true in Finland, England and Wales, but not in Scotland.

Stevens said individuals with schizophrenia tend to show indications of neurological disease eg. eye blinks/stares

This explanation does sugges reasons why individuals who have no family history of schizophrenia may develop the disorder. However, large ventricles have been found in non-schizophrenics. Cause and effect cannot be established as only associations have been identified. Brain dysfunction is linked to negative symptoms only

Evalution of Biological Explanations

Positive

• Maybe the different explanations explain different types of schizophrenia, eg. anti-psychotic drugs mainly relieve positives symptoms and so a biochemical explanations may be appropriate for type 1, brain dysfunction is linked to negative symptoms and so may be linked with type 2 schizophrenia

Negative

• Saying that there is one biological cause is reductionist as there are many different types of schizophrenia eg. type 1 display mainly positive symptoms and type 2 display negative symptoms

Anti-Psychotic Drugs

These are neuroleptic drus used in the treatment of schizophrenia and other psychotic disorders. They are major tranquilizers with sedate a person and ameliorate  the symptoms of psychosis, such a delusions and hallucinations. An excess of the neurotransmitter dopamine has been linked with schizophrenia. Phenothiazines bind to dopamine receptors and block the build up of dopamine. These tend to reduce the positive symptoms of schizophrenia rather that the negative symptoms. Another common drug is clozapine which is a neuroleptic drug that seems to have fewer side effects than others.

Evaluation

Alternative to mental institutees, howver, responsibility of care is now in the hands of the doctor and the patient.

Phenothiazines - effective for 60% of patients, this enables people to live in the community

Community care is sometimes inadequate -  particularly when there is poor compliance with medication. If antispychotic drugs are stopped suddenly the symptoms return. This is the revolving door syndrome - continue discharge and readmission

Hoge - side effects include symptoms similar to Parkinsons disease such as stiffness, immobility and tremors. The most serious side effect is tardive dyskinesia - uncontrollable sucking and smacking of the lips

Phenothiazines destroy a part of the brain and this process is irreversible

Appropriateness

• Works with the majority of patients so it is appropriate to administer
• Useful if a client is distressed
• To live in the community with drugs to control symptoms than in an institution
• Should be given in the smallest possible doeses to reduce side effects

Effectiveness

• The most effective of the trearments for schizophrenia
• Works quickly 60-65% success rate overall
• Symptoms can return 
• Side effects might overweigh the benefits
• Clozapine has up to 85% success and when neuroleptics has shown no improvement in patients, a third would improve when given this drug
• Clozapine has fewer side effects but it is more expensive and can lead to a potentially fatal blood disease in 1-2% of patients
• They are a control not a cure
• Not effective for negative symptoms

Ethics

• How can a patient with psychosis consent to the treatment?
• Side effects of drugs
• Irreversible damage 
• Half report grogginess, 18% say they can't concentrate, 16% have problems with salivation, 16% blurred vision

This involves the cutting of the neural tissue in the brain and was designed to alter the symptoms of severe depression. The first techniques was the lobotomy devised by Moniz and involves the severing of the connection between the frontal cortex and the lower centres of the brain. In the 1960s this was replaced by the prefrontal lobotomy which involved drilling two holes in either side of the skull and inserting a pointed instrument to sever nerve fibres. A more recent procedure is the cingulotomy where a tiny cut is made in the cingulum nerve fibres using an electrode needle. Moniz and others claimed that the procedure made schizophrenic and other patients less violent and easier to manage. Labotomy's did make patients calmer and about 70,000 were carried out between 1935-55. However, the side effects are so great that they are rarely performed any more. The side effects include apathy, diminished intellect, impaired judgement, come and even death

Evaluation

• Used as a last resort when drug treatmet and ECT havent worked

Appropriateness

• Performed on thousands as a response to overcrowding in mental institution and the absence of effective treatment
• Only used when other treatments have been exhausted

Effectiveness

• Was found to be effective on violent criminals during the 50s and 60s
• Could be effective when performed precisely and on the right patients

Ethics

• Informed consent - people may be in a fit state to consent
• Permanent damage could be caused - damage to congnitive abilities, can't exercise own will, alteration of persons normal thought process
• Needs a second doctor to consent

CBT aims to change dysfunctional emotions, thought processes and subsequent behaviours that result. It uses both behaviourist and cognitive approach

Rational-Emotive Therapy - Ellis - most common

• States that irrational thoughts lead to an irrational 'internal dialogue' causing irrational behaviour
• Aim is to challenge illogical thinking and strengthen their logical reasoning skills
• CBT tries to deal with hallucinations as they are seen as threatening
• Sufferers challenge their interpretation of hallucinations and propose an alternative explanations

Appropriateness

• Psychotic disorders is when a patient has a lack of coherent thinking -  they dont realise they have a problem, cognitive therapies are therefore inappropriate
• Growth in biological basis - dopamine is mainly responsible for the symptoms so need drugs?
• Might be valuable as a therapy alongside others eg, drugs, drugs reduce positive symptoms allowing them to engage more withthe CBT
• Morrison - can be adapted to challenge the dysfuctional beliefs sufferers have - reduced symptoms

Effectiveness

• Zimmerman - better at treating positive symptoms that no treatment at all - lasted up to 12 months 
• Helps counterbalaces the possibility of relapse
• Turkington -  effective in short term and occasionally in the long term
• Sensky - effective even 9 months after treatment had stopped
• Tarrier - no real benefits 1 year after and less after 2 years

Token Economy - operant conditioning principles

• Stage 1 - reward for not showing strange behaviour
• 2 - reward for showing 'normal' behaviour with 'tokes' eg, buying a film
• Ayllon and Azrin - studies female patients of a mental institute using token economy - useful

Appropriateness

• Token economy is useful in a many institutios and has given patients freedom when before they were locked up and controlled. Not in outside world - it would be hard to reward
• Not dealing with thre cause of schiz, Paul and Lentz does seem to have an effect on the behaviour of schiz patients but even the clients do not say they are 'cured', It is a techniques to manage behaviour, form of manipulation, Ethics have been questioned

Effectiveness

Paul and Lentz looked at the effectiveness of it compared to other therapies, 90% patients were receiving drug treatment at the start of the research.

Patients put into groups then assessed at the end - 4 1/2 years later

• 1. learning group - token economy - drug use dropped 11%
• 2. milieu therapy - treated morally, asked quuestions - drug use dropped 18%
• 3. treated as they normally would be in a mental institute - drug use rose 100%
• Members in all groups returned to the community but group 1 integrated much better

Ayllon and Azrin - found token economy reduced 'bizzare behaviour' and increased helping and 'normal' behaviour

Gripp and Magaro - patients with schiz using TE improved much more than using traditional methods

Gershone - compared TE with traditional therapies and found they spent more time doing activites, less time in bed and made fewer disturbing comments

Freud mainly focuses on neurotic disorders. Psychoanalysis 'the talking cure' not really used for schiz sufferers but it has been adapted to suit them and in some cases it has been successful

Sullivan and Pratt- said schiz was a way of returning back to childhood as they cant cope with the stress of life. They had developed a weak ego so return to childhood as they have no responsibility here and little stress. They encouraged Ps to learn adult form of communication, gradual relationship developed with the client and won't make eye contact or be face to face, they sit next to each other - less intimidating

Appropriateness

• Psychodynamic therapy states you can only be cured when the patient has an 'insight' into their disorder. Schiz is a lack of personal insight and therefore you can never claim to 'cure' schiz using psychoanalysis

Appropriateness

• Psychodynamic therapy states you can only be cured when the patient has an 'insight' into their disorder. Schiz is a lack of personal insight and therefore you can never claim to 'cure' schiz using psychoanalysis
• Suggested people who were undergoing psychoanalysis did not have schiz. It was an umbrella term for mental disorders
• People who were diagnoses by Sullivan and Pratt would not have been diagnosed today wit schiz

Effectiveness

• Little research to suggest it works with schiz
• Drake and Sederer found therapies with a close client-therapist relationship, age regression and high levels of emotionality worsened sufferers symptoms and were in hospital longer
• Staton found little effect on schiz sufferers
• In a study looking at patient who has been diagnosed with schiz and then discharged from a mental institute in New York found a significant lack of improvement from sufferers who had psychoanalysis. Gaining an insight into their condition worsened showing it could be more harm than good