Schizophrenia

Genetic Inheritance

• SZ is more common among biological relatives of a person.
• The closer the degree of relatedness, the higher the risk.

- Joseph (2004): concordance rate of 40.4% identical twins and 7.4% for non-identical twins.

- Tienari et al., (2000): 164 control adoptees in Finland whose biological mothers had SZ, 11 had SZ, comparedto 4/197 control adoptees.

Enlarged Ventricles

• Research has shown that SZ patients have 15% bigger ventricles.
• Part of the brain structure (neuroanatomy)

- However may be because of antipsychotic medication.

Dopamine Hypothesis

• Dopamine is a neurotransmitter that helps operate the brain.
• Dopamine is fired too quickly or too often.

- Amphetamines: cause synapse to flood with dopamine, producing hallucinations and dellusions.

- Antipsychotic Drugs: block acitivity of dopamine and hallucinations and dellusions stop.

- Parkinson's Disease: given L-dopa to increase dopamine levels, they develop SZ symptoms.

Antipsychotics

• Conventional Antipsychotics (reduce dopamine).

Effectiveness:

- Davis et al., (1980): analysed 29 studies, relapse occured 55% on placebos, 19% on real drug.

- Ross and Read (2004): 45% on placebos actually benefitted.

Appropriateness:

- side effects: 30% will develop Tardive Dyskenesia; being perscribed medication will affirm something is wrong with you and reduces motivation to look for possible solutions.

• Atypical Antipsychotics (block dopamine and serotonin)

Effectiveness:

- claims to reduce negative symptoms aswell, but marginal support.

- findings show only slightly more effective or the same as conventional.

Appropriateness:

- lower risk of Tardive Dyskenesia.

- fewer side effects, patients more likely to continue treatment.

Electro-convulsive Therapy (ECT)

• Electric current passed between 2 scalp electrodes to create a seizure (0.6 amps).
• 3 - 15 treatments required.

Effectiveness:

- Tharyan and Adams (2005): more people improved than on 'sham ECT', however results favoured medication.

Appropriateness:

- potentially life saving

- side effects - memory dysfunction, brain damage, death.

- ethical issues, Rose et al., (2005): meta-analysis, 1/2 felt ill informed, 1/3 felt forced into treatment.

Cognitive Behavioural Therapy (CBT)

• Assumption that people have a distorted belief which influences their behaviour.
• Event --> interpretation --> feeling --> behaviour.
• Patients encouraged to 'reality-test' their symptoms and change their faulty thought patterns.

Effectiveness:

- Gould et al.,: all 7 studies in meta-analysis reported decrease of positive symptoms after treatment, however diffcult to assess because patients are usually also on mediation.

Appropriateness:

- not everyone can benefit, 142 SZ patients - many deemed not suitable, older people less likely.

Psychoanalysis

• Aims to treat underlying cause using different techniques, e.g. dream analysis, free association.
• Once conflicts are made conscious, they can be resolved.

Effectiveness:

- Gottdiener (2000): meta-analysis of 37 studies, concluded it was an effective treament (66% improved).

Appropriateness:

- expensive.

- not worth extra effort when medication is available?

• SZ is a psychotic disorder characterised by the loss of contact with reality.
• DSM-IV-TR - SZ diagnosis requires one month of two or more positive symptoms.
• Onset between mid-teens and early 30s.
• Affects 1% of UK population.

Positive Symptoms - distortion of normal function.

• dellusions
• hallucinations
• experiences of control
• disordered thinking

Negative Symptoms - lack of normal function.

• affective flattening (lack of emotion)
• alogia (poverty of speech)
• avolition (loss of ability to initiate action or goal-directed behaviour)

Can scientists agree who has it?

Rosenham (1973): normal people admitted to psychiatric hospitals claiming they heard voices saying 'empty', 'thud' and 'hollow'.

• all but 1 were diagnosed as SZ.
• in a follow-up study, Rosenham warned of sending out more pseudopatients, but did not send any - detection rate was 21%.

Copeland et al., (1971): gave description of patient to 13 US and 194 UK psychiatrists.

• 69% US diagnosed as SZ, 2% UK diagnosed as SZ.

Can scientists agree on what it is?

Ross (1995)

• people with Dissociative Identity Disorder have more SZ symptoms than people with SZ.

Bentall et al., (1988): reviewed research into causes, outcomes and treatment of SZ.

• conclude SZ was not a useful scientific category.