Schizophrenia

Chlorpromazine :- tranquillise surgical patients whithout sedating them so they still have cognitive function. Led psychiatrists to discover that it has a theraputic effect and removed positive symptoms (hallucinations and delusions).

Phenothiazines :- most effective treatment for Sz. Attaches itself to dopamine receptors in the brain so stops dopamine from getting to the receptors. Positive symptoms (hallucinations and delusions) are contained and there are clear cognitive and behavioural improvements too.

Neuroplectics :- effective in controlling positive symptoms and have allowed SZ's to live outside institutions. Continued use of drugs at a low dosage helps in preventing relapse. 'Wonder drug' does not live up to its initial promises.

:) reduces symptoms within six months but they return when patients stop taking the drug, therefore it is unappropriate as patients have to take the drug for it to have any effect.

:) conventional drugs are good in reducing positive symptoms (delusions) but not negative symptoms (catatonic state). Therefore it is unappropriate as it does not take into account the individual differences (negative symptoms).

:) quick and easy to take unlike CBT which takes a lot of time and only works if the patient wants it to and is motivated.

:( the most widely used drugs do not seem effective against negative symptoms such as catatonic state. Therefore it is not effective as it doesnt take into account individual differences such as negative symptoms, e.g. catatonic state.

:( only the symptoms are treated therefore it is not effective as it does not get to the root cause.

:( around 30% do not respond to antipsychotic drugs, therefore drugs are not appropriate as they dont work for everybody.

:( drugs can cause distressing and sometimes irreversible side effects. Severe side effects can include tardive dyskinsia (uncontrollable lip and tongue movements) and 24% of sz's get this. Therefore is it not appropriate as people can obtain illnesses as a side effect from taking these drugs.

:( there are ethical issues such as 'chemical straightjackets'. Some people say that drugs take away personal control and personality and they can also lead to addiction. Therefore it is not appropraite as some may become addicted to the medication they are on, which would put them in a worse mental and physical state.

ECT stands for Electric Compulsuve Therapy.

The patient lies on a bed in loose clothes and receives a muscle relaxant and anaesthetic.

It involves passing a current of between 70volts and 130volts through the brain for half a second.

This is done by placing electrodes on the temples.

Once the patient comes around from the surgery they recall nothing.

It has been used to help sufferers of sz.

It was given 2-3 times a week for 3-4 weeks.

It is now mainly used for depression.

:( there is a lack of informed consent as the patients are not in the right state of mind when they agree to have the treatment, therefore we cannot establish cause and effect as we do not know how it works. This also makes ECT inappropraite as the patiants are not in the right starte of mind when they choose to have it and they do not remember it once they've had it - therefore the may agree to have the treatment again.

:( another issue is protection of participants. ECT used to be used as a punishment in the 1960's therefore it is unappropriate to use it as a treatment.

:( ECT was previously used for treating sz, however it has been proven to be ineffective and it has now been abandoned. However, it has been considered effective for depression.

CBT stands for Cognitive Behavioural Therapy.

The treatment is beased around the assumption that sz's have irrational and unrealistic thought processes. The aim of CBT is to alter/change these inappropriate thoughts and beliefs.

The overall goal of CBT is to challenge negative thoughts and beliefs and put them to a reality test. E.G. the therapist will ask them for evidence of delusions they may be having and will then encourage patients to come up with a more plausible alternative.

First, they challenge their thoughts in three ways:

1. Logical - does it make sense?

2. Empirical - produce evidence of it.

3. Pragmatic - how does this help you?

A patient would learn these three ways then practice them on a daily basis. Hopefully this will change their thoughts back to rational ones.

CBT also involves both cognitive and behavioural strategies:

Cognitive strategies: the use of distraction (e.g. elastic bands), concentration on a specific task and positive self talk.

Behavioural strategies: initiation of social contact, relaxing and breathing techniques and even ways to drown out hallucinatory voices.

Research to support :- Tarrier found that 73% of his patiends found that the strategies were successful in managing their symptoms. With this Tarrier developed the coping strategy enhancement which taught patients to develop and apply coping strategies. However, this shows that CBT is ineffective as it only controls the symptoms and does not get to the root cause.

Research to support :- Gould conducted a meta analysis and found that it has a significant positive effect on patients symptoms. This increases the reliability of the treatment as it was a meta analysis so all studies would have had to find consistent results. However, this also shows that CBT is ineffective as it only controls the symptoms and does not get to the root cause.

CBT works by toning down psychotic thoughts rather than eliminating them completely. So they dont get to the root cause of sz and just simply control the symptoms, this makes CBT ineffective.

Most studies show that patients have used CBT alongside drugs so therefore it is hard to establish cause and effect.

CBT has long term benefits, unlike drugs which only seem to work for the time you take them. This makes CBT more appropriate than drugs as it doesnt stop working so people with sz can continue in their normal daily lives.

It gives patients more freedom and control of themselves unlike the chemical straightjacket of drugs. This makes CBT more appropriate for people with sz as it will not lead to an addiction.

It takes a long time to do and needs commitment and motivation unlike the quick fix of drugs which is easily accessible. This makes CBT less appropriate as many people do not have the time for this treatment.

It has been shown that how a family communicates can affect the maintenance of sz.

One type of treatment programme aims to reduce the level of negative emotion in the family.

This treatment involves both the family and the individual with sz working together.

The family are provided with educational information about sz and ways of managing it, e.g. lowering expressed emotion.

STRENGTHS!

Research to support :- Pharoah et al did a meta analysis and found that family interventions were effective in significantly reducing rates of relapse and of admission to hospital in people with sz.

It helps improve compliance with taking medication which help with the outcomes of drug therapy. This also makes it effective.

WEAKNESSES!

Criticism of Pharoah et al :- results revealed that family therapies have a wide range of less effective outcomes. This means that the findings are not reliable.

Family therapy is only suitable for patients who still live with or are close to families. This makes it unappropriate as not everyone will be able to use this treatment.

Patients may not be in the right state of mind to accept the therapy therefore this also makes it unappropriate.

Individuals with sz have may problems with social skills, e.g. coping with stressful situations, assessing social situations and self care.

This training programme aims to teach people with sz complex interpersonal skills so they can learn to manage their lives effectively. They can then practice these skills in a safe environment before they use them in the real world.

STRENGTHS!

It avoids the chemical straightjacket of drugs and gives mental control back to patients, this makes them less dependendent on drugs. This makes it more appropriate as individuals will not develop an addiction.

Behavioural therapies give patients the skills and power to live outside institutions. This also makes it more appropriate as people with sz can then carry on with their normal daily lives, e.g. go to work.

WEAKNESSES!

Social skills training seems to only show short term gains, which are not always maintained after the therapy has ended. This makes it unappropriate as it will not be suitable for everyone.

 It also only treats the symptoms and does not get to the root cause. This makes it ineffective and as it does not trea the root cause.

This therapy is more effective in conjunction with other therapies than just by itself. This was shown by Hogathy, who found that patients on medication whilst receiving social skills training adjested to living in the community and avoid going back into hospital more successfully than other groups that were just receiving medication or social skills training.

Although the therapies are appropriate, they may not work for everyone and can be ineffective when used alone. For this reason it is best to comine biological and psychological therapies, by doing this there will be more successful outcomes.

There are two main classification systems that diagnose what sz is:

1. The international classification system for diseases (ICD)

2. The diagnostic and statistical manual of mental disorders (DSM)

The main difference is that the DSM organises each diagnosis into five levels (axes). This leads to being able to make a thorough diagnosis as they consider the persons symptoms in relation to all five axes.

ICD

At least one symptoms has to be present for at least one month:

1. Though echo, withdrawal or broadcast.

2. Delusions (thinking) of control.

3. Hallucinatory (see/hear) voices.

4. Persistent delusions.

Two symptoms are needed over at least a month:

1. Persistent hallucinations (see/hear).

2. Neologisms (new words).

3. Catatonic state (stare into space).

4. Negative symptoms, e.g. lack of emotion.

Positive symptoms are when there has been an addition to the persons behaviour, e.g. hallucinations.

Negative symptoms are when something is taken away from the persons behaviour, e.g. catatonic state.

An issue within this is communication shorthand. A patient with sz usually has more than one symptom, so it is much easier to incorporate these symtopms into a single diagnosis. This makes communication between professionals easier. However, this shorthand can lead to a lack of validity as it will not be specifically stating what the patient has. E.G one patient may have hallucinations whereas another may have delusions.

Another issue is the root cause (aetiology). There is no obvious single cause of sz, but knowing the diagnosis can aid research into investigating the underlying cause. This falls under the nature vs. nurture debate as we do not know whether sz is in our genes or whether we learn it from the environment.

A research method is that a reliable consistent diagnosis can point to a worthy treatment that can improve the symptoms.

An issue is misdiagnosis. As symptoms are subjective (opinion), this can lead to misdiagnosis. This is an obvious problem as it can lead to inappropriate treatments and unnecessary institutionalistaion.

Another issue is labelling. Diagnosis of sz can lead to labelling. This can be stigmatising to the individual and they can this can lead to the self fulfilling prophecy (where they live up to their label). The label of sz is very damaging in society and an individual can be isolated and judged.

A further issue is the assumption of two distinct categories (normal vs. abnormal). This doesnt allow for a grey area, as some with only mild symptoms would be labelled and treated the same as someone with severe schizophrenia. This does not take into account individual differences.

Cultural issues

An issue withing this is cultural relativism. It is not possible to make absolute statemnets about what is normal and abnormal, as abnormality is based on value judgements and these are culturally specific. Therefore we cannot generalisewestern theories and assumptions to non western cultures.

Another issue within this is imposed etic. There is a bias of imposed etic, as the tools designed to measure abnormality were developed in the western world on western behaviour and therefore cant be generalised to the non western world. This is because what the western see as abnormal may be normal in another culture so the tool (ICD) would not be measuring sz in another culture as the symptoms we have for sz may be normal in others.

Reliability

Reliability refers to the consistencies of the ICD when diagnosing schizophrenia. Or, the extent to which psychiatrists can agree on the same diagnosis when assessing patients.

An issue is that in physical medicine, a diagnosis can usually be supported by a lab text (e.g. x-ray). However, with mental disorders there is no objective (fact) test of reliability as doctors only have each other to agree with. All information when diagnosing schizophrenia will be subjective (opinion) based on what the patient says to how the doctor interprets it. So, this will lead to inconsistencies in diagnosis, which makes it unreliable.

A research method within this is that the early volumes of the ICD were low in reliability as terms were not clearly defined and some clinicians used different methods in assessing. However, these problems have since been addressed as there are now detailed definitions and standardised methods to follow when diagnosing schizophrenia.

Validity

Validity is whether the ICD and DSM actually measure what they are supposed to measure (schizophrenia).

An issue within this is that there is much overlap of symptoms to different illnesses in the ICD and DSM. This leads to comorbidity. This is where you have two illnesses at the same time. This is supported by Bentall who said that symptoms in schizophrenia delusions) can also be found in bipolar depression, so it is difficult to separate illnesses. Therefore the diagnostic system lacks validity as it is not measuring what it is supposed to.

Another issue is that people with schizophrenia can have a wide range of symptoms and treatments. This has lead to sub categories pf schizophrenia (undifferentiated schizophrenia). However, once diagnosed with undifferentiated schizophrenia a patient can then be re-diagnosed with another type of schizophrenia, therefore this makes it lack validity.

A valid classification system should be able to predict the outcome of treatments, however this has proved difficult in the ICD.

Rosenhan's study

He sent 8 pseudo patients to different asylums and they said they could hear the word 'thud'.

One of the patients was diagnosed as bipolar and the other 7 as schizophrenic.

This shows that that system did not measure what it was supposed to, so this questions the validity of the whole diagnostic system. If it was measuring what it was supposed to, they would have found that the patients were actually sane.

It also shows that the system lacks reliability as there is incosistencies in the diagnosis of patients.

Genetics (twin studies) AO1

Genetic theory states that the more genetically similar you are to someone with a disorder such as schizophrenia, the more likely you are to get the disorder too.

Gottesman suggests that schizophrenia is inherited through genes.

He studies 40 sets of twins. The concordance rate for monozygotic twins was 48% and only 17% for dizygotic twins.

Also, Cardno showed concordance rates of 26.5% for monozygotic twins and 0% for dizygotic twins.

Genetics (twin studies) AO2

An issue is that the fact that the concordance rate for twins is not 100%, therefore this means that schizophrenia cannot be accounted for by genetics (nature) alone. The environment (nurture) must also play a part.

A research method is that the sample size of twin studies is always going to be small, therefore this lacks population vailidity as you cannot generalise the results to all twins.

Another issue is that twin studies do not all use the same diagnostic criteria, therefore there will be different diagnosis' and this will lead to a different concordance rate. This makes these studies lack reliability.

Genetics (adoption studies) AO1

Tienari studies 155 adopted children whose biological mothers had schizophrenia. They had a concordance rate of 10% compared to 1% in adopted without a schizophrenic biological mother. This is very strong evidence that genetics are a risk factor for schizophrenia.

AO2

The concordance rates for adopted children is not 100%. Therefore this means that schizophrenia cannot be accounted for by genetics (nature) alone. The environment (nurture) must also play a part.

Genetics (family studies) AO1

Gottesman also studied families. He concluded that if both your parents suffer from schizophrenia, then you have a 46% chance of developing it yourself (compared to 1% chance of someone selected at random). The more genetically similar relatives are, the more concordance is found.

AO2

The evidence strongly suggests genetics (nature) is a factor. However, an issue is that it could also be explained in terms of the fact that genetically similar family members spend more time together and so environmental (nurture) factors could also have an affect.

The dopamine hypothesis AO1

This theory claims that excessive amounts of dopamine or an oversensitivity of the brain to dopamine is the cause of schizophrenia.

AO2

:) There is strong empirical support which suggests that dopamine (phenothiazines) also seem to reduce the symptoms of schizophrenia. Therefore this shows a relationship between dopamine and schizophrenia.

:) L-Dopa is a drug for parkinsons disease that actually increases dopamine. This in turn can produce symptoms of schizophrenia. Therefore this shows a relationship between dopamine and schizophrenia.

:) Post mortems of schizophreniacs show an increase of dopamine in parts of the brain. Therefore this shows a relationship between sopamine a schizophrenia symptoms.

The dopamine hypothesis AO2

:( Phenothiazines are the drugs that block dopamine, they do not seem to work for everyone therefore you cannot establish cause and effect between dopamine and schizophrenia (as there is only alink between the variables).

:( An issue is that the theory is over simplistic and has been criticised for using the treatment as the cause - this is known as the aetiology fallacy (false cause) - as doctors believe just because the treatment works, it must be the cause.

Brain Structure AO1

There is growing evidence that schizophrenia is down to physical abnormalities in the brain (large ventricles).

People with schizophrenia have abnormally large ventricles in the brain. Ventricles are fluid filled cavities. This means that the brains of schizophreniac's are lighter than normal.

AO2

Research to support :- Andreasen conducted a controlled CAT scan study and found significant enlargement of the ventricles in schizophreniacs compared to controls. However, this was only the case for men and not for women therefore we cannot generalise to the whole population.

:( It is difficult to establish cause and effect (only a link is shown between variables)  as many participants have suffered from schizophrenia for a while and have been undergoing treatment. Therefore this theory could be invalid as the brain structure could have changed due to the treatment or it could have always been different.

Crow

The main problem with such studies is that it is not found in all schizophreniac's. This lead to further research done by CROW.

He suggested that there were two types of schizophrenica, with two biological causes. He called this the two syndrome hypothesis.

1. Type one is genetically inherited and associated with dopamine. This is characterised by positive symptoms (delusions).

2. Type 2 is to do with brain structure and is characterised by negative symptoms (catatonic state).

Overall ending

Biological explanations (nature) do account for schizophrenia, however the fact that there is no conclusive explanation that accounts for all schizophrenics. Psychological explanations (nurture) also need to be considered.

Behavioural AO1

This approach explains schizophrenia as being caused by operant conditioning (rewards and reinforcements).

Early experience of punishment may lead to a child to retreat to an inner world. This causes others to label them as odd.

The bizarre behaviour shown many be rewareded with attention and sympathy and this encourages the individual to conform to the behaviour and to the label.

Behaviour will become more and more exaggerated until it is eventually labelled as schizophrenia.

Behavioural AO2

:( An issue is that this theory has been accused of being reductionist and mechanistic, as it reduces complex human behaviour like schizophrenia to rewards and reinforcements.

:( Another issue is that it ignores genetic influences such as dopamine (nature) and cognitive explanations (doesn't consider thinking to be important) as it only accounts for learning from the environment (nurture).

:( A further issue is that this theory is too deterministic, as it says we are predetermined to learn schizophrenia. It doesn not account for our thought processes (free will).

:( A final issue is that it has also been criticised for trivialising a very serious condition. Schizophrenia is being explained using the same principles we teach dogs tricks - this makes it too simplistic.

The schizophrenegenic mother AO1

This term is used to describe a mother who is cold, dominant and manipulative by being both overprotective and rejecting. This type of mothers actions are often very contradictory. It was believed that this causes the child to be resentful and distresful and this could then be manifested as schizophrenia.

AO2

This theory had very little supporting evidence and any research was based on very flawed methodology (as the research conducted was based on opinions therefore it was subjective).

However, the families of schizophrenics do seem to differ from those of non schizophrenics and so psychologists became more interested in the part the family may play in the course of schizophrenia, rather than the cause.

Expressed Emotion AO1

Most recent research has centred around the concept of expressed emotion. Expressed emotion can be being over critical ahowing hositility and even over concern (so over playing the emotions).

Expressed emotion is assessed by taping an interview with a relative of someone with schizophrenia and rating:

1. The number of critical comments.

2. The number of statemnets of dislike.

3. The number of statements showing over envolvement with the patient.

Brown highlighted that schizophrenic patients were more likely to relapse when restored homes that displayed high levels of expressed emotion.

Tarrier found strong correlation between relapse and living with expressed emotion.

Expressed emotion AO2

:( There is only correlational research therefore you canot establish cause and effect as only a link is shown between variables.

:( High expressed emotion has also been found in families with eating disorders and depression therefore there is no direct link to schizophrenia.

:( A self report method is used therefore there may have been social desirability (where a person lies to present themselves in the best light).

:( This may be subjective as it is based on the relatives opinion therefore it will lack validity.

The Diathesis Stress Model suggests that a schizophrenic already had a biological predispostition to schizophrenia, but it was triggered by an enviornmental factor such as a life change.