Schizophrenia

Positive symptoms:

• Delusions: grandeur, persecution, reference
• Hallucinations: unreal perceptions that can be auditory, visual, olfactory, and tactile
• Experiences of control: feeling that you are under control of an alien force e.g. spirits
• Disordered thinking

Negative symptoms

• Affective flattening: reduction or absence of emotion shown through facial expression, voice, body language
• Alogia: language deficits due to slow or blocked thoughts; an inability or lack of willingness to speak
• Avolition: lack of goal orientated behaviour

• Reliability: the extent to which diagnosis of SZ is consistent
  Test-retest reliability: whether a doctor can make the same diagnosis of a patient twice
  Inter-rater reliability: whether two doctors can independently make the same diagnosis of a patient. Whaley found that concordence between two doctors was only 0.11
• Validity: are we correctly diagnosing SZ? Do we have a clear definition of SZ? Some may argue no because we have limited understanding of SZ for example we don't know why some people get lots of negative symptoms and why others get lots of positive ones. We also don't know if the subtypes that have been suggested exist or not. 
  Predictive validity: the ability to predict a successful treatment from the diagnosis. Heather says there is only 50% chance of correctly predicting a treatment from the diagnosis. This suggests the predictive validity is reasonably low as 50% of patients will not be predicted a successful treatment.
   

• Becker et al compared 2 psychiatrists and found that their inter-rater reliability diagnosing 154 patients and found their concordence was 54%. This suggests that the inter-rater reliability is higher than Whaley suggested. This could be because doctors are not very well trained in mental health as they focus mainly on physical illnesses. 
• However even with trained psychiatrists 46% of patients gained a different diagnosis from two psychiatrists. This can have serious implications as it could cause SZs to lose faith in the health care system's ability to understand their condition and to help them get better. They may feel as if they are beyond help which could lead to deaths as SZs have a high self harm and suicide rate.
• RLA - implications for improving reliability. Perhaps doctors should not diagnose mental health disorders, patients should be sent to psychiatrists for a diagnosis or else we should train our doctors more in mental health. Furthermore we are using two manuals: the DSM and the ICD, if we are using two different definitions of SZ no wonder reliability is so low. This suggests we should decide on one. 
• Rosenhan: suggests we can't tell the sane from the insane - very low validity - criteria isn't accurate enough to separate SZs from non-SZs. Implications include stigma and taking the wrong medication. 
• Keith et al - class bias diagnosing SZ 1.9% lower 0.9% middle 0.4% upper. Most doctors are middle/upper - maybe more reluctant to diagnose someone in same social class.

• Genetic component: SZ runs in families, the higher the degree of genetic relatedness the greater the risk. Gottesman 48% MZ 17% DZ. Kety prevelance of getting SZ was 10x higher amongst biological relatives than adoptive relatives of SZs. 
• Dopamine: a neurotransmitter. SZs thought to have abnormally low D2 receptors meaning more dopamine. Research has found amphetamines (dopamine agonists) can cause hallucinations and delusions. Antipsychotics (dopamine antagonists) have been found to reduce SZ symptoms. L-Dopa, a drug given to Parkinson's sufferers to increase their low levels of dopamine,often leads to SZ symptoms occuring.

• Concordance rates would be higher - must be environmental factors. Diathesis-stress model + combine with psychodynamic approach. 
• Hard to separate genetics from environment.
• Determinism: suggests you don't have the power to change or improve your condition. SZs may lose hope - implications
• Genain quads. But all had dreadful childhood and some were much worse than others.
• Davis et al - not all SZs have high dopamine levels, antipsychotics don't reduce symptoms in all SZs. Clozapine has little effect on dopamine but is often effective in treating SZ - suggests other chemicals may be involved. Newer research suggests abnormal glutamate levels could be associated with SZ. 
• Dopamine - cause or effect?

Caused by maladaptive thinking and cognitive deficits 

• Frith - SZs have problems with meta-representation (awareness of ourselves and and of others) which may lead to disordered thinking. Thought insertion: unable to tell whether they thought something or whether they heard it. Hearing voices: unable to distinguish between what othre people say and what they thought. They also have problems with central control (doing what you want vs doing what you should do) this can explain avolition and affective flattening. 
• Hemsely - SZs have problems with selective filtering meaning they can't filter out irrelevant sensory information. This leads to them not being able to decide what to attend to resulting in sensory overload, confusion, and delusions. 

• Research support - Liddle + Morris found SZs performed poorly on stroop tests - supports central control problems: doing what they want to (saying the word) vs what they should do (saying the colour). 
• Cause or effect? It is unclear which causes which and it would be difficult to research - longitudinal studies. It could be argued that these deficits are just the symptoms of SZ and so it doesn't really explain what causes them meaning it's not an explanation at all. Limited explanatory power - needs to be combined with another approach to be able to explain e.g. dopamine hypothesis. 
• Determinism: can't do anything about deficits - destined to live with SZ symptoms forever - but free will/treatment e.g. CBT. Implications - blames patient - suicide rates
• Drury et al - found CBT resulted in a reduction in positive symptoms and a reduction of 25-50% in recovery time. Cognitive approach lead to successful therapy but whoa treatment aetiology fallacy.
• Yellowlees - RLA - implications for treatment. Designed a programme which produces virtual hallucinations. The aim is to make SZs realise their hallucinations are not real.

AO1

• Parenting: Fromm-Reichman suggest a schizophrenogenic mother may be responsible: cold, controlling, tense family atmosphere
• Trauma: early traumas can cause disorders: Stead et al found that SZ was the most likely disorder to be linked with child abuse. Children may use their imagination as a means of escape which could get out of control and turn into hallucinations. 

AO2

• Schofield et al compared childhood experiences of SZs and non SZs. Found significant differences in the reported quality of parenting. The mothers of SZs were more likely to be overprotective and less affectionate. 
• However is this cause or effect?
• Unethical to blame the parent
• Not all SZs have experienced trauma - limited explanatory power need to be combined with another approach. 

• Drug therapy: 
  1. Conventional antipsychotics: developped in the 1950s dopamine antagonist - blocks dopamine receptors, reducing the effect of dopamine on thoughts, behaviour, + emotions.
  2. Atypical antipsychotics: developped in the 1990s also known as 2nd generation anti-psychotics. Targets dopamine but also other chemicals such as serotonin and noradrenaline they reduce negative symptoms
  3. Clozapine: frequently used in treating SZ. They reduce positive symptoms
• ECT: used in last resort cases when other therapies have failed. Works by sending an electric shock through the brain which causes a seizure. This is thought to reactivate brain connections and cause a surge of neurotransmitters. Maximum 12 treatments

• 25% of patients do not find drugs effective. Davis et al - not all SZs have high dopamine levels and antipsychotics do not reduce symptoms in all SZs. Clozapine has little effect on dopamine but is often effective. Newer research suggests there is a link between abnormal glutamate levels and SZ. 
• Side effects - Conventional: permenant tardive dyskenesia. Atypical: weight gain. ECT: short-term memory loss, permenant memory problems, paranoia, depression. Appropriate? Cost-benefit analysis. Leiberman found 74% of patients discontinued drug treatment due to intolerable side effects. 
• Treats the symptoms not the cause - not a cure. May cause patients to stop looking for the cause or for environmental triggers/stressors which may make their condition worse. Combination of other psychological therapies such as social skills training may help tackle some of the underlying causes as well as reduce the symptoms from a biological point of view.
• Baker et al found that SZs were not good at remembering to take their drugs at the right time or the right amount in a virtual simulator - they checked the clock much less than non-SZs. Are drugs appropriate? Taking wrong amount/time could have negative consequences. 
• Effectiveness research support - Schooler found that 75% patients experienced 20% symptom reduction which proves it is effective for the majority of SZs but it only gives slight symptom relief. This suggests SZ is not completely biological and therefore a biological therapy alone will not cure it.
• Fisk - ECT 60-80% effective but only certain types of SZ. Sham ECT works well placebo?

• Family intervention: aims to reduce amount of negative expressed emotions, reduce feelings of hostility, maintain realistic expectation for patient performance, reduce burden of care for family, and enhance family's ability to anticipate and solve problems
• Social skills training: SZs often have problems with social skills this therapy teaches them intersocial skills that help them avoid stress and manage their lives more effectively. 

• Gottdeiner found 66% of patients improved after therapy compared to only 33% who improved without it. Effective
• However these studies all use participants on drugs at the same time so we can't separate effects of therapy from the effects of drugs. How much is due to which treatment? These therapies may not be as effective without drugs. It would be unethical to ask SZs to stop taking drugs to investigate so we'll never know!
• These therapies are not free, unlike CBT, which may put people off taking them. Many people may not be able to pay for them as if their SZ is severe they may not be in employement. People paying for therapy may have high expectations and may give up quickly if they do not feel it is worth the money meaning they may miss out on long term therapy benefits. 
• Karon + Vandon Boss suggest that these therapies may reduce the cost of SZ in the long run. Patients are less likely to be hospitalised and need to pay for in-patient care and they are more likely to recover to a point where they can gain employment. Therefore the benefits may outweigh the costs of paying and may end up saving patients money. 

AO1

• CBT: works on the basis that abnormality is caused by repetition of maladaptive thoughts.
  change faulty thinking
  challenging thoughts with facts and information e.g. that man
  teaching distractions from intrusive thoughts
  increasing social activity (to combat avolition)
  relaxation strategies to cope with stressors/triggers 

AO2

• Drury et al - found that CBT resulted in a reduction in positive symptoms and a reduction of 25-50% in recovery time. Effective
• Kingdon + Kirschen say that CBT is not suitable for all SZs as they won't engage fully with the therapist - maybe because they are skeptical, because it takes effort, or because you have to open up.