It is a split in the psche;
Disorganised thought processes
Split between intellect and emotion
Split between intellect and external reality.
Positive and negative symptoms- Andreasen et al
Lack of communication and emotional expression
Problems with diagnosing pos and neg symptoms
No universal agreement
The term 'Schiziophrenia' can be misleading.
Primary and Secondary impairments- Wing
Types of Schizophrenia
Only delusions and hallucinations
Only immobility, mutisim, echolia, grimacing etc
Only disorganised speech/behaviour and flat effect
Criteria not met for other types
Absence of delusions, hallucinations, disorganised speech and catonic behaviour.
Genetic explanation (1)
Gottesman and Shields
Relative Percentage of lifetime expectancy
Sibling with one parent with S 12.9%
Children with two parents with S 46.3%
Genetic explanation (2)
Gottesman and Shields
Concordance rate of MZ 46% and DZ 14%
47 mothers with S whose children were adopted within days by Psychiatrically well mothers. Found the incidence of S in the adopted children to be 16%.
Twin studies contain small samples
Family and Twin studies need to consider enviorment more
46% concordance rate suggests genotype is a major contribution
Findings show inheritence may play a huge part.
Main idea: Those with S have excessive dopamine activity in the brain. (The Dopamine Hypothesis).
Seeman et al
Using PET scans, found six times the density of D4 receptors in the brains of people with Schiziophrenia.
Problems of cause and effect
Not clear how nerotransmitters interact
Neuroimaging studies by Pearlson et al were carried out on patients not exposed to neuroleptic drugs which rules out problem of cause and effect
Structure of brain can be effected in those with Schiziophrenia.
Jerangon et al
Found significant cell loss in patients with S
Nasrallah et al
Gender differences in the thickening of these fibres are reversed in patients with S
Brain imaging studies
Raz and Raz
Significant increase in size over half the samples and on overall effect size of 0.6 in vectricular volume. This is a significant effect and can be linked to major functional abnormalties.
Suddath et al
Aim: To investigate twin pairs for structural abnormalities that could account for S in one of each pair.
Method: 15 MZ twin pairs- one of each pair had S. Given MRI scans.
Results: Co-twin with S had a smaller bilateral hippo-campus and larger ventricles than twin without S in 14 out of 15 pairs.
Conclusion: When genotype is controlled- significant diminished brain volume in twin with S.
Evaluation: Difficult to establish cause and effect.
Issue of cause and effect
Doesn't consider environmental contributions
Lewis- Attempts to link structural changes have not shown consistent findings.
Good evidence from Jerangon et al, Nasrallah et al and Raz and Raz.
Sociocultural explanations- Labelling
Labelling is the medicalisation of madness and using medical forms such as 'illness' and 'treatment' is a form of control that robs the indvidual of their liberity.
Self fullfilling prophecy- this occurs when a S patient is labelled
Rosenhan's key study
8 patients told to show symptom of S and 7 diagnosed as S (1 as suffering from a mood disorder) and put into an insitution. Could not leave until weeks later when in fact all were psychologically well.
Led to changes in the diagnostic system but had many ethical issues.
Does not explain cause of S
Ignores genetic evidence
Criticised for trivalising a very serious disorder.
Rosenhans study lead to changes in the diagnostic criteria- improved the reliablity of this diagnostic system.
Sociocultural explanations- Family Dsyfunction
Double bind (Bateson et al)- This is when a parent says one thing but their body language says another.
Family socialisation theory (Lidz et al)-
Schismatic families- Conflicts result in competition for affection of family members.
Skewed families- One partner is subsmissive and the other dominant. Children are encouraged to follow the dominant partner. This impairs cognitive and social development.
Difficult to prove a causal relationship
Not possible to untangle cause and effect
Sociocultural explanations- Expressed Emotion
Brown et al- People with S who were discharged from hospital and returned to parents/spouses fared worse than those returning to lodgings.
High levels of face to face contact were found to increase the risk of relapse. This was attributed to high emotional over-involvement and included hostility, critical comments (tone/content) and negative/positive emotion. Patients more likely to relapse if EE is high.
Bebbington and Kuipers
52% of families were high in EE. The relapse rate for thes families was 50% where as for low EE families it was at 21%.
Issue of cause and effect
Problem with how EE is measured
Ability to predict relapse rate of people with Schiziophrenia from the EE is measure is good
Increase or decrease synaptic activity
eg. Chlorpromazine reduces postive symptoms of S by reducing dopamine levels
Clozapine found to be effective for 80-85% of S sufferers. Able to treat negative symptoms and has fewer side effects.
Cole et al
344 patients from 9 different hospitals into two groups. One group given drug treatment and other placebo. 75% from drug group improved compared to 25% in placebo group.
Many bad side effects
No evidence for older neuroleptic drugs being effective for negative symptoms
Newer drugs eg. Risperidone do not lead to distressing side effects
Neuroleptics have become popular as biomonthly injections which help to prevent relapse.
Cognitive Behavioural treatments-
Focused on delusions and hallucinations.
Investigated coping strategies during psychotic episodes... 25 patients with S were interviewed. In their psychotic episodes.. 1/3 reported 'triggers' to their symptoms eg. feeling anxious and 75% reported major distress. 1/3 also reported disruption to their thinking and behaviour. 75% disclosed the use of coping strategies eg. distraction, positive self talk and relaxation. These coping strategies helped the indviduals to cope with their symptoms..
Therefore CSE (Coping Strategy Enchancement) was introduced.. it taught indviduals to use coping strategies to reduce the intensity/ frequencey of psychotic symptoms.
Asses content, asses emotional response, asses person's thoughts, prior warning and then asses the indviduals coping strategies. The indvidual then rates each strategy on effectiveness.
Tarrier's study had a high drop out rate
Intensive therapy; not suitable for all
Tarriers study good evidence and showed that CSE can be effective
Can be very effective if individual cooperates.
Treatments- Psychotherapy/Cognitive therapy
Relies on talking/listening
Includes cognitive and Psychodynamic therapies..
Start with least important belief and work with evidence for that belief. Thoughts put through 'reality testing'.
Aim: You verbally challenge that belief, which causes a reducation in conviction and then is put through reality testing.
Chadwick et al-
Nigel believed he could predict what people could say before they said it- put through reality testing using video tapes. He could not predict what the person on the video tape said before they said it- concluded that he did not have this power.
Not always suitable for all
Faster response to treatment than drugs (Drury et al)
Research trials show a 40% reduction rate in Psychotic symptoms (Kuipers et al)
Role of community care
Community care is resdential care, home care etc...
Stein and Test
Group of 65 people. One group receiving inpatient care plus aftercare. One other receiving training in 'community living'. During the first 12 months= 58 of control group readmitted to hospital while only 12 of 'community living' were readmitted.
Community care vs. Institutionalization
Better alternative to institutionalization as it can be more effective
Helps person adapt to life More ethical
Makes patient feel part of society
High staff turnover- hard for relationship to develop between patient and carer
High cost- very underfunded
Stable routine Protects community from harm
Better funded Can cause relapse/symptoms to occur
Withdrawal symptoms/ become dependent on drugs