schizophrenia

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Schizophrenia
Spit mind, effects thought processes, effects everyone differently - people can have various amount of episodes, and some can or cannot be controlled by medicine
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Two types
chronic and acute
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Chronic
Negative symptoms e.g. epathy
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Acute
Positive symptoms e.g. thought disorders
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Two types of symptoms
Positive and negative
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Possitive
excess or distortion of normal functioning e.g. hallucinations, dellusions
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Negative
lessening or loss of normal functioning - apathy, paucity of speech
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ISSUES WITH DIAGNOSIS
.
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DSM IV
used in america and some of europe, sypmtoms must be present for six months, five subtypes - Paranoid, Catatonic, Disorganised, Residual and Undifferentiated
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ICD 10
created by a roup of representatives from aroud the world, symptoms can be present for 1 month, 7 subtypes the 5 the same as DSM + simple and Post - Schizophrenic
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+ and - of DSM IV
- culture bias, cultures accept various behaviours diferently.
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+ and - of ICD 10
+ less culturaly bias + quicker diagnosis - some sympotms could be short term due to stress or trauma = false diagnosis + more accurate diagnosis
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RELIABILITY
tested via (test - retest or inter - rater testing)
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Studies
Beck, Soderberg and Jakobsen
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reliability - Beck
- 1962 - 54% concordance rate between practitioners when assessing 153 patients
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reliabilty - Soderberg
2005 - DSM IV - diagnosed patients and found a 81% concordance rate
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eval point of these two
+ diagnosis has improved over time
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reliabilty - Jakobsen
100 Danish patients with a history of psychosis - test reliability of the ICD 10 and found a concordance rate of 98% - high reliability compared with the 81 % of the DSM IV found by soderberg
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Eval of Jakobsen
suggesting the DSM IV is the inferior manual, small sample size , one culture - unable to generalise , multicultural study would have removed the bias
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Eval of reliability
+ have a common language so they can share research and ideas and can better their understanding + constant update = more reliable = better diagnosis
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VAIDITY
predictive, descriptive or aetiological - allows us to see how acurate data is
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Studies
Hollis, Heather and Bentall
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Validity - Hollis
DSM - 93 patients notes with early onset schizophrenia - they found a high stability in the diagnoses + suggesting a valid diagnosis
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Validity - Heather
found very few cases of mental disorders are known - only a 50% chance of predicting what tratment a patient will recieve based on diagnosis - has low predictive validity do we know that diagnosis isn't valid
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Validity - Bentall
- study in different areas - found rural and urban differences in diagnosis methods
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Eval of the study
- suggests a cultural difference in diagnosis of schiz, take into account in diagnosis - diagnosis establishes that the sufferer has i but not the cure or tell us about the cause - prevalance rates of diagnosis differ from rural to urban areas
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Implications with diagnosis
- Labelling os schiz has bad stigma - NHS, limited time and resources for each hospital, may only diagnose extreme cases - language barriers, if the psychologist doesn't speak the same language as the patent a wrong diagnosis could be given
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Implications with diagnosis cont.
- organic ploblem like brain tumors could produce schz like symptoms leading to false diagnosis
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BIOLOGICAL EXPLANATIONS
Genetics, Biochemical
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Genetics
passed down in the family via genes , study's - mz twins used = identical genes. Gene mapping - suggests several genes are involved in having vulnerability
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studies
cardno, Gottesman and Parmas
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Cardno
concord rates for schiz, MZ = 26.5% adn DZ = 0%
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Eval for Cardno
This supports the genetic theory - suggests genes can make someone more vulnerable - twins = minority of population = unable to generalise - only 26.5% so must be other factors
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Gottesman
controlled genes, risk of development = proportional to amount of genes shared with a relative - MZ = 48% , DZ = 17 , general chance of 1%
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Eval for Gottesman
+ suggests genes are an affecting factor to vulnerability - wasnt 100% + 1% generaly so there must be other factors
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Parmas
- longitudinal study on children w/ mothers with schiz - 16% concordance rate found
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Eval for Parmas
- genetics can lead to vulnerability -
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Biochemical
- Neurotransmitters + Hormones can lead to development of of schiz - increased number of D - 2 receptors on recieving neurons = increased dopamine minding and more neurons fired. - Higher dopamine = schiz
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Studies
Synder, Wong, Randrap and Munkvad and Drug therapies
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Synder
found - too much dopmine = developmen of schiz - if the have more D - 2 then more dopamine is produced + suggests a link between dopamine and schiz
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Wong
Pet scans, Schiz = double the density of dopamine receptor sites + objective measurements - may be other factors involved
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Randrap and Munkvad
rats - given amphetamines that raised dopamine levels, rats showed schiz behaviours, reversed by neuroleptic drugd that inhibit the release of dopamine
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Eval of Randrap and Munkvad
+ suggests that must have an effect on schiz - rats - x extrapolate and unethical
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Drug therapies
+ been proven to reduce symptoms + we can use dopamine reducing drugs to reduce the symptoms - doen't work for everyone - good for short term but doen't get to the root of the problem
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Eval of biological
- Other therapies - CBT that work - use theories together as its a huge illness that effects evryone diferently - deterministic - behaviours are predictable when they arent - also removes free will and gives them the stigma before diagnosis
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PSYCHOLOGICAL EXPLANATION
Cognitive, Psychodynamic
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Cognitve
Faulty thought processes, unable to filter incoming information and struggle to interpret the information
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Frith
schizo are unable to distinguish between internal and external forces, making is misinterpreted as significant can cause dellusions and hallusinations
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Studies
Frith, Bentall, Liddle and Morris
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Frith
- Changes in cerebral blood flow in the brains of people with schiz whilst the were doing cognitive tasks . suggests they were unable to consentrate, supporting friths research + objective measurements - may have shown researcher bias
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Bentall
Schiz cannot tell the difference between internal and external and ones they haddn't seen + supports the explanation as they were unable to tell the difference
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Liddle and Bentall
Schiz perform poorly on the stroop test , they were distracted by the irrelivant stimuli + supporting the cognitive approach
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evaluation of cognitive
- no universal support ( cant generalise to other countries) + usefull therapies
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PSYCHODYNAMIC
Schiz have regressed to a primary narcissism, lack of the ego means they cannot experience reality, have increased sexual and aggressive urges, caused by a stressful home environment or a truamatic childhood experience
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Studies
Fromme - reichman, Hemmersley and Read
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Fromme - reichman
role of a schizophrenogenic mother who would be cold and controlling towards the child this would create a tense and uncomfortable environment and this would lead to a schiz child + supports the explatnion stress from the situation = schiz
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Hemmersley
Hallucinations are linked to childhood abuse. + this suggests how big of an impact the childhood truma can have on latter development
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Read
reviewed studies of schiz and found a link between sexual abuse in childhood and later development of schiz + gives support to the Psychodynamic explanation
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evalution of the Psychodynamic explanation
- senstive subject - not all childhood traumas are reported + application of giving therapy after these traumatising events to prevent schiz
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OVERALL EVALUATION OF PSYCHOLOGICAL EXPLANATIONS
- Little empirical data from subjective analysis of case studies - isnt reliable data - individual differences many people have faulty thought processes but aren't schiz - many schiz have had no childhood traumas
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OVERALL EVALUATION OF PSYCHOLOGICAL EXPLANATIONS cont.
- reductionist- other explanations - deterministic - removes free will - pract app - therapies
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BIOLOGICAL TREATMENTS FOR SCHIZOPHRENIA
- Antipsychotics, ECT
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Antipsychotics
- Tablet, Injection or Syrup - eleviate symptoms of schiz
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The two types of Drugs
First gen (typical) and Second gen (atypical)
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First gen
- Chlorpomazine - stop dopamine production by blocking receptors in the synapses that absorb dopamine - relieve any positive symptoms e.g. hallucinations
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Second gen
- Clozapine reduce serotonin and dopamin levels - relieve any negative symptoms e.g. flattening of emotion
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Eval point
Work differently on different people, some will only need 1 dose whereas others ma need to take regular doses or it may not work at all
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Studies
Davis, Kahn and Liberman
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Davis
meta - analysis of 100 studies that compaired antipsychotics and placebos - 75% with antipsychotics improved after 6 weeks - less than 25% who improved on the placebo
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Davis eval
- suggests a medical benifit of drug treatments - placebos - show there that positive thinking may help to relieve symptoms as well, cognitive may impact as well - use a mixtuire of therapies
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Kahn
- compare first and second generation drugs and found that they are both effective for at least a year but after that second gen isnt neccesserily better than first gen.
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Liberman
-1,432 chronic schizophrenics - 74% discontinued the treatment within 18 months due to the severity of side effects - First = musculer disorders, Second = weight gain and metabolic effects
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Eval of Liberman
- suggests that drugs may not be safe - Large sample size
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EVALUATION OF DRUGS
- Effective therapy, cheap and easy to administer - patients can live a relatively normal life as opposed to many therapy sesions - stop medication = symptoms return( higfh relapse rate) - drug dependancy
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EVALUATION OF DRUGS
- side effects - weight gain - immune system failure and death - all drugs initialy tested on animals first = unethical
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ECT
- electric shocks to induce epileptic fit - remove syptoms as the two disorders cannot occur at the same time - best bilaterally - muscle relaxants and anasthetics are given every tim to reduce pain and injury
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Studies
Tharyan and adams, Fish
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Tharayan and Adams
ECT not allways effective in long term treatment plans - 26 studies found it was fairly effective in short term only, not as effective as drugs
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Fish
60 - 80% concordance rate but it was only effective on certain types of schiz and more treatments are needed - need lots of treatments so is more expensive and time consuming
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Evaluation of ECT
- high relapse rate means not effective as long term for everyone + no more of a risk than a minor operation under general anaessthetics
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OVERALL EVALUATION
- reductionist - ignores other factors - severe symptoms - doesnt get to the root of the problem
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Acute

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