Schizophrenia – Treby‘Schizophrenia is characterised byPsychosis – a loss of contact withreality’
Clinical Characteristics ofSchizophrenia:• Prevalence = 1% of the population(prevalence = The percentage of a populationthat is affected with a particular disease at agiven time.)Broken down into Positive Symptoms (Type I)and Negative Symptoms (Type II)
Symptoms:Positive Symptoms:Where something is added toyour personality.e.g.• Delusions – beliefs thatseem real, but aren’t.• Feeling they’re controlledby something.• Hallucinations – eitherauditory or visual.• Disordered thinking – theidea that thoughts havebeen inserted into yourmind.Negative Symptoms:Where something is removedfrom your personality.e.g.• Affective flattening – lack ofemotion.• Alogia – poverty of speech.• Avolition – having no driveto do anything.
First Rank Symptoms – Schneider 1959Schneider believed that first rank symptoms(Type I) such as:Delusions, feeling controlled by someone else,and hallucinationsWere only associated with schizophrenia.(However, these symptoms have also beenlinked with depression and bipolar.)SYNOPTICITY! Randy Gardener (1964) also experiencedType 1 symptoms, from sleep deprivation.
Different types of schizophrenia:1. Paranoid – Delusions &hallucinations2. Catatonic – unusual motoractivity, extreme negativism,peculiar posturing. V. Rare.3. Hebephrenic (ICD) orDisorganised (DSM) early age,disorganised speech, flataffect, some hallucinations &delusions.4. Undifferentiated –Schizophrenic symptoms thatdon’t neatly fit a diagnosis.5. Residual – At least oneepisode of schizophreniaexperienced in the past. Butno longer exhibiting signs ofthe disorder.The ICD-10 alsocontains 2 othersubtypes:Post-schizophrenicdepression (adepressive episodeafter a schizophrenicillness.Simpleschizophrenia(progressivedevelopment ofnegative symptoms,with no history ofpsychosis)
Classifying Mental Health Disorders:Diagnostic and Statistical Manual (DSM):• Published in America• English only• Predominantly used in the UK• Classifies 5 sub-types ofschizophrenia• Looks after 6 months of symptoms• Used by professionalse.g. psychiatrists, psychologists, socialworkers.• Contains mental health statistics• Multi-axial approach – as it notesthat mental illness rarely existswithout the influence of other factorsin an individuals life:Such as…1. Clinical syndromes2. Personality disorders3. Physical conditions4. Severity of psychosocial factors5. Highest level of functioningInternational Classification of Diseasesand related health problems (ICD):• Published by the WHO• International – multiple languages• Collection of health statistics• Classifies 7 sub-types ofschizophrenia• Looks after 1 month of symptoms• Mainly for disease – only chapter 5 isfor mental health• Does NOT look at social factors• 10 categories of mental disorders areidentified• Looks mainly at positive symptoms
Evaluating classificationsystems:Beck (1967) – RELIABILITYFour psychiatrists used the DSM to diagnose 153 patients.Each patient was interviewed separately with 2psychologists.There was 54% agreement on diagnoses of schizophrenia,even less agreement on sub-types.• Small sample, not necessarily representative. (though,mental health is not that prevalent)• People must be trained to understand DSM• Subjective• Lacks inter-rater reliability
Evaluating classificationsystems:Cooper et al (1972) – CULTURAL RELATIVISMWhen patients (with identical symptoms) presentedthemselves. Schizophrenia was TWICE as likely to bediagnosed by New Yorker psychiatrists using theDSM than Londoner psychiatrists using the ICD.The opposite was true of depression.• Unreliable• Cultural relativism – NY & L diagnose differently• Subjective
Evaluating classificationsystems:Temperline (1970) – VALIDITYInterview with an actor was recorded. 7 groupswere asked to assess his mental health.Groups consisted of professionals: e.g.psychiatrists, psychologists and law students.5/7 groups heard that the man beinginterviewed was interesting as he looks neurotic,but is actually psychotic. The 6th group heardnothing, and the 7th group heard he was healthy.
Temperline – continued!With those that heard he was neurotic, a majorityof them said that he was neuroticAnd there was further disagreement amongstprofessionalsGroup that heard he was mentally healthy: 100%said healthyThis shows that the DSM and ICD may lack validityas some diagnoses may already be formed fromexisting preconceptions rather than using themanuals themselves
Temperline – evaluation:• People look at the labels rather their ownopinion• Groups are all from different backgrounds(extraneous variable)• Individual differences amongst professionals –subjective
Evaluating classificationsystems:Rosenhan (1973) – LABELLINGEight people with no history of mental illness rocked up at a psychiatrichospital; claiming to be hearing voices in their head.Other than this, they answered further questions as mentally healthyindividuals.They were all admitted, once in, they acted completely normally.Staff reported normal behaviour as if it were abnormal.One patient kept notes in a diary. This was described as ‘excessive notetaking’.After, Rosenhan told a hospital about the study, and warned there would bemore pseudo-patients. He never sent any. But staff recorded that 43 of the 93admitted patients were pseudo-patients.• Ethical Issues – sending healthy people to a place for mentally ill• Self fulfilling prophecy could have caused these people to get ill• ‘labelling’ caused the nurses to act differently, which could cause long-term damage where people may be unable to get a job• Shows diagnosis should be more rigorous
Biological:Nature: genetics, brain damage, biochemistry,infectionThey differ from your nurture i.e. peers,upbringing, culture, friends, environment
Biological – Genetics:
Definitions!Word DefinitionSchizophrenia Psychosis… Loss of contact with realityMonozygotic twin (MZ) Identical twin (same genetics)Dizygotic twin (DZ) Non-identical (different genetics)Concordance rate Likelihood of one twin getting sameillness as the other twinTwin studies Studies involving twins, if they’re MZ thenthey have same genes, so we can see ifthey were influenced by nature (genes) ornurture (upbringing)Adoption studies Studies involving adopted children to seewhether or not they have same geneticdisorders as their real parents to see ifillnesses are inherited
Twin study - Cardnoet al (2002):• Diagnosed schizophrenia in twins• Used ‘Maudsley Twin Register’ to getstrict diagnosis• Showed 26.5% concordance rates inMZ twins• 0% concordance rates in DZ twinsThis shows that it is your genetics(nature) that affects schizophreniarather than your environment(nurture).
Evaluation – Cardnoet al (2002):• MZ twins are relatively rare, out of all,schizophrenia only has a prevalence of 1%...Always will be small sample size.
Adoption study – Kety (1994):• High rates of schizophrenia inindividuals who’s parents hadschizophrenia, but had been adoptedby psychologically healthy parents.Shows that genetics are moreimportant than your environment.Supports Cardnoet al (2002)
Adoption study -Tienari (1991):(in the Finnish Adoption Study)• Matched groups, each with 155 adopted kids• Group one = schizophrenic mother’s (10%developed schizophrenia)• Group two = psychologically healthy mother’s(1% developed schizophrenia)
Strengths & weaknesses (A02):Strengths WeaknessesTwin Studies: MZ have same geneticmakeup, so you can testNature vs NurtureObjective (quant data)Twins are rareDifferent criteria fordifferent twin studies (so,Cardno used Maudsley, butother people use others)Concordance ratesmeasured differently =subjectiveAdoption Studies: Nature vs nurtureObjective (quant data)Bigger sample sizespossible than twin = moregeneralisableIndividual differences (lifeevents)Extraneous variables e.g.life events…
Biological – Biochemistry:
Dopamine Hypothesis:The dopamine hypothesis suggeststhat messages from neurons thattransmit dopamine fire either toooften, or too regularly. Is is thoughtthat schizophrenics have highnumbers of the D2 receptors onthe receiving neurons, thereforemore dopamine binds to the cell.Comer (2003):Dopamine plays arole in attention. Disturbances maylead to problems with focussing,and the perception problems foundin schizophrenia.
Supports hypothesis –Grilly (2002):Parkinson’s disease:- Degenerative neurological condition- Low levels of dopamine- Prescribed ‘L-Dopa’ to raise dopamine in brain- Some individuals went on to developschizophrenic-type symptomsEthical issues – protection from harm
Supports hypothesis – Anti-psychoticdrugs:• Anti-psychotic drugs block activity ofdopamine in brain• By doing so, schizophrenic symptoms (e.g.hallucinations and delusions) are alleviates• They are known as dopamine antagonists
Supports hypothesis – Amphetamines(like speed):• Drugs that act as dopamine agonists• Means that synapses get flooded withdopamine• Large doses can cause hallucinations anddelusions (characteristics of schizophrenia)Hard to test – ethical issues – protection fromharm and … Drugs are illegal’n’ting
Supports hypothesis and contradictshypothesis – PET Scans:• Wong et al (1986) used PET Scans and founddopamine activity was greater inschizophrenics compared to a control• However, Copolov and Crook (2000) have notfound evidence of altered dopamine activity inschizophrenic’s brains.
Dopamine hypothesis – evaluation:• Objective – Quantitativedata, scientific• PET Scans (Wong et al1986)• Hormonal• Reliable• Deterministic – noblame • Reductionist – noconsideration for socialevents, may ignoreactual cause• Nature vs Nurture –NATURE, good as noblame. BUT, could leadto passive patients
Freud (1924):• Believed schizophrenia was a result of TWOprocesses:1) Regression to a pre-ego state2) Attempts to re-establish ego control
Freud (1924):Freud believed that schizophrenia came from:- Parents being cold/uncaring- Causing child to regress back into infantile state- Where the ego is not yet properly formed- Symptoms include: Delusions of grandeur(believing you can fly etc)- But also, auditory hallucinations could be seen asan individual’s attempt to re-establish ego control
Supporting Freud – Fromm-Reichmann(1948):• Overprotective, rejecting, dominant, andmoralistic mothers can contribute to childrendeveloping schizophrenia• Supports Freud in that the condition stemsfrom childhood
Supports Freud – Bateson et al (1956):• Children who get mixed-messagesfrom their parents are more likelyto develop schizophrenia• For example, if a mother was to tellher child she loved them, but lookaway in disgust if the child didsomething wrong. = mixedmessages• Prolonged exposure disrupts achild’s internally coherentconstruction of reality (perceptionof reality)DOUBLE-BIND THEORY
Argues Freud – Oltmannset al (1991):• Parents act differently once theirchild has been labelled asschizophrenic• Not prior to• Therefore it is not parentalinfluence and it argues Freud• (SYNOPTIC: kinda like in Rosenhan’s1973 pseudo-patients study as thenurses reacted to them differentlyonce they had been labelled)
Psychodynamic approach AO2:• Supporting research –Fromm-Reichmann(1948) (use other two inAO1)• Considers socialinfluences such asupbringing• Individual differences• Subjective• Simplistic – biology notconsidered
Cognitive for schizophrenia:
Cognitive:• Cognitive approach looks at biological factorsfor schizophrenia, says Type I/positivesymptoms come from biology• But further symptoms stem from peopletrying to make sense of their symptoms• They reject feedback from others and believethat their beliefs are manipulated by others
Cognitive – Frith (1979):• Argues schizophreniacomes from faulty attentionsystems• with an inability to filter outunnecessary info that theyhave gathered throughtheir senses• This leads to illusion ofdistorted thoughtsDoes not consider individualdifferences
Cognitive – Bentall (1994):• Schizophrenics have trouble with processinginformation• Shown in Stroop tests: Colour words (red and green)are substituted for emotional words (death andlaughter),• Schizophrenics take longer than non-schizophrenics toname the words.• Automatic subconscious processing – may account forpositive symptomsStroop tests may be unreliableIndividual differences
What have we learnt thus far…?• Cognitive psychology is concerned withthought processes such as memory andattention.• The cognitive approach to psychologyrecognises that biological factors contribute tothe positive symptoms of schizophrenia. Othersymptoms, such as negative symptomsdevelop from the individual attempting tomake sense of an experience.
More stuff we’ve learnt…• People provide information they need tomaintain a grasp on reality and if this does nothappen, psychosis may occur (loss of contactwith reality) and people may becomeparanoid they are being controlled bysomeone else.• A faulty attention system is blame as thereason for schizophrenia (Frith, 1979) as theycan not filter out unnecessary informationwhich leads to problems with attention.
Even more…• This is shown further by Bentall (1994) whoused the Stroop test to show problems withhow people with schizophrenia processinformation, showing disruption with theprocessing of emotional words.
Supports cognitive – Meyer-Lindenberget al (2002):• Excessive dopamine in the prefrontal cortex has directimpact on the working memory.• Where the schizophrenia stems from a disbelief inothers(Synoptic – links to dopamine hypothesis)Objective (hormones)
Supports cognitive – Yellowleeseet al(2002):• Developed a virtual hallucination machine• E.g. hearing a TV telling you to kill yourself• These were shown to schizophrenics to showtheir own hallucinations were unreal &irrationalEthical issues – protection from harm
Argues Cognitive – McKenna (1994):• Schizophrenics aren’t more easily distractedthan non-schizophrenics in cognitive tasksHistorical validityLab study may affect resultsDistraction = subjective
Cognitive AO2:• Yellowleeseet al (2002)• Free will• Application to real life:treatments• More holistic – approachbelieves that positivesymptoms have abiological influence• McKenna (1994)• Individual differences
Treatment of schizophrenia:
Antipsychotic drugs:• Chemotherapy (chemical treatments) used totreat symptoms of psychotic disorders such asschizophrenia and manic depression• Two types of antipsychotic drugs:Conventional and atypical…
Antipsychotic drugs:Conventional:• E.g. ChlorPROmazine (pro –treats positive symptoms)• Such as hallucinations anddelusions• Reduces the effects ofdopamine by blockingreceptors• Dopamine antagonists• Side effectsAtypical antipsychotic drugs:• E.g. Clozapine• Works on both positive andnegative symptoms(depression & apathy)• Acts on dopamine & serotoninreceptors• Side effects include tardivedyskinesia (involuntarymovement of mouth andtongue)• Less side effects
Effectiveness and appropriateness ofconventional and atypical drugs:Conventional:• Luft B (2006) Found thatconventional drugs are associatedwith sudden death whereasatypicals are not• Hill (1986) found that 30% ofpeople taking conventionaldevelop Tardive Dyskinesia• Ross and Read (2004) –Motivational deficits, such aslabelling, reinforcing ‘something’swrong with you’ which isunethicalAtypical:• Leuchtet al (1999) - Meta-analysis showed that atypicalare only a little better.• Jesteet al (1999) - Sideeffects. Less chance ofTardiveDyskinesia (5% of people)• Davis et al (1980) – Relapse.Placebo = 55% relapsedAtypicals = 2-22% relapsedIndividual differences etc etc
Antipsychotic drugs AO2• Biological• Objective• Real life application• Deterministic• Reductionist –individual differences
Psychological therapies forschizophrenia:
Psychoanalysis:• Getting to your subconscious to see if your childhoodaffected you – usually associated with Freud’spsychodynamic approach• Freud believed that this approach would not work asschizophrenics are unable to form a transference with theanalyst• This is when the emotions of a patient are unconsciouslyshifted onto the analystSubjectiveCheapQuickCan combine with medicine
Appropriateness of psychoanalysis –Gottdiener (2000):• Meta-analysis of 37 studies• Covering 2642 patients• 66% of them improved aftertreatment usingpsychotherapy/psyschoanalysis
Effectiveness of psychoanalysis:Malmbergand Fenton (2001)• It is impossible to draw adefinite conclusion for oragainst the effectiveness ofpsychoanalysis.• In fact the schizophreniapatient outcome researchteam (PORT) has even arguedthat psychoanalysis may beharmful to schizophrenics
Effectiveness of psychoanalysis:• Therapists areexpensive• Patients often treatedover a long time• Prevents it beingadopted on a largescale• Costly & timeconsuming
Cognitive behavioural therapy:• Caused by faulty thinking. Trying tofind root of the problem to proveirrational thoughts are irrational• Look at alternative explanations formaladaptive beliefs• Treats symptoms rather than causeFocuses on ‘negative behaviours’which are also deemed the ‘safestbehaviours’• People need to be trained to do it
Appropriateness of CBT - Kingdon andKirschen (2006):• 142 patients were tested,and found that manypatients were not suitablefor CBT as they would notfully engage with it.• In general, it was lesseffective on older folk thanyounger ones
Effectiveness of CBT: Gould et al(2001):• Meta-analysis of 7 studies• Reported that there was astatistically significantdecrease in the positivesymptoms ofschizophrenia aftertreatment7 studiespositivesymptoms
Evaluation for psychological therapiesof schizophrenia – AO2:• Comment on effectiveness andappropriateness for each• Can be used along side drugtherapies• Comment on effectiveness andappropriateness for each• Simplistic – only treatingthoughts even though cognitivetheory suggests that positivesymptoms derive from biologicalinfluences• People have to be trained to doCBT and psychoanalysis which isexpensive, time consuming• Individual differences – somepeople might not respond as wellto drug treatment as others
Key words:Word DefinitionPsychosis Loss of contact with realityPositive symptoms Added to personality e.g. delusions andhallucinationsNegative symptoms Something removed from yourpersonality, such as alogia = loss ofspeechBiochemistry Hormones and neurotransmittersChemotherapy Treatments based on chemicalsSerotonin A neurotransmitter, low levels of this havebeen linked to depressionDopamine A neurotransmitter, high levels have beenlinked to schizophrenia in the dopaminehypothesis
MOAAARR definitions!Word DefinitionDopamine antagonist Chemical which inhibits effect ofdopaminePlacebo ‘fake’ version of a drug which testswhether the drug has biological impactsRelapse When you lose your symptoms ofabnormality, but then they come backNeurotransmitter Chemicals that transmit impulses across asynapse causing a change in behaviour