Schizophrenia is characterized by psychosis, or a loss of contact with reality. It has a prevalence of 1% of the population and is classified into positive and negative symptoms. Positive symptoms include delusions and hallucinations, while negative symptoms involve a reduction in emotions and behaviors. Biological factors like genetics and dopamine levels are thought to contribute to schizophrenia. Treatment involves atypical antipsychotic drugs which target both positive and negative symptoms with fewer side effects than conventional drugs. However, antipsychotics may also have disadvantages like sudden death or involuntary movements.

1. Schizophrenia – Treby
‘Schizophrenia is characterised by
Psychosis – a loss of contact with
reality’

2. Clinical Characteristics of
Schizophrenia:
• Prevalence = 1% of the population
(prevalence = The percentage of a population
that is affected with a particular disease at a
given time.)
Broken down into Positive Symptoms (Type I)
and Negative Symptoms (Type II)

3. Symptoms:
Positive Symptoms:
Where something is added to
your personality.
e.g.
• Delusions – beliefs that
seem real, but aren’t.
• Feeling they’re controlled
by something.
• Hallucinations – either
auditory or visual.
• Disordered thinking – the
idea that thoughts have
been inserted into your
mind.
Negative Symptoms:
Where something is removed
from your personality.
e.g.
• Affective flattening – lack of
emotion.
• Alogia – poverty of speech.
• Avolition – having no drive
to do anything.

4. First Rank Symptoms – Schneider 1959
Schneider believed that first rank symptoms
(Type I) such as:
Delusions, feeling controlled by someone else,
and hallucinations
Were only associated with schizophrenia.
(However, these symptoms have also been
linked with depression and bipolar.)
SYNOPTICITY! Randy Gardener (1964) also experienced
Type 1 symptoms, from sleep deprivation.

5. Different types of schizophrenia:
1. Paranoid – Delusions &
hallucinations
2. Catatonic – unusual motor
activity, extreme negativism,
peculiar posturing. V. Rare.
3. Hebephrenic (ICD) or
Disorganised (DSM) early age,
disorganised speech, flat
affect, some hallucinations &
delusions.
4. Undifferentiated –
Schizophrenic symptoms that
don’t neatly fit a diagnosis.
5. Residual – At least one
episode of schizophrenia
experienced in the past. But
no longer exhibiting signs of
the disorder.
The ICD-10 also
contains 2 other
subtypes:
Post-schizophrenic
depression (a
depressive episode
after a schizophrenic
illness.
Simple
schizophrenia
(progressive
development of
negative symptoms,
with no history of
psychosis)

6. Classifying Mental Health Disorders:
Diagnostic and Statistical Manual (DSM):
• Published in America
• English only
• Predominantly used in the UK
• Classifies 5 sub-types of
schizophrenia
• Looks after 6 months of symptoms
• Used by professionals
e.g. psychiatrists, psychologists, social
workers.
• Contains mental health statistics
• Multi-axial approach – as it notes
that mental illness rarely exists
without the influence of other factors
in an individuals life:
Such as…
1. Clinical syndromes
2. Personality disorders
3. Physical conditions
4. Severity of psychosocial factors
5. Highest level of functioning
International Classification of Diseases
and related health problems (ICD):
• Published by the WHO
• International – multiple languages
• Collection of health statistics
• Classifies 7 sub-types of
schizophrenia
• Looks after 1 month of symptoms
• Mainly for disease – only chapter 5 is
for mental health
• Does NOT look at social factors
• 10 categories of mental disorders are
identified
• Looks mainly at positive symptoms

7. Evaluating classification
systems:
Beck (1967) – RELIABILITY
Four psychiatrists used the DSM to diagnose 153 patients.
Each patient was interviewed separately with 2
psychologists.
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

8. Evaluating classification
systems:
Cooper et al (1972) – CULTURAL RELATIVISM
When patients (with identical symptoms) presented
themselves. Schizophrenia was TWICE as likely to be
diagnosed by New Yorker psychiatrists using the
DSM than Londoner psychiatrists using the ICD.
The opposite was true of depression.
• Unreliable
• Cultural relativism – NY & L diagnose differently
• Subjective

9. Evaluating classification
systems:
Temperline (1970) – VALIDITY
Interview with an actor was recorded. 7 groups
were asked to assess his mental health.
Groups consisted of professionals: e.g.
psychiatrists, psychologists and law students.
5/7 groups heard that the man being
interviewed was interesting as he looks neurotic,
but is actually psychotic. The 6th group heard
nothing, and the 7th group heard he was healthy.

10. Temperline – continued!
With those that heard he was neurotic, a majority
of them said that he was neurotic
And there was further disagreement amongst
professionals
Group that heard he was mentally healthy: 100%
said healthy
This shows that the DSM and ICD may lack validity
as some diagnoses may already be formed from
existing preconceptions rather than using the
manuals themselves

11. Temperline – evaluation:
• People look at the labels rather their own
opinion
• Groups are all from different backgrounds
(extraneous variable)
• Individual differences amongst professionals –
subjective

12. Evaluating classification
systems:
Rosenhan (1973) – LABELLING
Eight people with no history of mental illness rocked up at a psychiatric
hospital; claiming to be hearing voices in their head.
Other than this, they answered further questions as mentally healthy
individuals.
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 note
taking’.
After, Rosenhan told a hospital about the study, and warned there would be
more pseudo-patients. He never sent any. But staff recorded that 43 of the 93
admitted 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

13. Biological:
Nature: genetics, brain damage, biochemistry,
infection
They differ from your nurture i.e. peers,
upbringing, culture, friends, environment

14. Biological – Genetics:

15. Definitions!
Word Definition
Schizophrenia Psychosis… Loss of contact with reality
Monozygotic twin (MZ) Identical twin (same genetics)
Dizygotic twin (DZ) Non-identical (different genetics)
Concordance rate Likelihood of one twin getting same
illness as the other twin
Twin studies Studies involving twins, if they’re MZ then
they have same genes, so we can see if
they were influenced by nature (genes) or
nurture (upbringing)
Adoption studies Studies involving adopted children to see
whether or not they have same genetic
disorders as their real parents to see if
illnesses are inherited

16. Twin study - Cardnoet al (2002):
• Diagnosed schizophrenia in twins
• Used ‘Maudsley Twin Register’ to get
strict diagnosis
• Showed 26.5% concordance rates in
MZ twins
• 0% concordance rates in DZ twins
This shows that it is your genetics
(nature) that affects schizophrenia
rather than your environment
(nurture).

17. 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.

18. Adoption study – Kety (1994):
• High rates of schizophrenia in
individuals who’s parents had
schizophrenia, but had been adopted
by psychologically healthy parents.
Shows that genetics are more
important than your environment.
Supports Cardnoet al (2002)

19. 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)

20. Strengths & weaknesses (A02):
Strengths Weaknesses
Twin Studies: MZ have same genetic
makeup, so you can test
Nature vs Nurture
Objective (quant data)
Twins are rare
Different criteria for
different twin studies (so,
Cardno used Maudsley, but
other people use others)
Concordance rates
measured differently =
subjective
Adoption Studies: Nature vs nurture
Objective (quant data)
Bigger sample sizes
possible than twin = more
generalisable
Individual differences (life
events)
Extraneous variables e.g.
life events…

21. Biological – Biochemistry:

22. Dopamine Hypothesis:
The dopamine hypothesis suggests
that messages from neurons that
transmit dopamine fire either too
often, or too regularly. Is is thought
that schizophrenics have high
numbers of the D2 receptors on
the receiving neurons, therefore
more dopamine binds to the cell.
Comer (2003):Dopamine plays a
role in attention. Disturbances may
lead to problems with focussing,
and the perception problems found
in schizophrenia.

23. 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 develop
schizophrenic-type symptoms
Ethical issues – protection from harm

24. Supports hypothesis – Anti-psychotic
drugs:
• Anti-psychotic drugs block activity of
dopamine in brain
• By doing so, schizophrenic symptoms (e.g.
hallucinations and delusions) are alleviates
• They are known as dopamine antagonists

25. Supports hypothesis – Amphetamines
(like speed):
• Drugs that act as dopamine agonists
• Means that synapses get flooded with
dopamine
• Large doses can cause hallucinations and
delusions (characteristics of schizophrenia)
Hard to test – ethical issues – protection from
harm and … Drugs are illegal’n’ting

26. Supports hypothesis and contradicts
hypothesis – PET Scans:
• Wong et al (1986) used PET Scans and found
dopamine activity was greater in
schizophrenics compared to a control
• However, Copolov and Crook (2000) have not
found evidence of altered dopamine activity in
schizophrenic’s brains.

27. Dopamine hypothesis – evaluation:
• Objective – Quantitative
data, scientific
• PET Scans (Wong et al
1986)
• Hormonal
• Reliable
• Deterministic – no
blame 
• Reductionist – no
consideration for social
events, may ignore
actual cause
• Nature vs Nurture –
NATURE, good as no
blame. BUT, could lead
to passive patients

28. Psychodynamic approach:

29. Freud (1924):
• Believed schizophrenia was a result of TWO
processes:
1) Regression to a pre-ego state
2) Attempts to re-establish ego control

30. 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 as
an individual’s attempt to re-establish ego control

31. Supporting Freud – Fromm-Reichmann
(1948):
• Overprotective, rejecting, dominant, and
moralistic mothers can contribute to children
developing schizophrenia
• Supports Freud in that the condition stems
from childhood

32. Supports Freud – Bateson et al (1956):
• Children who get mixed-messages
from their parents are more likely
to develop schizophrenia
• For example, if a mother was to tell
her child she loved them, but look
away in disgust if the child did
something wrong. = mixed
messages
• Prolonged exposure disrupts a
child’s internally coherent
construction of reality (perception
of reality)
DOUBLE-BIND THEORY

33. Argues Freud – Oltmannset al (1991):
• Parents act differently once their
child has been labelled as
schizophrenic
• Not prior to
• Therefore it is not parental
influence and it argues Freud
• (SYNOPTIC: kinda like in Rosenhan’s
1973 pseudo-patients study as the
nurses reacted to them differently
once they had been labelled)

34. Psychodynamic approach AO2:
• Supporting research –
Fromm-Reichmann
(1948) (use other two in
AO1)
• Considers social
influences such as
upbringing
• Individual differences
• Subjective
• Simplistic – biology not
considered

35. Cognitive for schizophrenia:

36. Cognitive:
• Cognitive approach looks at biological factors
for schizophrenia, says Type I/positive
symptoms come from biology
• But further symptoms stem from people
trying to make sense of their symptoms
• They reject feedback from others and believe
that their beliefs are manipulated by others

37. Cognitive – Frith (1979):
• Argues schizophrenia
comes from faulty attention
systems
• with an inability to filter out
unnecessary info that they
have gathered through
their senses
• This leads to illusion of
distorted thoughts
Does not consider individual
differences

38. Cognitive – Bentall (1994):
• Schizophrenics have trouble with processing
information
• Shown in Stroop tests: Colour words (red and green)
are substituted for emotional words (death and
laughter),
• Schizophrenics take longer than non-schizophrenics to
name the words.
• Automatic subconscious processing – may account for
positive symptoms
Stroop tests may be unreliable
Individual differences

39. What have we learnt thus far…?
• Cognitive psychology is concerned with
thought processes such as memory and
attention.
• The cognitive approach to psychology
recognises that biological factors contribute to
the positive symptoms of schizophrenia. Other
symptoms, such as negative symptoms
develop from the individual attempting to
make sense of an experience.

40. More stuff we’ve learnt…
• People provide information they need to
maintain a grasp on reality and if this does not
happen, psychosis may occur (loss of contact
with reality) and people may become
paranoid they are being controlled by
someone else.
• A faulty attention system is blame as the
reason for schizophrenia (Frith, 1979) as they
can not filter out unnecessary information
which leads to problems with attention.

41. Even more…
• This is shown further by Bentall (1994) who
used the Stroop test to show problems with
how people with schizophrenia process
information, showing disruption with the
processing of emotional words.

42. Supports cognitive – Meyer-
Lindenberget al (2002):
• Excessive dopamine in the prefrontal cortex has direct
impact on the working memory.
• Where the schizophrenia stems from a disbelief in
others
(Synoptic – links to dopamine hypothesis)
Objective (hormones)

43. 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 show
their own hallucinations were unreal &
irrational
Ethical issues – protection from harm

44. Argues Cognitive – McKenna (1994):
• Schizophrenics aren’t more easily distracted
than non-schizophrenics in cognitive tasks
Historical validity
Lab study may affect results
Distraction = subjective

45. Cognitive AO2:
• Yellowleeseet al (2002)
• Free will
• Application to real life:
treatments
• More holistic – approach
believes that positive
symptoms have a
biological influence
• McKenna (1994)
• Individual differences

46. Treatment of schizophrenia:

47. Antipsychotic drugs:
• Chemotherapy (chemical treatments) used to
treat symptoms of psychotic disorders such as
schizophrenia and manic depression
• Two types of antipsychotic drugs:
Conventional and atypical…

48. Antipsychotic drugs:
Conventional:
• E.g. ChlorPROmazine (pro –
treats positive symptoms)
• Such as hallucinations and
delusions
• Reduces the effects of
dopamine by blocking
receptors
• Dopamine antagonists
• Side effects
Atypical antipsychotic drugs:
• E.g. Clozapine
• Works on both positive and
negative symptoms
(depression & apathy)
• Acts on dopamine & serotonin
receptors
• Side effects include tardive
dyskinesia (involuntary
movement of mouth and
tongue)
• Less side effects

49. Effectiveness and appropriateness of
conventional and atypical drugs:
Conventional:
• Luft B (2006) Found that
conventional drugs are associated
with sudden death whereas
atypicals are not
• Hill (1986) found that 30% of
people taking conventional
develop Tardive Dyskinesia
• Ross and Read (2004) –
Motivational deficits, such as
labelling, reinforcing ‘something’s
wrong with you’ which is
unethical
Atypical:
• Leuchtet al (1999) - Meta-
analysis showed that atypical
are only a little better.
• Jesteet al (1999) - Side
effects. Less chance ofTardive
Dyskinesia (5% of people)
• Davis et al (1980) – Relapse.
Placebo = 55% relapsed
Atypicals = 2-22% relapsed
Individual differences etc etc

50. Antipsychotic drugs AO2
• Biological
• Objective
• Real life application
• Deterministic
• Reductionist –
individual differences

51. Psychological therapies for
schizophrenia:

52. Psychoanalysis:
• Getting to your subconscious to see if your childhood
affected you – usually associated with Freud’s
psychodynamic approach
• Freud believed that this approach would not work as
schizophrenics are unable to form a transference with the
analyst
• This is when the emotions of a patient are unconsciously
shifted onto the analyst
Subjective
Cheap
Quick
Can combine with medicine

53. Appropriateness of psychoanalysis –
Gottdiener (2000):
• Meta-analysis of 37 studies
• Covering 2642 patients
• 66% of them improved after
treatment using
psychotherapy/psyschoanaly
sis

54. Effectiveness of psychoanalysis:
Malmbergand Fenton (2001)
• It is impossible to draw a
definite conclusion for or
against the effectiveness of
psychoanalysis.
• In fact the schizophrenia
patient outcome research
team (PORT) has even argued
that psychoanalysis may be
harmful to schizophrenics

55. Effectiveness of psychoanalysis:
• Therapists are
expensive
• Patients often treated
over a long time
• Prevents it being
adopted on a large
scale
• Costly & time
consuming

56. Cognitive behavioural therapy:
• Caused by faulty thinking. Trying to
find root of the problem to prove
irrational thoughts are irrational
• Look at alternative explanations for
maladaptive beliefs
• Treats symptoms rather than cause
Focuses on ‘negative behaviours’
which are also deemed the ‘safest
behaviours’
• People need to be trained to do it

57. Appropriateness of CBT - Kingdon and
Kirschen (2006):
• 142 patients were tested,
and found that many
patients were not suitable
for CBT as they would not
fully engage with it.
• In general, it was less
effective on older folk than
younger ones

58. Effectiveness of CBT: Gould et al
(2001):
• Meta-analysis of 7 studies
• Reported that there was a
statistically significant
decrease in the positive
symptoms of
schizophrenia after
treatment
7 studies
positive
symptoms

59. Evaluation for psychological therapies
of schizophrenia – AO2:
• Comment on effectiveness and
appropriateness for each
• Can be used along side drug
therapies
• Comment on effectiveness and
appropriateness for each
• Simplistic – only treating
thoughts even though cognitive
theory suggests that positive
symptoms derive from biological
influences
• People have to be trained to do
CBT and psychoanalysis which is
expensive, time consuming
• Individual differences – some
people might not respond as well
to drug treatment as others

60. Key words:
Word Definition
Psychosis Loss of contact with reality
Positive symptoms Added to personality e.g. delusions and
hallucinations
Negative symptoms Something removed from your
personality, such as alogia = loss of
speech
Biochemistry Hormones and neurotransmitters
Chemotherapy Treatments based on chemicals
Serotonin A neurotransmitter, low levels of this have
been linked to depression
Dopamine A neurotransmitter, high levels have been
linked to schizophrenia in the dopamine
hypothesis

61. MOAAARR definitions!
Word Definition
Dopamine antagonist Chemical which inhibits effect of
dopamine
Placebo ‘fake’ version of a drug which tests
whether the drug has biological impacts
Relapse When you lose your symptoms of
abnormality, but then they come back
Neurotransmitter Chemicals that transmit impulses across a
synapse causing a change in behaviour