AQA A2 Psychology Unit 4 - Schizophrenia Practically everything needed for the exam under this board specification and for this topic.

1. A2 Psychology Unit 4
Schizophrenia

2. Schizophrenia
• Defined as a split from reality
– Not split or multiple personality
• Onset is 18-25
• Effects 1% of population
• An umbrella term used to describe 3 different types of
symptoms
– All characterised by a split form reality
• Key terms
– Delusions
• Belief that is maintained despite there being arguments, data and
refutation that should be concrete enough to destroy it
– Not religion, evolution, etc.
– Hallucinations
• Perceptual experience with all of the components of a real sensory
experience but without the normal physical stimulus for it to be real

3. Clinical Characteristics
• Positive (acute) symptoms
– Delusions
• Grandeur
– Believe they are someone “grand” or famous
– Believe they have “special” or “magical” powers
• Persecution
– Believe that people are “plotting” against them
– Being talked about by strangers
– Thoughts are being interrupted or broadcast
– Hallucinations
• Important for the diagnosis of Schizophrenia
• Occur more often than they do in other disorders
• Negative (chronic) symptoms
– Apathy/avolition
• Lack of energy and interest in normal goals
– Withdrawal/asociality
• Impaired social relationships
– Catatonia/cataleptic stupor
• Standing motionless like a statue
• Adapting odd/bizarre postures
– Echolalia
• Echoing of repetitive utterances of another person
• Copying the mannerisms of someone else

4. Clinical Characteristics
• Disorganised (in-between) symptoms
– Disorganised speech
• Problem organising ideas into words to be spoken
• May also be inappropriate content
– Disorganised behaviour
• Unable to organise and perform day to day activities
– Includes showering, dressing, preparing meals and eating
– Inappropriate affect
• Silliness and laughter out of context
– Flat emotions
• No emotional response in any situation
• Face becomes immobile, eyes, lifeless, speech toneless

5. Types of Schizophrenia
• Paranoid
– Mostly positive symptoms
• Can show other symptoms
– Will be classified as paranoid if any positive symptoms are shown
• Catatonic
– Mostly shows catatonic symptoms
– No positive symptoms
• Disorganised
– Mostly shows disorganised symptoms
– No positive symptoms
• Undifferentiated
– No clear pattern to symptoms
– No positive symptoms
• Residual
– No longer display symptoms

6. Issues of Classification and Diagnosis
• Classification
– Considerable overlap
• Other psychological disorders have similar symptoms to Schizophrenia
– Co-morbidity
• Person suffers from both Schizophrenia and another disorder
– Schizotypal personality disorder
• Person suffers from Schizophrenic symptoms but not from the actual disorder
• Specific to Schizophrenia
• Diagnosis
– Reliability/validity
• Low reliability
– Diagnosis is difficult
– No one symptom is essential
– Patients can differ greatly between one another but diagnosed as the same type
• Little predictive validity
– Diagnosis gives very little insight into how to predict the course of the illness or appropriate treatment
• Rosenhan
– Healthy participants complained about hearing voices (hallucinations)
– After being admitted, said they were fine but took an average of 19 days to be discharged
» Nearly all classified as being in “remission”
– Hard to diagnose Schizophrenia with good reliability and validity
» Low reliability for diagnosis
– Evaluation
» Kety - If you lie to a doctor, they won’t diagnose you correctly
» Ecological validity – field experiment
» Population validity – done in different US states
» Ethnocentric – only done in America

7. Issues of Classification and Diagnosis
• Diagnosis
– Medical bias
• Medical model resulted in complete neglect of non-biological explanations of Schizophrenia
• Psychiatrics are doctors
– Represent the privileged minority
• Emphasis of doctor’s training is on biology and genetics
• Drug treatments are successful and easy to use
– Could impact on the effort put into identifying the cause of the disorder
– Racism
• Ethnic differences
– Cole and Pilisuk
» Black people more likely to get drug treatment, less likely to get psychological treatment
– Cochrane
» West Indian men less likely to go to GP with psychiatric issues, more likely to be admitted to psychiatric
hospital
– Lipsedge and Littlewood
» Psychotic black patients twice as likely to be sectioned than native/immigrant whites
• Sociogenic hypothesis
– High numbers of mental illnesses among ethnic minority groups due to stress of moving country
» Triggers diathesis for mental illness
» Suggests that they would all remain mentally ill
• McKenzie
– Caribbean immigrants in UK less likely to have a continuing psychotic illness compared to white British people
– Emphasise medical issues with diagnosis
• Prejudice and ignorance of other cultures could also have a negative impact on reliability of diagnosis
• Debates
– Is psychology a science?
• Biological approach ignores all social factors

8. Evaluating Therapies
• Effectiveness
– Problems researching
• Placebo effect
– Drug more effective than placebo
• Double blind
– Researcher and participant interpret improvement due to nature of treatment
– General problems
• Drug fallacy
– Relieves symptoms but doesn’t make it better
• Curative or palliative
– Does it actually help or just relieve the symptoms
• Relapse
• Appropriateness
– Side effects
• Does it make us better
– Compliance
• Are we forcing them
– ECT
– Ethical issues
• Should we be doing it

9. Biological Explanation - Genetics
• Large amount of research suggests that development of Schizophrenia may be
partially genetic
• One of the key issues is the methodology involved in research
• Family studies
– Closer the person is related to someone with Schizophrenia, greater chance of developing
disorder
– Gottesman
• Reviewed concordance rates from family studies of Schizophrenia
• Both parents = 46%
• One parent = 16%
• Sibling = 8%
• All considerably higher than 1% of general population
– Can offer some explanation but is unlikely data fully accounts for the disorder
• Family members normally experience the same environment
• Twin studies
– Expect to see a higher concordance rate for MZ twins than DZ twins
– Kendler
• 50% concordance for MZ twins
– Thinking they were DZ’s did not decrease chances of developing the disease
• 15% concordance for DZ twins
– Believing they were identical did not increase chances of developing the disease
– Methodology issue
• Designed to identify effect of genetic variation
• Assumed all environmental factors will be the same
– Not always the case

10. Biological Explanation - Genetics
• Adoption studies
– Studying children with Schizophrenic parents but brought up in an alternative
environment
– Factors out environmental factors like family dynamics
– Tienari
• Finnish adoption study
• 155 Schizophrenic mothers gave children up for adoption
– Compared to 155 children adopted from non-Schizophrenic parents
• 10.3% with Schizophrenic mothers developed Schizophrenia
• 1.1% without Schizophrenic mothers developed Schizophrenia
• Genetic factors are clearly important but environmental are of equal
importance
• Debates
– Reductionist
• Over-emphasises genetic factors involved
• Over-simplified
• Allows in-depth research into genetic factors

11. Biological Explanation - Neurological
• Brain abnormalities
– Kraeplin
• Considered Schizophrenia a disease of the brain from abnormalities in the structure
• Ethical issues
– Researchers use post-mortems to establish evidence
– Only identified after death
– Can’t tell whether Schizophrenia was the cause of abnormalities or if it was a result of the brain
abnormalities
– PET and MRI scans allow researchers to look at a living brain
• During onset and more advanced Schizophrenia
• Brown
– Found decreased brain weight and enlarged ventricles
• Young
– Normal amygdale is asymmetrical but in Schizophrenic patients it is not
• Flaum
– Enlarged ventricles in Schizophrenia patients
• Buchsbaum
– Found abnormalities in frontal lobe, hippocampus and amygdale
– No agreement on where changes need to be
– Evidence does support structural brain abnormalities
• Research is done on dead or already diagnosed patients
– Can’t see if damage was always present
• Debates
– Is psychology a science
• Science always seeks to attempt to falsify its theory
• Always be suspicious of evidence with no empirical casual relationship
– Reductionist
• Over-emphasises neurological factors involved
– Deterministic
• If brain abnormalities are the cause of Schizophrenia, everyone with a brain abnormality should get it

12. Biological Explanation - Biochemical
• Imbalances in neurochemicals can cause Schizophrenic like symptoms
– Prolonged use of LSD has been known for inducing similar symptoms to Schizophrenia
• Antabuse (drug for alcoholism) has the same effect
• Dopamine hypothesis
– Excessive levels of Dopamine in the brain cause Schizophrenia
• Over production
• Faulty regulation
• Over sensitive receptors
– Support
• Anti-psychotic drugs block Dopamine receptors
– Appears to be successful
• L-Dopa of Parkinson's increases Dopamine
– Causes Schizophrenic symptoms
• Amphatamines increase Dopamine
– Cause hallucinations and paranoia
• Post-mortems of patients show greater density of Dopamine receptors
– Issues
• Davis
– Drugs decrease Dopamine almost immediately
– Full behavioural effects only begin to take place 2-3 weeks later
• Cohen
– May be due to other delayed effects on the brain
• To be effective, Dopamine levels have to be reduced below normal levels
– Just to normal levels should be enough if this was the case
– Contradictory evidence
• Carlsson
– Implicates other neurotransmitters in development of Schizophrenia
• Van Kammen
– Some studies report that Amphetamines reduce Schizophrenic symptoms
• Kety
– L-Dopa and Antipsychotics have similar therapeutic value

13. Psychological Explanation - Psychodynamic
• Schizophrenics fixate at the oral stage
– Harsh, uncaring upbringing
– Regress back to oral stage before ego (reality complex) is developed
• Explains split from reality
• Claims this is what leads to self important symptoms
• Individual will try to keep contact with the real world
– Leads to further symptoms
• Hearing God tell them they are someone famous to make sense of it
Psychodynamics
Hermeneutic All interpretations
Psychology is a science
which does not like
hermeneutic
• Not empirical (observable and measurable)
• Not falsifiable (conjecture – just an idea)
•No “real” evidence
Theories are based on
looking at Schizophrenics
and interpreting their
symptoms to identify a
cause – just guessing
But
• Schizophrenia is hard to explain as all patients are different
• Hard to diagnose as all diagnosis's are different
• Science can only produce nomothetic general explanations that can’t apply to all Schizophrenics
• Maybe an explanation that incorporates scientific factors with idiographic, individual, hermeneutic explanations would provide a better understanding
of individual differences found among patients

14. Psychological Explanation - Cognitive
• Cognitive impairments shown are involved in development of
disorder
• Claims as features appear (hearing voices) individuals try to make
sense of them
– Ask others to confirm validity
– When they don’t the person may believe that others are hiding the truth
– Could lead to further delusions
• Especially delusions of persecution
• Possible cognitive impairments
– McKenna
• Disorganised speech could be due to inability to concentrate
– Frith
• Delusions and hallucinations due to not recognising own intentions
• Paranoid Schizophrenic behaviour due to inability to infer others intentions
– Helmsly
• Disorganised thinking or unexpected behaviour due to loss of schemas or
memory confusion

15. Psychological Explanation - Behavioural
• Faulty learning
– Childhood experience impacts on rest of life
– Little or no social reinforcement forces child to learn from inappropriate external sources
• Could result in child’s verbal and/or behavioural responses being bizarre
– Anyone observing child’s behaviour will either
• Avoid it – not challenging behaviour
• React erratically – reinforcing behaviour
– Cycle will eventually deteriorate into a psychotic state
• Schizophregenic family
– Arieti
• Personality of parents could be possible explanation
– Cold, rejecting, dominating and prudish mother
– Detached, humourless, weak and passive father
– Mishler and Waxler
• Mother with a Schizophrenic daughter and “healthy” daughter will act differently around the two
– Mothers reactions affect daughters condition
– Parental personality rarely used as singular cause
• Debates
– Reductionist
• Over-emphasises impact of faulty learning
– Holistic approach should be taken
– Deterministic
• If it is really all down to a persons childhood, anyone with this childhood should have the disorder

16. Socio Cultural Explanation
• Mental illnesses among ethnic minorities because of stress
from moving to a different country
– Triggers diathesis for the disorder
• Theory can be linked to include lower class groups
• Harder and more stressful life = more likely to get
Schizophrenia
• Cooper
– More common in decaying intercity areas compared to poor rural ones
– 7x more common in African-Caribbean's than white’s
– Average rates in Caribbean countries similar to UK
– 2nd
generation African-Caribbean’s have higher risk than 1st
generation
• Higher because they have suffered stress of living in UK for longer
• Debates
– Reductionist
• Over-emphasises impact of stress on development of the disorder
– Deterministic
• If stress is the cause, anyone suffering from stress should get the disorder

17. Biological Treatments - Drugs
• Chemotherapy neuroleptics
– Block activity of Dopamine in the brain
• Typical antipsychotic drugs
– Several weeks of treatment before any sign of symptoms diminishing
– Are eventually effective in treating positive symptoms
– Jackson
• No good evidence for there being an effect on treating negative symptoms
– More effective treatment than any other when used alone
• Most effective is combining the treatments
– Sampath
• Half patients who were taking neuroleptic drug for 5 years were switch to a placebo
• 75% relapsed with placebo within 1 year
– Only 33% relapse with drug
• Placebo not as effective as typical antipsychotic drug
• Placebo group could have thought themselves into relapse
• Typical antipsychotics are effective but not always appropriate
– Windgassen/side effects
• 50% of patients suffered from grogginess
• 18% had problems with concentration
• 16% blurred vision
• Many develop Parkinson’s symptoms
• 2% develop neuroleptic malignant syndrome
– Muscle rigidity, altered consciousness, fever, possibly fatal
– Treatment stopped possibly developing this disease
• Tardive dyskinesia
– Involuntary sucking and chewing, jerky movements, writhing movements of mouth and face
– Can be permanent

18. Biological Treatments - Drugs
• Atypical antipsychotic drugs
– Work in a similar way to typical antipsychotics but also work on serotonin
– Advantages
• Have fewer side effects
• Can help patients who did not respond to typical antipsychotics
• More effective in treating negative symptoms as well as positive
– Research evidence
• Awad and Voruganti
– Fewer side effects than typical antipsychotics
– Benefited 85% of patients compared to 65% who took typical antipsychotics
• Meltzer
– 1/3 who had shown no improvement with typical responded well to the atypical drugs
– Side effects
• Agranulocytosis
– Very dangerous side effect
– Can kill
– Immune system shuts down
– 1-2% risk
– Olanzapine does not seem to cause it
– Effectiveness
• Most effective therapy for treatment
• Drug fallacy
– Only palliative, not curative
• Some patients become resistant to drugs
– Appropriateness
• Evidence for biological basis of disorder so biological treatment is logical
• Drug fallacy
– Palliative not curative
• Compliance of patients taking medication

19. Biological Treatments - ECT
• We don’t know how it works
• Generally forced upon you
– Only used as a last resort, when there is not other option
• Therapeutic effects on mental health
• Almost never effective
• Research evidence
– Tharyan
• Meta-analysis found ECT is beneficial short-term but not long-term
– Braya and Petrides
• Meta-analysis found ECT is effective when used alongside drug treatment
– Chanpattana
• Used in conjunction with antipsychotics has a significant reduction in positive symptoms
• Effectiveness
– Effective for patients who haven’t responded to antipsychotic drugs
– Effective for positive symptoms
– Only short term
– Palliative not curative
– Not as effective as when used for depression
– Very rarely used
• Appropriateness
– Clear evidence for biological beginning of disorder so biological treatment makes sense
– Very serious disorder therefore radical treatment seems appropriate
– Side effects
• Though usually short lived
– Inappropriate to use a treatment we have little understanding of

20. Psychological Treatments - Behavioural
• All behaviour is learnt through operant and classical condition and social learning theory
• Treatment
– Token economy
• Based on operant conditioning
• Rewarding desired behaviour
• Ayllon and Azrin
– Rewarded patients with tokens for performing “normal” actions
» Tokens could be exchanged for activities
– Number of chores performed by patients increased from 5 to 40+
• Paul and Lentz
– Used token economy on long term, hospitalised patients
– Patients developed various social and work related skills
– Became better at looking after themselves
– Symptoms were reduced
– Results were achieved when a reduction of drugs were given to the patients
– After 4.5 years, 98% of token economy patients had been released
» Only 45% non-token economy patients released
• Effectiveness
– Help patients develop new skills
– Very successful in institutions
• Not effective once rewards are removed
– Only deals with a few of the symptoms
• Negative and disorganised
– Produces more “normal” behaviours but has no impact on cognition
• Appropriateness
– Effective incentive to remove some very undesirable behaviour
– Can be used effectively alongside other treatments
– Desired behaviour chosen by staff not patients
• No free choice
– No effect on positive symptoms
– Changes only last while reinforcement is present

21. Psychological Treatments - Cognitive
• Change maladaptive thoughts to replace unwanted behaviours
• Coping Strategy Enhancement
– Situation set up so therapist and client can work together to improve coping strategies
– Emphasises that having hallucinations and delusions do not make you mad
• Everyone has them now and then
– Select one hallucination or delusion
– Client given task to apply coping strategy to the hallucination/delusions
– Therapist and client devise ways to make coping strategy more effective
• Effectiveness
– Tarrier
• Patients showed a significant reduction in positive symptoms than those on a waiting list for treatment
– Improvement still there 6 months after treatment
• Improved coping skills
– Associated with decreased hallucinations and delusions
• Almost half participants refused to take part or dropped out
– Pfammatter
• Meta-analysis
• CSE moderately effective in reducing positive symptoms and a slight improvement in social networking
• Showed we don’t know why it is effective
• Several different aspects to CSE treatment
– Has not been established which is most important
– Turkington
• Great majority of findings compare CSE to other control treatments and is found more effective
• Difference could be because CSE is especially effective or control treatment is inadequate
• Control treatments sometimes given by non-experts
• Use of inadequate control treatments might explain some findings
• Appropriateness
– Many symptoms are cognitive in nature so cognitive based therapy s fitting
– Many patients already use coping strategies so is appropriate to build on pre-existing ones
– Only works for certain positive symptoms
– Ignores the biological factors in Schizophrenia

22. Psychological Treatments - Psychodynamic
• Need to bring oral fixation to conscious awareness and gain insight
• Treatments
– Hypnosis
– Free association
– Dream analysis
• Effectiveness
– It doesn’t work
– Even Freud admitted it wasn’t effective
• Appropriateness
– If it doesn’t work we shouldn’t do it