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AQA A2 Psychology Unit 4 - Schizophrenia
- 1. A2 Psychology Unit4 Schizophrenia
- 2. Schizophrenia • Defined asa 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 Classificationand 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 Classificationand 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