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SCHIZOPHRENIA (DIAGNOSIS AND CLASSIFICATION (EVALUATION (RELIABILITY:
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SCHIZOPHRENIA
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BIOLOGICAL EXPLANATIONS
GENETIC BASIS:
- schizophrenia runs in families however there are shared environments as well as shared genetics
- schizophrenia is polygenic / aetiologically heterogenous
NEURAL CORRELATES:
- measurements of structure / function correlate with experience - positive / negative symptoms
NEGATIVE SYMPTOMS:
- ventral striatum is concerned with anticipation - abnormal functioning may cause avolition
- Juckel: found lower activity levels in ventral striatum of schizophrenia patients experiencing avolition (negative correlation)
POSITIVE SYMPTOMS:
- Allen: lower activity levels in superior temporal gyrus for schizophrenia sufferers experiencing auditory hallucinations than control
THE DOPAMINE HYPOTHESIS:
- dopamine neurotransmitters are believed to be involved in schizophrenia
HYPERDOPAMINERGIA IN THE SUBCORTEX:
- excess of dopamine receptors e.g in Broca's area may be responsible for speech poverty / auditory hallucinations
HYPODOPAMINERGIA IN THE CORTEX:
- low dopamine levels e.g in the prefrontal cortex (concerned with decision making / thinking) may be related to negative symptoms
EVALUATION
GENETIC SUSCEPTIBILITY:
- Tienari: children of schizophrenia sufferers were at a higher risk despite being adopted into a family with no history of schizophrenia
- Ripke: genetic variations significantly increase the risk of developing schizophrenia
MIXED EVIDENCE FOF THE DOPAMINE HYPOTHESIS:
- dopamine antagonists - amphetamines increase neurotransmitter and worsens symptoms (can cause symptoms in non-schizophrenics)
- antipsychotics work by reducing the levels of dopamine
- recent studies into the involvement of another neurotransmitter - glutamate
CORRELATION CAUSATION:
- though neural correlates show an abnormal brain system - this may not necessarily be the cause of the symptom (may be the result of the system)
PSYCHOLOGICAL TREATMENT
COGNITIVE BEHAVIOUR THERAPY:
- identify / challenge irrational thoughts
- doesn't get rid of symptoms but makes it easier to cope / allows patients to make sense of symptoms
TOKEN ECONOMIES:
- reward systems to manage maladaptive behaviour as a result of institutionalisation - improves quality of life / makes it easier to re-integrate into normal life
- tokens are secondary reinforcers (derive value from association with rewards)
EVALUATION
EFFECTIVENESS:
- Janhur: CBT for schizophrenia has a small bit significant effect
- Pharoah: family therapy reduces hospital readmission / improves quality of life for family and sufferers
TREATMENTS IMPROVE QUALITY BUT DO NOT CURE: it is a weakness of the treatment that it can only improve quality of life
ETHICAL ISSUES:
- in token economy systems - privileges are more available for mild symptoms - most severely ill suffer discrimination
- CBT may challenge paranoia but when does it interfere with freedom of thought
FAMILY THERAPY:
- improves quality of communication and interaction (some say the cause / some say just a stress / affects relapse rate
- reduces expressed emotion / stress increasing chances of compliance with medication
AIMS OF FAMILY THERAPY:
- forms an alliance with family members
- reduces stress of caring for a patient
- improves ability to solve problems
- reduces anger / guilt
- improves balance of own life / caring for a patient
- improves understanding of schizophrenia
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INTERACTIONIST APPROACH
DIATHESIS-STRESS MODEL
MEEHL'S MODEL:
- entirely genetic - the result of a single schizogene leading to a schizotype personality (characteristic - sensitivity to stress)
- Meehl: no schizogene - no stress will cause schizophrenia
MODERN UNDERSTANDING:
- no single schizogene - diathesis may be beyond genetic e.g trauma
- child abuse may affect the development of the brain
- originally - the stressor is psychological / modern - the stressor can be anything that risks triggering schizophrenia (recent studies look at the effects of cannabis)
TREATMENT:
- approach acknowledges both biological / psychological factors
- model often combines antipsychotics / therapy (usually CBT)
- UK tends to use both / USA tends to use medication
EVALUATION
EVIDENCE FOR VULNERABILITY / TRIGGERS:
- Tienari: large Finnish sample adoptees of schizophrenic mothers
- adoptive parenting style assessed - those characterised as lacking empathy had implications on the children - only those with a genetic risk
ORIGINAL DIATHESIS-STRESS IS OVERSIMPLIFIED:
- multiple genes increase vulnerability
- stress may come in different forms (vulnerability may be trauma as well as genetics / stressor can be biological)
EFFECTIVE COMBINATION OF TREATMENT:
- Tarrier: 315 patients randomly allocated to - medication + CBT / medication + counselling / just medication (control)
- patients in the two-combination conditions were found to have lower symptom severity
- no difference found for hospital readmission rates
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