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SCHIZOPHRENIA: THE INTERACTIONIST APPROACH - Coggle Diagram
SCHIZOPHRENIA: THE INTERACTIONIST APPROACH
EXPLANATION
THE DIATHESIS-STRESS MODEL
Original Theory
Mehl's Model (1962)
diathesis is one 'schizogene' causes the 'schizotypic personality' which is characterised by a sensitivity to stress
without this schizogene, no amount of stress can cause schizophrenia: a genetic predisposition is needed
Modern Thinking
STRESS
Family Dysfunction
Barlow and Durand (2009) reported that a family history of schizophrenia, indicating a genetic link, coupled with being a part of a dysfunctional stress or elevated the risk of developing schizophrenia.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain. Early and severe enough trauma, such as child abuse, can affect many aspects of brain development. For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active, making the person much more vulnerable to later stress.
Stress of schizophrenogenic mother / expressed emotion / double bind situation
Role of Cortisol
Walker (1997) found that schizophrenics have higher levels of cortisol and that the cortisol level is related to severity of symptoms, with stress-related increases in cortisol levels heightening genetically-influenced abnormalities in dopamine transmission that underpin vulnerability to schizophrenia, triggering the onset of the disorder.
Exposure to Flu
Murray (1996) reported that children who were born after flu epidemics where their mothers had contracted the disease while pregnant, especially in the second trimester, had an 88% increased chance of developing schizophrenia than children born the same time period whose mothers had not contracted the flu. This is suspected of causing defects in neural development, which increased vulnerability to schizophrenia due to brain damage, which has a knock-on effect on dopamine functioning.
Use of Cannabis
Cannabis has been found to be a stressor for schizophrenia by increasing the risk of developing the disorder by up to 7 times depending on the dose. Cannabis interferes with the dopamine system. Most people do not develop schizophrenia after smoking cannabis, and so there must be one or more vulnerability factors.
Birth Complications
Cannon et al. (2002) reviewed available evidence to find a positive correlation between birth complications and a vulnerability to developing schizophrenia with some indication of damage done to hormone and neurotransmitter systems and the immune system.
DIATHESIS
Cognitive - Psychological trauma that can affect brain development e.g. child abuse affecting the hypothalamic-pituitary-adrenal (HPA) system which can increase vulnerability to stress
Genetic - No single gene but a combination of genes (polygenic) that increase vulnerability to developing schizophrenia
Diathesis ('vulnerability') triggered by a stress causes the onset of schizophrenia
TREATMENT
DRUG THERAPY AND PSYCHOLOGICAL THERAPIES
Hogarty et al. (1986)
Assessed relapse rates in patients receiving a combination of psychological treatments and drug therapy or just drug therapy alone
Initial conclusions were that combining treatments increased their effectiveness
Follow up research suggests that combining treatments delays relapse rather that preventing it
PSYCHOLOGICAL THERAPIES
CBT – about 12 sessions to make sense of delusions and hallucinations
Admit patient to hospital– may need sectioning or continual care/supervision
Family therapy - to allow the family to both understand and support patients
Token economies – if hospitalised, then the use of token economies may help to improve day to day behaviours such as care of personal hygiene
DRUG THERAPY
Anti-psychotics to treat the positive symptoms and reduce psychotic thought processes
To reduce or control symptoms – this will help the person to access the psychological therapies better
EXPLANATION EVALUATION
EFFECTIVENESS
Not known how different factors contribute to the onset of schizophrenia. May differ between individuals. Causality cannot be established as it is not known whether certain things such as high cortisol levels are a trigger or consequence of schizophrenia.
OVER-SIMPLIFICATION OF A COMPLEX DISORDER
Multiple genes are thought to be responsible for schizophrenia and stress may come in many forms. Early trauma can be a cause as well as present stressors.
ROLE OF VULNERABILITY AND TRIGGERS
Tienari et al. provides support for genetic vulnerability and family-related stress. Suggests that poor parenting can be a possible source of stress that triggers the genetic predispositions thus supporting both biological and family dysfunction explanations.
DIFFERENTIAL SUSCEPTIBILITY HYPOTHESIS
Allows for the role of positive and negative environments. A negative environment can provide stressors that can lead to schizophrenia in someone with a genetic vulnerability. However, a positive environment can reduce the chances of schizophrenia developing. Supported by Tienari
TREATMENT EVALUATION
EFFECTIVENESS
Practical advantage as the combination of treatments seems to produce a better outcome, with more symptoms reduced and less chance of relapse. Allows for the teaching of functional social skills and when to apply them in real-life situations, Although expensive, greater effectiveness makes treatments cost-effective.