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Schizophrenia - Coggle Diagram
Schizophrenia
explanations of schizophrenia
Biological: The Genetic Basis of Schizophrenia
Heritability = refers to the extent to which a condition or trait has been passed on generationally through families via genes (genetic inheritance)
Gottesman reviewed cases of schizophrenia in families and found a 48% concordance rate between genetically identical siblings, compared to the populations 1%, suggesting it has a genetic component
Gottesman (1991) found a concordance rate of 48% for schizophrenia between MZ (monozygotic i.e. identical) twins. This shows the percentage likelihood of a person developing schizophrenia based on their relationship.
candidate genes =
Genes that may increase a person's risk of developing schizophrenia.
polygenic
multiple genes that may cause
evaluation
strength
supporting evidence
limiation
biologically deterministic - No control over biology,
Inherited from our parents
Biological: Neural Correlates of Schizophrenia
Neural correlates are measurements of the structure or function of the brain that correlate with the characteristic & symptoms of schizophrenia, and so may be implicated in the origins of schizophrenia.
areas of the brain and cause
superior temporal gyrus and anterior cingulate gyrus
Is thought to control the processing of speech, has been associated with the positive symptoms of schizophrenia e.g.
hallucinations
Schizophrenic patients show reduced volume of grey material in the STG which is associated with hallucinations
STG= located in the temporal lobe next to your ear, It plays a big role in processing sounds, especially speech and language comprehension
ACG= wrapped around the corpus callosum, Involved in emotion regulation, decision making, and controlling attention, which all help regulate stress and anxiety which leads to schizophrenia/depression if not proper
Ventral striatum
been associated with the negative symptoms of schizophrenia e.g. avolition
controls brains ability to feel pleasure from motivating itself and rewards for doing things - lack of dopamine
Enlarged ventricles
Ventricles are voids filled with fluid, deep within the brain, which are thought to provide a protective cushion effect for the brain. Enlarged ventricles are associated with schizophrenia
evaluation
empirical methods used / objective
The use of brain-imaging techniques such as PET, MRI and FMRI provide objective evidence for neural correlates of schizophrenia as they pinpoint specific brain structures implicated in the symptoms of the disorder
environmentally reductionist
There is no acknowledgement of the role of the environment to a neural correlates based explanation of schizophrenia which means that it lacks external validity
Biological: dopamine hypothesis (role of neurotransmitters)
dopamine is a neurotransmitter that has a excitatory effect and is associated with pleasure
high levels of dopamine are associated with the positive symptoms of schizophrenia in subcortical areas of the brain such as Brocas area - which is linked to speech poverty & auditory hallucinations
the neurons that transmit dopamine are though to fire too often causing the increase in dopamine
as well as the increase in amount of D2 receptors on the end of post synaptic neurons = more dopamine binding to the receptors to be up-taken
This is thought to lead to hallucinations and delusions.
evaluation
supporting evidence
Tauscher et al- antipsychotic drugs reduce dopamine levels and also reduce the symptoms of schizophrenia
socially sensitive
Genetic counselling- if one or more potential parents have a relative with schizophrenia, they risk passing these genes onto a child. Risk is only a possibility and the child could/ could not go on to develop schizophrenia. Raises sensitive implications about raising children with schizophrenia and 'desirable' genes
Psychological: Family Dysfunction Theories of
Schizophrenia
Family dysfunction= abnormal processes within a family, such as poor communication, cold parenting and high levels of expressed emotions.
the three family dysfunctions
Schizophrenogenic mother - Frieda Reichmann
Mother is cold, controlling and rejecting; father is often passive
Could lead to developing paranoid delusions and ultimately schizophrenia
double bind theory - Gregory Bateson
Child often finds them self in situations where they fear doing
the wrong thing
Emphasises the role of communication
Child is punished by withdrawal of love by parent
Lack clarification when wrong
Understanding the world as confusing and dangerous, reflected in symptoms like disorganised thinking and paranoid delusions
expressed emotion
High levels of emotion expressed towards a patient by their family, including verbal criticism, hostility, anger and controlling / over protective
Primarily triggered by being created through constant high stress levels and causes a relapse.
evaluation
Psychological explanations such as family dysfunction may be socially sensitive, as they place the responsibility of developing a mental disorder on the parents.
real world application - Cognitive behavioural therapy is a technique which has proved effective in treating the symptoms of those with schizophrenia then drug therapies such as antipsychotic meds.
Cognitive explanations for schizophrenia may be reductionist as they fail to consider the role of biological factors in developing schizophrenia. - Simon et al suggesting narrow ventral stratum is associated with negative symptoms
Psychological: Cognitive Explanation of Schizophrenia
dysfunctional thought processing is a cognitive habit or belief of how people with schizophrenia to interpret the world
types of dysfunctional thinking
Central control dysfunction
Our ability to manage suppress automatic responses such as speech. Failure of this can lead to disorganised thinking and speech poverty.
Dysfunctional thinking
cognitive habits or beliefs that cause the individual to evaluate information inappropriately and produces undesirable consequences.
Meta representation dysfunction
Our ability to recognise the source of thoughts and goals in our own head being ours. Failure of this can lead to believing that we are not carrying out these activities but the hallucinations / delusions are.
Classification & Diagnosis of Schizophrenia
Positive & Negative Symptoms
Positive symptoms- additional atypical experiences which go beyond normal experiences
hallucinations - involve disturbances in perception (rather than disturbances in thought) perceptions that have no basis in reality
delusions
involve beliefs that have no basis in reality
Negative symptoms - loss of a normal behaviour
Avolition - involves loss of motivation to carry out tasks and results in lowered activity levels. Sometimes called 'apathy'.
Speech poverty- is the inability to speak properly, characterised by lack of ability to produce fluent words
Issues in the Diagnosis & Classification of Schizophrenia
symptom overlap
Symptom overlap is when two or more illnesses share some of the same symptoms
Co-morbidity
Co-morbidity is when one patient is diagnosed with two or more mental illness
gender bias
Gender bias in diagnosis refers to any instances of a person being diagnosed according to their gender, rather than their symptoms
example - male clinician not diagnosing schizophrenic women with schizophrenia as he thinks she's just a hysterical women (alpha bias)
health is also based around male models so may be different for females ( androcentric)
Hambrecht et al.(1993) - found that males and females are equally at risk of developing schizophrenia but schizophrenia is under-diagnosed in women
culture bias
Culture bias in diagnosis refers to any instances of a person being diagnosed according to their culture, rather than their symptoms
an African patient is not diagnosed with schizophrenia by aBritish clinician, as the clinician may misunderstand or disregard their culture-specific symptoms
Culture bias may also occur when a clinician does not take a patient’s culture into account when making a diagnosis - due to health being modelled against western norms
Harrison et al.'s (1984) research suggested that those of West Indian origin were over-diagnosed with schizophrenia, by white doctors in Bristol, because of their ethnic background.
Schizophrenia= a severe mental disorder where contact with reality and insight are impaired, an example of psychosis
diagnosis
Classification - the process of organising symptoms into categories based on which symptoms frequently cluster together.
Diagnosis is possible because of classification
based on symptoms
The World Health Organisation's ICD-10 and the Psychiatric Association Diagnostic DSM 5 are the systems most commonly used to classify mental disorders.
The DSM-5 (the current edition) classes schizophrenia according to whether the patient has experienced at least two of the positive or negative symptoms (delusions, hallucinations, disorganised speech)
The ICD-10 classified schizophrenia according to whether two or more negative symptoms were present(see below)
Treatment & Management of Schizophrenia
Drug Therapy for Schizophrenia
Most common treatment for schizophrenia involves the use of antipsychotic drugs.
Typical (traditional) antipsychotics
chlorpromazine
from 400-800mg
1950s
blocks dopamine receptors in the brain (D2)
initially causing dopamine levels to build up in the synapse.
Atypical (newer) antipsychotics
Clozapine
Developed in 1970s
Not available as an injection- potentially fatal side effects
300-450mg a day
partially blocks D2 receptors
blocks serotonin receptors - helps increase dopamine where needed
dangerously low white blood cell - increased risk of diabetes and seizures
Risperidone
1990s
Developed similarly to clozapine just without the side effects
4-8mg, max of 12mg
Binds to dopamine and serotonin receptor sites.
evaluation
One strength of using antipsychotics to treat schizophrenia is there is evidence to support their effectiveness.
Thornley et al conducted a review of studies comparing effects of chlorpromazine on patients to people who received a placebo over 13 trials and 1121 ppts. Concluded chlorpromazine resulted in better functioning and reduction of symptom severity.
Antipsychotics are most effective at treating patients with the most severe symptoms who may not be treatable using non-drug therapies (Furakawa et al. 2015)
It is not clear as to how effective antipsychotics are in preventing relapses in patients who are in remission
fatal side effects - weight gain, increase risk of seizure and diabetes...
Psychological Therapies: CBT & Family Therapy
CBT
Aims to deal with and challenge negative thought patterns.
Techniques are used to alter someone's behavioural patterns.
Usually takes place over a period of 5-20 sessions.
Uses the ABCDE model to make sense of irrational cognitions and alter behaviours.
identify the ACTIVATING EVENT.
Understand BELIEF systems
CONSEQUENCES of these beliefs
Rationalise the DISPUTE
EFFECT of rastionalisation
generally a short-term solution
forms
Critical collaborative analysis
the therapist uses gentle questioning to help the patient to understand and challenge illogical deductions and conclusions
Normalisation
The therapist shares with the patient that many people have unusual experiences - helps reduce anxiety
Behavioural assignments
Homework tasks which are set to re-learn new patterns of behaviour and challenge the patient's pre-existing beliefs
family therapy
A psychological therapy carried out with all or some members of a family, it involves doing activities and tasks as a family with the aim of improving the communication within a family and reducing the stress of living as a family
Pharoah et al Identified a range of strategies that family therapists use to try to improve the functioning of a family
Reduce negative emotions - anger, guilt ...
Enable the family to work as a team and to understand that‘we’re all in this together’
Educate family members as to the nature of schizophrenia as an illness and dispel any myths or misinformation they may have about the condition
Burbach’s model of practice for dealing with schizophrenia
Identifying recourses including what different family members can/cant offer
Encouraging mutual understanding and creating a safe space for all family members to express their feelings
Sharing basic information and providing emotional and practical support for the family
Involves identifying unhelpful patterns of interactions
Training skills, such as learning stress management techniques
Looks at relapse prevention planning
Maintenance of strategies for the future
evaluations
strength
• Strength- economic benefits - initially expensive for patient, reduced costs in long term prevents relapse and hospitalisation. Patient more likely to return to work- good for wider economy/ less cost to tax payer
• Supporting evidence effectiveness of CBT- Jauhar et al- 34 studies of patients using CBT, found small but significant effect on positive and negative symptoms. At least partially cognitive explanation for schizophrenia- alter and challenge people's delusional thoughts, can change in behaviour
weakness
• Psychologically reductionist treatment- does not target biological factors which may cause disorder, such as an imbalance of dopamine. May not treat cause of disorder, could only be masking psychological symptoms. More effective approach would be to use drug therapy and cognitive behavioural therapy
Socially sensitive- family therapy requires high levels motivation and proactiveness from entire family and patient- may not be possible for everyone/ accessible. CBT requires high levels of motivation from patient, for some disorder may be too severe to complete the homework tasks (might be at a disadvantage because of avolition)
Token Economies for Schizophrenia
A token economy is one in which positive behaviours are rewarded and negative behaviours are discouraged
positively reinforced ( reward such as more tv time/primary reinforcer) by a neutral stimulus ( token/secondary reinforcer) by positive behaviour ( cleaning cell, be friendly)
evaluation
strength
supporting evidence - Dickerson et al. (2005) reviewed 13 studies of the use of token economy systems in the treatment of schizophrenia. 11 of these studies reported beneficial effects that were directly attributable to the use of token economies.
weakness
ethical issues - in order to make reinforcement effective, clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities that alleviate boredom. Also means that clinicians can impose their own social norms and expectations onto patients, which may be more challenging for those with severe symptoms to meet.
the interactionist approach
The Diathesis-Stress Model of Schizophrenia
The diathesis-stress model is based on an holistic approach to explaining a range of disorders, including depression and schizophrenia
assumes schizophrenia isn't caused by one source, but multiple such as biological, social, psychological
The original model (Meehl,1962) suggests that if someone has a genetic vulnerability (diathesis)to SZ this will be triggered by a stressful event or situation
stressors work to bring about the illness or to intensify symptoms of the existing illness
the higher the diathesis of someone the lower the stressor needs to be to trigger it
evaluation
lack of real world application - For example, Tarrier et al. (2004) randomly allocated 315 patients to a treatment condition of either: medication and CBT, medication and group counselling or a control group of only medication. They found that patients in the two combination groups showed lower symptoms levels than those in the control group, although there was no difference in rates of hospital readmission.
strength
supporting evidence - Tienari et al. (2004) studied 19000Finnish children whose biological mothers had been diagnosed with schizophrenia. This high genetic risk group were compared to a control group of adopted children without a family history of schizophrenia. Parents were assessed for their child-rearing style. They found that a child-rearing style characterised by high levels of criticism and conflict and low levels of empathy were implicated in the development of schizophrenia, but only for those in the high-genetic-risk group. High-genetic-risk adoptees reared in families with low scores on this child-rearing style scale were significantly less likely to have developed schizophrenia than high genetic risk adoptees reared in families with high scores on the child-rearing style scale.
Treatment According to the Interactionist Model
Cognitive & biological treatments
anti psychotics
CBT
Interactionist treatment usually starts with the patient taking antipsychotic medication to control their symptoms, followed by CBT: this process is designed to enable the schizophrenic person to be able to participate in CBT more successfully as the drug therapy should have reduced some of their symptoms prior to the CBT sessions
Evaluation
strength
Using the interactionist approach may prove to be cost-effective (i.e. good for the economy) if it is more successful than other treatments as the patient will improve more quickly and is less likely to relapse, saving money on health services and getting the patient back into the workplace more quickly
Strong supporting evidence as seen in, for example, Tarrier et al. (2018) above gives the interactionist approach good validity
weakness
For example, Tarrier et al. (2004) randomly allocated 315 patients to a treatment condition of either: medication and CBT, medication and group counselling or a control group of only medication. They found that patients in the two combination groups showed lower symptoms levels than those in the control group, although there was no difference in rates of hospital readmission.