Unit 6

6.1
Schizophrenic Man interview-Chris
The Psychologist Who Changed Sc
hizophrenia Treatment | Three C
hrists of Ypsilanti
ICD-11
Vs
DSM-5
ICD 11 DSM 5

a period of 1 month or more continuous signs of the disturbance persist for at

least 6 months

experiences of influence, passivity or control as a these symptoms are considered to be examples of

separate core symptom delusions

includes alogia or paucity of speech, asociality and restricts negative symptoms of Schizophrenia to
anhedonia diminished emotional expression and avolition

no such requirement - diagnosis is “frequently requires a deterioration in functioning in one or more

associated” with significant functional impairment major areas, such as work, interpersonal relations or
self-care, since the onset of the disturbance

identifies six symptom domains, rated on a 4-point identifies three separate domains (hallucinations,
scale (not present, mild, moderate, severe) delusions, disorganized speech), rated on a 5-point
scale (not present, equivocal, mild, moderate,
severe)

Used internationally Used in the US.

 Freeman
01 (2008)
What are the seven different ways that
VR can help with schizophrenia?
 Symptom Assessment
● VR can provide a standardised
assessment of symptoms

● Patients are presented with a

neutral social scenario so symptoms
can be analysed

● VR avatars can be programmed to

respond or not respond to test
behaviour in multiple scenarios
 Establishing symptom correlations

● VR can provide an ideal setting to

monitor behavioural and physiological
correlation of any symptoms

● A patient's movements can be easily

tracked alongside physiological
responses

● Patterns between symptoms can be easily

noticed by researchers
 Identifying predictive variables

● Pre-measures of personality and

behavioural aspects of
schizophrenia can be taken and
then used to predict how patients
may react to situations presented
to them outside of VR
 Identifying differential predictors

● Multiple variables can be assessed

within the relative safety of VR

● Social anxiety can be measured in

relation to schizophrenic symptoms
 Identifying environmental predictors
● VR setting can be easily manipulated

● Aspects of environmental influence can be

measured safely

● Patterns of triggers and reactors can be

identified

● Social paranoia may be linked to the size of

the room a patient is in, this can be
manipulated to see what the ‘trigger size’ is
 Establishing causal factors

● Experimental manipulation of factors

pre-VR can help determine cause and
effect

● Freeman: “manipulating pre-anxiety

levels (e.g anxiety-inducing, anxiety-
reducing and a control) can be easily
be implemented to see what effect this
has on patients in a controlled VR
environment”
 Developing treatment
This can be threefold:
a. Educate patients on which factors make
them better or worse

b. Expose patients to persecutory fears in

the VR environment that is less
threatening than exposure in a real-
life setting

c. Help patients learn to cope with the

symptoms presented
 02
Explanations
Explanations of schizophrenia and delusional disorders
 Alice and Carlos are discussing the causes of
schizophrenia. Carlos refers to someone he knows
and says ‘He has got schizophrenia and so has his
mum, so it must be genetic.’ Alice believes it is not
as simple as Carlos thinks.

1. Explain why Alice might be correct?

2. Suggest how the nature vs nurture debate could be

applied to the explanations of schizophrenia

3. Describe how adoption studies could be used to

help our understanding of the biological vs
environmental causes of schizophrenia
 Genetic Explanation:
Gottesman and Shields (1972, 1975)
Is there an inherited component to schizophrenia?

● Gottesman and Shield is one of the most quoted studies

● Researched adoption, twin, and family studies to see whether there was a genetic
component to schizophrenia

What are MZ and DZ twins?

● Monozygotic / MZ - identical twins

● Dizygotic / DZ - non-identical twins

What hypotheses can we create in relation to MZ/DZ twins and schizophrenia?

MZ twins have a higher
prevalence of
schizophrenia than DZ
twins when one has a
formal diagnosis
What is our opinion on the results?
What type of research did Gottesman and Shields conduct?
What conclusions can we draw (if any)?
 Genetic Explanation:
Gottesman and Shields (1972, 1975)
● Results to point towards a potential
genetic component to schizophrenia
as the rates for MZ twins is 25-58%
and DZ twins it is 9-26%

● None of the rates are 100%

○ What does this mean?

● Gottesman and Shields also examined

adoption studies and found a trend
○ What is the trend?
Genetic Explanation:
Gottesman and Shields (1972, 1975)
● Are there any ethical, practical, or theoretical concerns with Gottesman
and Shields’ studies?

● The study was a thorough review of the field of information available at

that time - good or bad?

● The research method was secondary data - good or bad?

● Many different sources were used - good or bad?

 Biochemical Explanation: Dopamine Hypothesis

● Dopaminergic systems in the brain of schizophrenics are overactive

○ What does this mean?

● When people experience amphetamine psychosis, it resembles schizophrenia

○ Why is that?

● Drug treatment (phenothiazines) helps treat symptoms of schizophrenia

○ What other symptoms could it cause?
Biochemical Explanation: Dopamine Hypothesis
Dopamine hypothesis has been
tested using PET scans.

Schizophrenics and healthy

participants were injected with L-
DOPA (used in the production of
dopamine).

L-DOPA was taken up

significantly faster in
schizophrenics, pointing to them
using more dopamine.
 Cognitive Explanation: Frith (1992)
● Schizophrenia is caused by faulty information processing

● In cognitive tests, schizophrenics perform worse than healthy individuals

● Frith: ‘schizophrenics may have a deficient ‘metapresentation’ system

○ What does this mean?
○ Metapresentation - system that allows people to reflect on thoughts,
emotions, and behaviour

● Those showing more negative symptoms may have dysfunctory supervisory

attention system
○ What does this mean?
○ DSA - system responsible for generating self-initiated actions
 Cognitive Explanation: Frith (1992)
● Frith and Done (1986) study

● Participants were asked to:

○ Name as many different fruits as possible
○ Generate as many designs for something as possible

● What do you think the researchers discovered about people with schizophrenia
(those with negative symptoms predominant)?

● Those with schizophrenia and predominant negative systems had great difficulty
completing these tasks

● How is this related to ‘dysfunctional supervisory attention system?

 Cognitive Explanation: Frith (1992)
● Frith also examined a central monitoring system
○ What does this system allow us to do?
○ Understand and label actions that we do as
being controlled by ourselves

● How do people with schizophrenia differ from

‘healthy’ people in relation to a central
monitoring system?
○ In some schizophrenics, Frith noticed that
their inner speech may not be recognised as
being self-generated
○ What does this mean?
 To what extent do you
feel that schizophrenia
is linked to nature rather
than nurture?
 03
Treatment
Treatment and management of schizophrenia and delusional disorder
Treatment

Token
Biochemical ECT CBT
Economies
 Biochemical Treatment
● Biochemical treatment centers on using drugs to alleviate the
symptoms

Typical Antipsychotics (aka first-generation)

● Aim to increase negative symptoms
● Aim to slow down positive symptoms

Side effects:
● Typical / Extrapyramidal
● Stiffness, peculiar walking stances
● Occur once patients begin course of medicine
 Biochemical Treatment
Atypical Antipsychotics (aka second generation)
● Developed in the 1990s
● E.g Clozapine
● Have beneficial effect on negative symptoms
● Effective for treatment-resistant patients
● Rapidly dissociate (block dopamine for a
short time)
● Rapid dissociation allows for normal
dopamine transmission and less side effects
 04
Task
Complete the table
Pharmacology - AN
TIPSYCHOTICS (M
ADE EASY)
 Electroconvulsive Therapy (ECT)
● Procedure where patient receives electricity
to induce a seizure
● Early attempts were not pleasant, now
patients are anaesthetised and given muscle
relaxers
● Up to 1 second of electricity, up to 1 minute
of seizure and 15 mins until patient regains
consciousness
● Psychologists and clinicians are divided on
the use of ECT
● ECT
 Electroconvulsive Therapy (ECT)
● Reviews of ECT have looked at 4 issues:
symptom response, technical application,
continuation/maintenance of ECT, and its
combination with medication.
● ECT can be quite effective with catatonic
schizophrenics and in reducing paranoid
delusions
● Evidence that it may improve a person’s
responsiveness to medication
● When used with medication, ECT works better
Should we still
use ECT?
 Token Economies: Paul and Lentz (1977)
● Token economies are based on operant conditioning
○ What does this mean?

● Token economies try and shape behaviour by giving out

tokens every time a relevant behaviour is shown

● Patients can accrue tokens and exchange them for

something they would like
○ How would this encourage behaviour?
 Token Economies: Paul and Lentz (1977)
● Paul and Lentz set up a token economy in an institution that
housed people with schizophrenia

● Patients were given tokens for appropriate behaviour

○ Participating in group therapy
○ Self-care
○ Appropriate socialisation
○ Refraining from angry outbursts

● Overall, the patients who went through the token economy

performed better than others.

● There was also a reduction in the need for medication in the token
economy group
Where / How else can
token economies be
used?
 Cognitive Behavioural Therapy (CBT): Sensky et
al (2000)
● Aims to change or modify thoughts and beliefs, and change the
way they process information

● A therapist will challenge irrational thoughts and unhelpful

behaviours

● Intention of CBT for schizophrenia is to help patients make sense

of the psychotic experiences and reduce negative effects

● Patients may also be given help to understand that views,

thoughts, and interpretations are not facts, then help to deal with
assessing them.
 Cognitive Behavioural Therapy (CBT): Sensky et
al (2000)
● Sensky et al tested the usefulness of CBT for persistent symptoms of
schizophrenia that were resistant to medication.

● Patients were recruited if they

○ Were aged 16-60
○ Had a diagnosis according to the ICD and DSM
○ Had symptoms for 6 months +
○ Had shown no improvement on medication
○ Did not abuse alcohol or drugs

● 90 participants were grouped into one of two groups

○ A CBT group designed for schizophrenia
○ A ‘befriending’ intervention.
 Cognitive Behavioural Therapy (CBT): Sensky et
al (2000)
● Both of the interventions were led by qualified nurses

● Patients were assessed at baseline, after treatment, and at a

follow up

● An assessor who was blind to the study rated the therapy

sessions for quality

● Both interventions resulted in a significant reduction in

negative and positive symptoms

● At a 9 month follow up, those who had received CBT

continued to improve whereas the befriending group did
not
 04
Task
Design a study to compare the effectiveness of two
treatments of schizophrenia