Schizophrenia

Symptoms

Positive Negative

Hallucinations - Sensory experiences that have no basis in Avolition - Severe loss of motivation to carry out everyday tasks
reality or distorted perception of real things. Experienced in relation to e.g. work, hobbies, personal care. Results in lowered activity levels and
any sense. E.g. hearing voices or seeing people who aren’t there. unwillingness to carry out goal-directed behaviour.

Delusions - Beliefs that have no basis in reality – make a person Speech poverty - A reduction in the amount and poverty of
with schizophrenia behave in ways that make sense to them but are speech. May include a delay in verbal responses during conversation.
bizarre to others. E.g. beliefs about being a very important person or the DSM emphasises speech disorganisation and incoherence.
victim of a conspiracy.

DSM-5: One positive symptom is required to be diagnosed with schizophrenia

ICD-10: Two or more negative symptoms are required to be diagnosed
Issues with diagnosis

• Reliability- will diagnosis be consistent between two or more

clinicians when diagnosing the same patient?
• Validity – is the criteria for diagnosing schizophrenia really testing
for schizophrenia?
Evaluation (must know all as all on the spec)

• Low reliability has been found in diagnosis of schizophrenia. Cheniaux et al. had two psychiatrists independently
diagnose 100 patients using both the DSM and ICD criteria. They found that inter rater reliability was very poor.
One clinician diagnoses 26 patients using the DSM and 44 patients using the ICD. Another clinician diagnosed 13
using the DSM and 24 using the ICD. This study shows not only that there is low reliability of diagnosis between
clinicians but that the criteria itself has low validity.
• A further limitation of diagnosis of schizophrenia is comorbidity. Schizophrenia is comorbid with depression and
substance abuse. For example avolitioin can also be a symptom of depression and hallucinations could be from the
drugs. This impacts on the reliability of the diagnosis and also on validity of the criteria used to diagnoses
schizophrenia
• Another limitation is gender bias. Since the 19080s more men have been diagnosed with schizophrenia than
women. Cotton et al. found that female patients function better than men especially in interpersonal functioning.
This may explain why some women have escaped diagnosis. This is a problem as it impacts on the reliability of
diagnosis
• Final limitation is culture bias. African American and English people of African origin in the UK are more likely to
be diagnosed with schizophrenia. However rates in west India and Africa are not high, foes not indicate genetic
vulnerability. This may be due to social factors and prejudice, and stress factors. Also due to the fact that some
symptoms such as hearing voices are looked on as a positive part of culture (communicating with the dead).
Biological explanations of schizophrenia:
Genetics

• There is a strong relationships between genetic similarity of family

members and likelihood of both developing schizophrenia
• Gottesman (1991) found that Mz twins have a 48% shared risk of both
developing schizophrenia while Dz twins have a 17% shared risk and
siblings have a 9% shared risk
Schizophrenia is polygenetic as more than one gene codes for it
• Different combinations of genes can code for it as schizophrenia is
aetiologically heterogeneous
• Ripke et al. studied 37,00 patients and found 108 separate genetic
variations associated with increased risk; many coded for the dopamine
neurotransmitter
Evaluation

• Tienari et al. did a study in which they looked at children who had parents with
schizophrenia but had been adopted shortly after birth by families without
histories of the disorder. It was found that a high number of the children still
developed schizophrenia and they couldn’t have learnt it from their parent
which supports that there must have been a genetic link. However the fact that
not all children developed schizophrenia suggests there must be environmental
influences as well
Biological explanations of schizophrenia:
Dopamine hypothesis

• Dopamine is widely believed to be involved in schizophrenia

because it is featured in the function of brain systems related to
the symptoms of schizophrenia
• High dopamine activity in the sub cortex is related to speech
poverty and hallucinations
• There is also levels of dopamine in the prefrontal cortex which is
responsible for thinking and decision making
Evaluation

• One limitation is that there is mixed support for the dopamine

hypothesises. Dopamine agonsits (e.g. amphetamines) that
increase dopamine can induce schizophrenia like symptoms in
people without schizophrenia. Ant-psychotic drugs that lower
dopamine can be effective in reducing symptoms. However some
of the candidate genes identified code for the production go other
neurotransmitters such as glutamate. This suggests that dopamine
cannot provide a complete explanation for schizophrenia and that
it is just one important factor.
Biological explanations of schizophrenia:
Neural correlates

• Neural correlates are the measurements of the structure of

function of the brain that correlate with positive or negative
symptoms of schizophrenia
• The ventral striatum is associated with anticipation of reward.
Avolition in schizophrenia may be explained as due to low activity
levels here
Evaluation

• As this is just a correlation we cannot a cause and effect as there

may be other factors involved. A negative correlation may suggest
that low activity in the ventral striatum causes schizophrenia
however it could be that avolition means less information passes
through the striatum resulting in the low activity. Therefore,
though neural correlates exist they tell us relatively little about
the causes of schizophrenia
Biological therapies for schizophrenia:
Drug therapy – typical antipsychotics
• Typical antipsychotic drugs such as chlorpromazine have been around since the 1950s
• They work by acting as antagonists in the dopamine system and aim to reduce the
action of dopamine
• They work by blocking dopamine receptors in the synapses of the brain, reducing the
action of dopamine
• Initially, dopamine levels build up after taking chlorpromazine but then production is
produced
• This normalises neurotransmission in key if the brain which in turn reduces symptoms
like hallucinations
• Chlorpromazine also has an effect of histamine receptors which appears to lead to a
sedation effect. Therefore it is also used to calm anxious patient when they are first
admitted to hospital
Biological therapies for schizophrenia:
Drug therapy – Atypical antipsychotics
• Atypical antipsychotics such as Clozapine have been around since the 1970s.
• The aim was to improve effectiveness of drugs in suppressing psychoses such as
schizophrenia and also minimise side effects
• They typically target a range of neurotransmitters including dopamine and serotonin
• Clozapine binds to dopamine receptors as chlorpromazine does but also acts on
serotonin and glutamate receptors
• Atypical antipsychotics have been found to be more effective than typical as it
reduces depression and anxiety in patients as wel as improving cognitive
functioning. It also improves mood which is important as up to 50% of schizophrenics
attempt suicide
• A newer drug called Risperidone was developed as Clozapine was involved in the
death of some patients from a blood condition called agranulocytosis
Evaluation

• Thronley et al. (2003) reviewed 13 trials (1121 participants) and found

that Chlorpromazine was associated with better functioning and reduces
symptom severity compared with a placebo.
• Meltzer at al. concluded that clozapine is more effect than typical
antipsychotics and that it is 30-50% more effective in treatment resistant
cases
• The use of antipsychotics to calm patients could be considered unethical
as they’re used to make things easier for the staff rather than to benefit
the patient themselves. Short-term use of antipsychotics to calm patients
is recommended by the national institute of health care excellence
however this practice is seen by some as a human rights abuse
Psychological explanations for schizophrenia:
Family dysfunction – Schizophrenogenic mothers

• This literally means mother who cause schizophrenia

• There mothers are either cold, rejecting and controlling or over-
protective.
• This creates a family environment of tension and secrecy which
leads to distrust then later develops into paranoid delusions and
ultimately schizophrenia
Psychological explanations for schizophrenia:
Family dysfunction – double bind

• Bateson et al. (1972) described how a child may be regularly

trapped in situations where they fear doing the wrong things but
receive conflicting messages about what counts as wrong
• They cannot express their feeling about the unfairness of the
situation
• When they get things wrong the child is punished with withdrawal
of love
• They learn that the world is confusing and dangerous, leading to
disorganised thinking and delusions
Psychological explanations for schizophrenia:
Family dysfunction – expressed emotion

• Expresses emotions is the level of emotions (mainly negative)

expresses towards the Schizophrenic patient and includes:
Verbal criticism of the patient
Hostility towards them
Emotional over involvement in their lives

• High levels of EE can cause stress in the patient, a primary

explanation for relapse in schizophrenic patients
Evaluation

• One of the problems with this theory is the methodology used. It’s going to be retrospective data
which can often be unreliable as the patients may have forgotten things or misremembered
• It could be argued that expressed emotion is not to much a cause but an effect of living with
schizophrenia. Living with a schizophrenic can be stressful which could lead to anger and hostility
in the household. It’s even been criticised as being unethical to criticise a family for expressed
emotion. However there is a lot of data showing that when a schizophrenic patient goes back to a
high EE environment there was a higher chance of relapse than those in low EE environments.
This has been supported by Vaughn who found a 50% relapse rate of those in high EE environments
and a 13% relapse rate in those of low EE environments
• Vuaghn and Leff also looked at the amount of face to face communication patients had with their
families. Those who spent less than 35 hours a week with the family (e.g. worked or went to a day
centre) were less likely to relapse.
• One limitation is that this could lead to a culture of blame, people blaming mothers and families
of those with schizophrenia which isn’t good when the family are already under a lot of stress
from having a family member with schizophrenia
Psychological explanations for schizophrenia:
Cognitive explanation

• Lower levels of information processing suggest cognition is

impaired. For example reduced processing in the ventral striatum
is associated with negative symptoms.
• Metarepresentation is the cognitive ability to reflect on thoughts
and behaviour. This allows us insight into our own intentions and
goals. It also allows us to interpret the actions of others.
Dysfunction in metarepresentation would disrupt our ability to
recognise our thoughts as our own. This would explain
hallucinations in schizophrenic patients
Evaluation

• It remains unclear whether cognitive factors are a cause of a

result of the neural correlates and abnormal neurotransmitter
levels in schizophrenia. For example, does dysfunctional
metarepresentation reduce levels of dopamine in superior
temporal gyrus? Or is it the other way around. This questions the
validity of the cognitive approach in explaining the underlying
origins of the condition
Psychological treatments for schizophrenia:
cognitive behavioural therapy
• The aim of CBT in general is to help patients identify irrational thoughts and
try to change them
• This could involve discussion on how likely the patients thoughts are to be true
• It makes them consider how their delusions are affecting them
• Can give patients a scientific explanation for their symptoms
• You’re not saying that they’re not experiencing the hallucinations and
delusions just explaining that they’re coming from their own mind
• Though this won’s stop the schizophrenia it can at least help the patient to
control their own thoughts
• This type of CBT is called belief modification
Evaluation

• Jones et al. (2000) did a meta analysis on patient trials of using CBT. He
found that it was good because it reduces intensity and frequency of
hallucinations but was less effective with their delusional beliefs.
However it did reduce their overall feeling of distress. So this shows that
CBT works for some symptoms but not for others
• Drury et al. (2000) did a 5 year follow up study of patients who’d had CBT.
He found that thought there was immediate benefits, the long term
effects were not as good compared to a control group. Therefore Drury
concluded that there’s no long term benefits or that the short term
benefits are not maintained. Long term there was no difference between
the control group and the CBT group so therefore CBT has less of an
application
Psychological treatments for schizophrenia:
Family therapy

• Family therapy is used to try and reduce expresses emotion within

the household as it tries to reduce stress within the family and
thus decreases risk of relapse
• It is done with the family rather than the individual
• It aims to increase interaction and communication within the
family
Evaluation

• The problem is that there’s not enough data to see if family

therapy really helps the patient. There is evidence that it works in
reducing relapse rates however it’s not a cure for schizophrenia.
This is beneficial because it’s better to be living independent than
in an institution and it makes family less of a trigger
• Pharoh et al. (2003) found that family therapy significantly
reduces the rate of relapse
Psychological treatments for schizophrenia:
Token economies

• Token economies use operant conditioning to reinforce desirable

behaviours
• Tokens (e.g. coloured disks) are given to patients who carry out
desirable behaviours
• This reward reinforces the desirable behaviour and becayse it is
given immediately prevents ‘delay discounting’ which is when the
effects are reduced due to a delayed reward
• Tokens have no value in themselves but can be exchanged for more
tangible rewards such as sweets. These are secondary reinforcers
Evaluation

• Token economies have been considered unethical as they

discriminate against those who are more severely ill as they are at
a disadvantage to getting a reward than other patients. Everyday
food and activities become a privilege and there is ethical issues in
just doing this. Many families have questioned the legality of these
economies and they are used less frequently today because of this.
Interactivist approach

• The diathesis-stress model combines both aspects of the biological explanations

for schizophrenia and parts of the psychological explanations for schizophrenia
Evaluation

• The diathesis aspect of the diathesis stress model may not necessarily be genetic. However brain damage
from the environment can also increase chances of developing schizophrenia. For example birth
complications have been found to make an individual four times more likely to develop the disorder later
in life than those who experience no such complications.
• Tienri did a study on 145 babies with high genetic risk of schizophrenia who were adopted into families
without a history of the disorder and 158 babies with low genetic risk. Adoptive families were given an
OPAS rating which measures factors such as conflict, lack of empathy and insecurity. Out of the 303
children, 14 went on the develop schizophrenia. 11 of these were from the high risk group. Those in the
high risk group had a significantly higher chance of getting schizophrenia if their adoptive family had a
high OPAS rating. This supports that both genetic vulnerability and an environmental trigger are needed to
develop schizophrenia
• However there are limitations with the methodology of this study. The families were only measured for
their OPAS rating on one occasion. There could have been factors making them seem more stressed at this
particular time when they’re not usually like this. They should have been tested on more than one
occasion. We also can’t say if the stress is caused by the family or the adoptee. Many adoptees act out at
a certain age which could cause the family stress or the family may have always been dysfunctional and
cause stress. Therefore this study may lack validity.