Schizophrenia

Front 1

What are the symptoms of schizophrenia?

Back 1

• Delusions

• Hallucinations

• Catatonia

• Social Withdrawal

• Alogia (Poverty of Speech)

• Thought Insertion

• Disorganised behaviour

• Experiences of Control

• Avolition

• Affective Flattening

(Two or more of these symptoms must be present for a month, with six months of social disturbance.)

Front 2

What are the five categories of schizophrenia and their symptoms?

Back 2

• Paranoid – delusions and hallucinations (no catatonia or flat affect)

• Disorganised – disorganised speech and behaviour (no catatonia or flat affect)

• Catatonic – motoric immobility, echolalia, echopraxia, mutism, peculiar movements

• Undifferentiated – doesn’t fit one of the above categories

• Residual – negative symptoms and/or attenuated symptoms (ie odd thoughts) still present

Front 3

Classification of schizophrenia AO2s

Back 3

• The undifferentiated category is overused and ill-defined.

• The catatonic category may just be due to the medication used to treat schizophrenia.

• There is a lot of overlap between categories.

• Goater et al (1999) found that ethnic minorities were over-diagnosed, suggesting bias in the categories or the psychiatrists.

Front 4

What is the genetic explanation of schizophrenia?

Back 4

Genetic explanations suggest that some people have a genetic predisposition to develop schizophrenia.

Front 5

What are the concordance rates for schizophrenia?

Back 5

48% MZ and 17% DZ twins. However, the MZ concordance rates are not 100% which suggests that the environment may play a role – eg identical twins are often treated more similarly.

Front 6

Genetic AO2s

Back 6

•Gottesman & Shields (1982), severe schizophrenia more likely to be due to genetics, as there was an 80% concordance rate of severe schizophrenia in MZ twins, compared to 50% in all forms.

• Tienara (1991), 10% of adopted children with schizophrenic mothers developed schizophrenia, compared to 1% of those who were adopted who didn’t have a mother with schizophrenia.

• Gottesman (2001) looked at 40 studies of schizophrenia over 60 years and found that children with parents who were both schizophrenic had a 48% chance of developing schizophrenia, 16% with one parent, 8% with a sibling, and just 1% with no relatives.

• However, family members are more likely to spend time with each other and so this may be why they are more likely to develop schizophrenia.

• Furthermore, sixty years ago diagnosis was very different, and so people who were diagnosed with schizophrenia in the studies Gottesman looked at may not be diagnosed with it now.

Front 7

What are neurochemical explanations of schizophrenia?

Back 7

Neurochemical explanations suggest that people with schizophrenia have more dopamine in their synapses, or possibly that their brains are more sensitive to dopamine, and this causes their symptoms.

Front 8

Neurochemical explanation AO2s

Back 8

• The direction of cause-effect is unclear.

• This explanation is very reductionist.

• Amphetamines and cocaine (which both increase dopamine levels) have been found to produce schizophrenia-like symptoms.

• Barlow & Durand (1995) found that the drug chlorpromazine, which stops the activation of dopamine receptors, works for the positive symptoms of 60% of people.

• However, this drug does not affect the negative symptoms, suggesting that there is an underlying cause that causes both positive and negative symptoms that is not dopamine.

• Timmons & Hamilton (1990) report that high doses of amphetamine (which stimulates DA activity) can result in acute psychosis resembling schizophrenia. This amphetamine psychosis can be treated with chlorpromazine.

• However, as this only causes schizophrenia-like symptoms and not schizophrenia itself, it suggests that something causes the high DA.

• Timmons & Hamilton (1990), Parkinson’s disease is caused by low DA and affects 1-2% of the general population but was found to be extremely rare in schizophrenics, supporting the idea that high DA is involved in schizophrenia.

Front 9

What is the labelling explanation for schizophrenia?

Back 9

Szasz (1962) suggested that schizophrenia doesn't exist and is simply a way that society labels people whose behaviour is strange and difficult to control. This label creates a stigma which may then lead to a self-fulfilling prophecy, where a person labelled with schizophrenia begins to display more symptoms after being labelled.

Front 10

Rosenhan's study of labelling AO2s

Back 10

• Rosenhan (1973) had eight people go to their doctors and tell them that they heard a voice in their head saying 'thud'. 7 were diagnosed with schizophrenia and all were hospitalised. They acted normally after this but were kept in for an average of 17 days, in which time they said that the doctors scared them and made them feel powerless, while the other patients could tell that they weren't ill. This supports the labelling explanation.

• However, this study was unethical and deliberately misleading of doctors.

• Furthermore, it doesn't prove that labels create a self-fulfilling prophecy.

Front 11

Other labelling AO2s

Back 11

• This explanation does not lead to a treatment.

• However, it did lead to better and more accurate diagnosis.

Front 12

What is the double bind explanation of schizophrenia?

Back 12

Bateson suggested that contradictory verbal and non-verbal messages (such as asking for a hug but flinching when it is given) cause children to lose touch with reality and learn not to trust their own feelings as they can't trust others'.

Front 13

Double bind AO2

Back 13

• These contradictory verbal and non-verbal messages may not cause schizophrenia but be caused by it instead (cause-effect is unclear).

Front 14

What is the expressed emotion explanation of schizophrenia?

Back 14

This theory suggests that criticism and hostility from family members will lead to relapse.

Front 15

Expressed emotion explanation AO2s

Back 15

• Leff &Vaughn (1985), positive family environments lowered relapse rates.

• However, the expressed emotion might be caused by the schizophrenia, rather than the other way round.

• Butzlaff & Hooley (1998) did an analysis of 20 EE studies and found that those in high EE families had a 70% relapse rate compared to 30% in low EE families.

• However, not all schizophrenics have family so this does not explain their schizophrenia.

• Furthermore, EE can cause a family to supress their emotions, but this is not helpful either.

Front 16

What is one example of a conventional anti-psychotic, how does it work, and what is a weakness of them?

Back 16

Chlorpromazine works by blocking dopamine receptors in the brain and can gradually weaken positive symptoms. However, these drugs only work on positive symptoms and can have bad side effects such as shaking and tardive dyskinesia.

Front 17

What are two examples on atypical drugs and what do they do?

Back 17

Clozapine and risperidone work on a wider range of neurotransmitters and reduce both positive and negative symptoms.

Front 18

Atypical drugs AO2s

Back 18

• Clozapine has fewer side effects than conventional drugs and also treats negative symptoms.

• However, there are some side effects, such as drowsiness, dizziness, and weight gain, which could cause someone to stop taking the drugs and relapse. Atypical drugs can also sometimes attack the immune system.

Front 19

Drug Treatment for Schizophrenia AO2s

Back 19

• Cole (1964), double-blind study, 3 groups taking different drugs and 1 group taking a placebo, found that 75% of the people on the drugs showed an improvement while only 25% of the placebo group showed an improvement.

• Antipsychotics can reduce hospital stays.

• However, it is difficult for medical professionals to supervise people on drugs and to make sure that they take them if they are not in an institution and this can mean that people don’t take their drugs because of side effects, forgetfulness, etc, and end up relapsing.

• Furthermore, the drugs only manage the symptoms, which means that people often have to take the medication for the rest of their lives.

• Patients often have to try multiple drugs to find one that works for them.

Front 20

How does cognitive therapy for schizophrenia work?

Back 20

Cognitive therapy aims to change maladaptive thoughts and behaviour. In therapy, the patient will be helped to understand their thinking patterns and find a way to help them deal with the voices they hear (often by talking to them until they gain control of them).

Front 21

Cognitive therapy AO2s

Back 21

• Romme & Escher (2000), focusing on voices reduces the likelihood of harm to the patient and to others.

• However, this approach (talking to voices) could encourage delusional thinking.

• Paying attention to the voices may also cause the person to do what the voices tell them to do.

• People with schizophrenia are irrational and so are not able to speak logically about their experiences, making therapy difficult.

• Furthermore, this therapy does not cure schizophrenia, although therapists argue that the aim of the therapy is to help the patient manage their symptoms, not necessarily cure them.

• Drugs may also be needed in conjunction with therapy.

Front 22

How do psychoanalytic therapies for schizophrenia work?

Back 22

Psychoanalytic theories suggest that schizophrenia is caused by unresolved unconscious conflicts, and so, in therapy, patients would be taught to strengthen their ego so that they could deal with these conflicts in the conscious mind.

Front 23

Psychoanalytic therapy AO2s

Back 23

• Psychoanalytic therapy is very subjective.

• There is no scientific basis.

• Schizophrenic people cannot speak articulately and so talking therapies are not useful.

• However, it can help a patient gain insight into their condition and allows people to discover important things about themselves.

• Katz & Gunderson (1990), psychoanalytic therapy may be harmful to people with positive symptoms.

Front 24

What is community care?

Back 24

Community care is a sliding scale of care that allows all patients to get the level of care that they need. It can range from residential care to sending text-reminders for medication.

Front 25

Community care AO2s

Back 25

• Not being hospitalised makes schizophrenics a greater risk to themselves and others.

• However, they are less likely to imitate the behaviour of other schizophrenic people when they are not in an institution with other people and so may recover more.

• Stein & Test (1980) followed the recovery of 65 schizophrenic people who had been released from an institution into community care and 65 who did not have that support. They found that 58 of those without community care relapsed, while 53 of those in community care did not relapse.

• Community care allows people to have more independence, although this can back fire and cause people to become homeless because they can’t cope.

• Community care can also put an unfair amount of stress on the family.

• Community care is often a postcode lottery, with different services being available in different places. This can mean that people do not get the care they need, and those who have their care cut while they are using it are likely to relapse.