Everything to do with schiz - a2 Psychology Lesson updates 13-14

Report
Schizophrenia
Essential Revision
In relation to
their chosen
disorder:
schizophrenia
Information to know
characteristics
of Sz
WhatClinical
do
we need
to know?
Issues surrounding the classification and diagnosis of including relablitity and
validity
Biological explanations of Sz, for example, genetics,
biochemistry
Psychological explanations of Sz; behavioural, cognitive, psychodynamic and
socio-cultural
Biological therapies for their chosen disorder, including their evaluation
in terms of appropriateness and effectiveness
Psychological therapies for Sz, for example, behavioural, psychodynamic and
cognitive-behavioural, including their evaluation in terms of appropriateness
and effectiveness
Schizophrenia
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Schizophrenia is one of the most chronic and disabling of
the major mental illnesses affecting thought processes. 1%
of the worldwide population suffers from schizophrenia.
In order for a diagnosis to be made, two or more of the
symptoms must be present for more than one month along
with reduced social functioning
The symptoms are separated into two categories; positive
and negative. Positive symptoms are an excess or distortion
of normal functions and negative symptoms are an
diminution or loss of normal functions.
The diagnostic criteria of the two systems (DSM and ICD)
are very similar, but the DSM states that signs of
disturbance should be apparent for at least 6 months,
whereas the ICD requires the signs to be apparent for one
month.
Diagnosing mental disorders
 DSM
(Diagnostic and statistical Manual of
Mental Disorders) is produced by the
American Psychiatric association. It
contains a list of symptoms for each
disorder and guidelines for clinicians who
make diagnosis.
 ICD: International Classification of
Diseases) is produced by the World Health
Organisation for both physical and mental
illnesses. Its aim is to follow the
epidemiology of diseases worldwide.
Clinical Characteristics
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Schizophrenia has been variously described as a disintegration of the
personality
A main feature is a split between thinking and emotion.
It involves a range of psychotic symptoms (where there is a break from
reality)
Generally, schizophrenic patients lack insight into their condition, i.e.
they do not realise that they are ill.
They must follow the pattern of symptoms (see next slide)
Positive and Negative Symptoms
A distinction has been made between type 1 and type 2 schizophrenia.
Type 1 is dominated by positive symptoms and type two by the negative.
Positive Symptoms
Negative symptoms
 Delusions – paranoia, grandiosity (i.e. Reduction in range and intensity of
believe they are Jesus)
emotional expression, including facial
 Experiences of control – thoughts and expression, tone of voice etc
actions are believed to be under
 Avolition – reduction or inability to
external control (i.e. of alien force).
take part in goal directed behaviour.
Auditory hallucinations – bizarre,
 Reactivity is not expected
unreal perceptions, usually auditory.  Thought blocking
 Thought disturbance and disordered
 Asocial behaviour
thinking – thoughts have been
inserted or withdrawn from the mind. Emotional blunting
 Psychomotor – catatonia –
 Language impairments
immobility and frenetic activity
 Disorganised behaviour
 catatonia – immobility – echopraxia,
echolalia
Subtypes of Schizophrenia
Paranoid Type – 35-40% (less
severe)
Preoccupation with one or more
delusions or frequent auditory
hallucinations. No disorganized
speech, disorganized or
catatonic behaviour, or flat or
inappropriate affect.
Catatonic Type – 10%
immobility or stupor excessive
motor activity that is apparently
purposeless, extreme negativism,
strange voluntary movement as
evidenced by posturing,
stereotyped movements,
prominent mannerisms, or
prominent grimacing.
Disorganized Type – 10%
Must have all; disorganized
speech, disorganized behaviour,
flat or inappropriate affect and
not meet the criteria for Catatonic
Type.
Undifferentiated Type – 20%
Variation between symptoms, not
fitting into a particular type
Residual Type – 20%
Absence of prominent delusions,
hallucinations, disorganized
speech, and grossly disorganized
or catatonic
behaviour. Plus presence of
negative symptoms or two or
more symptoms listed in Criterion
A for Schizophrenia
Main points
Reliability and validity of diagnosis
Reliability
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Both the DSM and the ICD are
used and this causes difficulties as
their criteria vary slightly.
Despite the use of these system
the reliability of diagnosis has
been shown to be as low as 0.11
by Whalley.
One symptom is “bizarre” delusion
however what seems bizarre to 1
psychiatrist might not seem bizarre
to another.
Mojtabi and Nicholson found an
inter-rater reliability of 0.4 which is
low to base such a serious
diagnosis
Rosenhan’s study shows that
reliability of diagnosis is
questionable and is influenced by
expectations and situational
factors.
Validity
• Comorbidity
Symptoms such as delusions and
thought disorders are also found in
other disorders such as bipolar
disorders.
• Predictive validity: it is impossible to
predict the development of Sz in a
particular individual therefore the Sz
has low predictive validity. 20% of Sz
recover their previous level of
functioning, 10%show significant
improvement, 30% show some
improvement but 40% never
recover.
Because of the stigma attached to
the diagnosis of Sz, psychiatrists might
be reluctant to diagnose such a
serious mental disorder therefore Sz
might be underdiagnosed.
Reliability;
Reliability concerns consistency of measurements, in relation to the
classification and diagnosis;
 inter-rater reliability – whether two or more clinicians make the same
diagnosis when independently assessing a patient. Some of this error may be
due to the fact that the same patient may give different information to
different doctors.
Test-retest reliability – whether the same clinician gives the same diagnosis
when given the same information
 Obviously a diagnosis is useless if it fails to be consistent; BECK found 54%
consistency when four experienced clinicians diagnosed 153 patients.
More on Reliability
There is both evidence for and against the reliability of a
diagnosis of schizophrenia;
 PRO – the diagnosis of schizophrenia has relatively high
reliability (+.81)
 ANTI – Read et al reported that test-retest reliability was
as low as +.31 and also described a 1970 study where
194 British and 134 American psychiatrists were asked to
provide a diagnosis on the basis of a case description.
69% American’s diagnosed schizophrenia and only 2% of
British did.
 Despite low reliability, the classification schemes are still
useful as they are better than nothing
 Classification systems are always being improved! (DSM
II with Rosenhan, now DSM IV)
Validity
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Reliability – an unreliable diagnosis cannot be valid (the diagnosis is
not true; the person does not have schizophrenia).
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Predictive validity – if diagnosis results in successful treatment
then the diagnosis must have been valid
At one extreme, up to 20% of those diagnosed with schizophrenia never have
a recurrence of the disorder after the first episode (Bichwood & Jackson,
2001). At the other extreme, about 10% of schizophrenics commit suicide
(Birchwood & Jackson, 2001) Poor predictive validity!
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Cultural/Ethnic Bias – Keith et al. (1991) also found that 2.1% of African-
Americans are diagnosed with schizophrenia, compared with 1.4% of white
Americans. However, African-Americans on average are more likely than
white Americans to live in poverty and to suffer marital separation. When
these factors were controlled for, it turned out that there was no difference in
the incidence of schizophrenia in the two groups.
Social Class bias - . Keith et al. (1991) reported that 1.9% of lower-class
people, 0.9% of middle-class people and only 0.4% of upper-class people
were diagnosed with schizophrenia.
Ethical issues around
classification and Diagnosis
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Problems with type 1 and type 2 errors i.e.
saying someone is schizophrenic when they
are not, or saying someone does not have
schizophrenia when they do.
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Labelling – diagnosis leads to labelling. While
this can be helpful in terms of providing an
appropriate treatment, it can be stigmatising
and lead to a self-fulfilling prophecy.
Genetics
Neurochemical & hormones
Structural brain abnormalities
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Biological Explanation: Genetics
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Prevalence of schizophrenia is the same all over the world (about 1%)
◦ Supports a biological view as prevalence does not vary with
environment
Risk rises with degree of genetic relatedness
◦ Spouse – 1% (same as G.P.)
◦ Child – 13%
◦ DZ twin – 17%
◦ MZ twin – 48%
Kendler et al (1985) found that
1st degree relatives of those with
schizophrenia are 18 times more
at risk than the general
Population
 Children with both parents who
suffer from schizophrenia have
a CONCORDANCE RATE OF 46%
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Biological Explanation: Genetics
The Copenhagen High-Risk Study (Kety et al. 1962)
 Kety identified 207 offspring of mothers diagnosed with
schizophrenia (high risk) along with a matched control of
104 children with ‘healthy’ mothers (low risk) in 1962
 Control group were matched on age, gender, parental socioeconomic status and urban/rural residence
 Children aged between 10-18 years at start of study
 Schizophrenia diagnosed in 16.2% of high risk group
compared to 1.9% in low risk group
Sherrington found that chromosome 5 has evidence of
susceptible schizophrenia.
Biological Explanation: Genetics
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To research more on the impact of genetics on schizophrenia, we can
compare concordance rates for identical (MZ) and fraternal (DZ) twins
Both share the same environment but only MZ twins have identical
genetics – if schizophrenia is genetically related, the concordance rate of
schizophrenia should be much higher in MZ twins.
To prove this many studies have been conducted – ALL OF THEM show
much higher concordance rate in MZ than DZ twins
To prove the genetic influence further, you have to research the power of
genetics in separate environments - researchers have sought out MZ
twins reared apart where at least 1 has been diagnosed with
schizophrenia
Used the Maudsley twin register and found 58%
(7/12 MZ twins reared apart) were concordant for
schizophrenia
Biological Explanation: Genetics
Although twin, adoption and family studies continue to support
that the degree of risk of developing schizophrenia increases
with degree of genetic relatedness, there are two factors which
stop us concluding biology as the source;
 No twin study has yet shown 100% concordance in MZ twins
 Studies conducted so far don’t tell us which genes might be
important for the transmission of schizophrenia.
Biochemical Explanation
The dopamine hypothesis- Comer (2003)
 Dopamine is one of the many neurotransmitters operating in the
brain.
 Dopamine neurons play a key role in guiding attention, so it is
thought that disturbances in this process may lead to the problems
of attention and thought found in people with schizophrenia.
 A group of drugs were developed in the 1950s called
phenothiazines, which bind to the D2 receptors, effectively
blocking the transmission of nerve impulses through these receptors
and therefore reducing deficit found in schizophrenic.
Evidence for Biochemical
Explanation
 Dopamine
substitutes such as L-Dopa increase
the positive symptoms of schizophrenia
 L-Dopa is used to treat Parkinson’s Disease which
is characterised by a lack of dopamine
 Too much L-Dopa produces psychotic symptoms in
Parkinson’s patients
 Large doses of anti-schizophrenic drugs (in both
‘normal’ and schizophrenic patients) produce
symptoms similar to Parkinson’s
 These drugs block the action of dopamine 
dopamine must be implicated in schizophrenia
Evidence for Biochemical Explanation
 Drugs
such as L-Dopa, cocaine, amphetamine, and
methylphenidate (Ritalin) act as ‘dopamine agonists’ –
mimicking the effects of dopamine because of their
similar molecular shapes..
• Davis (1974) injected schizophrenics with methylphenidate
and found a marked increase in symptoms
• Griffith et al (1972) studied 7 participants with a history of
amphetamine use: all were given large doses of
dextroamphetamine every hour for 5 days although none
had any previous history of mental illness, within 2-5 days
all were showing psychotic symptoms
General Evaluation of the Biochemical
Approach
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There are ethical problems with this research.
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might not just be about having too much dopamine.
Schizophrenics are thought to have an abnormally high
number of D2 receptors on their receiving neurons, resulting
in more dopamine binding and therefore more neurons
firing.
Increases
in dopamine leads to increases in positive
symptoms, but not negative symptoms. Negative symptoms
are better explained by structural brain abnormalities.
Brain structure
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Using PET, MRI and Cat scans researchers have discovered that
many schizophrenics have enlarged ventricles, cavities in the brain
that supply nutrients and remove waste. The ventricles of a person
with schizophrenia are on average about 15% bigger than normal
(Torrey, 2002).
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Brown et al. (1986) found decreased brain weight and enlarged
ventricles, which are the cavities in the brain that hold cerebrospinal
fluid. Flaum et al. (1995) also found enlarged ventricles, along with
smaller thalamic hippocampal and superior temporal volumes.
Buchsbaum (1990) found abnormalities in the frontal and pre-frontal
cortex, the basil ganglia, the hippocampus and the amygdale. As
more MRI studies are being undertaken, more abnormalities are
being identified. Structural abnormalities have been found more
often in those with negative/chronic symptoms, rather than
positive/acute symptoms, lending support to the belief that there
are two types of schizophrenia: Type 1 (acute) and Type 2 (chronic).
Evaluation
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research into enlarged ventricles and neurotransmitter
levels have high reliability because the research is
carried out in highly controlled environments, which
specialist, high tech equipment such as MRI and PET
scans. These machines take accurate readings of brain
regions This suggests that if this research was tested and
re-tested the same results would be achieved.
Suddath et al. (1990)used MRI to obtain pictures of the
brain structure of MZ twins in which one twin was
schizophrenic. The schizophrenic twin generally had
more enlarged ventricles and a reduced anterior
hypothalamus. The differences were so large the
schizophrenic twins could be easily identified from the
brain images in 12 out of 15 pairs. This suggests that
there is wider academic credibility for enlarged
ventricles determining the likelihood of schizophrenia
developing.
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The enlarged ventricles could be the effect rather than
the cause of Sz.
Beng-Choon Ho (2010) in a longitudinal correlational
study of 211 schizophrenics found that antipsychotic
drugs have measurable influence on brain tissue loss
over time. This was supported by Lewis (2009) who
administered antipsychotic drugs to primates and found
a brain volume loss of 10% . However this was a
correlational study so it does not show cause and effect
and this study was carried out on animals so we cannot
extrapolate to humans without caution.
if the reduction in brain volume is the cause of the
schizophrenic symptoms then it cannot explain why
after 30 years of the initial onset, 35% of the
schizophrenics are classified as "much improved".
Evaluation of Biological
Approach
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Humane approach; poses no blame on the individual or their
families – states that the people who become ill are purely
“unlucky”
Tends to provoke little fear or stigma
Effective treatments
Well established scientific treatments
Reductionist approach – Reference to Diathesis-Stress Model
Animal studies
Relies on self report
Treats symptoms, not causes
Behavioural
Cognitive
socio-cultural
Psychological Explanations;
Behavioural approach
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Behaviourists argue that learning plays a key role in the development of
schizophrenia. One suggestion is that early experience of punishment may lead
the child to retreat into a rewarding inner world. Others then label them as
‘odd’ or ‘strange’.
Scheff’s (1966) labelling theory suggests that individuals labelled in this way
may continue to act in ways that conform to this label. Bizarre behaviour is
rewarded with attention, and becomes more and more exaggerated in a
continuous cycle before being labelled as ‘schizophrenic’
Behaviourists have attempted to explain schizophrenia as the consequences of
faulty learning.
If a child receives little or no social reinforcement early on in life, the child will
attend to inappropriate and irrelevant environmental cues, instead of focusing
on social stimuli in the normal way.
Behaviourists explain the fact that schizophrenia runs in families as a function of
social learning. Bizarre behaviour by parents is copied by children. Parents then
reinforce this behaviour and the behaviour becomes progressively more
unusual, until eventually the child acquires the label of being ‘schizophrenic’.
Evaluation
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The validity of the behavioural model is moderately supported by the
success of behavioural therapies used with schizophrenic patients.
Social skills training techniques have been used to help schizophrenics
acquire useful social skills (Rodger et al.,2002). Allyon & Azrin (1968) have
shown that schizophrenics have learned to make their own beds, comb
their own hair etc. when given rewards for doing so.
Finally Roder et al. (2002) has demonstrated that social skills training
techniques have been used to help schizophrenics acquire social skills.
The success of such programmes in teaching new skills and reintegrating
schizophrenics back into the community suggests that these are skills that
schizophrenics failed to learn in the first place.
Overall this research can explain how schizophrenia symptoms are
maintained but it does not adequately explain where they came from in
the first place.
Critics claim that labelling theory ignores strong genetic evidence and
trivialises a serious disorder.
In what ways could it be argued that the behaviourist approach to schizophrenia
is reductionist?
Further Evaluation of
Behavioural Approach
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Experimentally tested
Speaks on the present, as well as the past (validity)
Effective treatments
Accounts for cultural differences
Simple model (reductionist)
Animal studies
Unethical?
Need to refer to effectiveness and appropriateness (i.e.
failure to take account of biological explanations is
inappropriate, but success as developing social skills is
effective).
Psychological Explanation:
Cognitive approach
Frith (1992) attempted to explain the
onset and maintenance of some of the
positive symptoms of schizophrenia.
This is called the faulty filter model.
His idea is that people with schizophrenia
are unable to distinguish between actions
that are brought about by external forces and
those that are generated internally. The filter
between conscious and preconscious
processing breaks down.
Most symptoms of schizophrenia can be explained in
three cognitive processes
Inability to generate willed
action (that is, any action that is
under the voluntary control of
the individual)
Inability to monitor willed action
Inability to monitor the beliefs
and intentions of others
These three processes are all part of a general
mechanism (called meta-representation) that
allows us to be aware of our goals and our
intentions and to understand the beliefs and
intentions of others.
Faulty operation of this
mechanism is due to functional
disconnection between frontal
areas of the brain concerned
with action and more posterior
areas of the brain that control
perception.
He has produced some evidence for his ideas
by detecting changes in cerebral blood flow
in the brains of people with schizophrenia
when engaged in specific cognitive tasks
Evaluation
 It has provided a comprehensive framework
for explaining many of the symptoms in
schizophrenia.
 Research support is far from conclusive and
the theory is still regarded as speculative.
 reductionist, fails to take into account the role
of environmental and biological factors.
Second cognitive theory:
Helmsley’s Model (1993)
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This is based on the failure of schemas to activate
as they usually would in everyday situations.
The result is that schizophrenics become
overloaded with sensory information and do not
know which things to pay attention to. This could
explain delusions.
He claims that hallucinations are internal thoughts
that are not recognised as coming from memory
so they appear to be external.
Helmsley claims that these are caused by
abnormalities in the hippocampus.
Evaluation
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So far there is no clear evidence to support
Helmsley’s model.
Cognitive theories simply explain symptoms in
terms of cognitive deficits they do not explain
where the deficits come from so there is not
yet a complete theory.
The diathesis-stress model (Zubin +Spring
1977) argue that stressful life events could
trigger psychotic symptoms providing there is
a genetic predisposition. Provides key support
for the nature-nurture debate because it
represents an interaction.
Evaluation of Cognitive
Approach
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Focuses on the current cognitions
Plenty of research into the idea
Influential and popular model
Includes biological and the psychological
Empowers the individual to change
Ignores the environmental influences
Unscientific
Blaming the individual can make the disorder worse
Is thinking irrational?
Which is the cause? Which is the effect?
Psychological Explanation;
Sociocultural factors
Family relationships & Double Bind Theory
Bateson et al. suggest that children who frequently receive
contradictory messages from their parents are more likely to
develop Sz because this prevents them from developing a
consistent construction of reality.
Tienary et al. found that adopted who had Sz biological
parents were more likely to develop Sz than normal children,
but only if the when the adopted family was rated as disturbed.
Double bind theory has mixed support, Berger found that Sz
reported a high recall of double-bind statements by their
mothers than did non-Sz (although their recall might have been
influenced by their Sz). Liem found no difference in patterns of
parental communication in families of Sz and non-Sz
Psychological Explanation:
Sociocultural factors
Expressed Emotion
This is a family style of communication that involves criticism
and emotional over involvement. High levels of EE are likely to
influence relapse rate.
Labelling theory: if a person displays unusual behaviours
associated with SZ they are considered deviant by society.
Once this label is applied, it becomes self-fulfilling leading to
further symptoms.
Scheff evaluated 18 studies and found that 13 of those were
consistent with self-fulfilling prophecy.
Psychological Explanation;
Sociocultural factors
Life events – Links with Diathesis-Stress Model
 A major stress factor that has been associated with a higher risk of
schizophrenic episodes is the occurrence of stressful life events, such as
the death of a relative, job loss or the break up of an intimate relationship.
It is not known how stress triggers schizophrenia, although high levels of
physiological arousal associated with neurotransmitter changes are
thought to be involved.
 Brown and Birley (1968) found that approximately 50% of people
experienced a major life event in the 3 weeks prior to a schizophrenic
episode, whereas only 12% reported one in the 9 weeks prior to that.
 Hirsch et al (1996) followed 71 schizophrenic patients over a 48 week
period. Life events made a significant cumulative contribution in the 12
months preceding relapse rather than having a more concentrated effect
in the period just prior to the schizophrenic episode.
 Although not all evidence supports the role of life events, in one study it
was found that there was no link between life events and the onset of
schizophrenia, patients being equally likely to have a major life event or
not in the 3 months before the schizophrenic episode.
Pharmacotherapy - Antipsychotic Drugs
Electroconvulsive Therapy (ECT)
Biological Treatment;
ECT – electro compulsive therapy
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ECT is not considered a first line treatment but may be
prescribed in cases where other treatments have failed.
It is not recommended as a treatment for schizophrenia
ECT works by using an electrical shock to cause a seizure (a
short period of irregular brain activity).
This seizure releases a ‘rush’ of chemical neurotransmitters and
temporarily alters function (eg. perception/memory etc)
ECT is given up to 3 or 4 times a week and usually for a
maximum of 12 treatments.
Before each treatment, the patient is given an anesthetic (to
induce sleep) and a muscle relaxant.
Then an electrical shock is applied to the patient’s head (via
electrodes). The shock will last only 1 or 2 seconds (high voltage
/ low amperage) and will make the brain have a seizure.
Biological Treatment:
ECT
Side effects may result from both the anesthesia and the ECT.
 Common side effects include temporary short-term memory
loss, confusion, paranoia, nausea, muscle aches and
headache.
 Some people may have longer-lasting/permanent problems
with memory/paranoia.
 Can cause death. (Shiwach et al, 2001: 1 death in 1,630
treatments)
 Evaluation of ECT
 ECT can have an immediate beneficial effect
 Significant benefit of ECT over placebo
 Huge research shows no damage to brain after ECT
 Risk of cognitive impairment
 Unscientific
 Risk of becoming used for social control
Biological Treatment;
Antipsychotic Drugs
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Drugs used to treat schizophrenia are called
ANTIPSYCHOTIC drugs, they work to suppress
hallucinations and delusions
Antipsychotic drugs are known as TYPICAL and
ATYPICAL
TYPICAL = well established
ATYPICAL = newer and less widely used
ATYPICAL ANTIPSYCHOTIC DRUGS tend to have fewer
side effects and act in different ways to typical
antipsychotic drugs
A patient is only ever on ONE psychotic drug at a time
(anti depressants can be taken at the same time)
ONE DRUG DOES NOT TREAT EACH MENTAL ILLNESS –
depends on the individual response to drug treatments
and clinicians preference for some drugs
Biological Treatment:
Conventional Antipsychotic Drugs
Reduce the effects of dopamine and therefore the symptoms of
Sz.
They bind to dopamine receptors without simulating them . They
can eliminate hallucinations and delusions.
Effectiveness:
Most studies on the effectiveness of conventional antipsychotic
drugs compare the relapse rates of those on medication with
those on a placebo. Davis et al. reviewed 29 studies and found
that the relapse occurred in 55% of the patients who were on
placebo compared to 19% on those who remained on drugs.
However Ross and Read argued that this is not a fair test as
people whose drugs are replaced by placebo are in a
withdrawal state .
Biological Treatment:
Atypical Antipsychotic Drugs
Atypical antipsychotic drugs act on the dopamine
pathway but they only occupy the dopamine
receptors temporarily. Therefore they have lower side
effects than the conventional antipsychotic drugs.
Effectiveness:
A meta-analysis (Leuch et al) found that the
superiority of the atypical antipsychotic drugs in the
treatment of negative symptoms is only moderate.
Biological Treatment;
Antipsychotic Drugs
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The atypical antipsychotics (also known as second generation
antipsychotics) are a group of unrelated* antipsychotic drugs used
to treat psychiatric conditions. Atypicals such as Clozapine work
differently from typicals in that they only attach to the specific D2
dopamine receptors (with a transient blocking action on excessive
perceptionisation).
Atypicals are preferred to conventional antipsychotics because they
produce less side affects (eg. tardive diskinesia*)
Good for ‘positive’ symptoms, however comparative affects on
‘negative’ schizophrenia are marginal (Leucht et al, 1999).
Evaluation of drug treatment
Strengths
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Highly effective
Proven to prevent the
reoccurrence of the mental
disorder
Most people are tolerant to the
side effects
Weaknesses
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Are not effective in treating
every patient
Nasty side effects – muscle
stiffness, slowing, shakiness,
change in appetite, diabetes,
cardiovascular
Drugs do not CURE the disorder
Delayed effects?
Patient is a passive recipient as
is not involved in the treatment
other than taking the tablets so
might reduce the motivation of
the patients to look for other
causes (life stressors) and tackle
these possible causes
Cognitive Behavioural Therapy (CBT)
Psychological treatments, such as cognitive behavioural therapy (CBT), can help
people with schizophrenia to cope better with the symptoms of hallucinations or
delusions. Psychological treatments can also help to treat some of the negative
symptoms of schizophrenia, such as apathy or a lack of volition/hedonism
(motivation / enjoyment in life).
Psychological Treatment;
CBT
Cognitive behavioural therapy (CBT) is based on the idea that most unwanted
thinking patterns, and emotional and behavioural reactions are learnt over a
long period of time.
The CBT approach to treatment differs slightly from conventional CBT methods. The
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aims of this therapy are as follows:
To challenge and modify delusory beliefs
To help the patient to identify delusions
To challenge those delusions by looking at evidence
To help the patient to begin to test the reality of the evidence
For example, you may be taught to recognize examples of delusional thinking
in yourself. You may then receive help and advice about how you can avoid
acting on these thoughts.
 Most people will require between eight to 20 sessions of CBT over the space of
six to 12 months. CBT sessions usually last for about an hour.
This type of treatment has been shown to be effective for reducing the positive
symptoms of schizophrenia, for reducing relapse and for enhancing recovery
when schizophrenia is diagnosed early.
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Psychological Treatment;
CBT
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CBT strategies to challenge & help modify delusory beliefs
 Identify delusions
 Challenge evidence on which delusions are based
 Design ‘experiments’ to test reality of this evidence
Chadwick & Lowe (1993) – significant reductions in delusions in 10
out of 12 patients
Normalising strategies where patient is taught to understand the
nature of schiz. symptoms
 Challenge ‘catastrophising’ beliefs about schizophrenia
 Help patient feel that symptoms are understandable and ‘normal’
Helps 70% of patients although other 30% may deteriorate (Kingdon
& Turkington, 1996)
Evaluation of CBT
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Gould et al. carried out a meta-analysis of seven studies and
found a significant decrease in the positive symptoms of Sz.
Kuipers et al. found that when combined with antipsychotic
drugs there was a lower drop out rate and greater patient
satisfaction.
Doesn’t work for everybody i.e. not suitable when the patient
are deluding as they cannot fully engage with the therapy
CBT for Sz works by generating less distressing explanations for
negative experiences rather than eliminate them completely.
Psychological Treatment;
Behavioural
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Implosion- Extinguishing anxiety by inducing the client to
imagine intensely anxiety-provoking scenes that, because
they produce no harmful consequences, lose their power to
induce fear.
Flooding- Extinguishing anxiety by exposing the clients to
actual fear-producing situations that, because they produce
no harmful consequences, lose their power to induce fear.
Modeling- Exposing clients to desired behaviour that is
modeled by an other person, and rewarding the client for
imitating that behaviour.
Evaluation of behavioural Approach
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Effective treatments
Cognitive sense
Patient responsible
Unethical?
Impractical methodology?
Restricted application
Other therapies
 Milieu
therapy
 Token
economy
Potential Exam Questions
Describe two psychological explanations of the Schizophrenia (8 marks)
Evaluate these explanations of Schizophrenia (16 marks)
“Psychologists believe that Schizophrenia can be explained solely by biological factors”
Discuss this claim with reference to the above quotation. (8+16 marks)
Describe and evaluate at least two issues in classifying or diagnosing schizophrenia (24 marks)
a) Explain issues relating to classifying schizophrenia as a mental disorder (5)
b) Discuss two explanations of schizophrenia from different perspectives in psychology (8 and 11 marks)
Describe and evaluate two psychological treatments of Schizophrenia (24 marks)
Describe the clinical characteristics of Schizophrenia (8 marks)
Explain and evaluate issues relating to the diagnosis of Schizophrenia as a mental disorder (16 marks)
Discuss the extent to which biological therapies can be used to treat Schizophrenia. (24 marks)

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