Schizophrenia

Treby
Schizophrenia is characterised
by Psychosis a loss of contact
with reality

Clinical Characteristics of
Schizophrenia:
Prevalence = 1% of the population
(prevalence = The percentage of a
population that is affected with a
particular disease at a given time.)
Broken down into Positive Symptoms
(Type I) and Negative Symptoms (Type
II)

Symptoms:
Positive Symptoms:
Where something is added to
your personality.
e.g.
Delusions beliefs that
seem real, but arent.
Feeling theyre controlled
by something.
Hallucinations either
auditory or visual.
Disordered thinking the
idea that thoughts have
been inserted into your
mind.

Negative Symptoms:
Where something is
removed from your
personality.
e.g.
Affective flattening
lack of emotion.
Alogia poverty of
speech.
Avolition having no
drive to do anything.

First Rank Symptoms Schneider

1959
Schneider believed that first rank
symptoms (Type I) such as:
Delusions, feeling controlled by someone
else, and hallucinations
Were only associated with schizophrenia.
(However, these symptoms have also
been linked with depression and bipolar.)
SYNOPTICITY! Randy Gardener (1964) also experienced
Type 1 symptoms, from sleep deprivation.

Different types of
schizophrenia:
1. Paranoid Delusions &
hallucinations
2. Catatonic unusual motor
activity, extreme negativism,
peculiar posturing. V. Rare.
3. Hebephrenic (ICD) or
Disorganised (DSM) early age,
disorganised speech, flat affect,
some hallucinations &
delusions.
4. Undifferentiated
Schizophrenic symptoms that
dont neatly fit a diagnosis.
5. Residual At least one episode
of schizophrenia experienced in
the past. But no longer
exhibiting signs of the disorder.

The ICD-10 also

contains 2 other
subtypes:
Postschizophrenic
depression (a
depressive
episode after a
schizophrenic
illness.
Simple
schizophrenia
(progressive
development of
negative
symptoms, with
no history of
psychosis)

Classifying Mental Health Disorders:

Diagnostic and Statistical Manual (DSM):
Published in America
English only
Predominantly used in the UK
Classifies 5 sub-types of schizophrenia
Looks after 6 months of symptoms
Used by professionals
e.g. psychiatrists, psychologists, social
workers.
Contains mental health statistics
Multi-axial approach as it notes that
mental illness rarely exists without the
influence of other factors in an
individuals life:
Such as
1. Clinical syndromes
2. Personality disorders
3. Physical conditions
4. Severity of psychosocial factors
5. Highest level of functioning

International Classification of
Diseases and related health
problems (ICD):
Published by the WHO
International multiple
languages
Collection of health statistics
Classifies 7 sub-types of
schizophrenia
Looks after 1 month of
symptoms
Mainly for disease only
chapter 5 is for mental health
Does NOT look at social factors
10 categories of mental
disorders are identified
Looks mainly at positive
symptoms

Evaluating
classification systems:
Beck (1967) RELIABILITY
Four psychiatrists used the DSM to diagnose 153
patients.
Each patient was interviewed separately with 2
psychologists.
There was 54% agreement on diagnoses of
schizophrenia, even less agreement on sub-types.
Small sample, not necessarily representative.
(though, mental health is not that prevalent)
People must be trained to understand DSM
Subjective
Lacks inter-rater reliability

Evaluating classification
systems:
Cooper et al (1972) CULTURAL RELATIVISM
When patients (with identical symptoms)
presented themselves. Schizophrenia was TWICE
as likely to be diagnosed by New Yorker
psychiatrists using the DSM than Londoner
psychiatrists using the ICD.
The opposite was true of depression.
Unreliable
Cultural relativism NY & L diagnose differently
Subjective

Evaluating
classification systems:
Temperline (1970) VALIDITY
Interview with an actor was recorded. 7 groups
were asked to assess his mental health.
Groups consisted of professionals: e.g.
psychiatrists, psychologists and law students.
5/7 groups heard that the man being
interviewed was interesting as he looks
neurotic, but is actually psychotic. The 6 th
group heard nothing, and the 7th group heard
he was healthy.

Temperline continued!
With those that heard he was neurotic, a majority
of them said that he was neurotic
And there was further disagreement amongst
professionals
Group that heard he was mentally healthy: 100%
said healthy
This shows that the DSM and ICD may lack validity
as some diagnoses may already be formed from
existing preconceptions rather than using the
manuals themselves

Temperline evaluation:
People look at the labels rather their
own opinion
Groups are all from different
backgrounds (extraneous variable)
Individual differences amongst
professionals subjective

Evaluating classification
systems:
Rosenhan (1973) LABELLING
Eight people with no history of mental illness rocked up at a psychiatric
hospital; claiming to be hearing voices in their head.
Other than this, they answered further questions as mentally healthy
individuals.
They were all admitted, once in, they acted completely normally.
Staff reported normal behaviour as if it were abnormal.
One patient kept notes in a diary. This was described as excessive note
taking.
After, Rosenhan told a hospital about the study, and warned there
would be more pseudo-patients. He never sent any. But staff recorded
that 43 of the 93 admitted patients were pseudo-patients.
Ethical Issues sending healthy people to a place for mentally ill
Self fulfilling prophecy could have caused these people to get ill
labelling caused the nurses to act differently, which could cause
long-term damage where people may be unable to get a job
Shows diagnosis should be more rigorous

Biological:
Nature: genetics, brain damage, biochemistry,
infection
They differ from your nurture i.e. peers,
upbringing, culture, friends, environment

Biological Genetics:

Definitions!
Word

Definition

Schizophrenia

Psychosis Loss of contact with

reality

Monozygotic twin (MZ)

Identical twin (same genetics)

Dizygotic twin (DZ)

Non-identical (different genetics)

Concordance rate

Likelihood of one twin getting

same illness as the other twin

Twin studies

Studies involving twins, if theyre

MZ then they have same genes,
so we can see if they were
influenced by nature (genes) or
nurture (upbringing)

Adoption studies

Studies involving adopted

children to see whether or not
they have same genetic disorders
as their real parents to see if
illnesses are inherited

Twin study - Cardno et al

(2002):
Diagnosed schizophrenia in twins
Used Maudsley Twin Register to get
strict diagnosis
Showed 26.5% concordance rates in
MZ twins
0% concordance rates in DZ twins

This shows that it is your genetics

(nature) that affects schizophrenia
rather than your environment
(nurture).

2002

Evaluation Cardno et al
(2002):
MZ twins are relatively rare, out of
all, schizophrenia only has a
prevalence of 1%... Always will be
small sample size.

Adoption study Kety

(1994):
High rates of schizophrenia 1994
in
individuals whos parents had
schizophrenia, but had been
adopted by psychologically
healthy parents.
Shows that genetics are
more important than your
environment.
Supports Cardno et al

Adoption study -Tienari

(1991):
(in the Finnish Adoption Study)

1991

Matched groups, each with 155

adopted kids
Group one = schizophrenic mothers
(10% developed schizophrenia)
Group two = psychologically healthy
mothers (1% developed
schizophrenia)

Strengths & weaknesses

(A02):
Strengths
Weaknesses
Twin Studies:

MZ have same
genetic makeup, so
you can test Nature
vs Nurture
Objective (quant
data)

Twins are rare

Different criteria for
different twin studies
(so, Cardno used
Maudsley, but other
people use others)
Concordance rates
measured differently
= subjective

Adoption Studies:

Nature vs nurture
Objective (quant
data)
Bigger sample sizes
possible than twin =

Individual differences
(life events)
Extraneous variables
e.g. life events

Biological Biochemistry:

Dopamine Hypothesis:
The dopamine hypothesis suggests
that messages from neurons that
transmit dopamine fire either too
often, or too regularly. Is is
thought that schizophrenics have
high numbers of the D2 receptors
on the receiving neurons,
therefore more dopamine binds
to the cell.
Comer (2003): Dopamine plays
a role in attention. Disturbances
may lead to problems with
focussing, and the perception
problems found in schizophrenia.

Supports hypothesis
Grilly (2002):
Parkinsons disease:
- Degenerative neurological condition
- Low levels of dopamine
- Prescribed L-Dopa to raise
dopamine in brain
- Some individuals went on to develop
schizophrenic-type symptoms
Ethical issues protection from harm

Supports hypothesis Antipsychotic drugs:

Anti-psychotic drugs block activity of
dopamine in brain
By doing so, schizophrenic symptoms
(e.g. hallucinations and delusions)
are alleviates
They are known as dopamine
antagonists

Supports hypothesis
Amphetamines (like speed):
Drugs that act as dopamine
agonists
Means that synapses get flooded
with dopamine
Large doses can cause hallucinations
and delusions (characteristics of
schizophrenia)
Hard to test ethical issues
protection from harm and Drugs

Supports hypothesis and contradicts

hypothesis PET Scans:
Wong et al (1986) used PET Scans
and found dopamine activity was
greater in schizophrenics compared
to a control

However, Copolov and Crook (2000)

have not found evidence of altered
dopamine activity in schizophrenics
brains.

Dopamine hypothesis
evaluation:
Objective
Quantitative data,
scientific
PET Scans (Wong
et al 1986)
Hormonal
Reliable
Deterministic no
blame

Reductionist no
consideration for
social events, may
ignore actual cause
Nature vs Nurture
NATURE, good as
no blame. BUT,
could lead to
passive patients

Psychodynamic approach:

Freud (1924):
Believed schizophrenia was a result
of TWO processes:
1) Regression to a pre-ego state
2) Attempts to re-establish ego control

Freud (1924):
Freud believed that schizophrenia came from:
- Parents being cold/uncaring
- Causing child to regress back into infantile
state
- Where the ego is not yet properly formed
- Symptoms include: Delusions of grandeur
(believing you can fly etc)
- But also, auditory hallucinations could be
seen as an individuals attempt to reestablish ego control

Supporting Freud FrommReichmann (1948):

Overprotective, rejecting, dominant,
and moralistic mothers can
contribute to children developing
schizophrenia
Supports Freud in that the condition
stems from childhood

Supports Freud Bateson et al

(1956):

DOUBLE-BIND
THEORY
Children
who get mixed-messages
from their parents are more likely
to develop schizophrenia
For example, if a mother was to
tell her child she loved them, but
look away in disgust if the child
did something wrong. = mixed
messages
Prolonged exposure disrupts a
childs internally coherent
construction of reality (perception
of reality)

Argues Freud Oltmanns et al

(1991):
Parents act differently once their
child has been labelled as
schizophrenic
Not prior to
Therefore it is not parental
influence and it argues Freud
(SYNOPTIC: kinda like in
Rosenhans 1973 pseudo-patients
study as the nurses reacted to
them differently once they had
been labelled)

Psychodynamic approach
AO2:
Supporting research
Fromm-Reichmann
(1948) (use other
two in AO1)
Considers social
influences such as
upbringing
Individual differences

Subjective
Simplistic biology
not considered

Cognitive for
schizophrenia:

Cognitive:
Cognitive approach looks at
biological factors for schizophrenia,
says Type I/positive symptoms come
from biology
But further symptoms stem from
people trying to make sense of their
symptoms
They reject feedback from others and
believe that their beliefs are
manipulated by others

Cognitive Frith (1979):

Argues schizophrenia
comes from faulty
attention systems
with an inability to filter
out unnecessary info that
they have gathered
through their senses
This leads to illusion of
distorted thoughts
Does not consider individual
differences

Cognitive Bentall (1994):

Schizophrenics have trouble with processing
information
Shown in Stroop tests: Colour words (red and
green) are substituted for emotional words
(death and laughter),
Schizophrenics take longer than nonschizophrenics to name the words.
Automatic subconscious processing may
account for positive symptoms
Stroop tests may be unreliable
Individual differences

What have we learnt thus

far?
Cognitive psychology is concerned with
thought processes such as memory and
attention.
The cognitive approach to psychology
recognises that biological factors
contribute to the positive symptoms of
schizophrenia. Other symptoms, such as
negative symptoms develop from the
individual attempting to make sense of an
experience.

More stuff weve learnt

People provide information they need to
maintain a grasp on reality and if this does
not happen, psychosis may occur (loss of
contact with reality) and people may become
paranoid they are being controlled by
someone else.
A faulty attention system is blame as the
reason for schizophrenia (Frith, 1979) as they
can not filter out unnecessary information
which leads to problems with attention.

Even more
This is shown further by Bentall
(1994) who used the Stroop test to
show problems with how people with
schizophrenia process information,
showing disruption with the
processing of emotional words.

Supports cognitive MeyerLindenberg et al (2002):

Excessive dopamine in the prefrontal cortex
has direct impact on the working memory.
Where the schizophrenia stems from a
disbelief in others
(Synoptic links to dopamine hypothesis)
Objective (hormones)

lindenberg
&

Supports cognitive Yellowleese

et al (2002):
Developed a virtual hallucination
machine
E.g. hearing a TV telling you to kill
yourself
These were shown to schizophrenics
to show their own hallucinations
were unreal & irrational
Ethical issues protection from harm

Argues Cognitive McKenna (1994):

Schizophrenics arent more easily
distracted than non-schizophrenics in
cognitive tasks

Historical validity
Lab study may affect results
Distraction = subjective

Cognitive AO2:
Yellowleese et al (2002)
Free will
Application to real life:
treatments
More holistic approach
believes that positive
symptoms have a
biological influence

McKenna (1994)
Individual
differences

Treatment of
schizophrenia:

Antipsychotic drugs:
Chemotherapy (chemical treatments)
used to treat symptoms of psychotic
disorders such as schizophrenia and
manic depression
Two types of antipsychotic drugs:
Conventional and atypical

Antipsychotic drugs:
Conventional:
E.g. ChlorPROmazine
(pro treats positive
symptoms)
Such as hallucinations
and delusions
Reduces the effects of
dopamine by blocking
receptors
Dopamine
antagonists
Side effects

Atypical antipsychotic
drugs:
E.g. Clozapine
Works on both positive
and negative symptoms
(depression & apathy)
Acts on dopamine &
serotonin receptors
Side effects include
tardive dyskinesia
(involuntary movement
of mouth and tongue)
Less side effects

Effectiveness and appropriateness of

conventional and atypical drugs:
Conventional:

Atypical:

Luft B (2006) Found that

conventional drugs are
associated with sudden death
whereas atypicals are not

Leucht et al (1999) - Metaanalysis showed that atypical

are only a little better.

Hill (1986) found that 30% of

people taking conventional
develop Tardive Dyskinesia
Ross and Read (2004)
Motivational deficits, such as
labelling, reinforcing
somethings wrong with you
which is unethical
Individual differences etc etc

Jeste et al (1999) - Side

effects. Less chance of Tardive
Dyskinesia (5% of people)
Davis et al (1980) Relapse.
Placebo = 55% relapsed
Atypicals = 2-22% relapsed

Antipsychotic drugs AO2

Biological
Objective
Real life application

Deterministic
Reductionist
individual
differences

Psychological therapies for

schizophrenia:

Psychoanalysis:
Getting to your subconscious to see if your childhood
affected you usually associated with Freuds
psychodynamic approach
Freud believed that this approach would not work as
schizophrenics are unable to form a transference with
the analyst
This is when the emotions of a patient are unconsciously
shifted onto the analyst

Subjective
Cheap
Quick
Can combine with medicine

Appropriateness of psychoanalysis
Gottdiener (2000):
Meta-analysis of 37
studies
Covering 2642 patients
66% of them improved
after treatment using
psychotherapy/psyscho
analysis

Effectiveness of psychoanalysis:
Malmberg and Fenton (2001)
It is impossible to draw a
definite conclusion for or
against the effectiveness
of psychoanalysis.
In fact the schizophrenia
patient outcome research
team (PORT) has even
argued that
psychoanalysis may be
harmful to schizophrenics

Effectiveness of
psychoanalysis:
Therapists are
expensive
Patients often treated
over a long time
Prevents it being
adopted on a large
scale
Costly & time
consuming

Cognitive behavioural
therapy:
Caused by faulty thinking. Trying to
find root of the problem to prove
irrational thoughts are irrational
Look at alternative explanations for
maladaptive beliefs
Treats symptoms rather than cause
Focuses on negative behaviours
which are also deemed the safest
behaviours
People need to be trained to do it

Appropriateness of CBT - Kingdon

and Kirschen (2006):
142 patients were
tested, and found that
many patients were not
suitable for CBT as they
would not fully engage
with it.
In general, it was less
effective on older folk
than younger ones

Effectiveness of CBT: Gould et al

(2001):
Meta-analysis of 7
studies
Reported that there
was a statistically
significant decrease
in the positive
symptoms of
schizophrenia after
treatment

7
studies
positive
sympto

Evaluation for psychological

therapies of schizophrenia AO2:
Comment on
effectiveness and
appropriateness for
each
Can be used along
side drug therapies

Comment on effectiveness and

appropriateness for each
Simplistic only treating
thoughts even though cognitive
theory suggests that positive
symptoms derive from
biological influences
People have to be trained to do
CBT and psychoanalysis which
is expensive, time consuming
Individual differences some
people might not respond as
well to drug treatment as others

Key words:
Word

Definition

Psychosis

Loss of contact with reality

Positive symptoms

Added to personality e.g.

delusions and hallucinations

Negative symptoms

Something removed from your

personality, such as alogia = loss
of speech

Biochemistry

Hormones and neurotransmitters

Chemotherapy

Treatments based on chemicals

Serotonin

A neurotransmitter, low levels of

this have been linked to
depression

Dopamine

A neurotransmitter, high levels

have been linked to schizophrenia
in the dopamine hypothesis

MOAAARR definitions!
Word

Definition

Dopamine antagonist

Chemical which inhibits effect of

dopamine

Placebo

fake version of a drug which

tests whether the drug has
biological impacts

Relapse

When you lose your symptoms of

abnormality, but then they come
back

Neurotransmitter

Chemicals that transmit impulses

across a synapse causing a
change in behaviour