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SCHIZOPHRENIA AQA SUMMARY NOTES
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Covering all A01, A02 and A03 that could possibly come up in your exams! Schizophrenia
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Schizophrenia: reliability and validity Biological explanations for Schizophrenia Psychological explanations for Schizophrenia Biological therapy for SchizophreniaPrevalence: serious mental disorders affecting 1% of Genetic basis: Family dysfunction: Typical antipsychotics:
population. More common in males, city dwellers and lower Family studies: there is a strong relationship between the Schizophrenogenic mothers: Fromm-Reichmann’s Dopamine antagonists: typical antipsychotic drugs eg
socio-economic groups. degree of genetic similarity and shared risk of schizophrenia. psychodynamic explanation of patients early experiences of chlorpromazine has been around since the 1950s. They work
Gottesman’s large scale study found someone with an aunt schizophrenogenic mothers (mothers who cause by acting as antagonists in the dopamine system and aimed
with schizophrenia has a 2% chance of developing it, 9% for schizophrenia). These mothers are cold, rejecting and to reduce the action of dopamine - they are strongly
Diagnosis: Diagnosis and classification are interlinked. To sibling and 48% for an identical twin. Family members also controlling, and create a family climate of tension and associated with the dopamine hypothesis.
diagnose a specific disorder, we need to be able to distinguish share environments but still indicates support for genetic secrecy. This leads to distrust and paranoid delusions and
one from another. We identify symptoms and use a view. eventually schizophrenia.
classification system to diagnosis the disorder. Abnormal upbringings create a fragile ego which can be Dopamine antagonists work by blocking dopamine receptors
broken by the ID, leading to regression to an earlier stage of in the synapses in the brain, reducing the action of dopamine.
Candidate genes: early research looked unsuccessfully for a life, dominated by innate instincts. There is no distinction Initially, dopamine levels build up after taking
Classification: identify symptoms that go together and link to single genetic variation to explain schizophrenia. between reality and fantasy and this creates an inability to chlorpromazine, but then production is reduced. This
be a disorder. Schizophrenia is polygenic - requires several genes. function with delayed gratification. normalises neurotransmission in key areas of the brain, which
It is also aetiologically heterogenous i.e risk is affected by in turn reduces symptoms like hallucinations.
different combinations.
DSM-5: one positive symptom must be present eg delusions, Ripke et al combined all previous data from genome wide Double bind theory: Bateson et al suggested that Schz is the
hallucinations, speech disorganisation and a positive or studies and found 108 separate genes associated with consequences of abnormal patterns in family Effects of chlorpromazine: chlorpromazine also influences
negative symptom. slightly increased risk of schizophrenia. communication. The patient is a symptom of a family wide histamine receptors which appears to lead to a sedation
Only includes mental disorders and tends to be used in USA problem and becomes ill in order to protect the stability of effect. It is generally used to calm down anxious patients
and Australia the family system. Patient is given mutually contradictory when they are first admitted to hospital.
Latest version of subtypes of schizophrenia has been Mutation: schizophrenia can also have a genetic origin in the signals by another person causing internal conflict, and
removed. absence of a family history because of mutation in parental symptoms represent an attempt to escape from double bind.
DNA. Evidence comes from the correlation between paternal Primary communication = complaint Atypical antipsychotics:
age (associated risk of sperm mutation) and risk of Metacommunication = another complaint acting on the Newer drugs: the aim of developing newer antipsychotics
ICD-10: two or more negative symptoms must be present eg schizophrenia was to maintain or improve upon the effectiveness of drugs
original complaint
avolition and speech poverty. in suppressing the symptoms of psychosis and also to
Includes all medical disorders and tends to be used in Europe. minimise the side effects of the drugs used.
Focuses on the use of subtypes to classify Schizophrenia. Neural correlates: Expressed emotion (EE): role of families in the maintenance
Dopamine: dopamine is widely believed to be involved in of schizophrenia rather than its cause. Families may be
schizophrenia because it is featured in the functioning of frequently hostile towards each other, critically either over Clozapine: Clozapine binds to dopamine receptors just like
Positive symptoms: additional experiences beyond the use of brain systems related to the symptoms. DA is a chemical chlorpromazine does but also acts when serotonin and
or under concerned which with each other’s lives. Families
ordinary existence. substance manufactured in the brain that transmits messages glutamate receptors. This drug was more effective than
said to be high in expressed emotion however some families
1. Hallucinations: unusual sensory experiences that have no between neurons and is one of the chemicals that causes typical antipsychotics, as it reduces depression and anxiety
do not express any characteristics.
basis or distorted perceptions of real things. Experienced in these neurons to fire. as well as improving cognitive function. It also improves
relation to any sense eg hearing voices or seeing things that mood which is important as up to 50% of people with
aren’t there. According to Vaughan + Leff, the extent of expressed emotion schizophrenia attempt suicide.
2. Delusions: beliefs that have no basis in reality eg believing Original DA hypothesis (hyperdopaminergia linked to within a family is a strong predictor of relapse rates amongst
they are a very important person or they are a victim of a subcortex): high dopamine activity in in the sub cortex Schz. Relapse rates of 51% of patients who returned to high
conspiracy theory. (central areas of the brain) associated with hallucinations and EE families whereas 13% amongst returning to low EE Risperidone: Risperidone was developed in the 1990s
3. Catatonic or abnormal motor behaviour: where an poverty of speech. Due to excess of DA receptors in pathways families. Suggest that stress of EE may trigger Schz. because clozapine was involved in the deaths of some
individual behaves in ways that seem inappropriate or linking from subcortex to Broca’s area. May explain specific people from a blood condition called agranulocytosis.
strange to the norms of society. Catatonia involves having symptoms eg poverty of speech and auditory hallucinations. Risperidone like clozapine binds to dopamine and serotonin
decreased reactivity to your environment. Cognitive explanations: receptors, however it binds more strongly to dopamine
4. Disorganised thoughts and speech: often known as word Dysfunctional thought processes: lower levels of information receptors and is therefore more effective in smaller doses
salad where an individual speaks in ways that are completely Updated DA hypothesis (hypodopamonergia linked to processing in some areas of the brain suggests cognition is than most antipsychotics and has fewer side effects.
incomprehensive. prefrontal cortex): Davis added that low levels of DA in the impaired. For example, reduced processing in the ventral
prefrontal cortex (responsible for thinking) could explain striatum is associated with negative symptoms.
negative symptoms. Explains origins of abnormal DA - genetic
Negative symptoms: loss of usual abilities and experiences. variations an early experience of stress makes some people
1. Speech poverty: reduction in the amount and quality of more sensitive to cortical hypodopamonergia and subcortex Metarepresentation: refers to the cognitive ability to reflect
speech. May cause a delay in verbal responses during Hyperdopaminergia on thoughts and behaviours (Frith). This dysfunction disrupts
conversations. DSM emphasises speech disorganisation and our ability to recognise our thoughts as our own - this could
incoherence as a positive symptom. lead to the sensation of hearing voices (hallucinations) and
2. Avolition: severe loss of motivation to carry out everyday 1. Superior temporal gyrus: involved in recognising sounds + experiences of having thoughts placed in the mind by others
tasks. Results in lowered activity levels and unwillingness to contains the primary auditory cortex (thought insertion, a delusion).
carry out goal directed behaviours. Andreason 1982 2. Ventral striatum: involved in motivation and reward
, 3. A lack of emotions: person’s voice becomes dull and
monotonous, and their face takes on a constant blank
appearance. Negative symptoms: avolition has been associated with one Central control: Frith also identified dysfunction of central
4. An inability to enjoy things they usually would. of the main reward centres in the brain (ventral stratium). control as a way to explain speech poverty - central control
5. Social withdrawal: where they find it hard to socialise or Juckel et al measured activity levels and found lower levels of being the cognitive ability to suppress automatic responses
become reluctant to speak to people. Schz compared to control groups. Shows a moderate while performing deliberate actions. People with
negative correlation between avolition and the ventral schizophrenia experience derailment of thoughts because
striatum. Implies avolition may be related to the failure of each word triggers automatic associations that they cannot
the brain to anticipate the ventral striatum. suppress.
Positive symptoms: Allen et al scanned patients with auditory
hallucinations and compared them with a control group.
Lower activation levels were found in the superior temporal
gyrus in the hallucination group, reduced activity in these
parts is a neural correlate for auditory hallucinations. Less
activity here may lead to difficulties in detecting the origins of
a voice which explains errors and auditory hallucination to
recognise internal monologues as self-generated.
Tienari: looked at 164 adopted children whose biological
mothers had schizophrenia, they had a concordance of 6.7%
compared to 2% in adopted children without schizophrenic
parents.
+ Good reliability: A reliable diagnosis is consistent between + Strong evidence base: Family studies show risk increases + Evidence linking family dysfunction to Schz: A review by + Evidence for effectiveness: Thornley et al reviewed data
clinicians (inter-rater) and between occasions (test-retest). with genetic similarity. Twin studies found 33% concordance Read et al reported that adults with schizophrenia are from 13 trials (1121 participants) and found that
Osorio et al (2019) reported that the diagnosis of Scz had rates for MZ and 7% for DZ twins. Adoption studies show disproportionately likely to have an insecure attachment. chlorpromazine was associated with better functioning and
excellent reliability using the DSM-5 classification. His study that biological children of parents with schizophrenia are at Also, 69% of women and 59% of men with schizophrenia reduced symptom severity compared with a placebo. That
had an inter-rater agreement of +97 and test-retest of +92. greater risk even if they grow up in an adoptive family. This have a history of physical and/or sexual abuse. This strongly also supports the benefits of atypical antipsychotics. Meltzer
This means that the diagnosis of Scz is still applied. shows that some people are more vulnerable to suggests that family dysfunction does make people more concluded that clozapine is more effective than typical
However, Beck et al (1961) found that the agreement on schizophrenia because of their genes. vulnerable to schizophrenia. antipsychotics, and that it is effective in 30-50% of treatment
diagnosis for 153 patients was only 53% arguing that the resistant cases. This means that, as far as we can tell,
inter-rater reliability. Although Beck’s study was conducted a antipsychotics work.
long time ago so will have poor temporal validity and may not - Environmental risk factors: Biological risk factors including - Poor evidence base to any of the explanations: There is CA: Most studies are of short-term effects only and some
be as updated as Osorio’s study. birth complications and smoking THC-rich best in teenage almost no evidence to support the importance of traditional datasets have been published several times, exaggerating
years. Psychological risk factors including childhood trauma family based theories eg schizophrenogenic mother and this size of the evidence base. Also benefits may be due to
eg 67% with schizophrenia reported at least one childhood double bind. Both theories are based on clinical observation calming effects of drugs rather than the real effect on
- Low validity: Criterion validity involves seeing whether trauma, this matched with 38% in the control group. This of patients an informal assessment of the personality of the symptoms. This means the evidence of effectiveness is less
different procedures used to assess the same individuals means genes alone cannot provide a complete explanation mother of these patients. This means that family impressive than it seems.
arrive at the same diagnosis. Cheniaux et al (2009) had two for schizophrenia. explanations have not been able to explain the link between
psychiatrists independently assess the same 100 clients. 68 childhood trauma and schizophrenia.
were diagnosed with Scz with ICD and 39 with DSM. This - Antipsychotic drugs have a likelihood of side effects: Typical
means that Scz is either over or under diagnosed suggesting Genetic counselling: if potential parents have a relative with antipsychotics are associated with dizziness, agitation,
that criterion validity is low. schizophrenia, they can be advised or risk of having a child Parent blaming: Research in this area may be useful, for sleepiness, weight gain. Long time use can lead to lip
Osorio’s study shows that the criterion validity remains with the condition. However the risk estimate is just an example showing that insecure attachment and childhood smacking and grimacing due to dopamine super sensitivity =
excellent when a single diagnostic system is used as the ICD average figure based on genetic similarity to relatives, and it trauma affected vulnerability to schizophrenia. However, tardive dyskinesia. The most serious side effect it neuroleptic
resulted in more clients being disorganised. doesn't take account of the future child's environment. This research is socially sensitive because it can lead to parent malignant syndrome (NMS) close by blocking dopamine
means that genetic counselling only provides a crude idea blaming. This creates additional stress for parents already action in the hypothalamus. This can be fatal due to
vulnerability an is of limited use. seeing their child experienced schizophrenia and taking disrupted regulation of several body systems. This means
- Co-morbidity with other conditions: If conditions often co- responsibility for their care. This means that research into that antipsychotics can do harm as well as good an individuals
occur they might be a single condition. Scz is commonly family dysfunction and schizophrenia will always be very may avoid them, therefore reducing effectiveness.
diagnosed alongside other conditions. For example Buckley et + Support for dopamine in the symptoms of Schz: controversial but worth it for potential benefits.
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