Psychological explanations for sz
Diagnosis and classification of Schizophrenia Biological explanations for sz Family dysfunction
Classification of schizophrenia (sz) Genetic basis Schizophrenogenic mothers: rejecting and controlling
No single defining characteristic: Schizophrenia runs in families • Fromm - Reichmann’s psychodynamic explanation
• SZ is a collection of symptoms • Strong relationship between genetic similarity of family members and experiences of schizophrenogenic mothers [mother
likelihood of both developing sz • Mothers = cold, rejecting and controlling; create a
DSM-5 and ICD-10 differ • Gottesman’s [1991] family study found MZ twins have a CR of 48%, DZ twins = secrecy
• DSM-5: one +ve symptom must be 17% CR and siblings = 9% CR • Leads to distrust and paranoid delusions and sz
present (delusions, hallucinations or
speech disorganisation) SZ is polygenetic and aetiologically heterogenous Double-bind theory: conflicting family communication
• ICD-10: two or more -ve symptoms • Existence of candidate genes • Bateson et al. child may be regularly trapped in situ
are sufficient for diagnosis (e.g. • Each individual genes confers a small increased risk of SZ [i.e. sz is wrong thing, receive conflicting messages about w
avolition and speech poverty) polygenetic] express their feelings about the unfairness of the situ
• Different combinations can lead to sz [i.e. sz is aetiologically heterogenous] • When they get it wrong often the child = punished b
Symptoms of sz: • Ripke et al. studied 37,000 patients and found 108 separate genetic variations world is confusing and dangerous, leading to disorg
Positive symptoms; additional experiences associated with increased risk; many coded for the dopamine
beyond those of ordinary existence neurotransmitter Expressed emotion: criticism and hostility lead to relapse in pati
1. Hallucinations: • Level of emotion [mainly -ve] expressed towards the
Sensory experiences Dopamine hypothesis Verbal criticism of the patient
that have no basis in Role of dopamine Hostility towards them
reality or distorted • DA is believed to be involved in SZ because it is featured in the functioning of Emotional over-involvement in their life
perceptions of real brain systems related to the symptoms of sz • High levels of EE cause stress in the patient, a prima
things patients with SZ
Experiences in relation Hyperdopaminergia linked to sub cortex
to any sense • High DA activity in sub cortex associated with hallucinations and poverty of Cognitive explanations
Auditory = hearing speech [e.g. excess of DA in broca’s area] Dysfunctional thought processing
voices • Lower levels of info processing in some areas of the
Visual = seeing people Hypodopaminergia linked to prefrontal cortex • E.g. reduced processing in the ventral striatum is ass
or things that aren’t
• More recent version
there Metarepresentation leads to hallucinations
• Low levels of DA in prefrontal = responsible for thinking and decision-making
2. Delusions • Is a cognitive ability to reflect on thoughts and beh
Beliefs that have no • This dysfunction disrupts our ability to recognise our
Neural correlates
basis in reality the sensation of hearing voices [hallucination] and
Brain activity linked with symptoms
Make sense to them but mind by others [delusions]
• Measurements of the structure or function of the brain that correlate with +ve
not to others
or -ve symptoms of sz
E.g. beliefs about being Dysfunction of central control leads to speech poverty
a very important person
Avolition + ventral striatum • Frith et al. also identified dysfunction of central con
or victim in a conspiracy poverty – central control being the cog. Ability to su
• Ventral striatum = involved in anticipation of reward [related to motivation],
loss of motivation [avolition] in sz may be explained by low levels here performing deliberate actions
Negative symptoms; loss of usual abilities and • People with SZ experience derailment of thoughts a
• Juckel et al. found a -ve correlation between ventral striatum activity and
experiences each word triggers automatic associations that the
overall -ve symptoms
1. Avolition
Severe loss of
Hallucinations + superior temporal gyrus
motivation to carry out Psychological therapies for SZ
• Allen et al. found that patients experiencing auditory hallucinations recorded
everyday tasks such as Cognitive behaviour therapy [CBT]
lower activation levels the superior temporal gyrus and anterior cingulate
hobbies or work Identify and change irrational thoughts
gyrus
Results in lowered • Aims of CBT = to help patients identify irrational thoughts and try
activity levels and to change them
unwillingness to carry Biological therapies for SZ: drug therapy • May involve discussion of how likely a patients belief are to be
out goal-directed
Typical antipsychotics true ad consideration of less threatening possibilities
behaviours
Dopamine antagonists
2. Speech poverty
• Been around since 1950’s CBT helps patients to understand their symptoms
A reduction in the
• Work by acting as antagonists in the DA system • Patients = helped to make sense of how their delusions and
amount and quality of
• Aim to reduce the action of DA – strongly associated with the DA hallucinations impact on their feelings and behaviour
speech
hypothesis • E.g. a patient may hear voices and believe they are demons so
May include; delay in
they will be very afraid
verbal responses during
Block dopamine receptors in the synapses • Offering an explanation for these symptoms reduces anxiety
conversations
• DA antagonists work by blocking DA receptors in the synapses of the and helps the patient realise their beliefs are not based on
DSM emphasises
brain, reducing the action of DA reality
speech disorganisation
• DA levels build up after taking chlorpromazine but then production is
and incoherence
reduced Family therapy
• Normalises neurotransmission in key areas of the brain, reduces symptoms Reduce expressed emotion [EE] in the family
Issues in diagnosis
like hallucinations • Family therapy = with families rather than individual patients
Key issues
• Aiming to improve communication and interactions in the
1. Reliability: the extent to which the
Chlorpromazine also has sedation effect family
diagnosis of sz is consistent
• Also has an effect on histamine receptors appears to lead to a sedation • Family therapists = try to reduce stress within the family, may
2. Validity: the extent to which the
effect contribute to patients risk of relapse [reduce levels of EE]
diagnosis and classification
techniques measure what they are • Used to calm anxious patients when they are first admitted to hospital
Improve family function: e.g. by reduction of guilt and improve
designed to measure, in this case
Atypical antipsychotics understanding
to measure sz
Target dopamine and serotonin • Pharaoh et al. identified a range of strategies family therapists
3. Co-morbidity: occurrence of two
Diagnosis and classification of Schizophrenia Biological explanations for sz Family dysfunction
Classification of schizophrenia (sz) Genetic basis Schizophrenogenic mothers: rejecting and controlling
No single defining characteristic: Schizophrenia runs in families • Fromm - Reichmann’s psychodynamic explanation
• SZ is a collection of symptoms • Strong relationship between genetic similarity of family members and experiences of schizophrenogenic mothers [mother
likelihood of both developing sz • Mothers = cold, rejecting and controlling; create a
DSM-5 and ICD-10 differ • Gottesman’s [1991] family study found MZ twins have a CR of 48%, DZ twins = secrecy
• DSM-5: one +ve symptom must be 17% CR and siblings = 9% CR • Leads to distrust and paranoid delusions and sz
present (delusions, hallucinations or
speech disorganisation) SZ is polygenetic and aetiologically heterogenous Double-bind theory: conflicting family communication
• ICD-10: two or more -ve symptoms • Existence of candidate genes • Bateson et al. child may be regularly trapped in situ
are sufficient for diagnosis (e.g. • Each individual genes confers a small increased risk of SZ [i.e. sz is wrong thing, receive conflicting messages about w
avolition and speech poverty) polygenetic] express their feelings about the unfairness of the situ
• Different combinations can lead to sz [i.e. sz is aetiologically heterogenous] • When they get it wrong often the child = punished b
Symptoms of sz: • Ripke et al. studied 37,000 patients and found 108 separate genetic variations world is confusing and dangerous, leading to disorg
Positive symptoms; additional experiences associated with increased risk; many coded for the dopamine
beyond those of ordinary existence neurotransmitter Expressed emotion: criticism and hostility lead to relapse in pati
1. Hallucinations: • Level of emotion [mainly -ve] expressed towards the
Sensory experiences Dopamine hypothesis Verbal criticism of the patient
that have no basis in Role of dopamine Hostility towards them
reality or distorted • DA is believed to be involved in SZ because it is featured in the functioning of Emotional over-involvement in their life
perceptions of real brain systems related to the symptoms of sz • High levels of EE cause stress in the patient, a prima
things patients with SZ
Experiences in relation Hyperdopaminergia linked to sub cortex
to any sense • High DA activity in sub cortex associated with hallucinations and poverty of Cognitive explanations
Auditory = hearing speech [e.g. excess of DA in broca’s area] Dysfunctional thought processing
voices • Lower levels of info processing in some areas of the
Visual = seeing people Hypodopaminergia linked to prefrontal cortex • E.g. reduced processing in the ventral striatum is ass
or things that aren’t
• More recent version
there Metarepresentation leads to hallucinations
• Low levels of DA in prefrontal = responsible for thinking and decision-making
2. Delusions • Is a cognitive ability to reflect on thoughts and beh
Beliefs that have no • This dysfunction disrupts our ability to recognise our
Neural correlates
basis in reality the sensation of hearing voices [hallucination] and
Brain activity linked with symptoms
Make sense to them but mind by others [delusions]
• Measurements of the structure or function of the brain that correlate with +ve
not to others
or -ve symptoms of sz
E.g. beliefs about being Dysfunction of central control leads to speech poverty
a very important person
Avolition + ventral striatum • Frith et al. also identified dysfunction of central con
or victim in a conspiracy poverty – central control being the cog. Ability to su
• Ventral striatum = involved in anticipation of reward [related to motivation],
loss of motivation [avolition] in sz may be explained by low levels here performing deliberate actions
Negative symptoms; loss of usual abilities and • People with SZ experience derailment of thoughts a
• Juckel et al. found a -ve correlation between ventral striatum activity and
experiences each word triggers automatic associations that the
overall -ve symptoms
1. Avolition
Severe loss of
Hallucinations + superior temporal gyrus
motivation to carry out Psychological therapies for SZ
• Allen et al. found that patients experiencing auditory hallucinations recorded
everyday tasks such as Cognitive behaviour therapy [CBT]
lower activation levels the superior temporal gyrus and anterior cingulate
hobbies or work Identify and change irrational thoughts
gyrus
Results in lowered • Aims of CBT = to help patients identify irrational thoughts and try
activity levels and to change them
unwillingness to carry Biological therapies for SZ: drug therapy • May involve discussion of how likely a patients belief are to be
out goal-directed
Typical antipsychotics true ad consideration of less threatening possibilities
behaviours
Dopamine antagonists
2. Speech poverty
• Been around since 1950’s CBT helps patients to understand their symptoms
A reduction in the
• Work by acting as antagonists in the DA system • Patients = helped to make sense of how their delusions and
amount and quality of
• Aim to reduce the action of DA – strongly associated with the DA hallucinations impact on their feelings and behaviour
speech
hypothesis • E.g. a patient may hear voices and believe they are demons so
May include; delay in
they will be very afraid
verbal responses during
Block dopamine receptors in the synapses • Offering an explanation for these symptoms reduces anxiety
conversations
• DA antagonists work by blocking DA receptors in the synapses of the and helps the patient realise their beliefs are not based on
DSM emphasises
brain, reducing the action of DA reality
speech disorganisation
• DA levels build up after taking chlorpromazine but then production is
and incoherence
reduced Family therapy
• Normalises neurotransmission in key areas of the brain, reduces symptoms Reduce expressed emotion [EE] in the family
Issues in diagnosis
like hallucinations • Family therapy = with families rather than individual patients
Key issues
• Aiming to improve communication and interactions in the
1. Reliability: the extent to which the
Chlorpromazine also has sedation effect family
diagnosis of sz is consistent
• Also has an effect on histamine receptors appears to lead to a sedation • Family therapists = try to reduce stress within the family, may
2. Validity: the extent to which the
effect contribute to patients risk of relapse [reduce levels of EE]
diagnosis and classification
techniques measure what they are • Used to calm anxious patients when they are first admitted to hospital
Improve family function: e.g. by reduction of guilt and improve
designed to measure, in this case
Atypical antipsychotics understanding
to measure sz
Target dopamine and serotonin • Pharaoh et al. identified a range of strategies family therapists
3. Co-morbidity: occurrence of two
