Schizophrenia
Essay Plans
Discuss Reliability and Validity in the Diagnosis and Classification of
Schizophrenia
AO1:
- Reliability is a measure of consistency of symptom measurement.
- Validity is a measure of whether the diagnosis represents something real and
distinct and measures what it claims to.
- Co-morbidity is where one or more disorders occur simultaneously with
schizophrenia. This can cause problems with the reliability of the diagnosis as
there may be confusion over which disorder is being diagnosed.
Depression Co- Buckley et al (2009) found that 50% of patients with schizophrenia
morbidity also have a diagnosis of depression. 47% of patients with
schizophrenia also have substance abuse. Very severe depression
can look like schizophrenia and vice versa, therefore they may just
be one condition. This causes issues with descriptive validity as
having simultaneous disorders may suggest that schizophrenia is not
a separate disorder. This is also a limitation because it could mean
that clinicians may administer incorrect or ineffective treatments.
- There are issues with gender bias in the diagnosis of schizophrenia, there are
suggestions that the majority of clinicians are men, and they misapply diagnostic
criteria to women.
- Males tend to suffer more negative symptoms than women and have higher rates
of substance abuse, whereas females have better recovery rates and lower
relapse rates.
- There are also different predisposing factors which give men and women different
vulnerability at different points in life. Males first onset is typically between 18
and 25. They have 2 peaks at 21 and 39. Females first onset is generally between
25 and 35. They have 3 peaks at 22, 37 and 62.
Females are Cotton et al (2009) found that female patients typically function
more high better than men, as generally they have closer relationships, so they
functioning get more support. This may be why the diagnosis rates are lower in
women as their better interpersonal functioning may bias practitioner
to under-diagnose schizophrenia. This is an issue as men and women
suffering the same symptoms may experience different diagnoses.
Underdiagnosis in women means that women may not receive
treatment and services that may benefit them.
- There are also issues with cultural bias in the diagnosis of schizophrenia, there is
a tendency to over-diagnose members of other cultures as suffering with
schizophrenia.
- In Britain Afro-Caribbean’s are more likely to be diagnosed than whites. They are
also more likely to be compulsorily confined to secure hospitals – maybe because
most psychiatrists are white.
- Racism and stress may also contribute to higher levels of schizophrenia.
Poor inter-rater Copeland (1971) gave 134 US and 194 British psychiatrists a
reliability description of a patient. 69% of the US psychiatrists diagnosed
schizophrenia, but only 2% of the British ones gave them the same
diagnosis.
Low rates of Rates of schizophrenia in Africa and the West Indies are low, this may
schizophrenia in be due to the fact that positive symptoms such as hearing voices
Africa may be more acceptable in African cultures because of cultural
beliefs in communication. However, psychiatrists from a different
cultural tradition may view these experiences as bizarre.
Describe and Evaluate Biological Explanations for Schizophrenia
, AO1:
- The risk of schizophrenia increases with genetic similarity.
- Gottesman (1991) found a 48% chance of schizophrenia is MZ twins and a 17%
chance of schizophrenia in DZ twins, and siblings have a 9% shared risk.
- Schizophrenia is polygenetic and aetiologically heterogeneous (multiple different
gene combinations can lead to schizophrenia)
- Ripke et al (2014) studied 37000 patients and found 108 different gene
combinations associated for increased risk of schizophrenia. Many of these coded
for the dopamine neurotransmitter.
Research A strength of the genetic explanation is the strong evidence.
Support Gottesman (1991) clearly shows how genetic similarity and shared
risk of schizophrenia are closely related. Adoption studies also show
that the biological children of parents with schizophrenia are at a
heightened risk of schizophrenia even if they grow up with an
adoptive family. This shows that some people are more vulnerable to
schizophrenia due to their genetic makeup.
Environmental A limitation of the genetic explanation is that there is evidence that
factors environmental factors can also increase the risk of developing
schizophrenia. Links between things such as birth complications,
smoking cannabis in teenage years or childhood trauma have also
been shown to increase the risk of schizophrenia. Mørkved et al
(2017) found that 67% of people with schizophrenia or related
psychotic disorders reported at least one childhood trauma, as
opposed to 38% of a matched group with non-psychotic mental
health issues. This means that genetic factors alone cannot provide a
complete explanation for schizophrenia.
Risk of Mutation A strength is that the role of mutation supports the genetic
explanation. Schizophrenia can take place in the absence of family
history of the disorder such as through mutation of paternal DNA in
sperm cells due to radiation. Brown et al (2002) found that there is a
link between paternal age and the risk of schizophrenia from 0.7% in
father under 25 to 2% in fathers over 50. This is due to the fact that
there is an increased risk of mutations in older men. This evidence
supports the importance of genetic factors in the development of
schizophrenia.
- The dopamine hypothesis states that neurons transmitting dopamine fire too easily
or too often leading to schizophrenia.
- Drugs used to treat schizophrenia cause symptoms similar to Parkinson’s disease,
which is a caused by low dopamine levels. Therefore, schizophrenia may be the
result of high levels of dopamine.
- Subcortical hyperdopaminergia (high levels of dopamine in the subcortex) is
associated with hallucinations and speech poverty. For example, an excess of
dopamine receptors in Broca’s area
- Cortical hypodopaminergia (low levels of dopamine in the prefrontal cortex) is
associated with the negative symptoms of schizophrenia such as problems in
decision making and other cognitive problems.
- Cortical hypodopaminergia can lead to subcortical hyperdopaminergia.
- The current versions of the hypothesis try to explain the originals of abnormal
dopamine levels. It is thought that both genetic variations and early experiences to
stress make people more sensitive to cortical hypodopaminergia and then subcortical
hyperdopaminergia.
Research A strength of the dopamine hypothesis is that there is research
Support support. Amphetamines increase dopamine levels, and these worsen
the symptoms in people with schizophrenia and induce symptoms in
Essay Plans
Discuss Reliability and Validity in the Diagnosis and Classification of
Schizophrenia
AO1:
- Reliability is a measure of consistency of symptom measurement.
- Validity is a measure of whether the diagnosis represents something real and
distinct and measures what it claims to.
- Co-morbidity is where one or more disorders occur simultaneously with
schizophrenia. This can cause problems with the reliability of the diagnosis as
there may be confusion over which disorder is being diagnosed.
Depression Co- Buckley et al (2009) found that 50% of patients with schizophrenia
morbidity also have a diagnosis of depression. 47% of patients with
schizophrenia also have substance abuse. Very severe depression
can look like schizophrenia and vice versa, therefore they may just
be one condition. This causes issues with descriptive validity as
having simultaneous disorders may suggest that schizophrenia is not
a separate disorder. This is also a limitation because it could mean
that clinicians may administer incorrect or ineffective treatments.
- There are issues with gender bias in the diagnosis of schizophrenia, there are
suggestions that the majority of clinicians are men, and they misapply diagnostic
criteria to women.
- Males tend to suffer more negative symptoms than women and have higher rates
of substance abuse, whereas females have better recovery rates and lower
relapse rates.
- There are also different predisposing factors which give men and women different
vulnerability at different points in life. Males first onset is typically between 18
and 25. They have 2 peaks at 21 and 39. Females first onset is generally between
25 and 35. They have 3 peaks at 22, 37 and 62.
Females are Cotton et al (2009) found that female patients typically function
more high better than men, as generally they have closer relationships, so they
functioning get more support. This may be why the diagnosis rates are lower in
women as their better interpersonal functioning may bias practitioner
to under-diagnose schizophrenia. This is an issue as men and women
suffering the same symptoms may experience different diagnoses.
Underdiagnosis in women means that women may not receive
treatment and services that may benefit them.
- There are also issues with cultural bias in the diagnosis of schizophrenia, there is
a tendency to over-diagnose members of other cultures as suffering with
schizophrenia.
- In Britain Afro-Caribbean’s are more likely to be diagnosed than whites. They are
also more likely to be compulsorily confined to secure hospitals – maybe because
most psychiatrists are white.
- Racism and stress may also contribute to higher levels of schizophrenia.
Poor inter-rater Copeland (1971) gave 134 US and 194 British psychiatrists a
reliability description of a patient. 69% of the US psychiatrists diagnosed
schizophrenia, but only 2% of the British ones gave them the same
diagnosis.
Low rates of Rates of schizophrenia in Africa and the West Indies are low, this may
schizophrenia in be due to the fact that positive symptoms such as hearing voices
Africa may be more acceptable in African cultures because of cultural
beliefs in communication. However, psychiatrists from a different
cultural tradition may view these experiences as bizarre.
Describe and Evaluate Biological Explanations for Schizophrenia
, AO1:
- The risk of schizophrenia increases with genetic similarity.
- Gottesman (1991) found a 48% chance of schizophrenia is MZ twins and a 17%
chance of schizophrenia in DZ twins, and siblings have a 9% shared risk.
- Schizophrenia is polygenetic and aetiologically heterogeneous (multiple different
gene combinations can lead to schizophrenia)
- Ripke et al (2014) studied 37000 patients and found 108 different gene
combinations associated for increased risk of schizophrenia. Many of these coded
for the dopamine neurotransmitter.
Research A strength of the genetic explanation is the strong evidence.
Support Gottesman (1991) clearly shows how genetic similarity and shared
risk of schizophrenia are closely related. Adoption studies also show
that the biological children of parents with schizophrenia are at a
heightened risk of schizophrenia even if they grow up with an
adoptive family. This shows that some people are more vulnerable to
schizophrenia due to their genetic makeup.
Environmental A limitation of the genetic explanation is that there is evidence that
factors environmental factors can also increase the risk of developing
schizophrenia. Links between things such as birth complications,
smoking cannabis in teenage years or childhood trauma have also
been shown to increase the risk of schizophrenia. Mørkved et al
(2017) found that 67% of people with schizophrenia or related
psychotic disorders reported at least one childhood trauma, as
opposed to 38% of a matched group with non-psychotic mental
health issues. This means that genetic factors alone cannot provide a
complete explanation for schizophrenia.
Risk of Mutation A strength is that the role of mutation supports the genetic
explanation. Schizophrenia can take place in the absence of family
history of the disorder such as through mutation of paternal DNA in
sperm cells due to radiation. Brown et al (2002) found that there is a
link between paternal age and the risk of schizophrenia from 0.7% in
father under 25 to 2% in fathers over 50. This is due to the fact that
there is an increased risk of mutations in older men. This evidence
supports the importance of genetic factors in the development of
schizophrenia.
- The dopamine hypothesis states that neurons transmitting dopamine fire too easily
or too often leading to schizophrenia.
- Drugs used to treat schizophrenia cause symptoms similar to Parkinson’s disease,
which is a caused by low dopamine levels. Therefore, schizophrenia may be the
result of high levels of dopamine.
- Subcortical hyperdopaminergia (high levels of dopamine in the subcortex) is
associated with hallucinations and speech poverty. For example, an excess of
dopamine receptors in Broca’s area
- Cortical hypodopaminergia (low levels of dopamine in the prefrontal cortex) is
associated with the negative symptoms of schizophrenia such as problems in
decision making and other cognitive problems.
- Cortical hypodopaminergia can lead to subcortical hyperdopaminergia.
- The current versions of the hypothesis try to explain the originals of abnormal
dopamine levels. It is thought that both genetic variations and early experiences to
stress make people more sensitive to cortical hypodopaminergia and then subcortical
hyperdopaminergia.
Research A strength of the dopamine hypothesis is that there is research
Support support. Amphetamines increase dopamine levels, and these worsen
the symptoms in people with schizophrenia and induce symptoms in
