Schizophrenia – a severe mental disorder where contact with reality & +ve symptoms – experienced in -ve Symptoms –
insight are impaired. addition to normal experiences experiences that represent
- 1% pop suffer, peak onset 25-30yrs. No more than 1/5 recover. (Type 1 SZ) a loss of usual experiences.
Diagnosis – deciding whether an individual has an illness using Hallucinations – disturbances of (Type 2 SZ)
classifications. perception & senses. (voices) Avolition – reduction,
Classification – process of organising symptoms into categories based on Delusions – irrational beliefs difficulty & inability for goal-
which symptoms group together in suffers. (grandeur, persecution, under directed behaviour.
- SZ has no determining single characteristic but is a cluster of external control) Speech poverty – reduced
(unrelated) symptoms that group together and cause SZ. Speech disorganisation – speech freq & quality or delayed
DSM-5 ICD-1O is incoherent/ changes topic mid- speech.
American classification International classification sentence.
One +ve symptoms must Two or more +ve or -ve symptoms are
be present sufficient
Subtypes removed. Recognises subtypes (disorganised/ paranoid
SZ)
Strength Weakness (validity/ reliability)
Validity - the extent to which we are measuring what we are intending to
- Criterion validity – do different assessment systems arrive at the same diagnosis for the same patient.
- Validity is poor when the diagnosis only works for one gender/ culture
Inter-rater reliability – do different assessors agree on the same diagnosis.
Serper 1999 – co-mobility SZ Inter-rater reliability – consistency of diagnosis between psychologists
& substance abuse patients Cheniaux – 2 psychologists rated 100 patients.
could be separately - More likely to be diagnosed with ICD than DSM = ↓criterion validity.
diagnosed from those with - Psych 1 = 26/100 (DSM-5) and 44/100 (ICD-10)
singular condition. - Psych 2 = 13/100 (DSM-5) and 24/100 (ICD-10)
Inter-rater reliability co morbidity 2 conditions co-exist in same individual at same time.
Soderberg (2005) – found - Buckley 2009 - 50% SZ’s have depression & 47% have substance abuse
80% concordance rate in - Could be the same illness, or psychologists are poor at telling the difference.
diagnosing SZ with DSM, 60% - Wrong diagnosis = wrong treatment = ineffective
in ICD. symptom overlap - 2+ conditions share symptoms.
- DSM is more reliable than - Bipolar disorder & SZ share +ve symptoms such as delusions & -ve symptoms such as avolition.
ICD because it is more - Under ICD person would be diagnosed with SZ, but under DSM person may be diagnosed with bipolar
specific disorder.
- As classifications have - Therefore reducing the criterion validity of each classification.
evolved & become more cultural bias
specific, reliability has - Cochrane1977 – Incidence rate of Afro-Caribbeans & white people is 1% in both populations. However, when
increased. Afro-Caribbeans live in Britain they are 7x more likely to be diagnosed.
- Incidence rate in both cultures is similar so over-diagnosis is not due to genetic factors but cultural bias.
- Therefore suggesting a lack of validity in diagnosing SZ cross culturally.
Gender bias
- Longenecker 2010 – since 1980 men are diagnosed more often than women. (Women are high functioning,
hide symptoms)
, Biological Explanations – inherited factors & dysfunctional brain
Psychological explanations
activity
Family disfunction – SZ is due to abnormal family communication
Genetic Basis - SZ can be inherited through genes & runs in families.
styles, this conflict & criticism creates stress = body releases cortisol
- Gottesman – risk of developing SZ
- Release of cortisol enters the flight/ fight response and can be
o Rate in MZ twins = 48%, DZ twins = 17%
harmful physically/ mentally in the long-term causing anxiety, &
o Rate if parents have SZ = 17% depression
o Rate if siblings have SZ = 9% 1. Schizophrenogenic Mother – cold, rejecting, controlling mothers.
- Candidate genes – individual genes believed to be associated with - Leads to a distrust that manifests into paranoid delusions &
increased risk of onset. anxiety
- Polygenic (Ripke) – 108 genetic variations associated with - Used reports from patients to generate theory.
increased risk of SZ, genes work in combination. - (Now a rejected theory)
- Aetiologically heterogeneous – a different combination of genes 2. Double-bind hypothesis – child revies conflicting messages from
leads to onset in each patient. parents & punished by withdrawal of love.
Strength Weakness. - Child believes world is confusing & dangerous, loose sense of
Interactionist approach – Tienari – Gottesman – MZ = reality = reflected in disorg thinking & delusions.
adoptees reared in high stress ↑environment - E.g. ‘you are too difficult to live with, but you cannot live without
environment had ↑risk of SZ onset, Ripke – found 108 genetic me’.
only when they had a genetic variations all associated with 3. Expressed emotion in cause of relapse – the level of -ve
vulnerability. SZ emotion expressed towards a person with SZ causing stress
Dopamine hypothesis – inherited genes cause high levels of - Verbal criticism, hostility, emotional over-involvement.
excitatory neurotransmitter dopamine = +ve symptoms. - Person is less likely to comply to therapy, take medication =
1. hyperdopaminergia in subcortex = +ve symptoms relapse.
- ↑dopamine in Broca’s area means neurone fire’s dopamine to Strength Weakness
readily/often. Excess D2 receptors receive & transmit signals = Kavanagh 1992 – 26 SZ patients SZ mother RM - reports from SZ
auditory hallucinations. returned home, relapse rate of patients
2. hypodopaminergia in pre-frontal cortex = -ve symptoms 48% in double-blind environment Bias to blaming mothers
(modern) compared to 21% in healthy. - complex illness cannot purely
- ↓dopamine in pre-frontal cortex associated with thinking, impairs Interactionist approach – be environmental factors.
ability to construct grammatical sentence or make decisions = Tiernari found adoptees reared in Cause of Effect? - SZ creates
speech poverty & avolition. high stress environments had high emotional states does,
Neural Correlates – correlation between brain structure & functioning ↑risk of SZ onset, only in those dysfunctional family or child
with symptoms of schizophrenia. with a genetic vulnerability. comes first.
- Those with SZ have a diff brain structure/ activity to control. Dysfunctional though processing – loose metacognition awareness
-ve symptoms (avolition) +ve symptoms (hallucinations) 1. Metarepresentation is the ability to recognise own thoughts/
↓activity in ventral striatum fMRI test found ↓activity in the actions as being carried out by ourselves & insight into intentions/
responsible for eval of reward temporal and cingulate gyri in emotions of others = hallucinations
-ve correlation between activity those experiencing hallucinations 2. Central control is the ability to suppress automatic responses
& severity of SZ than normal. while we perform deliberate actions. = disorganised speech.
Strength Weakness
Strength Weakness Stirling 2006 – SZ patients took 2x longer to name Unfalsifiable
Curran - Noll 2009 – 1/3 people still experience ink colours in Stroop test – asks pts to identify –
dopamine hallucinations when on antipsychotics. colour of word despite word being ‘brown’ metacognition
agonists Ripke – many of the genes identified are involved NICE Review – found CBTp reduced rehospitalisation is invisible.
produce +ve with other NTs (serotonin) the hypothesis ignores. by 18mo compared to antipsychotics alone. Desc & not
symptoms in No distinct genes means correlation is weakened Neural correlates - ↓activity in ventral striatum & explanation
insight are impaired. addition to normal experiences experiences that represent
- 1% pop suffer, peak onset 25-30yrs. No more than 1/5 recover. (Type 1 SZ) a loss of usual experiences.
Diagnosis – deciding whether an individual has an illness using Hallucinations – disturbances of (Type 2 SZ)
classifications. perception & senses. (voices) Avolition – reduction,
Classification – process of organising symptoms into categories based on Delusions – irrational beliefs difficulty & inability for goal-
which symptoms group together in suffers. (grandeur, persecution, under directed behaviour.
- SZ has no determining single characteristic but is a cluster of external control) Speech poverty – reduced
(unrelated) symptoms that group together and cause SZ. Speech disorganisation – speech freq & quality or delayed
DSM-5 ICD-1O is incoherent/ changes topic mid- speech.
American classification International classification sentence.
One +ve symptoms must Two or more +ve or -ve symptoms are
be present sufficient
Subtypes removed. Recognises subtypes (disorganised/ paranoid
SZ)
Strength Weakness (validity/ reliability)
Validity - the extent to which we are measuring what we are intending to
- Criterion validity – do different assessment systems arrive at the same diagnosis for the same patient.
- Validity is poor when the diagnosis only works for one gender/ culture
Inter-rater reliability – do different assessors agree on the same diagnosis.
Serper 1999 – co-mobility SZ Inter-rater reliability – consistency of diagnosis between psychologists
& substance abuse patients Cheniaux – 2 psychologists rated 100 patients.
could be separately - More likely to be diagnosed with ICD than DSM = ↓criterion validity.
diagnosed from those with - Psych 1 = 26/100 (DSM-5) and 44/100 (ICD-10)
singular condition. - Psych 2 = 13/100 (DSM-5) and 24/100 (ICD-10)
Inter-rater reliability co morbidity 2 conditions co-exist in same individual at same time.
Soderberg (2005) – found - Buckley 2009 - 50% SZ’s have depression & 47% have substance abuse
80% concordance rate in - Could be the same illness, or psychologists are poor at telling the difference.
diagnosing SZ with DSM, 60% - Wrong diagnosis = wrong treatment = ineffective
in ICD. symptom overlap - 2+ conditions share symptoms.
- DSM is more reliable than - Bipolar disorder & SZ share +ve symptoms such as delusions & -ve symptoms such as avolition.
ICD because it is more - Under ICD person would be diagnosed with SZ, but under DSM person may be diagnosed with bipolar
specific disorder.
- As classifications have - Therefore reducing the criterion validity of each classification.
evolved & become more cultural bias
specific, reliability has - Cochrane1977 – Incidence rate of Afro-Caribbeans & white people is 1% in both populations. However, when
increased. Afro-Caribbeans live in Britain they are 7x more likely to be diagnosed.
- Incidence rate in both cultures is similar so over-diagnosis is not due to genetic factors but cultural bias.
- Therefore suggesting a lack of validity in diagnosing SZ cross culturally.
Gender bias
- Longenecker 2010 – since 1980 men are diagnosed more often than women. (Women are high functioning,
hide symptoms)
, Biological Explanations – inherited factors & dysfunctional brain
Psychological explanations
activity
Family disfunction – SZ is due to abnormal family communication
Genetic Basis - SZ can be inherited through genes & runs in families.
styles, this conflict & criticism creates stress = body releases cortisol
- Gottesman – risk of developing SZ
- Release of cortisol enters the flight/ fight response and can be
o Rate in MZ twins = 48%, DZ twins = 17%
harmful physically/ mentally in the long-term causing anxiety, &
o Rate if parents have SZ = 17% depression
o Rate if siblings have SZ = 9% 1. Schizophrenogenic Mother – cold, rejecting, controlling mothers.
- Candidate genes – individual genes believed to be associated with - Leads to a distrust that manifests into paranoid delusions &
increased risk of onset. anxiety
- Polygenic (Ripke) – 108 genetic variations associated with - Used reports from patients to generate theory.
increased risk of SZ, genes work in combination. - (Now a rejected theory)
- Aetiologically heterogeneous – a different combination of genes 2. Double-bind hypothesis – child revies conflicting messages from
leads to onset in each patient. parents & punished by withdrawal of love.
Strength Weakness. - Child believes world is confusing & dangerous, loose sense of
Interactionist approach – Tienari – Gottesman – MZ = reality = reflected in disorg thinking & delusions.
adoptees reared in high stress ↑environment - E.g. ‘you are too difficult to live with, but you cannot live without
environment had ↑risk of SZ onset, Ripke – found 108 genetic me’.
only when they had a genetic variations all associated with 3. Expressed emotion in cause of relapse – the level of -ve
vulnerability. SZ emotion expressed towards a person with SZ causing stress
Dopamine hypothesis – inherited genes cause high levels of - Verbal criticism, hostility, emotional over-involvement.
excitatory neurotransmitter dopamine = +ve symptoms. - Person is less likely to comply to therapy, take medication =
1. hyperdopaminergia in subcortex = +ve symptoms relapse.
- ↑dopamine in Broca’s area means neurone fire’s dopamine to Strength Weakness
readily/often. Excess D2 receptors receive & transmit signals = Kavanagh 1992 – 26 SZ patients SZ mother RM - reports from SZ
auditory hallucinations. returned home, relapse rate of patients
2. hypodopaminergia in pre-frontal cortex = -ve symptoms 48% in double-blind environment Bias to blaming mothers
(modern) compared to 21% in healthy. - complex illness cannot purely
- ↓dopamine in pre-frontal cortex associated with thinking, impairs Interactionist approach – be environmental factors.
ability to construct grammatical sentence or make decisions = Tiernari found adoptees reared in Cause of Effect? - SZ creates
speech poverty & avolition. high stress environments had high emotional states does,
Neural Correlates – correlation between brain structure & functioning ↑risk of SZ onset, only in those dysfunctional family or child
with symptoms of schizophrenia. with a genetic vulnerability. comes first.
- Those with SZ have a diff brain structure/ activity to control. Dysfunctional though processing – loose metacognition awareness
-ve symptoms (avolition) +ve symptoms (hallucinations) 1. Metarepresentation is the ability to recognise own thoughts/
↓activity in ventral striatum fMRI test found ↓activity in the actions as being carried out by ourselves & insight into intentions/
responsible for eval of reward temporal and cingulate gyri in emotions of others = hallucinations
-ve correlation between activity those experiencing hallucinations 2. Central control is the ability to suppress automatic responses
& severity of SZ than normal. while we perform deliberate actions. = disorganised speech.
Strength Weakness
Strength Weakness Stirling 2006 – SZ patients took 2x longer to name Unfalsifiable
Curran - Noll 2009 – 1/3 people still experience ink colours in Stroop test – asks pts to identify –
dopamine hallucinations when on antipsychotics. colour of word despite word being ‘brown’ metacognition
agonists Ripke – many of the genes identified are involved NICE Review – found CBTp reduced rehospitalisation is invisible.
produce +ve with other NTs (serotonin) the hypothesis ignores. by 18mo compared to antipsychotics alone. Desc & not
symptoms in No distinct genes means correlation is weakened Neural correlates - ↓activity in ventral striatum & explanation
