Schizophrenia

This section explores the topic of Schizophrenia as part of the Psychology module Issues and Options in Psychology. These notes cover classification, explanations, therapies, and the interactionist approach to Schizophrenia.

Classification of Schizophrenia

Symptoms of Schizophrenia

Positive Symptoms: Additions to normal behaviour and perception, including:

Hallucinations: Sensory experiences without an external stimulus, often auditory (e.g., hearing voices) but can involve any sense.

Delusions: False beliefs that are resistant to logic, such as delusions of persecution (believing others want to harm them) or grandeur (believing they have special powers).

Negative Symptoms: Loss or reduction of normal functions, including:

Speech Poverty (Alogia): Reduced fluency and productivity of speech, often making conversations challenging.

Avolition: Lack of motivation to pursue purposeful activities, which may lead to neglect of personal hygiene or loss of interest in hobbies.

Reliability and Validity in Diagnosis

Reliability: Consistency in the diagnosis of schizophrenia. Inter-rater reliability is a concern, as different clinicians may diagnose differently based on symptoms.

Validity: Accuracy of the diagnosis. Challenges include:

Co-morbidity: The presence of additional disorders (e.g., depression or substance abuse), which can complicate diagnosis and treatment.

Culture Bias: Diagnostic practices may vary across cultures, with some symptoms more accepted in certain cultures, potentially leading to over- or under-diagnosis.

Gender Bias: Some evidence suggests that men are more likely to be diagnosed, potentially due to gender stereotypes about behaviour.

Symptom Overlap: Symptoms of schizophrenia overlap with other disorders (e.g., bipolar disorder), making accurate diagnosis challenging.

Biological Explanations for Schizophrenia

Genetic Explanation

Schizophrenia appears to have a genetic component, with higher risk associated with family history. Twin studies indicate higher concordance rates for identical twins, and adoption studies show increased risk even when raised apart from biological parents.

Neural Correlates

Dopamine Hypothesis: Suggests that schizophrenia is linked to an overactivity of dopamine, particularly in brain regions like the mesolimbic pathway. Excess dopamine is thought to contribute to positive symptoms, while low dopamine in the prefrontal cortex may be associated with negative symptoms.

Brain Structure: Some studies have shown structural abnormalities in people with schizophrenia, including enlarged ventricles and reduced grey matter in specific brain regions, possibly linked to symptom severity.

Psychological Explanations for Schizophrenia

Family Dysfunction

Expressed Emotion (EE): Families with high levels of EE (criticism, hostility, and emotional over-involvement) may increase relapse rates in individuals with schizophrenia.

Double Bind Theory: Bateson’s theory proposes that children who receive contradictory messages from caregivers (e.g., being told they are loved but treated harshly) are at higher risk of schizophrenia, as it causes confusion and leads to disordered thinking.

Cognitive Explanations

Suggest that faulty thought processes and biases contribute to symptoms.

Dysfunctional Thought Processing: Individuals with schizophrenia may have impairments in processes such as perception and attention, leading to hallucinations or delusions. For example, they may attribute personal significance to random events or have difficulty distinguishing internal thoughts from external stimuli.

Drug Therapy for Schizophrenia

Typical Antipsychotics

Examples: Chlorpromazine

Mechanism: Primarily block dopamine receptors, which can reduce positive symptoms by lowering dopamine activity in the brain.

Side Effects: Typical antipsychotics can cause significant side effects, including tardive dyskinesia (involuntary muscle movements) and drowsiness.

Atypical Antipsychotics

Examples: Clozapine, Risperidone

Mechanism: Target both dopamine and serotonin receptors, which may reduce both positive and negative symptoms.

Side Effects: Fewer motor side effects compared to typical antipsychotics, but may cause weight gain and increase risk for conditions like diabetes.

Psychological Therapies for Schizophrenia

Cognitive Behaviour Therapy (CBT) 

Aim: Helps patients identify and challenge distorted beliefs and thoughts, such as delusions or paranoia.

Techniques: Patients learn to evaluate the evidence for their beliefs, reduce distress caused by symptoms, and develop coping strategies to manage symptoms more effectively.

Family Therapy

Aim: Supports families to improve communication, reduce stress, and develop strategies to help the individual with schizophrenia.

Key Components: Education about schizophrenia, reducing expressed emotion within the family, and helping families to identify signs of relapse early.

Token Economies

Used in institutional settings to encourage positive behaviours in individuals with schizophrenia, such as self-care and socialisation.

Mechanism: Patients receive tokens for desirable behaviours, which they can exchange for rewards (e.g., snacks, leisure activities).

Effectiveness: Primarily effective for managing behaviour rather than treating core symptoms of schizophrenia.

Interactionist Approach to Schizophrenia

Importance of the Interactionist Approach

Schizophrenia is seen as resulting from a combination of biological, psychological, and social factors, rather than a single cause.

Diathesis-Stress Model

Diathesis (Vulnerability): Genetic predisposition or early neurological trauma may increase vulnerability to schizophrenia.

Stress: Environmental factors, such as family dysfunction, drug use, or traumatic events, may trigger schizophrenia in those already vulnerable.

Treatment Implications: An interactionist approach suggests combining biological treatments (e.g., medication) with psychological therapies (e.g., CBT and family therapy) to address both the biological and environmental aspects of schizophrenia.

Summary

This module explores the complexities of schizophrenia, including classification, biological and psychological explanations, and treatments. An understanding of both symptoms and diagnostic challenges is critical for accurate diagnosis and treatment. Biological theories focus on genetics and brain chemistry, while psychological theories highlight family dynamics and thought processing. Treatments range from drug therapies to psychological therapies and token economies. The interactionist approach underscores the value of a multi-faceted approach, combining biological and psychological interventions to address the full range of factors contributing to schizophrenia.