SCHIZOPHRENIA INTRODUCTION
SCHIZOPHRENIA SPECIFICATION
Classification of schizophrenia. Positive symptoms of schizophrenia include hallucinations and delusions. Negative symptoms of schizophrenia include speech poverty and avolition.Reliability and validity in diagnosis and classification of schizophrenia, including reference to co-morbidity, culture and gender bias and symptom overlap.
Biological explanations for schizophrenia: genetics and neural correlates, including the dopamine hypothesis.
Psychological explanations for schizophrenia: family dysfunction and cognitive explanations, including dysfunctional thought processing.
Drug therapy: typical and atypical antipsychotics.
Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token economies as used in the management of schizophrenia.
The importance of an interactionist approach in explaining and treating schizophrenia; the diathesis-stress model.
Assessment and examination questions
ASSESSMENTS
Activity:
The following examples show neologisms, clang associations, loose associations, and disturbances of effect.
For EXAMPLES 1-3, circle words or phrases in the illustrations given and identify which of the above they are.
In EXAMPLE 2, show the chain of loose connections.
In EXAMPLE 3, suggest a category of Schizophrenia.
Example one:
I am a nun. If that’s not enough, you are still his. That is a brave cavalier; take him as your boon-swagger Caroline; you know well you are my lord because I am bored, and you like a sword in the Fjord. If you are the habbicontin, Mrs K is still best by fear. Handle the gravy carefully. Where is my paintbrush? Where are you, Monet?
Example Two:
“I am writing on paper. The pen which I am using is from a factory called ‘Perry & Co’. This factory is in England. I assume this. Behind the name of Perry Co. the city of London is inscribed, but not the city. The city of London is in England. I know this from my school days. Then, I always liked geography. My last teacher in that subject was Professor August A. He was a man with black eyes. I also like black eyes. There are also blue and grey eyes and other sorts, too. I have heard it said that snakes have green eyes. All people have eyes. There are some, too, who are blind. A boy leads about these blind people. It must be very terrible not to be able to see. There are people who can’t see and, in addition, can’t hear. I know some who hear too much. One can hear too much. There are many sick people in Burgholzi; they are called patients. One of them I like a great deal. His name is E. Sch. He taught me that in Burgholzi, there are many kinds of patients, inmates, and attendants. Then there are some who are not here at all. They are all peculiar people ….”
Example Three
“Carl was twenty-seven years old when he was first admitted to a psychiatric facility; gangling and intensely shy, he was so incommunicative at the outset that his family had to supply initial information about him. It seemed they had been unhappy and uncomfortable about him for quite some time. His father dated the trouble some time back in high school. He reported. “Carl turned inwards, spent a lot of time in his room alone, he had no friends and did no schoolwork.” His mother was especially troubled by his untidiness. He really was an embarrassment to us, and things have not improved since. “You could never take him anywhere without an argument about washing or changing his clothes. And once he was there, he wouldn’t speak to anyone” His parents further reported that after living away from home for three years, Carl moved back. Disagreements between Carl and his family became frequent and intense. He became more reclusive, bizarre, and sloppy. His parents became more isolating and irritable. Finally, they could take it no longer and took him to hospital. He went without resistance. After ten days in the hospital, Carl told the psychiatrist working with him. “I am an unreal person. I am made of stone or else I am made of glass. I am wired precisely wrong. But you will not find the key to me. I have tried to lose the key to me. You can look closely if you want, but you will see more from far away. Shortly after that, the psychiatrist noticed that Carl “…. smiles when he is uncomfortable and smiles more when he is in pain. He cries during television comedies, seems angry that justice is done and is scared when someone compliments him. He roared with laughter on hearing that a child had tragically been burnt. He grimaces often. He eats very little but always carries away food. After two weeks, the psychiatrist said to him,” You hide a lot. As you say, you are wired precisely wrong. But why won’t you let me see the diagram?” Carl answered, “Never will you find the external lever that will sever me forever with my real, seal, deal heel. It is not on my shoe, not even on my sole. It walks away.”
CLASSIFICATION QUESTIONS
How long do symptoms have to be present before a diagnosis of Schizophrenia can be made for ICD 10 and DSM V? (2 marks)
Give four examples of how language can be disordered in Schizophrenia. (4 marks)
What is a delusion? (2 marks)
What is a hallucination? (2 marks)
Define positive symptoms (4 marks)
Which of the following are not negative symptoms: (3 marks)
HALLUCINATIONS
AVOLITION
DELUSIONS
ANHEDONIA
DELUSIONS
POVERTY OF SPEECH
THOUGHT CONTROL
Outline two positive symptoms (4 marks)
Define negative symptoms (4 marks)
Outline four negative symptoms. (8 marks)
Name three types of delusions (3 marks)
What is thought control (2 marks)
What is meant by effect? (2 marks)
Name four different types of effect (4 marks)
What is the difference between chronic and acute onset Schizophrenia? (4 marks)
What is Type One Schizophrenia? (4 marks)
Why is using the Type One Schizophrenia and Type Two Schizophrenia categorisations of schizophrenia fallible? (4 marks)
Name ICD subtypes (7 marks)
Name the DSM IV subtypes (5 marks)
Name two differences between current ICD and DSM in Schizophrenia classification? 4 marks)
Outline the classification of Schizophrenia (5 marks)
SUBTYPE ACTIVITY
Read the examples of Schizophrenia below and look at your textbook or my webpage for definitions:
For each one, decide if the DSM subtype is: Paranoid, disorganised, catatonic, residual, and undifferentiated or indeed not Schizophrenia at all.
Say whether the symptoms are mainly positive, mainly negative, or mixed.
Mary is 21 and was first presented to the psychiatric services as an out-patient at the age of 19. She gave a two-month history of social withdrawal associated with paranoid delusions. A diagnosis of probable paranoid schizophrenia was made, and she was treated. However, her condition continued to deteriorate. Over the next two months, she became retarded and mute and was admitted to hospital. At this time, she began to have freezing episodes and started to walk backwards. During her freezing episodes, she should stand rigid for hours and ignore any instructions from nurses to move.
Tommy is 41. According to the family, he has always been withdrawn, and his behaviour is sometimes inappropriate. His sister-in-law gave the example of him waking her up in the middle of the night to cook home some breakfast! Over the last year, Tommy has frequently talked at length and has difficulty understanding. He often goes days without speaking to people.
Dave is 24. Over the last three months, he has visions of aliens walking around him when he goes to work. His speech has become rambling, and often, his friends cannot tell what he is saying. A few weeks ago, Dave was told his old college friend had died, and in response, he laughed. He has stopped showering regularly and believes his water system has been poisoned. He has lost a lot of weight as he no longer bothers to cook. His neighbour was worried about Dave when she saw him sitting on the floor in the corner shop grimacing.
Mike is a 33-year-old divorced male with two children he rarely sees, ages 8 and 10. A psychiatrist has never seen him. His family doctor has tried getting him to see a local psychiatrist, but Mike refuses. Mike says he knows someone has removed his brain and replaced it with someone else's. He believes that this brain is controlling him and that he is not responsible for his actions. He works daily and has been in his current job for 15 years. He says he has many friends, but sometimes he thinks one of them did this to him. He is convinced he must protect his brain by wearing a hat (even to bed). He can speak fine and goes to work every day. He doesn’t think his thoughts are unusual.
Susan is 20 years old. She suffered from depression when she was 15. She has now been discharged from her psychiatrist and has been free of depression for the last three years. She is taking her final university exams, has had trouble sleeping, and has experienced bad dreams for the last few weeks. She is feeling stressed out and overwhelmed.
BIOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA QUESTIONS
GENETIC EXPLANATION
What is a concordance rate? (2 MARKS)
Cite five important concordance rates for relatives of schizophrenics. (5 MARKS)
Why are these concordance rates important for the genetic argument? (5 MARKS)
Four criticisms of family studies (8 MARKS)
Two criticisms of twin studies (4 MARKS)
Two criticisms of separated twin studies (4 MARKS)
Two criticisms of adoption studies (4 MARKS)
Two other criticisms of genetic explanations of SZ. (4 MARKS)
NEURAL CORRELATES
What is a neural correlate? (4 MARKS)
Give three examples of neural correlates in Schizophrenia (6 MARKS)
Give two disadvantages of neural correlates theory. (4 MARKS)
What do people typically experience when they produce too much Dopamine? (4 MARKS)
What is the Dopamine 1 hypothesis? (4 MARKS)
Name four disadvantages of the Dopamine hypothesis 1(8 MARKS)
What do people typically experience when they produce too little Dopamine? (4 MARKS)
What is the Dopamine 2 hypothesis? (4 MARKS)
Name four disadvantages of Dopamine hypothesis 2? (8 MARKS)
Give four disadvantages that pertain to both Dopamine hypotheses 1 and 2 (8 MARKS)
PSYCHOLOGICAL EXPLANATION OF SCHIZOPHRENIA QUESTIONS
COGNITIVE EXPLANATIONS FOR SCHIZOPHRENIA
What is a dysfunctional thought process? (4 MARKS)
What is the cognitive explanation of schizophrenia? (6 MARKS)
Give two disadvantages of the cognitive explanation for schizophrenia. (4 MARKS)
Give two advantages of the cognitive explanation for schizophrenia. What is a neural correlate? (4 MARKS)
FAMILY DYSFUNCTIONAL EXPLANATIONS FOR SCHIZOPHRENIA: DOUBLE BIND THEORY BY BATESMAN
What is a family dysfunctional explanation of Schizophrenia? (6 MARKS)
What is a double bind? (3 MARKS)
According to Bateman, Schizophrenia is caused by double binds; explain how. 6 MARKS)
How do researchers measure double binds? (4 MARKS)
Name and outline two studies that support the Double bind theory (4 MARKS)
Why do psychological explanations of schizophrenia, such as the Double bind theory, struggle to obtain scientifically valid and reliable studies to support their theories? (8 MARKS)
FAMILY DYSFUNCTIONAL EXPLANATIONS FOR SCHIZOPHRENIA: EXPRESSED EMOTION
What is expressed emotion (EE), e.g., what is high expressed emotion (HEE). (4 MARKS)
What is low expressed emotion (LEE)? (4 MARKS)
How do researchers measure EE? (4 MARKS)
Name and outline two studies that support expressed emotion theory. (6 MARKS)
Expressed Emotion theory does not explain the cause of Schizophrenia, only the course of the illness. Explain what that means, e.g., what is the difference between course and cause explanations of SZ? (8 MARKS)
Secondly, why is it easier to research psychological explanations, such as EE theory, that investigate the course of the illness? (6 MARKS)
How does EE affect the course of Schizophrenia? (4 MARKS)
other evaluative points about EE theory? (4 MARKS)
NATURE AND NURTURE EXPLANATIONS FOR SCHIZOPHRENIA
What is the interactionist theory of Schizophrenia? (4 MARKS)
What is the diathesis-stress model of schizophrenia? (4 MARKS)
What support does the interactionist model have that shows schizophrenia is caused by both nature and nurture? (6 MARKS)
DRUG TREATMENT FOR SCHIZOPHRENIA QUESTIONS
Outline the function of dopamine, e.g., what does it do? (4 MARKS)
Describe problems people may experience with imbalances in DOPAMINE production, e.g., + and -. (4 MARKS)
What is an agonist? (2 MARKS)
What is an antagonist? (2 MARKS)
What is an antipsychotic? (2 MARKS)
What is a typical or conventional antipsychotic? (2 MARKS)
How did anti-psychotics originate? (2 MARKS)
Name two typical antipsychotics. (2 MARKS)
How do typical antipsychotics work? (2 MARKS)
What are the four adverse symptoms of taking typical antipsychotics? (2 MARKS)
Name two other issues that devalue the efficacy of typical antipsychotics. (2 MARKS)
What is an A-Typical anti-psychotic? (2 MARKS)
Name two A- typical antipsychotics? (2 MARKS)
Give two advantages of taking A-typical anti-psychotics versus taking Typical anti-psychotics. (4 MARKS)
Two disadvantages of taking A typical antipsychotic? (4 MARKS)
What are the findings for the length of time on typical and A-typical anti-psychotics? (4 MARKS)
PSYCHOLOGICAL TREATMENTS FOR SCHIZOPHRENIA QUESTIONS
TOKEN ECONOMIC TREATMENTS FOR SCHIZOPHRENIA QUESTIONS
What is a token economy? (3 MARKS)
How is it theorised that a token economy h
What form of behaviourism is the Token economy derived from? Give an example. (3 MARKS)
Give three disadvantages of using a token economy (6 MARKS)
COGNITIVE BEHAVIOURAL THERAPY TREATMENTS FOR SCHIZOPHRENIA QUESTIONS
RELIABILITY AND VALIDITY OF SCHIZOPHRENIA QUESTIONS
ACTUAL AQA QUESTIONS
Name and briefly outline one negative symptom of schizophrenia. (Total two marks)
Read the item and then answer the question that follows. Louise comes from a family with a history of schizophrenia, as both her grandfather and an aunt have been diagnosed with the disorder. Louise’s father has recently died from cancer, and she has just moved out of the family home to start a university course. Although she has always been healthy in the past, she has just begun to experience symptoms of schizophrenia, such as delusions and hallucinations. Using your knowledge of schizophrenia, explain why Louise is now showing symptoms of schizophrenia. (Total four marks)
Discuss one or more biological explanations for schizophrenia. (Total 16 marks)
Discuss biological explanations for schizophrenia. (Total 16 marks)
Discuss biological explanations for schizophrenia. (Total 16 marks)
Describe and evaluate biological explanations for schizophrenia. Refer to evidence in your answer.(Total 16 marks)
“There is considerable evidence that biological factors cause schizophrenia. These can be genetic, neuroanatomical, biochemical, viral or a combination of such factors.” Discuss biological explanations of schizophrenia. (Total 16 marks)
What terms are used by family systems theorists to describe A and B below? (Total two marks)
A Being free to decide how to behave and feel in control of one’s life.
B When a family is over-protective, distinctions between family members are blurred.
Briefly outline family dysfunction as an explanation for schizophrenia. (Total two marks)
Outline one psychological explanation of schizophrenia. (Total four marks)
Explain how family dysfunction might be involved in schizophrenia. Refer to one or more types of family dysfunction in your answer. (Total four marks)
Jack has been diagnosed with schizophrenia. He describes his family background to his therapist:‘I could never talk to mum. She fussed over me all the time. I tried to do what she said but could never please her. One minute, she seemed all affectionate, and the next minute, she would make nasty comments. My dad hated all the arguments and stayed out of it.’ Describe the family dysfunction explanation for schizophrenia and explain how Jack’s experiences can be linked to the family dysfunction explanation. (Total eight marks)
Briefly discuss two limitations of the family dysfunction explanation for schizophrenia.
Evaluate one psychological explanation for schizophrenia. (Total six marks)
Evaluate psychological explanations of schizophrenia. (Total 16 marks)
Which of the following best describes neural correlates as an explanation for schizophrenia? Shade one box only. (Total one mark)
A: There is a correlation between brain plasticity and symptoms of schizophrenia.
B: There is a correlation between brain structure and function and symptoms of schizophrenia.
C: There is a correlation between dysfunctional thinking and symptoms of schizophrenia.
Outline and evaluate one or more psychological explanations for schizophrenia. (Total 16 marks)
Discuss the use of an interactionist approach in explaining and treating schizophrenia. (Total 16 marks)
Outline one or more biological explanations (s) for schizophrenia. Compare biological explanation(s) for schizophrenia with the family dysfunction explanation for schizophrenia. (Total 16 marks)
Outline and evaluate the use of antipsychotic drugs to treat schizophrenia. (Total eight marks)
Apart from effectiveness, briefly explain one limitation of drug therapy for schizophrenia. (Total 2 marks)
Read the item and then answer the questions that follow: Two years ago Jenny was diagnosed with schizophrenia. She has been taking an atypical antipsychotic drug, and there have been improvements in her positive symptoms. However, she still suffers negative symptoms and side effects. Her psychiatrist wants to change her medication from typical antipsychotics to one of the atypical antipsychotics and has also suggested cognitive behavioural therapy.
A. Outline one negative symptom of schizophrenia. (2 marks)
B. Concerning the item above, explain why Jenny’s psychiatrist wants to move her on to one of the atypical antipsychotics. (4 marks)
Briefly explain one advantage of cognitive behavioural therapy in the treatment of schizophrenia. (2 marks)
Below are four evaluative statements about token economies as used in the treatment of schizophrenia. Which statement is TRUE? Shade one box only. (Total 1 mark)
A: Token economies can be used effectively in any environment.
B: Token economies have a positive effect on thinking.
C: Token economies help to promote acceptable behaviours.
D: Token economies address the cause of the problem.
Discuss token economies as a method used in the management of schizophrenia. (Total eight marks)
Briefly outline how cognitive behaviour therapy (CBT) is used to treat schizophrenia and explain one limitation of using CBT to treat schizophrenia. (Total four marks)
Jay and Mary are clinical psychologists. They each work with patients who have schizophrenia. Both Jay and Mary treat their patients without the use of drugs.Jay explains how he involves close relatives in treatment for less tension. Mary describes how she helps patients to gain an understanding of their thoughts and develop effective strategies to help themselves. Describe and evaluate family therapy and cognitive behaviour therapy as treatments for schizophrenia. Refer to Jay and Mary in your answer. (Total 16 marks)
Martine has schizophrenia. She is afraid because she believes that her care workers are trying to hurt her. She hears voices telling her to lock the doors and windows so the care workers cannot enter her house. She thinks about nothing else. Explain how a cognitive behaviour therapist might treat Martine’s symptoms. (Total 4 marks)
‘Therapies can be time-consuming and, in some cases, uncomfortable for the client. It is, therefore, very important to offer the most appropriate and effective type of treatment.’ Outline and evaluate two or more therapies used in the treatment of schizophrenia. (Total 16 marks)
Outline and compare two treatments for schizophrenia. (Total 16 marks)
What terms are used by psychologists to describe A and B below? (Total two marks)
A When a person has two or more disorders at the same time.
B When two different disorders have a symptom in common.
Briefly outline and evaluate one study of validity about the diagnosis of schizophrenia. (Total four marks)
Discuss issues associated with the reliability and validity in the diagnosis and classification of schizophrenia, including reference to co-morbidity, culture and gender bias and symptom overlap (Total 16 marks)
