Schizophrenia • Clinical characteristics of the chosen disorder • Issues surrounding the classification and diagnosis of their chosen disorder, including reliability and validity • Biological explanations of their chosen disorder, for example, genetics, Biochemistry • Psychological explanations of their chosen disorder, for example, behavioural, cognitive, psychodynamic and socio-cultural • Biological therapies for their chosen disorder, including their evaluation in terms of appropriateness and effectiveness • Psychological therapies for their chosen disorder, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectiveness

Sz– Characteristics/Symptoms Thought process disorder, characterised by disruption to a person’s perceptions, emotions and beliefs Hallucinations / Delusions Social Withdrawal Though Control Catatonic behaviour Type 1 Symptoms – Positive (add something eg. Hallucinations) Type 2 Symptoms – Negative (withdraw something eg social behaviour)

Sz – Diagnostic Criteria Positive Symptoms Negative Symptoms Diagnosis 2 or more characteristic symptoms Social/occupational dysfunction Duration (at least 6 months) Exclusion of mood disorders Exclusion of organic cause 2 classification systems – ICD and DSM, recognise different subtypes of schizophrenia.

Sz - Issues Surrounding Classification Reliability Extent to which psych’s agree on same def Whaley (2001) inter-rater reliability 0.11 Positive symptoms more useful for diagnosis Lower inter-rater reliability on bizarre vs non-bizarre symptoms Issues with cultural bias (DSM and ICD) Further development of classification systems

Sz - Issues Surrounding Classification Validity Is it measuring what it claims to measure? No, as classification systems are not consistent When people are labelled psychiatrists are not objective to identify the symptoms Difficult to define the disorder from others Validity of subtypes are questioned as some overlap

Sz – Biological Explanations – AO1 (Genetic, biochem, neuroanatomical) S more common among bio relatives Twin studies (higher concordance for MZ) Adoption – showed genetic support Increase in dopamine = Sz Enlarged ventricles. Linked to negative not positive symptoms Result of poor brain development rather than disorder?

Sz - Biological Explanations – AO2 No consistency with twin results (concordance rates and issues of reliability of definitions) – may reflect environment similarity. Never 100% concordance Small samples Ethics – adoption, twins, mental health etc. Difficult to analyse brain – PET scans Drugs can increase S symptoms i.e. Amphetamines Dopamine link – correlational question of Cause & Effect Reductionist and deterministic – based on biology Neuroanatomical – usually from post-mortems again, cause & effect

Sz - Psychological Explanations – AO1 (Family, cognitive, diathesis) Diathesis (genetic vulnerability and environmental trigger = disorder) Family – usually found in dysfunctional families, high levels of expressed emotion e.g. hostility Cognitive (Frith and Helmsley’s models) – impaired thought processes

Sz – Psych Explanations – AO2 Most are ‘partial’ apart from D-S Model (draws together genetics and environment) Sz may be a result of the environment and living with a disturbed individual (EE) Nature vs. nurture – bring in genetics as an opposing side Expressed Emotion has lead to effective treatment for relatives & patients Cultural Bias – most research based on western, individualistic society EE studies usually correlation Ethics – research highly sensitive area, issues of consent and withdrawal

Sz – Biological Therapies Biological – Chemotherapy Prior to Chemo surgery and ECT – show awareness – not humane etc Antipsychotic drugs – alleviate some of the symptoms i.e. hallucinations Phenothiazines are most effective, work by reducing dopamine Low dose can prevent relapse

Sz – Therapies – Bio – AO2 Not effective against negative symptoms Reduce symptoms within 6 months If medication stopped symptoms return Treat symptoms but not the cause, needs to work alongside another form of treatment Reductionist Can produce distressing side effects eg. Facial tics Regulation and monitoring important Ethics – right to refuse medication! Chemical straightjacket?

Sz - Therapies Psychological (social/family intervention, CBT, psychodynamic therapy) Psychodynamic – causes relapse and makes worse! (Tarrier) CBT – altering thoughts and behaviours (Tarrier) Social intervention – reliable as findings replicated. Has also improved treatment settings (application). Wing and Brown, negative symptoms improved if socialised Family intervention – altering the environment and give practical coping skills. Reduces relapse

Sz – Psych Therapies – AO2 Therapies provide coping strategies and alleviate symptoms but do not cure Only work if the person is of sound mind (need medication as a first line of intervention) Difficult to distinguish whether therapy is having an affect or if it is the antipsychotic drugs Most therapy occurs in controlled environment and then the individual has to apply to real life. Needs to be maintained otherwise relapse Most are active processes Support for CBT from a range of studies Gives patient responsibility for disorder & treatment More holistic as have to be used in combination.