AQA A Level Psychology Schizophrenia

by Yum Yum Mama Team

AQA A-Level Psychology Schizophrenia Checklist

1. Classification of Schizophrenia

✅ Define schizophrenia and explain why classification is important.
✅ Outline the DSM-5 and ICD-11 criteria for diagnosing schizophrenia.

2. Symptoms of Schizophrenia

Positive Symptoms

✅ Define positive symptoms.
✅ Explain hallucinations (with examples).
✅ Explain delusions (with examples).

Negative Symptoms

✅ Define negative symptoms.
✅ Explain speech poverty (alogia).
✅ Explain avolition (lack of motivation).

3. Issues in Diagnosis and Classification

✅ Define reliability in schizophrenia diagnosis (test-retest, inter-rater reliability).
✅ Define validity in schizophrenia diagnosis (criterion validity, predictive validity).
✅ Explain co-morbidity and its impact on diagnosis.
✅ Explain culture bias in schizophrenia diagnosis (examples and research).
✅ Explain gender bias in schizophrenia diagnosis (examples and research).
✅ Explain symptom overlap (e.g., similarities with bipolar disorder).

4. Biological Explanations for Schizophrenia

✅ Explain the genetic basis of schizophrenia (family, twin, and adoption studies).
✅ Explain the role of neural correlates in schizophrenia.
✅ Outline the dopamine hypothesis (hyperdopaminergia and hypodopaminergia).

5. Psychological Explanations for Schizophrenia

✅ Explain family dysfunction (schizophrenogenic mother, double-bind theory, expressed emotion).
✅ Explain cognitive explanations, including:

  • Metarepresentation dysfunction
  • Central control dysfunction
    ✅ Define dysfunctional thought processing and link to symptoms.

6. Biological Treatment: Drug Therapy

✅ Explain how typical antipsychotics work (e.g., chlorpromazine, dopamine antagonists).
✅ Explain how atypical antipsychotics work (e.g., clozapine, risperidone).
✅ Compare the effectiveness and side effects of typical vs. atypical antipsychotics.

7. Psychological Treatments

✅ Explain Cognitive Behavioural Therapy (CBT) for schizophrenia:

  • How it helps (challenging delusions, coping strategies).
  • Strengths and weaknesses.

✅ Explain Family Therapy for schizophrenia:

  • How it helps (reducing expressed emotion, improving communication).
  • Strengths and weaknesses.

✅ Explain Token Economies for managing schizophrenia:

  • How they work (operant conditioning, reinforcement).
  • Strengths and weaknesses.

8. The Interactionist Approach

✅ Explain the diathesis-stress model of schizophrenia.
✅ Compare the biological vs. psychological approaches to schizophrenia.
✅ Explain how an interactionist approach influences treatment (combining drug therapy with psychological therapy).

 

 

 

 

✅ Define schizophrenia and explain why classification is important.

Schizophrenia is a severe mental disorder characterised by disruptions in thought processes, perception, emotions, and behaviour. It often includes positive symptoms (such as hallucinations and delusions) and negative symptoms (such as avolition and speech poverty).

Importance of classification:

  • Standardisation: A clear classification system ensures that schizophrenia is diagnosed consistently across different healthcare professionals and countries.
  • Treatment planning: A valid diagnosis allows for appropriate medical and psychological treatments to be applied.
  • Research and understanding: Helps researchers study the disorder systematically to improve treatments and outcomes.
  • Differentiation from other disorders: Ensures schizophrenia is not misdiagnosed as another condition with overlapping symptoms, such as bipolar disorder.

 

✅ Outline the DSM-5 and ICD-11 Criteria for Diagnosing Schizophrenia

Schizophrenia is classified differently in the two main diagnostic manuals:

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders - 5th Edition)

  • Requires at least two of the following symptoms for a significant portion of time over one month, with at least one symptom being (1), (2), or (3):
    1. Delusions
    2. Hallucinations
    3. Disorganised speech
    4. Grossly disorganised or catatonic behaviour
    5. Negative symptoms (e.g., reduced emotional expression, avolition)
  • Symptoms must persist for at least six months, including at least one month of active symptoms.
  • The disorder must impair social, occupational, or personal functioning.
  • Schizophrenia subtypes (e.g., paranoid, catatonic) were removed in DSM-5 as they were considered unreliable.

ICD-11 (International Classification of Diseases - 11th Edition)

  • Requires at least two of the following symptoms for one month:
    1. Delusions
    2. Hallucinations
    3. Disorganised thinking (evidenced by disorganised speech)
    4. Disorganised behaviour (including catatonia)
    5. Negative symptoms (e.g., apathy, social withdrawal, speech poverty)
  • Unlike DSM-5, functional impairment is not a strict requirement for diagnosis, though it is often observed.
  • Subtypes have been removed, aligning with DSM-5, as research suggests that schizophrenia symptoms can change over time.
  • Introduces course specifiers, such as:
    • First-episode vs. multiple-episode schizophrenia
    • Episodic vs. continuous course

Key Differences Between DSM-5 and ICD-11

Feature DSM-5 ICD-11
Diagnosis duration 6 months (1-month active symptoms) 1 month
Number of symptoms required 2+ symptoms 2+ symptoms
Functioning impairment required? Yes No (but typically present)
Subtypes included? No No
Course specifiers? No Yes (e.g., first-episode, episodic, continuous)
Emphasis on cognitive symptoms? Less explicit More emphasis (e.g., cognitive impairments)

Summary

  • ICD-11 is more flexible and acknowledges the variation in how schizophrenia presents over time.
  • DSM-5 has a longer duration requirement (6 months), whereas ICD-11 requires only 1 month.
  • ICD-11 introduces course specifiers, which allow clinicians to better describe how schizophrenia develops.
  • Both systems removed subtypes, as they were seen as unreliable.

 

 

2. Symptoms of Schizophrenia

Schizophrenia symptoms are typically divided into positive symptoms (excesses or distortions of normal functioning) and negative symptoms (deficits or reductions in normal functioning).

✅ Positive Symptoms

Definition:
Positive symptoms are additions to a person’s normal experience, meaning they exaggerate or distort reality. These symptoms include hallucinations, delusions, disorganised speech, and disorganised behaviour.

✅ Hallucinations (with examples)

Hallucinations are false sensory experiences that occur without an external stimulus. They can affect any of the five senses, but auditory hallucinations are the most common in schizophrenia.

Examples:

  • Auditory hallucinations: Hearing voices that criticise, command actions, or converse with each other (e.g., a person hears a voice telling them they are worthless).
  • Visual hallucinations: Seeing people, objects, or lights that aren’t there (e.g., seeing shadowy figures).
  • Tactile hallucinations: Feeling sensations on the skin, like bugs crawling or an electric shock.

✅ Delusions (with examples)

Delusions are strongly held false beliefs that persist despite evidence to the contrary.

Types of delusions:

  • Paranoid delusions (delusions of persecution): Believing others are plotting harm, spying, or controlling them (e.g., "The government is tracking me through my phone").
  • Delusions of grandeur: Believing one has special powers or status (e.g., "I am the chosen saviour of the world").
  • Delusions of control: Believing one's thoughts or actions are controlled by an external force (e.g., "Aliens are controlling my mind through satellites").
  • Delusions of reference: Believing random events or media have personal significance (e.g., "The TV is sending me secret messages").

✅ Negative Symptoms

Definition:
Negative symptoms involve a loss or reduction in normal functioning. They are less noticeable than positive symptoms but significantly impact daily life, making individuals appear withdrawn, unmotivated, or emotionally unresponsive.

✅ Speech Poverty (Alogia)

Speech poverty (alogia) is a reduction in verbal communication. It can manifest as:

  • Limited speech output: The person speaks very little, giving one-word answers or remaining silent.
  • Slowed speech: Responses are delayed, and forming sentences takes effort.
  • Difficulty finding words: The person struggles to express thoughts clearly.

Example:
A person with alogia may respond to "How was your day?" with "Fine." and not elaborate further, even when encouraged.

✅ Avolition (Lack of Motivation)

Avolition is a severe lack of motivation to initiate and sustain goal-directed behaviour.

Symptoms of avolition include:

  • Neglecting personal hygiene (e.g., not showering, wearing the same clothes for days).
  • Loss of interest in hobbies or activities they once enjoyed.
  • Struggling with daily tasks, like making meals or paying bills.
  • Social withdrawal, avoiding friends or family.

Example:
A person with avolition might stay in bed all day, even if they have responsibilities, because they feel no motivation to get up and complete tasks.

Summary

Symptom Type Definition Examples
Positive Symptoms Additions to normal experience (distort reality) Hallucinations (hearing voices), Delusions (believing they are being followed)
Negative Symptoms Loss of normal functions Speech poverty (one-word answers), Avolition (lack of motivation to wash or eat)

 

 

3. Issues in Diagnosis and Classification of Schizophrenia

Diagnosing schizophrenia is challenging due to issues with reliability, validity, co-morbidity, and biases in the classification systems.

✅ Reliability in Schizophrenia Diagnosis

Reliability refers to the consistency of a diagnosis when different clinicians assess the same patient or when the same patient is diagnosed multiple times. Two key types of reliability are:

  1. Test-retest reliability – The extent to which a patient receives the same diagnosis when re-evaluated at different times.

    • Low test-retest reliability means that the diagnosis may change over time, making it unstable.

  2. Inter-rater reliability – The extent to which different clinicians give the same diagnosis to the same patient.

    • Research (e.g., Cheniaux et al., 2009) found that one psychiatrist diagnosed schizophrenia in twice as many cases as another, showing low inter-rater reliability.

🛑 Problem: If schizophrenia is not reliably diagnosed, treatment plans may be inconsistent, reducing patient care quality.

✅ Validity in Schizophrenia Diagnosis

Validity refers to whether schizophrenia is correctly diagnosed and whether the diagnostic criteria measure what they intend to. Two types of validity are:

  1. Criterion validity – Whether different classification systems (e.g., DSM-5 and ICD-11) give the same diagnosis for the same patient.

    • Problem: Rosenhan (1973) found that healthy individuals were diagnosed with schizophrenia in psychiatric hospitals, showing the diagnosis may not be valid.

  2. Predictive validity – Whether a diagnosis can accurately predict the course of the disorder and treatment outcomes.

    • Problem: Schizophrenia has varied symptoms and responses to treatment, making prediction difficult.

🛑 Problem: If the diagnosis lacks validity, some patients may receive incorrect or ineffective treatments.

✅ Co-Morbidity and Its Impact on Diagnosis

Co-morbidity is when two or more disorders occur together in the same individual.

  • Schizophrenia often co-exists with depression (50%), substance abuse (47%), and anxiety disorders.
  • Buckley et al. (2009) found that co-morbidity is common, making it difficult to diagnose schizophrenia separately.

🛑 Problem:

  • If schizophrenia co-occurs with depression, should it be diagnosed as one disorder or two?
  • Overlapping symptoms may lead to misdiagnosis, meaning some patients receive the wrong treatment.

✅ Culture Bias in Schizophrenia Diagnosis

Culture bias occurs when diagnostic criteria are applied unfairly across different cultures, leading to over-diagnosis or under-diagnosis in specific groups.

  • Cochrane (1977) found that Black Caribbean immigrants in the UK were 7 times more likely to be diagnosed with schizophrenia than White individuals.
  • Fernando (1998) argued that this is due to cultural misunderstandings, rather than an actual higher prevalence.
  • In some cultures, hearing voices from ancestors is seen as spiritual, but Western clinicians may diagnose it as hallucinations.

🛑 Problem:

  • Over-diagnosis in ethnic minorities may lead to unnecessary medication and stigma.
  • Under-diagnosis in some cultures means patients may not receive the treatment they need.

✅ Gender Bias in Schizophrenia Diagnosis

Gender bias occurs when diagnostic criteria are applied differently to males and females, leading to misdiagnosis.

  • Longenecker et al. (2010) found that schizophrenia is more commonly diagnosed in men than women.
  • Cotton et al. (2009) found that women with schizophrenia often show better social functioning, which may lead clinicians to underestimate symptoms and delay diagnosis.

🛑 Problem:

  • Men are over-diagnosed, possibly due to gender stereotypes.
  • Women are under-diagnosed, as their ability to maintain relationships and employment may mask symptoms.
  • This means some individuals do not receive the treatment they need.

✅ Symptom Overlap (e.g., Similarities with Bipolar Disorder)

Symptom overlap occurs when schizophrenia shares symptoms with other disorders, making diagnosis difficult.

  • Schizophrenia and bipolar disorder both include delusions, hallucinations, and thought disorder.
  • Ellason & Ross (1995) found that people with dissociative identity disorder (DID) actually have more schizophrenia symptoms than those with schizophrenia itself.

🛑 Problem:

  • Misdiagnosis is common – a patient might receive bipolar medication instead of antipsychotics, which could be ineffective.
  • Inconsistent treatment leads to worse outcomes.

🔎 Summary of Issues in Diagnosis and Classification of Schizophrenia

Issue Definition Problem
Reliability Consistency in diagnosis (test-retest, inter-rater reliability) Diagnoses are inconsistent across clinicians and over time
Validity Whether schizophrenia is accurately diagnosed (criterion, predictive validity) Misdiagnosis and inappropriate treatment
Co-morbidity Presence of other disorders alongside schizophrenia (e.g., depression, anxiety) Difficult to distinguish schizophrenia from other conditions
Culture Bias Some ethnic groups are over- or under-diagnosed Black males in the UK are over-diagnosed due to cultural misunderstandings
Gender Bias Males and females diagnosed differently Women are under-diagnosed due to better social functioning
Symptom Overlap Schizophrenia shares symptoms with other disorders (e.g., bipolar disorder) Patients may be misdiagnosed and given the wrong treatment

 

4. Biological Explanations for Schizophrenia

Schizophrenia has strong biological roots, with research focusing on genetics, brain structure and function (neural correlates), and neurotransmitter imbalances (dopamine hypothesis).

✅ Genetic Basis of Schizophrenia

Genetic explanations suggest that schizophrenia runs in families, meaning people who have a close relative with schizophrenia are at a higher risk of developing the disorder. However, genetics alone cannot explain schizophrenia, as environmental factors also play a role.

Key Genetic Evidence

  1. Family Studies

    • Gottesman (1991) found that the risk of developing schizophrenia increases with genetic relatedness:
      • 1% risk in the general population.
      • 9% risk if a sibling has schizophrenia.
      • 48% risk if an identical twin has schizophrenia.
    • This supports the idea that schizophrenia has a genetic component, but since the concordance rate in identical twins is not 100%, other factors must also be involved.

  2. Twin Studies

    • Joseph (2004) found that monozygotic (MZ) twins (who share 100% of their genes) have a 40-50% concordance rate, whereas dizygotic (DZ) twins (who share 50% of their genes) have a 10-15% concordance rate.
    • Since MZ twins do not show a 100% concordance rate, environmental influences must also contribute.

  3. Adoption Studies

    • Tienari et al. (2000) studied adopted children whose biological mothers had schizophrenia.
    • He found that 7% of these children developed schizophrenia, compared to only 2% of the control group (children with no genetic history of schizophrenia).
    • This suggests a strong genetic influence, but the low percentage indicates environmental factors also play a role.

🛑 Problem with Genetic Explanations:

  • Nature vs. Nurture: Family studies cannot separate genetic from environmental influences (e.g., family dysfunction).
  • Diathesis-Stress Model: Most researchers now believe schizophrenia results from a genetic predisposition triggered by environmental stressors.

✅ Neural Correlates in Schizophrenia

Neural correlates refer to abnormalities in brain structure and function associated with schizophrenia. Brain imaging studies have identified differences in brain activity and structure between people with and without schizophrenia.

Brain Structure Abnormalities

  1. Enlarged Ventricles

    • Johnstone et al. (1976) found that people with schizophrenia have larger ventricles (fluid-filled cavities in the brain).
    • This suggests a loss of brain tissue, especially in the prefrontal cortex, which is responsible for decision-making and cognitive functions.

  2. Reduced Activity in the Prefrontal Cortex

    • The prefrontal cortex is responsible for planning, decision-making, and rational thought.
    • People with schizophrenia often show less activity in this area, which may explain disorganised thinking and impaired decision-making.

  3. Abnormal Functioning of the Superior Temporal Gyrus and Anterior Cingulate Gyrus

    • Allen et al. (2007) found that people with schizophrenia who experience auditory hallucinations have lower activation in the superior temporal gyrus and anterior cingulate gyrus.
    • This suggests these brain regions play a role in processing speech and auditory information.

🛑 Limitations of Neural Correlates:

  • Correlation, not causation: It is unclear whether brain abnormalities cause schizophrenia or if schizophrenia leads to brain abnormalities.
  • Not all individuals with schizophrenia show the same brain abnormalities, making it difficult to establish a direct link.

✅ The Dopamine Hypothesis

The dopamine hypothesis suggests that schizophrenia is caused by abnormal dopamine activity in the brain. Dopamine is a neurotransmitter that influences thinking, emotion, and perception.

1. Hyperdopaminergia (High Dopamine Levels) in the Subcortex

  • Excess dopamine in the subcortical areas (e.g., limbic system) is linked to positive symptoms like hallucinations and delusions.
  • Evidence:
    • Amphetamines, which increase dopamine levels, can induce schizophrenic-like symptoms in non-schizophrenic individuals.
    • L-Dopa, a drug used to treat Parkinson’s disease by increasing dopamine, can cause hallucinations.
    • Antipsychotic drugs, which block dopamine receptors, reduce positive symptoms in many patients.

2. Hypodopaminergia (Low Dopamine Levels) in the Prefrontal Cortex

  • Reduced dopamine activity in the prefrontal cortex is linked to negative symptoms like avolition and speech poverty.
  • Weinberger & Gallhofer (1997) found that schizophrenia patients had low dopamine activity in the prefrontal cortex, which may explain cognitive impairment and lack of motivation.

Revised Dopamine Hypothesis

  • The original dopamine hypothesis focused only on excess dopamine, but newer research suggests that schizophrenia involves both increased and decreased dopamine levels in different brain regions.

🛑 Limitations of the Dopamine Hypothesis:

  • Not all patients respond to dopamine-based treatments, suggesting other neurotransmitters (e.g., glutamate) may also be involved.
  • Antipsychotic drugs block dopamine almost immediately, but symptoms take weeks to reduce, indicating dopamine may not be the sole cause.

🔎 Summary of Biological Explanations for Schizophrenia

Biological Explanation Key Findings Supporting Evidence Limitations
Genetic Basis Schizophrenia has a hereditary component Gottesman (1991), Tienari et al. (2000) Concordance rates are not 100% (environmental factors play a role)
Neural Correlates Brain abnormalities (e.g., enlarged ventricles, reduced prefrontal activity) Johnstone et al. (1976), Allen et al. (2007) Correlation, not causation
Dopamine Hypothesis Hyperdopaminergia (high dopamine) causes positive symptoms; hypodopaminergia (low dopamine) causes negative symptoms Antipsychotic drugs reduce symptoms; amphetamines increase symptoms Other neurotransmitters (e.g., glutamate) may also be involved

 

 

5. Psychological Explanations for Schizophrenia

Psychological explanations focus on family interactions and cognitive dysfunctions as potential causes of schizophrenia. These explanations suggest that environmental and cognitive factors play a crucial role in the development and maintenance of the disorder.

✅ Family Dysfunction as a Cause of Schizophrenia

Family dysfunction theories suggest that abnormal family communication patterns and relationships increase the risk of schizophrenia. Three key theories include:

1. The Schizophrenogenic Mother (Fromm-Reichmann, 1948)

  • Definition: A schizophrenogenic (schizophrenia-causing) mother is cold, rejecting, controlling, and creates a climate of tension and secrecy in the family.
  • How it leads to schizophrenia:
    • This hostile environment causes paranoia and distrust in the child.
    • As a result, the child may withdraw from reality and develop delusions and disorganised thinking.
  • Criticism:
    • Outdated and sexist – places blame on mothers without scientific evidence.
    • No consistent research support.

2. Double-Bind Theory (Bateson et al., 1956)

  • Definition: Children who regularly receive contradictory messages from parents develop confusion about reality.
  • How it leads to schizophrenia:
    • When a parent says "I love you" but acts coldly, the child receives conflicting messages.
    • This traps the child in a paradox, making it impossible to respond correctly.
    • They may develop disorganised thinking, paranoia, and delusions as a coping mechanism.
  • Example:
    • A mother tells her child to be independent, but when the child makes a decision, she criticises them for not consulting her.
  • Criticism:
    • Lacks empirical support – schizophrenia occurs even in families without double-bind communication.
    • Biological factors play a much stronger role.

3. Expressed Emotion (EE) and Relapse (Brown, 1959)

  • Definition: Expressed Emotion (EE) refers to high levels of criticism, hostility, and emotional over-involvement in families of schizophrenia patients.
  • How it affects schizophrenia:
    • High EE creates a stressful environment that can trigger a relapse in individuals vulnerable to schizophrenia.
  • Types of EE:
    • Critical comments: Constant negative feedback (e.g., "You're so lazy, you never do anything right").
    • Hostility: Verbal or non-verbal expressions of anger.
    • Emotional over-involvement: Excessive concern or control over the individual’s life.
  • Supporting Research:
    • Kavanagh (1992) found that relapse rates in schizophrenia patients were twice as high in high-EE families compared to low-EE families.
  • Criticism:
    • EE may be a result rather than a cause of schizophrenia (families may become high EE after the illness develops).

✅ Cognitive Explanations of Schizophrenia

Cognitive explanations focus on faulty information processing as the cause of schizophrenia.

1. Metarepresentation Dysfunction (Frith, 1992)

  • Definition: Metarepresentation is the ability to reflect on one’s own thoughts and intentions.
  • How it leads to schizophrenia:
    • A dysfunction in metarepresentation means the person cannot recognise their own thoughts as self-generated.
    • This may cause hallucinations (e.g., hearing voices they believe are from an external source).
    • Delusions of control (e.g., believing thoughts are inserted into their mind by an external force).
  • Example: A person may hear their own inner speech but misattribute it to another person or entity.

2. Central Control Dysfunction (Frith, 1992)

  • Definition: Central control is the ability to suppress automatic responses and remain focused.
  • How it leads to schizophrenia:
    • A failure in central control means the person cannot filter irrelevant thoughts or stimuli, leading to disorganised speech and thought disorder.
  • Example:
    • In a conversation, when a topic reminds them of another idea, they blurt it out instead of staying on track.
    • Word Salad – speech becomes jumbled and incoherent.

✅ Dysfunctional Thought Processing

  • Definition: Dysfunctional thought processing refers to abnormal ways of thinking that cause schizophrenia symptoms.
  • Types of dysfunctions:
    • Impaired attention – Difficulty filtering out unnecessary stimuli, leading to sensory overload.
    • Memory deficits – Problems with working memory, making it hard to follow conversations.
  • Link to Symptoms:
    • Hallucinations may result from faulty metarepresentation.
    • Delusions may be caused by an inability to distinguish real and false beliefs.
    • Disorganised speech results from central control deficits, where thoughts become fragmented.

🔎 Summary of Psychological Explanations for Schizophrenia

Explanation Key Concept How It Causes Schizophrenia Supporting Research Limitations
Family Dysfunction Schizophrenogenic mother Cold, rejecting parenting leads to paranoia No strong research support Blames mothers
Family Dysfunction Double-bind theory Contradictory messages lead to confusion Bateson (1956) Lacks empirical support
Family Dysfunction Expressed Emotion (EE) High criticism increases relapse rates Kavanagh (1992) EE may result from schizophrenia
Cognitive Explanation Metarepresentation Dysfunction Inability to recognise own thoughts causes hallucinations and delusions Frith (1992) Doesn't explain all symptoms
Cognitive Explanation Central Control Dysfunction Inability to suppress automatic responses causes disorganised speech Frith (1992) Does not identify the root cause of cognitive deficits

📌 Key Takeaways

  • Family dysfunction theories suggest high-stress family environments increase schizophrenia risk.
  • Cognitive explanations focus on abnormal thought processing, leading to hallucinations, delusions, and disorganised speech.
  • Expressed emotion (EE) is linked to relapse rather than initial onset.
  • Metarepresentation dysfunction explains hallucinations, while central control dysfunction explains disorganised speech.

 

6. Biological Treatment: Drug Therapy

Drug therapy is the primary biological treatment for schizophrenia. Antipsychotic drugs help manage symptoms by targeting dopamine levels in the brain. There are two types of antipsychotics:

  1. Typical Antipsychotics (First-generation) – Developed in the 1950s
  2. Atypical Antipsychotics (Second-generation) – Developed in the 1990s

✅ How Typical Antipsychotics Work (e.g., Chlorpromazine, Dopamine Antagonists)

Mechanism of Action:

  • Typical antipsychotics are dopamine antagonists, meaning they block dopamine receptors in the mesolimbic pathway.
  • This reduces dopamine activity and decreases positive symptoms (hallucinations, delusions).

Example: Chlorpromazine

  • Blocks D2 dopamine receptors, reducing dopamine transmission.
  • Has a sedative effect, often used to calm patients.

Effectiveness:

  • Reduces positive symptoms like hallucinations and delusions.
  • Research shows 60-70% improvement in patients within 6 weeks.

Side Effects:
❌ Extrapyramidal Side Effects (EPS) – Parkinson’s-like tremors, involuntary facial movements (tardive dyskinesia).
❌ Sedation and Drowsiness – Can make daily functioning difficult.
❌ Neuroleptic Malignant Syndrome (NMS) – A rare but fatal condition causing high fever and muscle rigidity.

🛑 Limitations:

  • Only treats positive symptoms, not negative ones.
  • Severe side effects may lead patients to stop taking medication.

✅ How Atypical Antipsychotics Work (e.g., Clozapine, Risperidone)

Atypical antipsychotics were developed to reduce side effects while also treating negative symptoms.

Mechanism of Action:

  • Target multiple neurotransmitters (dopamine and serotonin).
  • Loosely bind to dopamine receptors, allowing some dopamine transmission, which may explain fewer movement-related side effects.
  • Increase serotonin activity, which helps reduce negative symptoms like avolition and speech poverty.

Example 1: Clozapine

  • Binds to D2 dopamine receptors, but also acts on serotonin (5-HT) and glutamate receptors.
  • More effective than typical antipsychotics but has serious risks.

🔴 Danger: Clozapine can cause agranulocytosis (a deadly reduction in white blood cells), requiring regular blood tests.

Example 2: Risperidone

  • Binds more strongly to dopamine and serotonin receptors than clozapine.
  • Works well at lower doses, reducing side effects.

Effectiveness:

  • Treats both positive and negative symptoms.
  • Less risk of tardive dyskinesia than typical antipsychotics.

Side Effects:
✅ Lower risk of extrapyramidal side effects compared to typical antipsychotics.
❌ Weight gain, diabetes, drowsiness.
❌ Clozapine requires constant monitoring due to agranulocytosis risk.

✅ Comparison of Typical vs. Atypical Antipsychotics

Feature Typical Antipsychotics (e.g., Chlorpromazine) Atypical Antipsychotics (e.g., Clozapine, Risperidone)
How they work Block dopamine receptors (D2) Affect dopamine and serotonin
Symptoms treated Only positive symptoms Both positive and negative symptoms
Effectiveness 60-70% improvement in positive symptoms More effective in treating negative symptoms
Side effects High risk of tardive dyskinesia, Parkinsonism Lower risk of movement side effects but risk of weight gain and agranulocytosis
Compliance (adherence) Lower (patients stop due to side effects) Higher (fewer movement-related side effects)

🔎 Summary of Drug Therapy for Schizophrenia

  • Typical Antipsychotics (e.g., Chlorpromazine)
    ✅ Effective for positive symptoms
    ❌ High risk of extrapyramidal side effects (e.g., tardive dyskinesia, tremors)
    ❌ Less effective for negative symptoms

  • Atypical Antipsychotics (e.g., Clozapine, Risperidone)
    ✅ Treat both positive and negative symptoms
    ✅ Lower risk of movement side effects
    ❌ Clozapine can cause agranulocytosis (life-threatening)

 

7. Psychological Treatments for Schizophrenia

Psychological treatments for schizophrenia focus on managing symptoms and improving functioning, rather than curing the disorder. Three key therapies include:

  1. Cognitive Behavioural Therapy (CBT)
  2. Family Therapy
  3. Token Economies

✅ Cognitive Behavioural Therapy (CBT) for Schizophrenia

How CBT Helps

CBT is based on the idea that faulty thinking patterns contribute to schizophrenia symptoms. The goal is to challenge irrational beliefs and develop coping strategies.

Key Techniques in CBT for Schizophrenia:

  1. Challenging Delusions and Hallucinations

    • The therapist helps the patient identify irrational beliefs (e.g., "People are controlling my thoughts") and evaluate evidence for and against them.
    • Patients learn that hallucinations do not have to control them.

  2. Coping Strategies

    • Patients are taught ways to manage hallucinations (e.g., distraction, relaxation techniques, ignoring voices).
    • Helps reduce distress and anxiety.

  3. Normalisation

    • The therapist explains that hearing voices or having unusual thoughts is more common than patients think.
    • This helps reduce stigma and distress.

Strengths and Weaknesses of CBT for Schizophrenia

✅ Strengths:

  • Reduces distress associated with delusions and hallucinations.
  • Improves daily functioning by helping patients manage symptoms.
  • No side effects compared to drug therapy.

❌ Weaknesses:

  • Does not eliminate symptoms – only helps patients cope with them.
  • Requires motivation and insight, which some patients may lack.
  • Not effective for all patients, especially those in severe psychotic states.

✅ Family Therapy for Schizophrenia

How Family Therapy Helps

Family therapy aims to reduce stress and conflict in families, particularly high expressed emotion (EE), which can trigger relapses.

Key Techniques in Family Therapy:

  1. Reducing Expressed Emotion (EE)

    • Educates families about schizophrenia and its causes.
    • Teaches them not to blame the patient and how to reduce criticism and hostility.

  2. Improving Communication

    • Encourages active listening and clear communication.
    • Helps families express concerns without confrontation.

  3. Problem-Solving and Crisis Management

    • Teaches families how to handle stressful situations without escalating conflicts.
    • Helps in managing medication routines and appointments.

Strengths and Weaknesses of Family Therapy

✅ Strengths:

  • Reduces relapse rates – Pharoah et al. (2010) found that family therapy reduces hospital readmissions.
  • Improves family relationships, creating a supportive environment for the patient.
  • Can be combined with drug therapy for better results.

❌ Weaknesses:

  • Not suitable for all patients, especially those without strong family support.
  • Relies on family cooperation – if relatives are unwilling to engage, therapy is less effective.
  • Does not directly reduce symptoms, only reduces relapse risk.

✅ Token Economies for Managing Schizophrenia

How Token Economies Work

Token economies use operant conditioning (reinforcement) to improve the behaviour of schizophrenia patients, particularly those in institutional settings.

Key Principles:

  1. Tokens as Secondary Reinforcers

    • Patients receive tokens when they engage in positive behaviours (e.g., getting dressed, socialising).

  2. Exchanging Tokens for Rewards

    • Tokens can be exchanged for privileges, snacks, or time with visitors.

  3. Encouraging Positive Behaviour

    • Over time, patients develop better self-care and social skills.

Strengths and Weaknesses of Token Economies

✅ Strengths:

  • Encourages adaptive behaviours (e.g., hygiene, communication).
  • Can be effective in institutional settings where patients lack motivation.

❌ Weaknesses:

  • Only works in structured environments – effects do not generalise to everyday life.
  • Ethical concerns – some argue it is manipulative, as patients may feel forced to comply.
  • Does not treat core symptoms, just improves behaviour.

🔎 Summary of Psychological Treatments for Schizophrenia

Treatment How It Works Strengths Weaknesses
CBT Challenges delusions and develops coping strategies Reduces distress, improves functioning, no side effects Does not remove symptoms, requires motivation
Family Therapy Reduces expressed emotion (EE) and improves communication Lowers relapse rates, supports families, complements drug therapy Requires family involvement, does not treat symptoms directly
Token Economy Uses reinforcement to encourage positive behaviours Improves self-care and socialisation in institutions Effects do not generalise, ethical concerns

📌 Key Takeaways:

  • CBT helps patients manage symptoms, but does not cure schizophrenia.
  • Family therapy reduces relapse risk by improving family relationships.
  • Token economies improve patient behaviour but do not treat the disorder itself.

 

8. The Interactionist Approach to Schizophrenia

The interactionist approach acknowledges that schizophrenia is caused by a combination of biological and environmental factors. It integrates biological (genes, neurotransmitters, brain structure) and psychological (stress, trauma, cognitive dysfunction) explanations.

✅ The Diathesis-Stress Model of Schizophrenia

The diathesis-stress model suggests that schizophrenia develops due to a genetic or biological vulnerability (diathesis) that is triggered by environmental stressors (stress).

Key Components of the Model:

  1. Diathesis (Biological Vulnerability)

    • Some individuals inherit a genetic predisposition for schizophrenia.
    • Research (e.g., Gottesman, 1991) shows that the risk of developing schizophrenia is higher in individuals with a family history of the disorder.
    • Other biological factors, such as dopamine imbalances or abnormal brain structure, can also contribute.

  2. Stress (Environmental Triggers)

    • Psychological stressors (e.g., childhood trauma, family dysfunction, substance abuse) can activate the disorder in those who are already vulnerable.
    • Varese et al. (2012) found that children who experienced trauma were three times more likely to develop schizophrenia later in life.
    • Urban living and cannabis use have also been identified as potential environmental triggers.

Diathesis-Stress Model Example:

  • Person A has a genetic predisposition for schizophrenia but experiences a low-stress environment → They may never develop schizophrenia.
  • Person B has the same genetic predisposition but experiences childhood abuse, bullying, and high stress → They develop schizophrenia due to the interaction of genes and environment.

🛑 Key Point:

  • Schizophrenia is not purely genetic or purely environmental – both factors interact to determine risk.

✅ Biological vs. Psychological Approaches to Schizophrenia

Approach Key Explanation Supporting Evidence Limitations
Biological Caused by genetics, brain abnormalities, and dopamine imbalances Gottesman (1991) – Family studies show genetic risk Does not explain why some people with a genetic risk do not develop schizophrenia
Psychological Caused by stress, trauma, dysfunctional families, and cognitive issues Varese et al. (2012) – Childhood trauma increases schizophrenia risk Cannot explain why symptoms often improve with biological treatments (e.g., antipsychotics)
Interactionist Schizophrenia develops when biological vulnerability interacts with environmental stress Tienari et al. (2004) – Adopted children with a family history of schizophrenia were more likely to develop the disorder only if they were raised in a dysfunctional family Difficult to pinpoint exact triggers; interactions between biology and environment are complex

✅ How the Interactionist Approach Influences Treatment

The interactionist approach combines biological and psychological treatments to provide a more holistic treatment strategy.

1. Combining Drug Therapy with Psychological Therapy

  • Biological treatment: Antipsychotic drugs reduce symptoms by regulating dopamine levels.
  • Psychological treatment: Cognitive Behavioural Therapy (CBT) helps patients cope with delusions and hallucinations.
  • Evidence: Tarrier et al. (2004) found that patients who received a combination of CBT and drug therapy showed greater symptom reduction than those who received only drug therapy.

2. How an Interactionist Approach Improves Outcomes

✅ More effective than single treatments – Drugs treat biological symptoms, while therapy addresses psychological issues.
✅ Reduces relapse rates – Family therapy lowers stress, preventing symptom recurrence.
✅ Personalised treatment – Patients can receive different combinations of treatments based on their needs.

🔎 Summary of the Interactionist Approach

Aspect Explanation
Diathesis-Stress Model Schizophrenia results from a biological predisposition (diathesis) combined with environmental stressors
Evidence for Interaction Tienari et al. (2004) – Adopted children with genetic risk were more likely to develop schizophrenia only in dysfunctional families
Treatment Implications Combines drug therapy (antipsychotics) and psychological therapy (CBT, family therapy)
Effectiveness Tarrier et al. (2004) – Combination treatment is more effective than drugs alone

📌 Key Takeaways:

  • Schizophrenia is best understood using the interactionist approach, which integrates both biological and psychological explanations.
  • The diathesis-stress model explains schizophrenia as an interaction between genetic vulnerability and environmental stressors.
  • Combining drug therapy with CBT and family therapy provides the most effective treatment.

 

Related Posts

    Back to Education