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Schizophrenia

Schizophrenia is a psychotic disorder that affects about 1% of the population. It is the condition most associated with ‘madness’. Schizophrenia is not a ‘split personality’, but there is a loss of contact with reality and in severe cases a complete disintegration of personality. The main symptoms are disturbances of thought processes, but there can also be disturbances of emotions and behaviour. In men it often begins in the mid-20’s and in women the early-30’s.

Symptoms of schizophrenia: Schizophrenics have positive and negative symptoms. Positive symptoms are additions to behaviour and include actual symptoms that can be observed. Negative symptoms are where normal functioning is not present. Diagnosis of schizophrenia according to the DMS requires 1 month of two or more symptoms.

Positive symptoms:

  • Hallucinations, where the patient hears or see things that do not exist.
  • Delusions, such as delusions of control, where the patient thinks their actions are being controlled by outside forces, or delusions of grandeur where the patient believes they are grand or famous.
  • Thought insertion, where the patient thinks that the thoughts in their head are put there by someone else.
  • Thought Withdrawal, where the patient believes that outside forces are taking thoughts from their mind.
  • Disorganised speech (inappropriate speech).
  • Disorganised behaviour.
  • Cataleptic stupor and bizarre postures.
  • Excessive motor activity.
  • Echolalia – the patient repeatedly echo’s words spoken by others, or the accentuated imitation of the mannerisms of people.

Negative symptoms:

  • Flat emotions – no emotional response can be elicited to any stimulus; face is immobile, eyes are lifeless and speech is toneless.
  • Social withdrawal – the patient no longer interacts with family and friends.
  • Lack of speech – the patient uses as few words as possible.
  • Apathy – loss of interest in normal goals.

Types of schizophrenia: There are five different types of schizophrenia: paranoid, disorganised, catatonic, residual and undifferentiated. Different symptoms are present in the different types of schizophrenia.

Paranoid type: Delusion of control and grandeur and auditory hallucinations.

Disorganised type: Disorganised speech and behaviour as well as flat emotions.

Catatonic type: Apathy, loss of drive, cataleptic stupor and bizarre postures, excessive motor activity and echolalia.

Residual type: Individuals diagnosed with the residual type generally have a history of schizophrenia but have reduced psychotic symptoms.

Undifferentiated type: Diagnosed when people have symptoms of schizophrenia that are not sufficiently formed or specific enough to permit classification of the illness into one of the other subtypes.

Biological explanation for schizophrenia

The biological uses the cause of schizophrenia as physiological. These include both genetic and biochemical factors (the effect of neurotransmitters).

Family and twin studies:

  • Schizophrenia does seem to run in families and have a genetic link.
  • The closer the degree of genetic relatedness, the greater the risk of developing the disorder.
  • Both family and twin studies have been used to study the genetic influence on schizophrenia.

Adoption studies:

  • Because of the difficulties of disentangling genetic and environmental influences for the individuals who share genes and environment, studies of adoptees are used.

Biochemical studies:

  • Dopamine is one of the many different neurotransmitters operating in the brain.
  • Schizophrenics are thought to have an abnormally high number of D2 receptors on their receiving neurons, resulting in more dopamine binding and therefore more neurons firing.

Evaluating the biological explanation of schizophrenia:

Is their evidence for the theory?

– Gottesman (1991) found that 1% of the population had schizophrenia; but that the percentage increased the closer you were genetically to someone who had it. It increased to 48% if the sibling is an identical twin. This study shows a genetic factor in causing schizophrenia, it also shows that the environment plays a part.

– Heston (1966) compared adopted children whose natural mother had schizophrenia and adopted children whose mother did not have a mental order. Of the children with schizophrenic mother, 10% went on to develop it, whilst none of the other group did. This suggests that it can be passed on from parent to child.
– Patients with Parkinson’s disease have low levels of dopamine. Some patient who were taking the drug L-Dopa to raise their dopamine levels developed schizophrenic-type symptoms. Grilly (2002).

Can it be applied to real life?

A strength of the theory is that antipsychotic drugs have been developed such as Phenothiazine’s which block dopamine receptors and alleviate the symptoms of schizophrenia. If the receptors are blocked, then less dopamine will be taken up so that the effects of excess dopamine can be avoided. This supports the idea that excess dopamine is a cause of schizophrenia.

Is this theory reductionist?

A weakness of this theory is that it is reductionist as it focuses on biology alone. If schizophrenia was completely caused by genetics then the risk of an MZ twin having schizophrenia if their twin already has it would be 100%. Also, it is hard to know if excess dopamine causes schizophrenia or if schizophrenia causes excess dopamine.

Can the theory explain individual differences?

This explanation can account for individual differences in terms of concordance rates i.e. the higher the concordance rate, the greater the risk of developing the disorder.

Which side of the Nature-Nurture debate is this theory on?
This explanation is based on the nature side of the debate as it focuses on genetic inheritance and the role of the neurotransmitter dopamine in causing schizophrenia. However, there are also factors in the environment which can cause relapse such as living in a family where there is high expressed emotion (expressed emotion is the critical, hostile, and emotionally over-involved attitude that relatives have towards a family member with a disorder).

Is the theory scientific?
The theory have research evidence from twin and adoption studies as well as supporting evidence for the biochemical explanation and so it can be considered scientific.

Biological treatments for Schizophrenia: Drug Therapy

Just as different approaches suggest different causes of schizophrenia, they also suggest different treatments. The treatment focuses on what the approach feel is the cause. So, a biological treatment will focus on changing our thinking patterns as genitive psychologists feel that is the cause of mental disorders.

  • Anti-psychotic drugs, also known as neuroleptics, were first developed in the 1950’s. They helped sedate the person and also reduced the intensity and frequency of hallucinations and delusions.
  • Further anti-psychotic drugs have since been developed. These fit into the dopamine receptors in the brain, blocking the dopamine and stopping it being picked up, so minimizing its effects, e.g. Chloropromazine.
  • They are more effective when given at the onset of schizophrenia.
  • Each patient is only put on one anti-psychotic drug at a time, it is important the patient takes their medication regularly.
  • Drug level is manipulated to ensure appropriate dose level for each patient.
  • Medication can be given under supervision or given to the patient for self-regulation.
  • Usually the patient will be kept in an institution until their condition has improved.

Evaluation of Drug Therapy:

How effective is the therapy?
Pickar et al. (1992) compared the effectiveness of Clozapine with other neuroleptics and a placebo drug. He found Clozapine was the most effective in treating symptoms, even in patients who did not respond to previous drugs, and the placebo was the least effective.

Emsley (2008) studied the effect of injecting the antipsychotic drug Risperidone. He found that those who had the injection early in the course of their disorder had high remission rates and low relapse rates. In 84% of the patients there was at least a 50% reduction in positive and negative symptoms.

Are there any practical issues involved in the use of this therapy?
One practical issues is whether the addict will be prepared to make a commitment to the regular treatment required. Non-compliance or partial compliance when it comes to taking the drugs is a major barrier to the treatment of schizophrenia and can lead to relapses. Rosa et al. found that only 50% of patients comply with drug therapy.

Are there any ethical issues involved in the use of this therapy?
There are ethical issues involved in treating mental disorders with drugs. Patients suffering from schizophrenia may cause distress to those around them by their unusual behaviour; drugs may be given to control the patient. The side-effects of drugs can be distressing for them but patients will still be pressured to take the drugs to control their symptoms.

Power of practitioner?
Those administering the drug therapy will have expert power over the type of drug used to treat schizophrenia, the number of sessions the patient has to attend and for supervising the patient. However, the individual can choose whether or not to attend the treatment sessions.

Does the treatment tackle the cause or just the symptoms?
Drugs may treat the symptoms, but they do not address the cause of the disorder. Often, the patient has to continue taking the drugs, despite problems of dependence and tolerance.

Cognitive explanation of Schizophrenia:

Cognitive explanations acknowledge the role of biological factors for the cause of initial sensory experiences of schizophrenia however further features of the disorder appear as the individual attempts to understand them. It explains the cause of schizophrenia as a problem with processing information. It is thought that schizophrenics have distorted beliefs, and these beliefs influence their behaviour.

Schizophrenics usually first discover symptoms of voices and abnormal sensory experiences, this then usually makes them turn to friends and family to confirm the experiences. Those that cannot confirm the reality of the sensory experiences and voices start to believe that they must be hiding the truth. This can lead to rejection of support and feedback from peers and others around them and so disillusioned beliefs and ideas that they are being manipulated and persecuted start to form. This shows that the basis of schizophrenia is biology based, whether genetic or not, then other symptoms such as hallucinations and delusions are formed, these of which are cognitive.

Evaluation of Cognitive Explanation for Schizophrenia:

Is their evidence for the theory?
Bentall et al. (1991) asked Ps either to think of category items for themselves, such as types of cars, or to read the category items they were given, such as a list of cars. He wanted to see if there was a difference in performance between schizophrenics who had hallucinations, schizophrenics who did not have hallucinations, and non-schizophrenics. A week later they were given a revised list of words, from which they had to pick out words they had thought of themselves, words they were given originally, and new words. Schizophrenics with hallucinations did the worst, schizophrenics without hallucinations did better, and non-schizophrenics did the best. This suggests that schizophrenic patients with hallucinations find cognitive tasks demanding as they have difficulty in retaining information in memory over a period of time.

Can it be applied to real life?
A strength of the application is by understanding schizophrenia from the cognitive perspective; appropriate treatment such as cognitive behavioural therapy (CBT) has been developed to focus on changing the thinking patterns of patients with schizophrenia. It does not aim to cure the disorder but to allow the patient to function relatively normally.

Is this theory reductionist?
A weakness of the explanation is cause is difficult to establish as high levels of negative thinking may be present in schizophrenic individuals; this may not be the cause of the disorder, but the result of it.

Can the theory explain individual differences?
The theory can explain individual differences in extent to which patients with schizophrenia have problems in processing information. This will then determine how serious the symptoms experienced by each patient will be.

Which side of the Nature-Nurture debate is the theory on?
According to the explanation, the basis of schizophrenia is biologically based which supports the nature side of the debate. Other symptoms such as hallucinations and delusions are formed these are cognitive as the individual attempts to understand the symptoms by turning to family members in the environment and this supports the nurture side of the debate.

Is the theory scientific?
Mental processes can’t be observed therefore this theory is difficult to test experimentally, so this explanation can be criticised for not being scientific.

Cognitive therapy treatment for Schizophrenia – Cognitive Behavioural Therapy (CBT)

This therapy combines the cognitive and behavioural approaches. The cognitive assumption behind it is that our beliefs about the world affect how we see the world and ourselves; the behavioural part aims to change our behaviour.

CBT focuses on present behaviour and thought instead of focusing on how these thoughts developed. The therapist has to accept the patient’s perception of reality and then use this misperception to help the patient manage. It aims to allow the patient to use information from the world to make adaptive rather than maladaptive decisions. It does not aim to cure schizophrenia but to allow the patient to function relatively normally.

An agenda is set so that both therapist and patient know what they aim to get out of the sessions. The therapist helps the patient to identify their faulty misinterpretations of the world and correct them. This is done by questioning and challenging maladaptive thoughts so that the patient realizes they are incorrect and can change them to more realistic thoughts. Patients are also taught how to ignore the voices they hear, if that is one of their symptoms.

Evaluation of CBT
How effective is the therapy?
Chadwick (2000) studied 22 schizophrenics who heard voices. They each had eight hours of CBT, and all had reduced negative beliefs about how powerful the voices were, and how much the voice controlled them, thus allowing them to live with the auditory hallucinations better.
Gould et al. (2001) carried out a meta-analysis of studies that looked at the effectiveness of CBT in conjunction with taking antipsychotics. He found that there was a large reduction in positive symptoms in most cases, with drop-out rates of about 12%, considerably lower than those who stop taking antipsychotics without CBT.

Are there any practical issues involved in the use of this therapy?
Until recently, it was thought that CBT would not be effective for schizophrenics as their whole perception of reality is different. This makes it difficult to get them to challenge their beliefs, which to them are rational. However, CBT can be combined with family therapy and assertive community therapy programs to reduce chances of relapse and there are also no side effects with this therapy.

Are there any ethical issues involved in the use of the therapy?
Some psychologists have suggested that by working with patients and getting them to see that they have distorted views and beliefs, this can lead to them feeling depressed as they are made fully aware of their maladaptive thought processes.

Power of practitioner?
The practitioner should act as a facilitator in the sessions so if they do have power it is expert of referent power. This means that they are not an authority figure but instead are seen as role models to aspire to because of their knowledge and skills.

Treating the symptoms or the cause?
A weakness of this therapy is that it only tries to alleviate the symptoms of schizophrenia rather than finding a cure for it.