Schizophrenia

Schizophrenia

Diagnosing and Classification
1. DSM
  1. patterns of symptoms over 6 months.
  2. no subtypes
  3. mostly just positive types, but look for a collection for longer, doesn't recognise catatonia as schizophrenia but a separate condition.
  4. USA
2. ICD
  1. have to see 1 symptom for at least one month
  2. recognise subtypes- paranoia
  3. recognises catatonic symptoms and negative ones on its own.
  4. World wide diagnosis.
3. Both
  1. hallucinations, delusions or disorganised thinking.
  2. hearing criticising or controlling voices.
  3. negative symptoms are featured in both but dsm outs importance on positive.
4. Main issues.
  1. BECK found 54% concordance with experienced experts in diagnosis between 153 patients.
  2. 80% diagnosis of patients DSM with ICD 20%. Japan even call it integrative disorder. shows cultural difference.
  3. wide variation of symptoms.
  4. HEATHER theres a 50% chance of guessing treatment- too varied.
  5. SZASZ politically sanctioned social control, SCHEFF people conform to their label, BOYLE + BENTALL not reliable or vaild, but accept mental illness.
Psychological Accounts of
1. Family Models
  1. BATESON: 'double blind theory'
    1. Receive contradicting messaged, repeated exposure to this leads to mental escape, self deception and concept of reality.
    2. 40% divorce rate, 1% schizophrenia rate
  2. BROWN: dysfunctionality causes relapse
    1. looked at interviews between parents and sufferer.
  3. only correlational, those in a high risk group but good parenting didn't get it.
2. Cognitive Model
  1. focus is on improvement of thoughts, neologisms.
    1. attention impairment, bombarded with senses which become stress.
  2. easily overwhelmed- bad social skills.
3. Neuropsychology
  1. FRITH AND HELMSLEY
    1. arise from disconnection of schemas and current sensory input.
  2. internal events are misinterpreted as sensations caused by external stimuli. this can lead to hallucinations.
  3. abnormalities in the hippocampus.
  4. every things stressful
  5. CHADWICK had a case where a patient thought he could predict the future. To challenge this the patient watched videos and had to predict the future of what will happen after the video is un-paused.
4. Diathesis-Stress Model
  1. ZUBIN+SPRING
  2. have a biological predisposition and the trauma starts the illness
  3. KETY: 16.2% with it their mums have it
Biological Accounts of
1. Genes
  1. MIYAKAWA looked at DNA in families, finding they have an active PPP3CC.
  2. KENDLER 1st degree relatives 18x more likely.
  3. GOTTSMAN 58% MZ concordance, 7% DZ.
  4. KETY found high rates when bio parents have SZ but adopted ones healthy .
2. Dopamine
  1. neurotransmitter, if given amphetamines can ioncrease it ad therefore SZ risk.
  2. OWEN et al found evidence of more receptors in autopsy.
  3. either theres too much of it, or the receptors are sensitive to the neurotransmitter.
3. Brain dysfunctionality..
  1. radio waves, PET, MRI scans into 3d image.
  2. WOOD et al, 79 with high risk, 49 healthy, those risk have smaller hippocampus.
  3. WEINBEUGER, cant tell if its a cause of consequence.
Therapies
1. Drugs
  1. Typical
    1. Chloropromazine
      1. Works to reduce dopamine receptors in the brain. Reduces only positive symptoms.
        Means less dopamine is abosorbed
    2. Ignores negative symptoms, symptoms come back when the drugs are stopped, 24% of people develop tardive dyskinesia after 7 years
  2. ATypical
    1. Clozapine
      1. Works by reducing serotonin levels in the brain. helps alleviate positive and negative symptoms. JULIEN argues it helps people live independently (only 28% do)
    2. only half of people who are resistant to typical drugs respond to clozapine, can effect the immune system.
  3. only 30% respond
    1. LEUTCH: only slightly improved, studied two cases
2. CBT
  1. ELLIS AND BECK
  2. Challenges irrational beliefs
    1. ask to evidence of delusions
    2. CHADWICH: patient delusions of grandeur. showed videa 50 X saw his irrationality.
      1. KUIPERS: with anitpyscholtic drugs effective, and low drop out rate.
  3. BRENNER: those with this have lower hospital rates.
    1. GOULD: found that all 7 studies in meta analysis saw reduction in symptoms.
3. Social Skills Training
  1. HALFORD+HAYES developed a programme comprising of converstion skills: insertion (getting involved) conflict management ( helping with overwhelming emotions)
  2. modelling/reinforcement
  3. doesn't generalise
4. Family Intervention
  1. methods to help/ spot relapse
  2. develop good relationships
  3. not qualified
5. Care in the Community Act (SCULL)

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