Schizophrenia Facts:
1. Schizophrenia is more commonly diagnosed in men women( men, women )
2. About 1% 5% 10%( 1%, 5%, 10% ) of the population suffer from schizophrenia
3. People are more likely to be diagnosed if they live in the city countryside( city, countryside )
4. Working Middle Upper( Working, Middle, Upper ) class people are more likely to suffer from schizophrenia

DSM 5 10 2( 5, 10, 2 ): Must have one two+( one, two+ ) positive negative( positive, negative ) symptoms to be diagnosed
ICD 10 5 2( 10, 5, 2 ): Must have two+ one( two+, one ) negative positive( negative, positive ) symptoms to be diagnosed

There are 3 main types of delusions in schizophrenia:
1. Delusions of grandeur: Somatic delusions: Delusions of persecution:( Delusions of grandeur:, Somatic delusions:, Delusions of persecution: ) the false belief that the sufferer is someone of extreme importance
2. Delusions of persecution: Delusions of grandeur: Somatic delusions( Delusions of persecution:, Delusions of grandeur:, Somatic delusions ) the false belief that the sufferer is being targeted- makes them very suspicious. These are the most common form of delusions for sufferers.
3. Somatic delusions: Delusions of grandeur: Delusions of persecution:( Somatic delusions:, Delusions of grandeur:, Delusions of persecution: ) a preoccupation with one's body- the false belief that something is wrong/odd with their body e.g. tumours, blood made of silver

Reliability references the consistency validity accuracy( consistency, validity, accuracy ) of a study. One important measure of reliability is inter-rater integrated experimental valid( inter-rater, integrated, experimental, valid ) reliability. This is the consistency of multiple one( multiple, one ) researchers' diagnoses- do they all come to the same a different a similar( the same, a different, a similar ) conclusion?

Cheniaux Buckley Rosenhan( Cheniaux, Buckley, Rosenhan ) et al. (2009) asked two psychiatrists to independently work together to( independently, work together to ) diagnose 100 patients using the DSM and ICD criteria. Inter-rater reliability was poor good( poor, good ):
One psychiatrist diagnosed 26 patients using the DSM ICD( DSM, ICD ) and 44 patients using the ICD DSM( ICD, DSM )
The other psychiatrist diagnosed 13 patients with the DSM ICD( DSM, ICD ) and 24 using the ICD DSM( ICD, DSM ).
This shows that the results are not consistent; if they were, both psychiatrist would have diagnosed the same number of patients e.g. both diagnosed 26 using the DSM.

One way of assessing validity of diagnosis is criterion validity inter-rater reliability external validity internal validity( criterion validity, inter-rater reliability, external validity, internal validity ). This is whether two diagnostic systems come to the same a different( the same, a different ) conclusion in terms of diagnosis of a patient. Good criterion validity would mean two diagnostic systems (e.g. DSM and ICD) give the same diagnosis to the same patient.

Cheniaux et al. (2009) did a study in which two psychiatrists independently diagnosed 100 patients using the DSM and the ICD. It was found that DSM diagnosed almost half as many double the amount of the same amount of( almost half as many, double the amount of, the same amount of ) patients with schizophrenia in comparison to the ICD e.g. one psychiatrist diagnosed 13 people using the DSM and 24 using the ICD. This clearly indicates that the two diagnostic systems are not are( are not, are ) reaching the same conclusions in terms of diagnosis, and therefore the criterion validity inter-rater reliability( criterion validity, inter-rater reliability ) is poor.

Both schizophrenia and bipolar disorder involve positive symptoms such as delusions speech poverty social withdrawal( delusions, speech poverty, social withdrawal ), and negative symptoms such as avolition hallucinations( avolition, hallucinations ). Based on the DSM ICD( DSM, ICD ), in which you must have one positive symptom, you may be diagnosed with schizophrenia when you actually have bipolar disorder, or vice versa.

Symptom overlap has one main issue: misdiagnosis reliability odd diagnosis( misdiagnosis, reliability, odd diagnosis ). This can lead to either incorrect treatment identification of cause dismissal( treatment, identification of cause, dismissal ) (could actually worsen the illness) and labelling payment economic issues( labelling, payment, economic issues ) (affects mortgages, employment, and insurance).

Longenecker found that men women( men, women ) are more likely than women men( women, men ) to be diagnosed with schizophrenia. However, this difference does not does( does not, does ) mean they are necessarily more likely to suffer from schizophrenia; it may actually be a case of gender culture( gender, culture ) bias. One argument is that they do suffer more than women men( women, men ) do because they are genetically psychologically( genetically, psychologically ) more vulnerable to developing schizophrenia. However, others argue that men are more less( more, less ) likely to be diagnosed because women do not outwardly display symptoms so they may be underdiagnosed overdiagnosed( underdiagnosed, overdiagnosed ) with schizophrenia. They may also be more high functioning than men, so can continue to work despite symptoms. This questions the validity reliability( validity, reliability ) of the diagnostic and classification systems.

African Americans are several times more less( more, less ) likely than white people to be diagnosed with schizophrenia. However, rates of schizophrenia in Africa are relatively low high similar( low, high, similar ), so it can be concluded that these differences are not are( are not, are ) due to genetic vulnerability for schizophrenia, but rather the result of bias in diagnosis. For example, hearing voices in Africa is often seen as a form of communication with ancestors, and is therefore more acceptable. As well as this, white psychiatrist may over-interpret symptoms and distrust the honesty of black people. This is an example of cultural gender lack of( cultural, gender, lack of ) bias.

Ripke et al (2014) carried out a wide scale small( wide scale, small ) study that combined the data of all previous human genome studies. The genetic make-up of 37,000 schizophrenics was compared to that of 113,000 healthy people. There were 108 2 thousands of( 108, 2, thousands of ) separate variations that were linked to the onset of schizophrenia, with some of them coding for neurotransmitters such as dopamine histamine amino acids( dopamine, histamine, amino acids ).

High Low( High, Low ) numbers of dopamine receptors in Broca Wernicke( Broca, Wernicke )'s area (associated with speech production) lead to high low( high, low ) levels of dopamine activity in the area. One symptom this can cause is disorganised speech, a positive negative( positive, negative ) symptom.
Low High( Low, High ) levels of dopamine in the pre-frontal cortex (associated with planning and decision making) lead to negative positive( negative, positive ) symptoms such as avolition and social withdrawal.

Curran Tauscher Ripke( Curran, Tauscher, Ripke ) et al (2004) found that dopamine agonists antagonists( agonists, antagonists ) (such as amphetamines, which increase decrease( increase, decrease ) the levels of dopamine in the brain) can produce schizophrenic symptoms such as hallucinations. This supports the idea that hyperdopaminergia hypodopaminergia( hyperdopaminergia, hypodopaminergia ) plays a role in the development of schizophrenia.
Tauscher Curran Ripke( Tauscher, Curran, Ripke ) et al (2014) found that dopamine antagonists agonists( antagonists, agonists ) (such as antipsychotics., which decrease increase( decrease, increase ) the levels of dopamine in the brain) can reduce schizophrenic symptoms, supporting the role of hyperdopaminergia hypodopaminergia( hyperdopaminergia, hypodopaminergia ).
However, Ripke Tauscher Curran( Ripke, Tauscher, Curran ) et al found that some of the genes linked to schizophrenia don't code for dopamine, but rather for glutamate histamine amino acids( glutamate, histamine, amino acids ), suggesting dopamine is not is( is not, is ) the sole cause of schizophrenia.

Fromm-Reichmann Ripke Curran Bateson( Fromm-Reichmann, Ripke, Curran, Bateson ) (1948) suggested the psychological explanation for schizophrenia that a schizophrenogenic mother can influence the development of schizophrenia. A schizophrenogenic mother is cold and dominant kind and friendly quiet and distant clingy and attention-seeking( cold and dominant, kind and friendly, quiet and distant, clingy and attention-seeking ), causing conflict and tension in the family. This causes secrecy honesty unity( secrecy, honesty, unity ), leading to distrust and, eventually, paranoia peace a stable environment( paranoia, peace, a stable environment ). This therefore causes schizophrenic symptoms such as persecutory delusions disorganised speech delusions of grandeur flat effect( persecutory delusions, disorganised speech, delusions of grandeur, flat effect ).

Bateson (1972) proposed the double single half triple( double, single, half, triple ) bind theory: faulty lack of too much( faulty, lack of, too much ) communication in families causes schizophrenia. This involves contradictory honest hostile( contradictory, honest, hostile ) messages, e.g. mother telling child to do something, but when they do it they are punished. This leads to confusion and fear of doing the wrong thing. The individual will then develop strategies and behaviours to avoid ensure( avoid, ensure ) the double bind situation, which results in symptoms such as avolition, social withdrawal and the flat effect.

Cognitive explanations for schizophrenia revolve around dysfunctional functional personal( dysfunctional, functional, personal ) thought processing. Lowered processing in the ventral striatum and superior temporal gyrus support oppose( support, oppose ) the cognitive explanation, as they emphasise how changes in thought processing can cause schizophrenic symptoms.
There are two main explanations:
1. Dysfunctional meta-representation meta-analysis meta-presentation( meta-representation, meta-analysis, meta-presentation )- disruption in the ability to recognise our own others'( our own, others' ) actions and thoughts as being carried out by ourselves, causing hallucinations negative symptoms( hallucinations, negative symptoms ).
2. Lack of central control- the inability ability( inability, ability ) to supress automatic voluntary( automatic, voluntary ) thoughts, causing disorganised speech. The Stroop test found that schizophrenics take twice half( twice, half ) as long to supress their automatic thoughts compared to a control group.

Berger (1965) found that schizophrenic patients reported higher lower equal( higher, lower, equal ) recall of double bind statements compared to non-schizophrenics. This is therefore is supporting opposing( supporting, opposing ) evidence for the double bind theory, however it lacks reliability validity( reliability, validity ); the patients already have schizophrenia, so they may be experiencing delusions which make them believe they experienced double bind situations, when they actually didn't. For example, if they were questioned before the onset of the symptoms, they may have had lower recall, meaning there would not would( would not, would ) be consistency over time.

One disadvantage of the negative expressed emotion theory is that 52% of schizophrenics who return to homes with high expressed emotions don't relapse relapse( don't relapse, relapse ). The reason for this may be individual therapist disorder( individual, therapist, disorder ) differences such as the types of symptoms the experience (negative vs. positive), their personality and the severity of symptoms. This indicates that negative expressed emotion is not is( is not, is ) a full explanation for schizophrenia.

Typical drug therapy for schizophrenia was introduced in the 1950 70 90( 50, 70, 90 )s, with a drug called chlorpromazine clozapine risperidone( chlorpromazine, clozapine, risperidone ) that could either be injected or consumed. This therapy involves dopamine antagonists agonists( antagonists, agonists ): the drug blocks the receptor sites for dopamine in post-synaptic neurons, hence decreasing increasing( decreasing, increasing ) levels of the neurotransmitter, meaning symptoms such as hallucinations avolition( hallucinations, avolition ) are reduced. Chlorpromazine is also used as a sedative, as it is linked to the neurotransmitter histamine glutamate( histamine, glutamate ) as well.

Atypical drug therapy for schizophrenia was introduced in the 1970 50 90( 70, 50, 90 )s, with a drug called clozapine chlorpromazine risperidone( clozapine, chlorpromazine, risperidone ). The aim of this type of drug therapy was to reduce the side effects of typical drug therapy. Like chlorpromazine, this drug also binds to dopamine receptors on the post-synaptic neuron, hence blocking them, but it also does the same for neurotransmitters serotonin histamine( serotonin, histamine ) and glutamate noradrenaline( glutamate, noradrenaline ). It is often prescribed to suicidal less severe uncooperative( suicidal, less severe, uncooperative ) patients for its mood-enhancing effects. However, this drug is also known to cause agranulocytosis tardine dyskinesia( agranulocytosis, tardine dyskinesia ), a fatal blood disorder, so a new drug was made in the 1990 50( 90, 50 )s, risperidone. It has the same binding qualities as clozapine, but binds more less( more, less ) strongly, so the doses are smaller and the side effects are reduced.

While drug therapy does support the dopamine serotonin genetic glutamate( dopamine, serotonin, genetic, glutamate ) hypothesis as an explanation for schizophrenia, it can also be said that it does not take takes( does not take, takes ) into account other biological factors such as genes and neural correlates, or external factors such as family dysfunction. This is therefore a limitation an advantage( a limitation, an advantage ) of drug therapy.

Reality Fantasy Surreality( Reality, Fantasy, Surreality ) testing in CBT involves the patient and psychologist discussing how likely their beliefs are to be true interesting schizophrenic( true, interesting, schizophrenic ). It also involves considering less threatening interesting boring( threatening, interesting, boring ) possibilities linked to their beliefs. As well as this, CBT helps patients recognise the link between hallucinations/delusions and their feelings/behaviour.

Personal therapy is an approach to CBT drug therapy family( CBT, drug therapy, family ). The aim of personal therapy is to evaluate describe overcome( evaluate, describe, overcome ) the experiences of a patient, including triggers and consequences. Patients are then provided with strategies to cope with their issues. There are four techniques developed:
1. Distraction for Discussion of Evaluation of( Distraction for, Discussion of, Evaluation of ) intrusive thoughts
2. Challenging Describing Agreeing with the( Challenging, Describing, Agreeing with the ) meaning of thoughts
3. Increase/decrease Increase Decrease( Increase/decrease, Increase, Decrease ) in social activity to distract from low mood
4. Relaxation Avoidance Activity( Relaxation, Avoidance, Activity ) techniques
Personal therapy also helps patients recently discharged from hospital to deal with daily life e.g. recognising signs of relapse.

Family Drug( Family, Drug ) therapy aims to improve faulty communication in families, specifically treating negative positive( negative, positive ) expressed emotion (hostility, criticism, emotional over-involvement). It involves the presence of all some most( all, some, most ) family members, and all must be completely mostly somewhat( completely, mostly, somewhat ) open. Strategies to improve communication include removing increasing acknowledging( removing, increasing, acknowledging ) burden of care (sharing care of schizophrenic family member), removing feelings of guilt, and decreasing increasing acknowledging identifying( decreasing, increasing, acknowledging, identifying ) negative forms of communication.

Pharoah (2010) found that family therapy CBT drug therapy( family therapy, CBT, drug therapy ) increased decreased( increased, decreased ) compliance to medication and therefore decreased increased( decreased, increased ) relapse rates.

Token economies are a form of management for schizophrenia, used to modify increase identify( modify, increase, identify ) maladaptive symptoms caused by institutionalisation operationalisation internalisation( institutionalisation, operationalisation, internalisation ). It is based on operant classical( operant, classical ) conditioning and is useful for long short( long, short ) term patients in psychiatric wards.
Clinicians develop a list of behaviours that they believe will improve a patient's engagement in daily life, such as getting out of bed or brushing teeth. If a patient carries out this behaviour, they are immediately later( immediately, later ) rewarded with a token (secondary primary( secondary, primary ) reinforcer) which can be exchanged for a reward such as sweets or magazines.

Azran and Ayllan (1968) did a study into the effectiveness of token economies family therapy drug therapy CBT( token economies, family therapy, drug therapy, CBT ). They studied female male child( female, male, child ) patients in a psychiatric wards and found that those who did token economy systems exhibited didn't exhibit( exhibited, didn't exhibit ) the desired behaviours set by clinicians, suggesting token economy is isn't( is, isn't ) effective.

The diathesis-stress model
Diathesis Stressor( Diathesis, Stressor ): vulnerability
Stressor Diathesis( Stressor, Diathesis ): trigger

Original diathesis-stress model for schizophrenia
Diathesis: genetic psychological traumatic( genetic, psychological, traumatic ) vulnerability- the schizogene (one gene which leads to development of the schizotypic personality, characterised by sensitivity to stress)
Stressor: environmental psychological genetic( environmental, psychological, genetic ) trigger- stress in childhood e.g. schizophrenogenic mother

Modern diathesis-stress model
Diathesis: not necessarily always( not necessarily, always ) a genetic vulnerability, and multiple genes are involved. Psychological trauma can also cause vulnerability
Stressor: the stressor is not necessarily always( not necessarily, always ) just psychological, it is simply any factor which increases the risk of the onset of schizophrenia e.g. smoking cannabis