Psychology: SCHIZOPHRENIA

Schizophrenia

CLINICAL CHARACTERISTICS OF SCHIZOPHRENIA

Schizophrenia is a group of related disorders relating to the termed
psychotic – disconnected from reality.

There are 4 main characteristics of schizophrenia.

1. Cognitive
Delusions of thought – thoughts disorder that include delusions
and thought interferences
a. Delusion of grandeur – beliefs that they are someone famous or
grand e.g. they believe that they are Einstein, or Elvis Presley.
This also includes beliefs that they have grand or magical powers.
b. Delusions of Persecutions – beliefs that they are being persecuted
or that people are plotting against them, that they are being spied
on or that they are being talked about. They become paranoid.
Feel victimised.
Disorganised speech
This symptom includes inappropriate speech, repeating sounds, inventing
strange words, and jumbled speech. Word salad.
2. Perceptual Symptoms – affects what you see or
hear
a. Auditory Symptoms – hearing voices. These voices are often
abusive, critical, warning or danger or giving orders.
b. Visual Hallucinations – such as size, space and colour
distortions. They are less common. These symptoms include
seeing distortions of colour, size and shape e.g. feeling that bugs
are crawling all over your body.
5. Emotional symptoms
Inappropriate affect – e.g. laughing at the wrong time (at a funeral)
Flat emotions – lack of any emotional response
4. Behavioural symptoms
Disorganised speech – several disruptions in the ability to perform daily
activities
Cataleptic stupor – a lack of motor activity. Patients remain still like
statues. Can be still for a long time, like statues (bizarre positions)
Excessive motor activity – moving in an odd and/or disturbing ways,
include strange gestures, and are apparently purposeless and are not
influenced by external stimuli. E.g. repetitive movements, rocking oneself.

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DIAGNOSING SCHIZOPHRENIA
The DSM-IV is the current manual for diagnosing schizophrenia. It is used
to assess and diagnose a disorder.
Criteria is DSM-IV for diagnosing schizophrenia
1. Two or more of the following for a significant time in a ONE month
period
a) HALLUCINATIONS – (auditory, visual etc) if widespread than no other
symptoms necessary
b) DELUSIONS – (grandeur or persecution) if the delusions are very bizarre
than no other symptoms necessary
C) CATATONIC OR DISORGANISED BEHAVIOUR

d) NEGATIVE SYMPTOMS – flat emotions

2. The disruption to the person’s life must last approximately 6
months. They must produce deterioration in functioning at daily life.
Categorising schizophrenia into Clinical Types
There are two types of Schizophrenia
Type 1 Type 2
Functional – there’s no Organic – related to the brain
obvious physical organic dysfunctions/abnormality
cause chronic – negative
Acute – positive symptoms quieter – motor activity and
Very bizarre – adds flat emotions – takes away
something to the personality from personality, e.g. apathy
e.g. hallucinations slower onset – last longer
Sudden onset – short worse final outcome
duration
The DSM-IV identifies 3 subtypes of schizophrenia
Subtypes Type 1 Type 2

Paranoid Type Delusions of

grandeur
Delusions of
Persecution
Auditory
Hallucinations
Disorganised Type Disorganised speech
Disorganised behaviour
Inappropriate affect
Flat emotions
Catatonic Type Apathy
Loss of drive

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Cataleptic Stupor and

bizarre
Excessive motor activity
Echolalia

BIOLOGICAL EXPLANATIONS FOR SCHIZOPHRENIA

Genetics
There is clear evidence that the chances of being diagnosed with
schizophrenia increases if they are related with someone with the
disorder. This suggests that genes are an important factor.

There are three types of studies which support the link between
schizophrenia and genes. Family studies are one of them.
GOTTESMAN carried out a review of data from families and that there was an
increased chance of developing the disorder the more closer related there
family members were to each other.
Findings – he found that the general population had a 1% lifetime chance
of developing schizophrenia. If a sibling was diagnosed that the risk is 9%.
If ONE parent had been diagnosed there is a 17% chance, if both parent
had been diagnosed then there was a 46% chance of developing
schizophrenia. Yet the highest finding was if an identical twin has been
diagnosed then the risk is increased to 48%. Gottesman concluded – as
genetic similarity increases so does the risk of developing the
illness.
EVALUATION-
1. Families tend to chare more than genetic material – They share the
same environment. So that suggests that it can’t be just due to nature
(genetics) and so nurture (the environment, family life) is also a factor.
It could be that the family member imitated the stage behaviour.
2. Data collected relied on an interview technique – that means
interviewer bias becomes a factor and also the interview may just
mistake the behaviour for what it is (ADHD).
3. The data was retrospective – the data talks about past that leaves
room for the data found to be interpreted as the participants had to
remember the past. Memory is not reliable as demonstrated by
eyewitness testimony research.

Twins Studies are another type of reached used to find the link between
schizophrenia and genes.

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GOTTESMAN reviewed and summarised 40 studies to see the concordance

rate for MZ twins and DZ twins. Found 17% concordance rate for DZ twins
was found compared to 48% for MZ twins. It was concluded that this
supports the hypothesis that there is genetic link between genetics
and schizophrenia and that genes are important because MZ
twins had a higher concordance rate.
EVALUATION-
Twins usually share more than just there genes – from an early age they
are treated exactly alike share the exact same childhood and family
environment. A probable explanation could be that they copied one
another.
Adoption studies are the last type of reach conducted into
schizophrenia and this research makes the link between genes and
schizophrenia more concrete as twins share two separate environment
and MZ twins are exactly alike.
KETY ET AL – carried out research on Danish adults who had been adopted at
an early age between 1924 and 1947. Half the sample had been
diagnosed with schizophrenia and the other half had not. The two groups
were matched of variables such as age and sex. The biological and non-
biological relatives of the two groups were compared to check if
schizophrenia was found. They found, in the group of the schizophrenic
adults the rate of schizophrenic biological relatives were higher (14%)
than the rate for the non-biological relatives (2%). This clearly supports
the genetic argument and suggests that environment is less
important.
EVALUATION-
The research was carried out in the only in Denmark – this means that it
generalisations from the findings cannot be made to other cultures.
The statistics – these were gathered over a long time (70 years) and the
interpretations of the symptoms for schizophrenia have differed over the
years. This means that the data is less reliable as the certainty whether
the participants had the illness is questioned.

Overall Evaluation
• Deterministic
• Reductionist
• Concordance rate – the rate is never 100% so the role of the
environment cannot be discounted.
• The research cannot account for diagnoses in individuals where
there is no family history.
• Correlation studies – most of the research are correlation studies
this means that cause and effect cannot be established i.e. genes
because schizophrenia cannot be established.

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Biochemistry
Research has found a considerable difference in the brain chemistry of
schizophrenics and non-schizophrenics.
A particular neurotransmitter, Dopamine has been the found to have a
particular effect. Early research suggested that an excess of dopamine
was the cause of schizophrenia. To support this, researchers used post-
mortem studies and PET scans which clearly showed the high levels of
dopamine in schizophrenic patients.
Yet recent research has found that it is more than just high levels of
dopamine. It is because of more is picked up and used by the receptors
sites are more sensitive or it could be that there are more receptors to
pick it up.

Support for dopamine hypothesis

• Amphetamines and cocaine, they stimulate the dopamine receptors
and can produce a state similar to that of a paranoid schizophrenic.
• Anti-schizophrenic drugs reduce the effects of schizophrenia by
blocking dopamine receptors.
• Also, it has been found that anti-schizophrenic drugs produce side
effect that are similar to Parkinson’s disease, like muscle tremor and
difficulty walking. This means that as Parkinson’s is partly due to low
levels of the neurotransmitter dopamine than it can be assumed
that schizophrenia may also involve an excess of it.

Evaluation
• The drugs used are usually only good for treating the symptoms of
positive/type 1 schizophrenia. Yet the negative symptoms are not
treated effectively by drugs.
• Cause and effect becomes a problem. This is because it is not
understood whether the dopamine changes caused schizophrenia or
that schizophrenia caused the high dopamine levels.
• It has been found that some schizophrenics improve when they
were given amphetamines. But this contradicts the dopamine

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hypothesis as it sates that amphetamines increase dopamine levels

and that people get worse if the dopamine levels become high.
Davidson argues that it can be explained by looking at
schizophrenic in terms of the type (type 1/positive or type
2/negative). Positive symptoms are alleviated while negative
symptoms seem to worsen with the drug.

Conclusion
Although there is evidence to support the hypothesis but the support
cannot be a conclusive explanation for all cases of schizophrenics.
It could be that positive symptoms of schizophrenia have on cause i.e.
related to dopamine and negative symptoms have another entirely
different cause e.g. serotonin or even brain damage.

PSYCHOLOGICAL EXPLANATIONS FOR SCHIZOPHRENIA

Family relationships
This is the idea behind it is that a person gets schizophrenia because they
have been raised in a dysfunctional family. The family is dysfunctional
because of the way the family communicate and interact with each other.

Double-bind Communication
This part argues that parents communicate contradictory messages to
their children. They say one thing but their tone or gestures communicate
the opposite. E.g. a parent asks her child how her day in school was then
ignores her and watches TV.
The longer this goes on the more the child will misinterpret the parent’s
contradictory messages and become increasingly confused. This confusion
will eventually distort the child sense of reality which could lead to
schizophrenic symptoms such as paranoia, hallucinations.
Studies to support
Berger found that schizophrenics reported high levels of double-bind
communications than non schizophrenics suggesting that this type of
communication may be a causal factor.
However this study used a self-report method, which means that
individual may be biased and my not give the true information. Also, the
study used a correlation, which means that cause and effect cannot be
established, can’t prove which came first.

Expressed Emotions
High levels of expressed emotions involves families that are overly
involved with each other, overprotective of the disturbed family member,
voicing self sacrificing attitudes to the family member and also being

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critical, hostile and resentful of the family members. These types of fails
believe that the schizophrenic member to have more control over their
symptoms.
Studies to support
Bultzulaff analysed 27 studies and found that 70% of parents in high
expressed emotions families suffered relapsed whereas only 31% of
families is low expressed emotion relapsed. This shows that family
interactions are important especially with relapse. Healthy families have a
protective effect whereas unhealthy families have the opposite.

Evaluation
• Deterministic – it ignore free will. The explanation suggests that if a
person is in that kind of family, then the schizophrenic will have a
relapse or the person is more likely to get schizophrenia.
• Reductionist – it reduces very complex disorder down to just family
relationships. Schizophrenia is too complex to do that.
• Over emphasises nurture and ignore other factors. It can’t be just
singularly due to nurture, nature is also involved.
• Other studies do not support the double-bind communications.
Liem found that no difference in the patterns of behaviour in
families with a schizophrenic child and those without. Also, Hall &
Levin did a review of family studies and found no evidence of a
contradiction in the verbal and non-verbal messages between
parents and children.

Need an interactionist approach to look at schizophrenia properly as it is

much too complex. The diatheses-stress model would be the best
approach – a mixture of nature and nurture.

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Cognitive Explanation

This explanation claims that biological problems come about first –

causing sensory experiences like hearing voices.
Sufferers then turn to their family and friends to help them understand
what is happening only for them to deny that the person has done
anything wrong with them. Sufferers then start to believe that those
around them are trying to hide the truth from them so they reject all
feedback from others and develop belief (delusions) that they are being
manipulated or persecuted. So suffers take a rational path to madness.
This theory has not been tested but a link between sensory dysfunctioning
and delusional thinking has been observed in people who are hard of
hearing.
A t first people who begin to lose their hearing are not aware what’s
happening at accuse people of whispering around them. When they are
told that is not the case, hearing impaired people believe that they are
being deceived or plotted giants.
Logical thinking = delusional conclusions

Evaluation
• Can generalise – the theory is limited to only one type of
schizophrenia – type 2. Can’t apply to the other types.
• Causation is a problem – the explanation is unclear s to whether the
cognitive problems are the cause of schizophrenia or whether
schizophrenia is the cause of cognitive problems.

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• The explanation is an interactions theory as it is acknowledges the

role of biological factors and how these factors interact with
psychological factors.
• There is evidence to support those biological factors cuases
cognitive problems. Meyer-Lindeberg found a link between poor
memory and the reduced activity in the prefrontal cortex. Also
Schekle studied a patient who experience auditory hallucinations
due to an abscess in pons.

Overall Conclusion
There are many explanations that suggest causes of schizophrenia – some
biological and some psychological. None of these approaches offer a
complete explanation on their own, however. So an interactionist
approach is needed which includes both nurture and nature arguments.
The genes load the gun but the environment pulls the trigger.