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Schizophrenia: Explanations and Treatments

BIOLOGICAL APPROACH

Genetics

Heston (1966)

Aim: Investigated the role of genetics in schizophrenia

Method:

  • Compared 47 adopted children whose biological mother had schizophrenia
  • With control group of no schizophrenia history

Results: None of the controls were diagnosed, 16% of the schizophrenic mothers’’ offspring had the illness.

Conclusion: Inheritance does play a part on the disorder

Evaluation

  • Inheritance can put people at risk, stress can also play a part
  • Could be several genes responsible for the symptoms

Biochemical Explanations

  • Excess of dopamine has been implicated in schizophrenia
  • Dopamine – active in the limbic system in the brain governing emotion.

Evidence

  • Kimble – anti-psychotic drugs which reduce the levels of dopamine are effective in reducing the symptoms
  • Iverson – Schizophrenics patients show high levels of dopamine in brain.

Evaluation

  • Does excess dopamine cause schizophrenia, or does schizophrenia have an affect on dopamine levels
  • May be that receptors in the brain are more sensitive

Biological Treatment

  • Anti-psychotic drugs – reduce positive symptoms
  • Chloropromazine – blocks dopamine receptors in the brain, so neurons done respond to dopamine
  • Side effects – weight gain, tremors, drowsiness

Evaluation

  • Reduced the number of long-stay patients in hospitals
  • Some patients do not find the side effect difficult to cope with
  • Drug treatments aren’t a cure, can return if they stop taking drugs

PSYCHODYNAMIC APPROACH

  • Schizophrenia due to conflict in personality
  • Adult Schizophrenia – ego is overwhelmed by either the id or superego
  • Ego goes back to youth
  • Individual has delusions of self-importance, like the demanding behaviour of a baby
  • Fantasies become confused with reality, as the ego tries to get control
  • Hallucinations and delusions will emerge, as the ego tries to gain sense of reality

Evaluation

  • No scientific evidence
  • STIRLING and HELLEWELL – schizophrenic behaviour no similar to infant
  • Research not found a correlation between early childhood experiences and following diagnosis

Psychodynamic Treatments

  • Didn’t use psychoanalysis – patients incapable of forming close relationship with therapist
  • SULLIVAN – used psychotherapy
    • Sufferer returns to a child-like state, because they experienced childhood trauma and are unable to handle adult communication
    • A trusting relationship could be slowly built-up with the patient which would lead to success

Evaluation

  • Sullivan’s patients only mildly disturbed, may not have been diagnosed with schizophrenia

BEHAVIOURAL APPROACH

  • Explains schizophrenia as a learned response
  • People will behave in a schizophrenic way if they reinforced by it, develops by operant conditioning
  • May observe behaviour of other schizophrenics

Evaluation

  • Doesn’t explain how schizophrenics get symptoms in the first place
  • Simplifies distressing condition to attention seeking strategy
  • Social learning can explain how patient’s symptoms can multiply as they are in contact with other patients in hospital.

Behavioural Treatments

Experiment: PAUL AND LENTZ (1977)

Aim – Investigated the effectiveness of operant conditioning by reinforcing appropriate behaviour with schizophrenic patients.

Method –

  • Set up token economy system in hospital ward
  • Patients given tokens as reward when behaved appropriately
  • Could be exchanged for luxury items

Results

  • Positive and negative symptoms were significantly reduced
  • 11% of patients need drug treatment, compared to 100% of the control group

Conclusion – operant conditioning is an affective means of treating people with chronic schizophrenia

COGNITIVE APPROACH

  • Faulty information processing
  • PICKERING – catatonic breaking in auditory attention, making social interaction difficult, as individual overloaded with auditory information. Withdrawal from world keep sensory manageable.
  • FRITH – Schizophrenics fail to monitor their own thoughts

Evaluation

  • No causes to what causes cognitive changes
  • Diagnosed in adulthood, no link to childhood
  • Approach is being used to develop new strategies of copying with the disorder

Cognitive Treatment

  • Voice-hearers can be helped to being voices under their control
  • Psychotherapy – controlling thought processes instead of uncovering unconscious (Bentall)
  • Asks the patient to focus on the voice – whether male or female, tone
  • Patients are told that the voice represent part of their thought processes
  • Encouraged to develop strategies to protect themselves against the voices
    • Relaxation techniques, talking to others.

Evaluation

  • May support delusional thinking in their patients
  • Paying attention to voice may result in doing what the voices say
  • ROMME and ESCHER – focusing reduces harm to the self or others

SOCIOCULTURAL EXPLANATIONS

Labelling

Scheff

  • Those receiving help carried a stigma or mark of social disgrace
  • Labelling creates expectations; patients may behave differently and create a self-fulfilling prophecy.

Experiment: ROSENHAN

Aim: Provided a powerful example of the effect of labelling.

Method:

  • 8 normal people admitted to hospitals
  • 7 diagnosed with schizophrenia
  • Instructed to act normally, do not take any medication

Results:

  • Participants often ignored by staff – powerless and fear
  • Other real patients recognised normality and asked pseudo-patients if they were reporters
  • None of them managed to convince the staff they were sane

Conclusion – perceptions of patients affected by the labels they have been given.

Evaluation

  • Contributed a revision to diagnosis and patient care
  • Labelling theory has provoked any practitioners to re-examine their own expectations.

Family Dysfunction

  • Concentrates on the cultural and social environment
  • Schizogenic mother’ – cold, dominant, created conflict and caused schizophrenia in the child. Said to be rejecting, overprotective, and fearful of intimacy.
  • BATESON – thought that the faulty communication within families was a cause. Double bind – child in no win situation contradictory messages.

Evaluation

  • No clear evidence that families creates schizophrenia

Effectiveness of Treatment Methods

  • Most effective antipsychotic drugs
  • Behavioural treatments good for changing behaviour of long term delusions
  • No effective psychotherapy, investigated more cognitive treatments, to deal with symptoms
  • All treatments ignore social/environmental factors

Institutional care and community care

  • Patients can imitate other patients behaviour
  • Doesn’t teach how to fend for self
  • Community care
    • Provide help to patients outside hospital ward
    • Occupational therapist – building social skills
    • Nurses – visit patients at home
    • Can attend day centres where they can meet with others

Evaluation

  • Concerned with the quality between two services
  • Some don’t get the attention and care they need
  • Institutionalisation – allows close monitoring, support and treatment. Prevents self-harm.
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