TSR Wiki > Study Help > Subjects and Revision > Revision Notes > Psychology > Psychopathology
What do I need to know?
You need to know about:
- Schizophrenia
- OCD
- Depression
For each of these you need to make sure that you know about the
- Clinical Characteristics
- Biological Explanations
- Psychological Explanations
- AO2
Schizophrenia
What is Schizophrenia?
It is a mental disorder, which disrupts a persons thinking and moods. The DSM has schizophrenia in the top 10 causes of disability in the west.
Schizophrenia involves a disruption of cognitions and emotions which impacts a persons language, thought, perception and sense of self.
It is often divided into positive and negative symptoms. Positive symptoms are additional behaviour. Negative symptoms involve a decrease in behaviour.
Around 1% of the population suffers from schizophrenia. Onset usually occurs between 15 and 45, and it is occurs 4-5 years earlier in males than it does in females.
Clinical Characteristics
Schizophrenia can be divided into positive and negative symptoms.
Positive symptoms add to the behaviour of the individual, while negative takes away from it.
Onset of schizophrenia can be either chronic or acute:
- Chronic – slow change and development of symptoms.
- Acute – sudden appearance of symptoms, usually after a stressful event.
Schizophrenia can be either:
- Episodic = mainly positive symptoms
- Chronic =mainly negative symptoms
For a diagnosis, at least 2 or more positive symptoms must be present for at least a month.
| Positive
| Negative
|
| Delusions
| Affective Flattening
|
| Experiences of Control
| Alogia (poverty of speech)
|
| Auditory Hallucinations
| Avolition (disinterest in goals)
|
| Disordered Thinking
| Catatonia
|
| Sterotypy (rocking)
| Echolalia (repeating sounds)
|
Types of Schizophrenia
- Paranoid – delusions and/or hallucinations and predominant.
- Catatonic – psychomotor abnormality, individuals may adopt strange poses or flail uncontrollably.
- Hebephrenic – (also, disorganised) behaviour is aimless, speech is incoherent.
- Undifferentiated – a general category for individuals who do not fit in the other categories.
Biological explanations
Schizophrenia can be described in terms of biology using a number of explanations:
- Genetics (twin or family studies)
- The Diathesis Stress model uses both biological and psychological explanations for schizophrenia, and is useful when used as AO2.
Genetics
Twin Studies
- Gottesman & Shields (82) – found that 58% of MZ twins (100% of genes) were concordant for schizophrenia. This was much higher than DZ twins. They also suggested than both affected and unaffected MZ twins pass the increased risk of development onto their children.
- Fischer (71) – 9.4% of schizophrenic’s offspring develop schizophrenia. A much greater chance than the normal population which is 1%.
- Cardno (99) – MZ twins had 40% concordance, while DZ had 5.3%.
Evaluation
- In twin studies where MZ twins are brought up apart, they were still in the womb together so environmental factors cannot be entirely discounted.
- MZ twins may be treated more similarly than DZ twins, and so there would be more similarities anyway.
- The other 50% of twins who do not develop schizophrenia has no explanation, so there must be more to schizophrenia development than genetics. Diathesis stress can be used to explain this.
Family Studies
- Kendler (85) – First degree relatives (share 50% of genes) and are 18x more at risk than the general population.
- Kety (62) – In Denmark used 207 offspring of mothers with schizophrenia (high risk) and compared them with children of 104 mothers without schizophrenia (low risk). The high-risk group 16.2% developed schizophrenia, while in the low risk group 1.9% had it.
- Heston (66) – longitudinal study of 47 people born to schizophrenic women in a mental institution. Infants were separated at birth and raised by foster parents. There was a control of 50 children from the same childrens homes. They found that 66% had mental health problems, but only 18% of the controls had any. 17% developed schizophrenia.
Evalution
- You cannot know whether it was environment or genetics which caused the schizophrenia, as both mother and child share environment and 50% of genes.
- Social Learning theory could say that the mothers behaviour was taught to the children by the children seeing the mother getting attention for being schizophrenic.
Dopamine
Schizophrenia results from an excess of dopamine. It is a neurotransmitter which causes neurons to fire.
L-dopa is a synthetic dopamine releasing drug, it can produce acute schizophrenic symptoms in non-schizophrenics.
Amphetamines (such as LSD) also have this effect.
- Randrup found that when he administered amphetamines to rats, they exhibited behaviour similar to those suffering from schizophrenia. These effects were reversed by providing neuroleptic drugs. Amphetamines, increase levels of dopamine. It was found that large doses of amphetamines when given to people with no psychological disorders caused paranoid behaviour, similar to schizophrenia.
Too much dopamine causes neurons to fire too often and transmit too many messages, ‘overloading’ people, and causing many of the symptoms of schizophrenia.
- Owen (87) – found from autopsy evidence found that people with schizophrenia had an excess of dopamine receptors. More receptors leads to more firing and an overproduction of messages, and so schizophrenia.
Evaluation
- Anti-psychotic drugs do not appear to help everyone with schizophrenia. They are more effective with episodic than chronic schizophrenia.
- These drugs block dopamine receptors quickly, but effects take weeks to subside.
- Research from Kapur and Remington (96) suggests that schizophrenia may result from a reaction between serotonin and dopamine, rather than just dopamine.
- Carlsson (99) implicates other neurotransmitters such as serotonin and glutamate in the development of schizophrenia.
Neuroanatomical
MRIs have shown through examination of brains of schizophrenics that there are definite structural abnormalities in the brains of many schizophrenics.
- Brown (86) – found decreased brain weight and enlarged ventricles in the brains of schizophrenics.
Diathesis-Stress Model
Certain individuals have a predisposition to schizophrenia, but will only go on to develop it if they are exposed to stressful or triggering situations.
The predisposition may be genetic and the result of illness or damage in early life (e.g. preeclampsia during pregnancy, viral infection etc.).
Stressful events include: major life events, traumatic experience, and dysfunctional families.
It straddles the biological and psychological explanations by suggesting the cause is biological and psychological. Good for AO2.
Viral
Some researchers suggest schizophrenia maybe caused by exposure to viruses before birth. These may not have effect until puberty when they are activated by hormonal changes and cause schizophrenic symptoms.
- Torrey found that a significant number of people with schizophrenia are born during the winter; this is when exposure to viruses is at its peak.
- Van Os studied fingerprints of MZ twins and found that schizophrenics have fingerprint abnormalities e.g. more ridges than their non-schizophrenic twin. Fingerprints develop in the second trimester of pregnancy when the baby is most at risk from viruses. Therefore the abnormalities indicate viral infections during this period, which predispose a person to schizophrenia.
Evaluation
- This explains why schizophrenia appears in people with no family history of schizophrenia.
- There is no evidence that all schizophrenics have been exposed to viruses.
Psychological Explanations
Psychological explanations of schizophrenia include:
- Family Relationships and High Expressed Emotion
Cognitive
This is how people think and process information. Schizophrenia is characterised by profound thought disturbance – this could be due to ‘cognitive deficits’ which impairs thought processes such as perception and memory, forming cognitive biases (when you believe something which is segregated from others and everything else is disregarded) which affect the way people see and interpret the world.
Evaluation
- Cognitive biases are useful and can gain insights into the behaviour of schizophrenics. For example, sexual abuse can lead to a cognitive bias which sees the world as dangerous and threatening.
- Cognitive approaches do not explain the causes of cognitive deficits or where they come from in the first place. They turn to the biological approach to explain these deficits.
Behavioural explanations
This explanation suggests schizophrenia is a consequence of faulty learning. If a child receives little or no social reinforcement early in life, the child will pay more attention to irrelevant environmental cues (e.g. the sound of a word rather than its meaning).
Their behaviour will eventually appear bizarre and others will label them as ‘weird’ and avoid them. According to Scheff’s labelling theory, individuals who have been labelled this way may continue to act in ways that match the label. The bizarre behaviours may be rewarded by attention and sympathy so are reinforced and will eventually become so bizarre that they are labelled as schizophrenic.
Evaluation
- Behavioural explanations are supported by many behavioural therapies used on schizophrenic patients. Social skills training techniques have been used to help schizophrenics acquire useful social skills e.g. schizophrenics have learnt to make their own bed and comb their hair when rewarded. These programmes have been successful in reintegrating schizophrenics back into the community.
- However, behavioural explanations ignore the genetic evidence found by many studies (e.g. Gottesman).
- Support for the labelling theory came from a member of the audience when Paul Meehl was giving a lecture. The man said he ‘kept his finger up his arse to prevent his thought from running out, and tried to tear his hair out with the other hand because it belonged to his father’. The man did all this because someone had called him a schizophrenic.
Family Relationships
Research suggests that schizophrenia results from a dysfunctional family which cause s harm to its members.
- Bateson (56) – Double-Bind Hypothesis suggests that schizophrenic families communicate in a destructively ambiguous fashion (e.g mother tells son she loves him, but turns her head away in disgust). Prolonged exposure to this, leads to an incoherent construction of reality which may manifest itself as schizophrenia.
Evaluation
- Berger (65) found schizophrenics reported higher recall of double-bind situations than non-schizophrenics. (However, this is retrospective data and so is unreliable)
- Hall & Levin (80) analysed data from previous studies and found no difference in communication between schizophrenic families and non schizophrenic families.
Uni-Polar Depression
What is depression?
Depression is a mood disorder. It is a low emotional state. Unipolar means sufferers only have lows, unlike the mood swings associated with bipolar depression.
Depression can be either reactive or endogenous.:
- Reactive – it is a reaction to stressful events.
- Endogenous – arises from within the person, or is dependant on internal factors.
Clinical Characteristics
For a diagnosis, 5 or more of the following must be present for longer than two weeks, with no outside reason for depression (e.g. bereavement):
| Cognitive
| Behavioural
| Emotional
| Physical
|
| Low self-esteem
| Decrease in sexual activity
| Sadness
| Weight loss
|
| Guilt
| Loss of appetite
| Irritability
| Fatigue
|
| Negative thoughts
| Disordered sleep
| Apathy
| Aches and pains
|
| Suicidal thoughts
| Poor care of self and others
|
| Sleep disturbance
|
| Poor memory
| Suicide attempts
|
| Menstrual changes
|
| Lack of concentration
|
|
|
|
Biological Explanations
Genetic
- Gerschon (90) – reviewed 10 family studies of depression and found that between first-degree relatives the chance of getting depression between 7% and 30% - this is much higher than the general population.
- Kendler and Prescott (99) – studies 4000 US twin pairs and found that 39% correspondence for depression. The study found no gender differences, but Bierut (99) found a stronger link between females than males.
- Wender et al (86) found biological relatives of adopted depressives were 8x more likely than adoptive relates to have depression themselves.
Evaluation
- Gerschon’s study does not show whether it is environmental or genetic factors which cause depression.
- Although the risk for depression is higher for MZ twins, the chances are not 100% and so genetics are not the only factor in explaining this.
- There may be a genetic predisposition, additional causes.
Biochemical
- Kety (75) – suggests that depression is caused by a deficiency in noradrenaline. Noradrenaline is controlled by serotonin and dopamine, and when levels of the other two are low, noradrenaline levels may fluctuate.
- Teuting et al (81) – analysed urine of depressed and normal people and found lower levels of products associated with noradrenaline in depressives.
Dopamine may be involved in depression in old age, as the dopamine content of the brain decreases over the age of 45. However, L-dopa imitates the action of dopamine when given to depressives, has no specific anti-depressant effect.
Evaluation
- Drugs used to alter neurotransmitters affect the chemical immediately, but the results of these take several weeks to have a significant effect on mood.
- Cause and effect cannot be established, as it may be that depression is caused by low levels of noradrenaline, or that low levels of noradrenaline cause depression.
- Females are more likely to be diagnosed with depression arguably because of female hormones. However, only a small amount of women develop post-natal depression, and so it is not an inevitable response to hormonal changes.
- It is likely that a biological and genetic predisposition is present in depressives, and environmental stressors cause it to develop.
Psychological Explanations
Psychodynamic
Freud suggested that depression is linked to Melancholia – we harbour negative feelings towards loved ones, and when we lose those loved ones we direct those feelings towards ourselves, manifesting as depression. Freud believed that depression is related to some loss experienced in early childhood. He thought there was a similarity in symptoms between those suffering from depression and the response to death of a loved one. Similar symptoms were extreme sadness, loss of appetite, disturbed sleep patterns and social withdrawal.
People who received too little or too much love from their parents were more prone to depression because both experiences involve loss. Too little love from parents left the child feeling unworthy of their love and constant low self-esteem. Too much love from their parents left their child thinking that unconditional love will last their whole life, yet as they grow older the love they received as a child lessens. Both seek to compensate for their loss and become dependent on others for love/affection. A loss in adult life can bring back these childhood experiences, triggering those same feelings which elevate the adult feelings to severe levels. The adult may also blame the loved one for dying or deserting them and feel anger and rejection as a consequence. This anger may then be internalised, leading to guilt that may end in depression.
Some people become depressed without the loss of a loved one. Freud explains this by suggesting that the loss can be imagined or symbolic. For example, they may feel that unless they meet certain perceived expectations, they will be rejected and unloved. Freud suggested that to avoid the distress caused by any conflict, an individual could employ self-defence mechanisms, which would help prevent anxiety-arousing thoughts and impulses from reaching consciousness. Freud felt that regressions might be linked to depression because going back to a childlike state in order to tackle depressive symptoms, may bring back memories that trigger feelings of unworthiness and rejection, which will enhance the feelings already in existence.
Evaluation
- Difficult to test empirically as impossible to demonstrate unconscious motivations.
- Studies have shown that people with depression are angrier than normal people, but there is no evidence to show that this anger is directed inwards.
Behavioural
- Lewinsohn (74) – believes that learning theory can be used to explain depression. For example, if someone loses a job or is bereaved, there may be less chances for having pleasant experiences, and so no positive reinforcement is gained and depression may occur.
The depression may also be positively reinforced by getting sympathy or attention from others. However this does not explain why depression can continue after sympathy has waned.
- Seligman’s (74)- study on dogs found that helplessness can be learned. If placed in an inescapable and unavoidable situation, the dogs would accept their fate and lie down. Seligman applied this to humans, saying that helplessness is learned. People lose motivation, and they learn they are unable to influence situations.
Evaluation
- Is not a full explanation, and so is inadequate.
- Other studies have found no evidence of learned helplessness in humans, but that some people actually try harder to escape – could be due to individual differences, or a predisposition to depression
Cognitive
- Beck (67) – claimed that depression was due to negative thinking, and mainly 3 behavioural patterns:
- negative views of the self
- negative views of the world
- negative views of the future
He called this the cognitive triad. These thoughts are unconscious and unintentional. This causes people to develop a ‘negative self-schema’. These schemas may be the result of childhood experiences, such as abuse, neglect, bullying or the loss of a parent.
This all causes cognitive distortions, which causes them to view the world negatively. They may see bad things as their own fault, or may magnify bad things and minimise the good.
Evaluation
- Cognitive research has helped our understanding greatly over the past few decades.
- Cognitive therapies have proven very useful in treating and alleviating the symptoms of depression.
- Cause is difficult to establish, as high levels of negative thinking may be present in depressed individuals, it is correlational data. The negative thinking may not be the cause of depression, but a result of it.
Obsessive-Compulsive Disorder
What is OCD?
It has been categorized by the DSM-IV. Clinical characteristics include:
- Obsessions – recurrent thoughts perceived as repulsive or forbidden (e.g. germs everywhere)
- Compulsions – repetitive behaviours which reduce anxiety of he obsession (e.g. hand washing)
Diagnosis requires recurrent, persistent and intrusive or inappropriate thoughts which are not caused by the outside world. The individual must recognise that the behaviour is excessive and a product of their own mind.
Clinical Characteristics
| Obsessions
| Compulsions
|
| Cleanliness
| Rituals
|
| Doubts
| Checking
|
| Ruminations/internal debates
|
|
| Impulses
|
|
Sufferers of OCD experience obsessions. These are recurrent thoughts which cannot be ignored or pushed out of the mind and so create anxiety. An example of an obsession is thinking there are germs everywhere.
Sufferers also experience compulsions, which are repetitive behaviours that reduce anxiety caused by obsessions. The person is aware that the compulsions are excessive and unreasonable but believe something bad may happen if they are stopped, therefore compulsions also create anxiety. An example of a compulsion is washing hands continuously to get rid of germs.
Biological Explanations
According to the biological explanation genetic factors play a big role in developing OCD, including:
- Biochemicals
- Genetics
- Neuroanatomical
Biochemicals
- Zohar found that deficient uptake of serotonin was a characteristic of OCD.
- Lydiard found that when the patients taking serotonin increasing drugs are taken off them, they have a resurge of symptoms.
The first is the neurotransmitter serotonin, which is produced by one cell and is passed to other cells in the brain via receptors. It is thought that some receptors may block serotonin, therefore is cannot reach key areas in the brain. Serotonin deficiency means that nerve cells do not communicate properly; Serotonin affects the efficiency of communication in the cortex.
But 40% of OCD patients don’t respond to SSRIs, suggesting other neurotransmitters are involved. Dopamine has been said to be another factor in causing OCD.
Animal studies have found that by raising animal’s levels of OCD they exhibit similar behaviour of people with OCD.
Evaluation
- Drugs can increase levels of serotonin in the brain. SSRI and Anafril drugs do this and have been found to reduce the symptoms of OCD. Shows clear link between serotonin decrease and OCD.
- The role of serotonin in OCD has been supported by drug therapies which use SSRI’s to increase serotonin levels. They were successful in reducing the symptoms of OCD. However, there is no evidence that serotonin is the cause of OCD; it may just be an effect.
- Antipsychotic drugs block dopamine and when given to OCD patients, they reduced the symptoms significantly.
- However, again there is no evidence that dopamine is the cause of OCD, it may jus be an effect.
Genetics
For example a serotonin imbalance may be passed on from parent to child (inherited). First degree relatives of people with OCD are significantly more likely to have OCD than the general population.
- Nedstadt found 80 patients with OCD and 343 of their 1st degree relatives compared to 73 control patients and 300 of their 1st degree relatives.
People with a 1st degree relative with OCD are 5x more likely to get it than the general population.
- Billett’s meta-analysis of 14 twin studies found that identical twins were twice as likely to develop OCD if their twin had the disorder than fraternal twins.
Evaluation
- Genetic evidence suggests a high inheritance rate for OCD compared with other disorders. Concordance for OCD was found to be between 53% - 87%, whereas for depression it is 46%.
- Pauls (86) studied patients with tourettes and their families, and he found that OCD is a form of expression of the same gene that determines tourettes. However, tourettes is not the only disorder associated with OCD, obsessional behaviour is also seen in autism and anorexia. It is found that 2/3 patients with OCD experience at least one episode of depression. This suggests that the DSM classification is wrong. It could be that clinician ma be putting false terms to syndromes which have the same treatments. This labelling leads to a self-fulfilling prophecy.
- The fact that children display different behaviours associated with OCD suggests that it is not inherited. E.g. daughter may line up dolls, while mum washes dishes. If it was inherited, they would be the same.
Neuroanatomy
Another genetic factor in developing OCD is thought to be a mutation in the COMT gene, which terminated the action of dopamine and noradrenaline. The mutated gene may be inherited from both parents. However, this mutated gene appears in many healthy people, therefore it has been suggested that a single mutated gene doesn’t cause the disorder, but the disorder is expressed when one has may mutated genes.
- Rappoport and Wise found that OCD may be from a structural dysfunction in the CNS, Surgery to remove this dysfunction has been found to relieve OCD.
Evaluation
- The results from surgery have been inconsistent. Aylward found no difference between patients and controls.
- Serotonin levels could be due to dysfunctions in the brain, and so both causes could be linked.
Psychological Explanations
These say that there is a psychological reason for the development of OCD.
Psychodynamic
Freud said that OCD was caused by rigid toilet training practices in childhood, leading to internalised conflicts. The child becomes anally fixated; this expresses itself as an adult as obsessional cleaning compulsions.
Evaluation
- Salzman says that Freudian psychoanalysis may have a negative effect on patients when trying to help them recover from OCD. This is because it makes patients think too much. Short term psychotherapy is seen to be more beneficial.
Behavioural
If a child sees a model behaving in this way, and the model is rewarded then it is more likely to be repeated. When the child cleans something then reduces their worry or negative emotions, they have avoided a negative situation and this reinforced OCD through operant conditioning.
Cognitive
OCD stems from faulty thinking which are taken to the extreme. When the environment stimuli are paired with these anxiety-provoking thoughts. This triggers the obsessional thoughts and compulsive actions.
Evaluation
- Clark found that people with OCD do have more intrusive thoughts, and that their behaviours are to neutralise these thoughts
- Cognitive therapy has been found to be very successful in treating patients.
Comments
Contributers
