Month: June 2023

Categories
A2 - Organisational Psychology

Maslow’s Hierarchy of Needs

________ = most important text;

________ = important text;

________ = illustrative text (examples);

________ = text to memorise as is (facts and figures)

Description of the Theory

Maslow’s theory of motivation at work suggests that individuals have five basic needs arranged in a hierarchical pyramid. The needs include physiological needs, safety needs, love and belongingness needs, esteem needs, and self-actualization needs. Maslow believed that these needs must be fulfilled in order, starting from the bottom, for motivation to increase. In the workplace, employees prioritize fulfilling their basic physiological and safety needs, such as adequate wages and a safe environment. Once these needs are met, they seek love and belongingness, including acceptance and social interaction. Finally, employees strive for esteem and self-actualization, desiring respect, recognition, personal growth, autonomy, and freedom.

Relevant Issues and Debates

Application to Everyday Life

Strengths of Application to Everyday Life

1. By addressing employees’ basic needs, organizations can create an environment that enhances motivation. For example, by ensuring employees have enough wages to meet their physiological needs, such as buying food and staying warm, organizations can motivate them.

2. Another strength is the theory’s potential to prevent problems at the workplace. For instance, providing a pension plan and maintaining a safe workplace can help employees feel protected and valued.

Weaknesses of Application to Everday Life

1. The application of Maslow’s hierarchy of needs to everyday life lacks ecological validity as it oversimplifies the complex nature of human motivation. For example, it suggests that once physiological and safety needs are met, an individual will automatically prioritize love and belongingness needs. However, in reality, a person with achievement orientation would prioritize esteem needs.


2. The application of Maslow’s hierarchy of needs to everyday life shows cultural bias by assuming a universal hierarchy of needs that applies to all individuals. In reality, collectivist cultures prioritize belongingness needs over individualistic cultures, which prioritize esteem needs and self-actualization.

Individual and Situational Explanations

Maslow’s theory supports an individual explanation because it focuses on the individual’s needs and motivations within the workplace.. It emphasizes the individual’s progression through the hierarchy of needs and their personal fulfillment, rather than situational factors.

Strengths of the Individual Explanation

1. The individual explanation has application in the workplace. By addressing employees’ basic needs, organizations can create an environment that enhances motivation. For example, by ensuring employees have enough wages to meet their physiological needs, such as buying food and staying warm, organizations can motivate them.

2. The individual explanation emphasizes the role of personal responsibility in fulfilling higher-level needs. For instance, an employee can actively seek opportunities for advancement, engage in decision-making processes, or participate in skill-enhancing courses to fulfill their esteem and self-actualization needs. 

Weaknesses of the Individual Explanation

1. The theory neglects the interaction of individual and situational factors in the workplace. For instance, it fails to acknowledge that factors such as organizational culture, leadership style, and job characteristics can significantly influence an employees’ needs, thereby, his motivation.


2. The individual explanation reduces workplace motivation by limiting it to a hierarchical model of basic needs. It fails to consider the various psychological, social, and environmental factors that shape an individual’s motivation. For example, personal goals, career aspirations, job satisfaction, etc.

Cultural Differences

Maslow’s theory does not support cultural differences because it assumes a universal hierarchy of needs. However, cultural values and priorities can vary, influencing which needs are considered more important. For example, individualistic cultures may prioritize self-actualization, while collectivist cultures may prioritize belongingness needs.

Strengths of Cultural Differences

1. Understanding cultural variations in the importance placed on various needs can help organizations create inclusive environments for all employees. For example, recognizing that some individuals prioritize esteem needs over social needs can help strategize individual accomplishments, job titles, promotions, etc.

2. The nomothetic approach of Maslow’s theory allows for recognizing cultural variations in the prioritization of needs, when applied to different cultures. For instance, while esteem needs may be significant for individualistic cultures, collectivistic cultures might emphasize belongingness needs.

Weaknesses of Cultural Differences

1. One weakness of cultural differences is the potential of stereotyping in the workplace. For example, assuming that employees from collectivist cultures lack esteem needs and thereby the ambition to pursue higher-level positions may prevent them from achieving their full potential.

2. Another weakness is the presence of ethnocentrism in the workplace. For instance, in a multinational company with a predominantly Western cultural orientation, the organization may highlight individual accomplishments following esteem needs. However, employees from Asian cultures who value collective achievements would feel rejected as their belongingness needs would not be met.

Determinism versus Free Will

Maslow’s theory supports a free will perspective. It suggests that individuals have the freedom to progress through different stages based on their choices and experiences. For example, when basic physiological needs are met, employees have the freedom to pursue higher needs like esteem and self-actualization through job decisions and personal growth.

Strengths of Free Will

1. The free will perspective acknowledges that individuals have the autonomy and agency to satisfy their needs in the workplace. For example, an employee can work towards satisfying his self-actualization needs by seeking personal growth opportunities, such as enrolling in skill development courses.

2. The free will perspective has good ecological validity because it acknowledges that people are not solely driven by external factors but also by their internal desires and aspirations. For instance, Maslow’s hierarchy highlights that employees have diverse needs beyond just basic survival or financial security. 

Weaknesses of Free Will

1. The free will perspective overlooks organizational factors and places undue blame on individuals for their motivational state. For example, if an employee is demotivated due to low wages or an unsafe workplace, solely attributing their lack of motivation to personal choice neglects the impact of external circumstances that may be beyond their control.


2. It  overlooks how various external factors can impact behavior, making it challenging to control. For instance, if an employee’s physiological needs are not met, by being given insufficient wages to afford food, expecting him to show optimal behavior is unrealistic.

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Categories
A2 - Clinical Psychology

Freeman et.al. (2003) – Key Study

The Study

Aims

  • To investigate whether nonclinical individuals have persecutory thoughts in virtual reality;
  • To investigate cognitive factors that predict the occurrence of persecutory ideation in virtual reality, with a particular focus on emotional processes.

Method

Sample
  • 24 individuals;
  • all without a history of mental illness;
  • recruited by advertising;
  • all from University College London;
  • 21 were students;
  • 3 were administrative staff;
  • 12 males and 12 females;
  • paid volunteers

Procedure

Step-by-step outline-

  • Consent and Information:
    • Consent obtained from participants for their participation in the study:
    • Participants are not informed that the study specifically examines persecutory thoughts to prevent priming of reactions.

  • VR Equipment Training:
    • Participants then received training on how to use the virtual reality (VR) equipment.

  • Entering the Virtual Environment:
    • Participants were then asked to enter the virtual environment which was a virtual ;
    • Instructions given: “Please explore the room and try to form some impression of what you think about the people in the room and what they think about you.”

  • Selection of Virtual Scene:
    • A neutral library scene was chosen for the study, considering the university population;
    • The virtual room was designed as a library, but participants were not informed of this during the study to allow them to form their own impressions.

  • Avatars in the Library:
    • There are 5 avatars in the library scene;
    • 3 avatars sat at one desk, while 2 avatars sat at another desk on the opposite side of the room.

  • Ambiguous Avatar Behavior:
    • Occasionally, the avatars showed potentially ambiguous behavior such as smiling, looking around, and talking to each other.

  • Duration in the Virtual Room:
    • Participants spent 5 minutes in the virtual room.

  • Exiting the Virtual Room:
    • Participants were instructed to leave the virtual room after the allotted time.

  • Questionnaire and Interview:
    • All participants then completed a questionnaire and a short semi-structured interview regarding their experiences in the virtual environment;
    • The interviews were video recorded and later rated by an expert clinical psychologist on a 6-point scale for persecutory ideation

  • Handling Priming of Persecutory Thoughts:
    • The study design addressed the possibility of priming persecutory thoughts through the questionnaires measuring cognitive processes (see measures section below);
    • Half of the participants completed the questionnaires after exiting the virtual environment;
    • The other half completed the questionnaires both before and after entering the virtual environment.

  • Participant Balance and Compensation:
    • Male and female participants were balanced in each of the two conditions (pre- and post-virtual environment completion of questionnaires);
    • Participants were compensated for their participation in the study.

Measures
  1. Brief Symptom Inventory (BSI):
  • A 53-item self-report measure to assess 9 symptom dimensions over the past 7 days;
    • 9 dimensions include Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism;
  • Each item is rated on a 5-point distress scale (0–4);
  • Total score obtained is the Global Severity Index.

2. Paranoia Scale:

  • A 20-item self-report scale to measure paranoia in college students;
  • Measures both ideas of persecution and reference;
  • Each item is rated on a 5-point scale;
  • Scores range from 20 to 100, with higher scores indicating greater paranoid ideation.

3. Spielberger State Anxiety Questionnaire:

  • A 20-item self-report measure of state anxiety;
  • Each item is rated on a 1–4 scale;
  • Scores range from 20 to 80, with higher scores indicating higher levels of anxiety.

4. VR-Paranoia Questionnaire:

  • A 15-item self-report questionnaire specifically devised for the study;
  • Assesses participants’ views of the avatars in the virtual environment;
  • 3 areas assessed –
    • persecutory thoughts about the avatars (VR-Persecution),
    • ideas of reference about the avatars (VR-Reference), and
    • positive beliefs about the avatars (VR-Positive)
  • Each item is rated on a 4-point scale (0–3);
  • Scores can range from 0 to 15 for each subscale, with higher scores indicating greater endorsement of items.

5. Sense of Presence Questionnaire:

  • Assesses the extent to which participants experience a sense of being in the virtual world;
  • Consists of 6 questions rated on a scale of 1 to 7;
  • Higher numbers indicate greater reported presence;
  • A score of 6 or 7 on a question is coded as 1, while all other scores are coded as 0;
  • Total score can range between 0 and 6.

Results

  • General:
    • Mean score on the Paranoia Scale: 31.8, SD = 10.8, minimum = 20, maximum = 61.
    • No significant difference in Paranoia Scale scores between males and females.

  • Persecutory Ideation in the Virtual Library:
    • VR-Persecution scores were positively correlated with VR-Reference scores (r = +0.48) and negatively correlated with VR-Positive scores (-0.54);
    • Persecutory ideation in VR was also positively correlated with blind ratings of persecutory ideation from recorded interviews (r = +0.59).

  • Sense of Presence in VR:
    • Participants reported a moderate sense of presence in the virtual library;
    • Anxiety levels did not increase after entering the virtual environment.

Predictors of Persecutory Ideation in VR:

  • VR Persecution did not significantly correlated with scores on the Paranoia Scale;
  • Higher VR-Persecution scores tended to be associated with higher BSI-Paranoia scores;
  • VR Persecution scores correlated with other BSI dimension scores, Spielberger State Anxiety score, and sense of presence score;
  • Higher levels of interpersonal sensitivity and anxiety were associated with higher levels of persecutory ideation in virtual reality.

Conclusions

  • Nonclinical individuals have persecutory thoughts in virtual reality;
  • The cognitive and emotional processes of paranoia, reference and anxiety predict the occurrence of persecutory ideation in virtual reality.

Methodological Evaluation

Sampling

Sample Characteristics
  • Strengths
    • Study involved non-clinical individuals, broadening understanding of persecutory ideation beyond diagnosed mental health patients;
    • Equal gender recruitment ensured representative sample and minimized gender biases in study findings.
  • Weaknesses
    • With only 24 individuals, findings may lack generalizability. A larger sample ensures stronger results;
    • Mainly university students and staff were included, limiting generalization to non-university  populations.
Sampling Technique
  • Paid Volunteer
  • Strengths
    • Participants easier to recruit as too many people would be fearful of VR or find the experiment too time consuming and refuse to participate;
    • Participants more cooperative for a lengthy study that required many self report questionnaires to be answered sincerely.
  • Weaknesses
    • Participant recruitment introduced bias as those interested in virtual reality were more likely to participate;
    • Participants knew about participating in a virtual environment beforehand, potentially changing their behaviour to watch the avatars too closely

Operationalization of Variables

  • Strengths
    • The study employs recognized and validated tools (BSI, Paranoia Scale, etc.) for accurate assessment, increasing validity;
    • Combining semi-structured interviews and observer ratings added qualitative depth to quantitative measures, increasing scope of findings
  • Weaknesses
    • No standard questionnaire for measuring paranoia in virtual reality; researchers created their own, challenging reliability;
    • Study used ambiguous avatars in a library scene, potentially influencing participants’ perceptions of persecution, reducing ecological validity

Examples of Controls

  1. Non-clinical individuals were recruited to study persecutory ideation in virtual reality without preexisting mental illness;
  2. A neutral library scene was used to explore persecutory thoughts without explicit hostility;
  3. Questionnaires were completed before and after the virtual environment to assess potential priming effects;
  4. An expert clinical psychologist conducted a semi-structured interview and rated participants’ responses for persecutory content.

Research Method (Correlational Study)

  • Strengths
    • Study used multiple measures like surveys, interviews, and observations to understand worry and sadness, increasing validity;
    • Study looks at how personality and emotions relate to persectory thoughts, offering new insights for research
  • Weaknesses
    • Only 24 people were part of the study, who were not mentally ill. Results may not apply widely;
    • Participants weren’t randomly assigned for different groups, making it harder to conclude that paranoia causes persecutory ideation.

Ethical Evaluation

  1. Informed consent: Participants consented but knowledge of study was unclear;
  2. Right to withdraw: not explicitly mentioned;
  3. Deception: Researchers hid their focus on persecutory thoughts;
  4. Protection from physical harm: No apparent physical harm mentioned;
  5. Protection from psychological harm: Potential distress to people having persecutory ideation in relation to the avatars in the virtual library;
  6. Debriefing: Questionnaire and interview, but debriefing not mentioned;
  7. Privacy: Virtual environment privacy measures not specified;
  8. Confidentiality: Handling of personal data and identity not addressed.

Issues and Debates

Individual and Situational Explanations

Both explanations supported

  • Individual Explanation
    • Paranoia as explaining persecutory ideation
  • Situational Explanation
    • VR environment explaining persecutory ideation

  • Strengths of Individual Explanation
    • Encourages treatment of paranoia to stop persecutory delusions;
    • Encourages delusional patients to take responsibility for reducing their paranoid thinking.

  • Weaknesses of Individual Explanation
    • Use of self-report methods to understand paranoid thinking, subject to social desirability, reducing validity
    • Separating the influence of individual and situational factors is difficult – whether VR environment causes persecutory ideation or paranoia

  • Strengths of Situational Explanation
    • The study used a special computer room with lifelike characters to simulate real-life situations, increasing ecological validity;
    • Psychologists indirectly encouraged to look at behaviours of people around a patient also while diagnosing and treating schizophrenia, increasing social responsibility 

  • Weaknesses of Situational Explanation
    • People only used the virtual world for 5 minutes, so it may not show long-term effect of situation;
    • The study didn’t compare virtual experiences with real-life situations, which could confirm paranoid thoughts in the real world.

Idiographic versus Nomothetic

Both approaches explanation supported

  • Idiographic Approach
    • Study included individual comments (qualitative data) to understand unique experiences and subjective perspectives of participants;
  • Nomothetic Approach
    • Study examined correlations (quantitative data) between variables to identify general patterns and trends applicable to a broader population.

  • Strengths of Idiographic Approach
    • Provided rich qualitative data through semi-structured interviews, capturing individual experiences and perceptions;
    • Allowed for personalized assessment of persecutory thoughts and beliefs, providing a detailed understanding of participants’ unique perspectives

  • Weaknesses of Idiographic Approach
    • Subjectivity in scoring and interpreting qualitative data may introduce bias and affect the reliability of the findings;
    • Limited generalizability due to the small sample size and specific characteristics of the participants from one university.

  • Strengths of Nomothetic Approach
    • Provides quantitative data for statistical analysis, allowing for generalization and comparison between participants;
    • Allows for identification of correlations between variables, such as persecutory thoughts and emotional distress.

  • Weaknesses of Nomothetic Approach
    • Limited depth of understanding due to reliance on quantitative measures, potentially missing nuanced experiences and perspectives;
    • Lack of contextual information and individual variability might overlook important factors influencing persecutory thoughts and emotional distress.

Generalizability of Findings

  • Strengths of Generalizability
    • The use of virtual reality (VR) creates a realistic environment, increasing the ecological validity of findings;
    • The study included an equal number of male and female participants, allowing for potential gender-related differences to be considered in the generalizability of the findings

  • Weaknesses of Generalizability
    • With only 24 participants, the findings may not fully represent the broader population, limiting generalizability;
    • The study took place in a virtual reality setting with avatars, which may not fully reflect real-life interactions and situations.

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Categories
A2 - Clinical Psychology

Genetic Explanation of Schizophrenia

The Explanation

  • Schizophrenia has a strong genetic component.

  • Monozygotic (identical) twins have a higher concordance rate for schizophrenia as compared to dizygotic (fraternal) twins.
    • Gottesman and Shields analyzed 24 sets of MZ twins and 33 sets of DZ twins from a sample of 467 twins registered at a hospital in London. They found that around 50% of MZ twins shared a schizophrenic status, while only about 9% of DZ twins did.

  • Genome-wide association studies (GWAS) have identified multiple gene variants associated with schizophrenia.

  • Schizophrenia is a polygenic condition, meaning it involves thousands of gene variants.

  • Many of the genes linked to schizophrenia are involved in the synthesis, transportation, and breakdown of neurotransmitters like dopamine.

  • DiGeorge syndrome, which involves a deletion on chromosome 22, increases the risk of developing schizophrenia.
    • In this syndrome, the COMT gene, which codes for an enzyme involved in dopamine breakdown is found to be deleted.

  • Another gene, the DISC1 gene may increase the risk of schizophrenia by affecting the neurotransmitter GABA, which regulates dopamine activity.

Relevant Issues and Debates

Individual and Situational Explanations

  • Genetic explanation is purely individual

  • Strengths
    • When comparing identical and non-identical twins, higher schizophrenia rates in identical twins suggest genetic influence, guiding prevention of the disorder;
    • DiGeorge syndrome with COMT gene deletion links to increased risk of schizophrenia, encouraging genetic testing for early identification

  • Weaknesses
    • Genes are important, but not enough to explain schizophrenia. Other factors are involved too, such as cognitive style;
    • Schizophrenia genetics are complicated, with many genes involved, making it hard to understand the disorder through genes  alone

Nature versus Nurture

Genetic explanation supports only nature

  • Strengths
    • When comparing identical and non-identical twins, higher schizophrenia rates in identical twins suggest genetic influence, guiding prevention of the disorder;
    • DiGeorge syndrome with COMT gene deletion links to increased risk of schizophrenia, encouraging genetic testing for early identification.

  • Weaknesses
    • Genes and the environment work together. Genetic differences can be affected by environmental factors like stress or trauma;
    • MZ twins are treated more similarly than DZ twins by parents because of their same gender and appearance, so it’s hard to tell if differences are from genes or environment

Reductionism versus Holism

Genetic explanation is reductionist

  • Strengths
    • Focusing on specific genes such as COMT in schizophrenia helps us understand its genetic causes better and find targeted treatments such as those reducing dopamine levels;
    • Finding specific genes for measurement like COMT and DISC1 helps scientific investigation and knowledge advancement about role of genes in schizophrenia

  • Weaknesses
    • Focusing on genes and chemicals oversimplifies schizophrenia, ignoring its complexity with cognitive,environmental and social factors;
    • Reducing schizophrenia to genes overlooks the impact of stress, trauma, substance abuse, and social factors on the disorder, reducing generalizability

Determinism versus Free Will

  • Genetic Explanation is determinist

  • Strengths
    • Genes play a big role in schizophrenia based on studies of families and twins. DNA determines susceptibility, reducing the tendency to blame the individual;
    • COMT and DISC  gene variations are linked to schizophrenia, showing a genetic tendency for the disorder. Thus, genetic risk can be controlled to prevent the disorder

  • Weaknesses
    • Schizophrenia is caused by many genes working together, but no single gene determines it completely. This challenges the deterministic explanation;
    • Schizophrenia is not only influenced by genes but also by environmental factors like stress or trauma, making the explanation reductionist.

Idiographic versus Nomothetic

  • Strengths
    • Large-scale studies like family, twin, and genome-wide association studies have found strong evidence for role of genes in schizophrenia, increasing validity;
    • Data has been gathered in these studies from very large and diverse samples, increasing generalizability to populations.

  • Weaknesses
    • Nomothetic approach ignores personal experiences and individual differences in schizophrenia’s development and symptoms;
    • Nomothetic approach oversimplifies complex factors in schizophrenia, ignoring how genetics, environment, and psychology interact to cause the disorder.

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Categories
A2 - Clinical Psychology

ICD-11 Criteria for Schizophrenia

________ = most important text;

________ = important text;

________ = illustrative text (examples);

________ = text to memorise as is (facts and figures)

Description of Criteria

The ICD-11 criteria for schizophrenia include a set of symptoms and duration requirements for diagnosis. First, there must be characteristic symptoms such as delusions, hallucinations, disorganized thinking, and negative symptoms. Second, these symptoms must be present for a significant portion of time during a one-month period. Third, continuous signs of the disorder must be observed for at least six months, which includes prodromal or residual symptoms. Fourth, other potential causes for the symptoms must be ruled out, such as substance abuse or medical conditions. Finally, the diagnosis requires significant impairment in social, occupational, or personal functioning.

Relevant Issues and Debates

Individual and Situational Explanations

The ICD-11 criteria for schizophrenia primarily support an individual explanation. It focuses on the presence of characteristic symptoms like delusions, hallucinations, and disorganized thinking in the affected person, rather than situational factors.

Strengths of Individual Explanation

1. The individual explanation in the ICD-11 criteria for schizophrenia allows for practical application to everyday life. For example, it emphasizes the presence of symptoms like delusions and hallucinations that are experienced by the affected person, enabling clinicians to assess and provide appropriate interventions tailored to the individual’s needs.

2. The individual explanation in the ICD-11 criteria for schizophrenia promotes the notion of personal responsibility. By emphasizing the presence of symptoms like disorganized thinking, it recognizes that the affected person plays a crucial role in managing their symptoms and seeking appropriate treatment.

Weaknesses of Individual Explanation

1. The ICD-11 does not explicitly consider how external stressors, such as trauma or social circumstances, may contribute to the development or exacerbation of symptoms. This limitation hinders a comprehensive understanding of the complex interplay between individual and situational influences.

2. The individual-focused perspective in the ICD-11 criteria for schizophrenia tends to reduce the disorder by overlooking the broader societal and cultural contexts that shape an individual’s experiences. For example, the criteria do not extensively explore the influence of cultural beliefs, discrimination, or socioeconomic factors, which are relevant in understanding schizophrenia holistically.

Idiographic versus Nomothetic Approach

The ICD-11 criteria for schizophrenia primarily support a nomothetic approach. It provides a standardized set of symptoms and diagnostic guidelines that emphasize the presence of specific symptoms such as delusions, hallucinations, etc. shared across different cases.

Strengths of Nomothetic Approach

1. The nomothetic perspective allows for the identification of widespread principles of human behavior. For example, it outlines specific symptom criteria such as delusions, hallucinations, and disorganized thinking that are commonly observed across individuals with schizophrenia, providing a framework to understand and classify their experiences.


2. The criteria demonstrate strength in psychometrics by providing a minimum duration of symptoms and specifying the number and types of symptoms needed for diagnosis, enhancing the reliability and validity of assessments and diagnoses.

Weaknesses of Nomothetic Approach

1. The nomothetic perspective has a weakness in terms of reductionism. The criteria does not fully capture the unique subjective experiences and variations in symptom manifestation among different individuals with schizophrenia. For example, some patients may have more negative than positive symptoms, making their diagnosis difficults.

2. Another weakness is that it can restrict the tailoring of treatments based on a person’s specific circumstances. For example, the criteria do not account for factors such as co-occurring conditions, personal preferences, or social support systems that may significantly influence treatment outcomes.

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Categories
A2 - Clinical Psychology

A Case Study of Schizophrenia – Aneja et.al. (2018)

Case Description

Demographics

  • 14 year old boy;
  • remarkable physical features – elongated face, large ears;
  • middle SES;
  • residing in urban area;
  • attained age-appropriate developmental milestones;
  • born from unplanned but wanted pregnancy

Background

  • exposed to father’s aggression from childhood;
  • boy 10 years old when parents divorced over domestic violence issues;
  • started living with maternal grandparents from when he was 11 years old

Early Symptoms

  • not specific to schizophrenia
  • declining academic performance and handwriting starting at 12 years of age;
  • fist fights and other undesirable behaviour at school;
  • preference for solitary activities, particularly eating alone at home

Early Treatment

  • consultation with private psychiatrist;
  • medicine given which reduced aggression and irritability;
  • medicine gradually stopped

Intermediate Symptoms

  • after 1 year of early treatment, schizophrenia-specific symptoms seen;
  • auditory hallucinations, hearing commanding voices;
  • paranoia of mother conspiring with those talking in commanding voices to tease him;
  • eventual drop out from school;
  • talking to self and shouting at imaginary persons till late night;
  • declining socialization and self-care

Intermediate Treatment

  • consultation with a different psychiatrist;
  • diagnosis of schizophrenia now achieved;
  • prescription of antipsychotic medicines;
  • some improvement in symptoms;
  • poor compliance due to side effect of weight gain;
  • relapse within 3 months

Hospitalization

  • Hospitalization due to frequent aggressive episodes;
  • diagnosis of very early onset schizophrenia (VEOS) achieved;
  • initial improvement with antipsychotic medicines and subsequent discharge;
  • readmission to hospital after return of hallucinations and aggression after two weeks;
  • ECT (electro-convulsive therapy) now administered;
  • psychoeducation regarding schizophrenia and supportive psychotherapy provided to family;
  • activity schedule, occupational therapy and modifications for diet also provided to boy;

Recovery

  • resolved issues post hospitalization – violence, hallucinations
  • unresolved issues – irritability, socialization, apathy, avolition, weight gain, aversion to start school, bone marrow function

Relevant Issues and Debates

Case Studies

  • Justification
    • in-depth exploration of symptoms, treatment and recovery of schizophrenia in the body;
    • longitudinal investigation of the progress of schizophrenia in the boy – right from birth and childhood circumstances to treatment and recovery in the present day

  • Strengths
    • Comprehensive understanding of schizophrenia;
      • investigation of aspects like difficulties in school, academic decline, challenges in the family, treatment using outpatient and inpatient treatment, use of medication and ECT, etc.
    • Understanding of Progression of schizophrenia
      • changes in behaviours of boy noted overtime such as declining academic performance, increasing social withdrawal, increasing aggression and violence, etc.

  • Weaknesses
    • Limited generalizability of findings;
      • the boy’s case had peculiar features, including his facial appearance, relationship with father, history of domestic violence at home, etc. which integrate to form a unique case that might not apply to child cases of schizophrenia;
    • Subjectivity of Findings
      • diagnosis and treatment of the boy was subject to the clinical judgment of different psychiatrists

Individual and Situational Explanations

  • Case supports both explanations–
    • Individual explanation supported by peculiar appearance of boy and temperament;
    • Situational explanation supported by aggressive behaviour of father and divorce during childhood and exposure to various treatments

  • Strengths
    • Holistic perspective;
      • inclusion of both individual and situational aspects gives a more comprehensive understanding of the disorder
    • Increased Potential for Treatment;
      • consideration of individual and situational factors enables psychiatrists better opportunity to treat patients as they can target multiple factors for improvement

  • Weaknesses
    • Limited exploration of Situational Explanation
      • more situational factors such as the boy’s school environment, relationship with teachers and fellow students, etc. could be investigated further for even better understanding of the disorder
    • Limited exploration of Interaction of Individual and Situational Explanations
      • while both explanations have been investigated – their interaction – or how each compounds with the other in the progression of the disorder is not sufficiently explored, limiting understanding

Use of Children

  • Strengths
    • Developmental Perspective of Schizophrenia;
      • gradual development of schizophrenia from general symptoms in childhood to specific progression in adolescence explored
    • Early Identification and Intervention
      • a VEOS case is presented by using a child, showcasing the impact of schizophrenia in near adolescence, its identification and intervention

  • Weaknesses
    • Ethical Considerations
      • the boy was too disturbed to provide informed consent to his diagnosis and treatment – and to withdraw even when he experienced severe side effects and many interventions proved ineffective
    • Practical Challenges
      • the boy was too young especially during the early phase to self-report his experiences and he might have been selected in the first place due to availability which is not the case with many children, limiting generalizability

Idiographic versus Nomothetic

  • Study largely supports an idiographic approach since it is a single case study

  • Strengths
    • Individualized Understanding
      • unique factors to the boy – his family background, symptoms at school, physical appearance, response to medications, improvement of symptoms in response to various treatments, etc. explored to provide a deeper understanding
    • Personalised Treatment
      • boy provided with treatments specific to his symptoms at various stages – first general medication, then antipsychotic medication, then ECT and tailored therapy, etc. resulting in probably the best outcomes

  • Weaknesses
    • Restricted Generalizability
      • since specific investigation and treatment was conducted, the understanding and application may not generalize beyond the boy’s case
    • Extensive use of Resources
      • customization of treatment to the boy meant consultation with various psychiatrists, trial of different treatments, etc. over the course of several years – which is not practicable beyond research investigation

Generalizability of Findings

  • Strengths
    • Longitudinal Investigation
      • the case shows possibility of recovery from several intense symptoms of schizophrenia over the course of long-term treatments
    • Multidisciplinary Approach
      • use of a variety of methods borrowed from psychiatry, psychology and occupational therapy to treat the boy brings about the role of complex factors in schizophrenia treatment

  • Weaknesses
    • Focus on Single Case of Schizophrenia
      • only the case of one boy of a very specific age, nationality, etc. was investigated; restricting generalizability to adults, children of other nationalities, etc.
    • Limited Followup of Treatment Outcomes
      • only a 6-month long follow-up was done to study which symptoms of the disorder still persisted or did not in the boy, limiting understanding to longer term outcomes

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