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 genesĀ  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 DISCĀ  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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