Discuss issues of reliability and validity associated with classification and diagnosis of schizophrenia (3 marks + 16 marks)

Reliability and validity have been associated with the classification and diagnosis of schizophrenia. In terms of reliability, psychologists would have to agree on the same diagnoses when separately assessing patients. If they fail to do that, this means that it lacks reliability. Additionally, if psychologists fail to agree on who has schizophrenia, then this raises questions about what schizophrenia actually is. One key issue is that the symptoms of schizophrenia tend to be unreliable. There have been psychologists that have assessed 489 admissions to a psychiatric unit to find out whether positive or negative symptoms were more suitable for determining a diagnosis of schizophrenia. They found that positive symptoms were more useful than negative symptoms for diagnosis. The diagnosis for schizophrenia is too broad and therefore different combinations of characteristics can have the same diagnosis of schizophrenia, for example, it was found that patients with a condition called DID actually showed more schizophrenic symptoms than people diagnosed as schizophrenics. In another experiment, psychiatrists were asked to distinguish between bizarre and non-bizarre delusions and researchers concluded that even for this requirement, it lacked reliability as psychiatrists failed to distinguish between schizophrenics and non-schizophrenics. This can be seen to be problematic because of the fact that psychiatrists may be biased, looking for evidence of schizophrenia in patients. Moreover, the researchers asked the psychiatrists, which means that they used a form of an interview, which may, itself, be unreliable, as they may not always be truthful during interviews, only conforming to the socialistic views. Studies have also shown that there are massive differences in terms of reliability across and between countries. A psychologist gave a description of a patient to 134 US psychiatrists and 194 British psychiatrists. He found that 69% of the US psychiatrists had diagnosed the patient as schizophrenic, but only 2% of the British psychiatrists gave the same diagnosis. This clearly shows issues of reliability between countries. Another study which raised the issues of reliability was Rosenhans study, where normal people offered themselves to a psychiatric hospital in the USA, claiming that they heard voices in their heads saying hollow empty and thud. They were all diagnosed as schizophrenic and admitted and all throughout their stay at the hospital, none of the staff recognised them as normal, raising questions about what schizophrenia actually is. Outline and evaluate one or more biological explanations of schizophrenia (25 marks) The biological explanation of schizophrenia states that there is somehow a genetic predisposition, and to test this, psychologists have assessed genetic formations by assessing twin and adopted families. Gottesman looked at concordance rates of MZ and DZ twins. He had analysed over 40 studies of MZ and DZ twins and found that, for MZ twins, if one twin had schizophrenia, then there was a 48% chance of the other twin developing

the disorder. For DZ twins, this was 17%. In another study, Gottesman examined over 57 schizophrenics, 40% of them being MZ and 60% of them being DZ. If the pair was seen to be discordant, in this case, one twin had schizophrenia and the other did not, then the non-schizophrenic was observed for 13 years to see whether the disorder would develop at a later stage. They found that the concordance rate for MZ twins was 42%, similar to the first study and they found a 9% concordance rate for DZ twins. When looking at studies that looked at the genetic contribution to schizophrenia, the fact that MZ twins did not share a 100% concordance rate indicates that it was not just purely genes that were involved, environmental factors could have been too. Identical twins are also more likely to be raised in the same environment and have the same friends as well as experience the same things. These factors alone may have affected Gottesmans study. Also, the nature v nurture debate. Some, such as Gottesman, may argue that schizophrenia is due to genetics alone, however, it can be argued that behaviour can be obtained through experience, such as learning through interactions with the physical and social environment. For example, the behavioural explanation, if a child watches her big sister, who is schizophrenic, receive more attention from her parents because of her schizophrenic characteristics, she may copy that behaviour in order to gain the same amount of attention. Additionally, because her sisters behaviour is reinforced (more attention), the younger sister may also gain the same level of attention and therefore continue to act this way i.e. laugh in inappropriate situations or claim that she sees or hears things. It is also difficult to differentiate between MZ and DZ twins, especially at birth. However, in many of the first studies, such as Gottesman, blood tests were not taken in order to access whether they were MZ or DZ twins and the decision was purely based on physical appearance. Another biological explanation for schizophrenia states that an access of dopamine activity in the causes schizophrenia. Dopamine is a neurotransmitter that causes neurons to fire too easily and transmit too many messages. This overload in messages is said to cause schizophrenic like characteristics. Schizophrenics are thought to have a high number of D2 receptors, which increase the levels of dopamine and therefore, more neurons firing. There are three sources that are said to play a key role in schizophrenia and dopamine. Antipsychotic drugs, although there are many types, work by blocking the activity of dopamine in the brain and by reducing stimulation of dopamine, they get rid of symptoms such as hallucinations and delusions. The fact that these drugs get rid of so many symptoms of schizophrenia suggests that they may be a significant contribution to the disorder. Other drugs, such as amphetamines, stimulate nerve cells containing dopamine, causing an overload in dopamine levels. Large doses of amphetamines given to people who have never had psychological disorders can cause the characteristics hallucinations and delusions of a schizophrenic. Another role is of Parkinsons disease. It has been found that there are low levels of dopamine activity in people who suffer from Parkinsons disease. It was

found that some people who were taking the drug known as L-DOPA, to raise their dopamine levels, were developing schizophrenic like symptoms. The dopamine hypothesis is known to state that high levels of dopamine is the cause of schizophrenia, however, it may be that the disorder causes high levels of dopamine, not the other way around, therefore the cause and effect cannot be inferred. Dopamine is not the only neurotransmitter involved, as there is research to show that serotonin plays a role. There are other drugs that treat schizophrenia which not only have an effect on dopamine but also other neurotransmitters, such as serotonin. The new drugs are seen as more effective in controlling the symptoms of schizophrenia than the old drugs, which only dealt with dopamine. Researchers are currently exploring how dopamine interacts with other neurotransmitters in the brain. The diathesis-stress model combines both genetic and biological approach with levels of stress. It suggests that schizophrenia results from an interaction between genes and environmental stress, as schizophrenia cannot be purely caused by genetic factors alone. Psychologists believe that addictive behaviour can be explained solely by cognitive factors Discuss this claim with reference to the above quotation. The cognitive view on addiction states that our ways of thinking and interpreting events may lead to the development of addictive behaviour. A person may use drugs as a way of dealing with their personal problems. There are many theories and models that help the explain this claim. The self-medication model states that individuals deliberately take drugs to treat the psychological symptoms they suffer from. The drugs are seen as helping them with a particular problem. Initiation of drug use and the choice of that drug depends on the specific effect that the person desires. For example, some drugs, such as alcohol, are chosen because they may help the person deal with anxiety, whereas others only consume alcohol to control their aggressive behaviour. Smokers have reported that they only continue to smoke as a way of relieving stress, even though there has been research which does not support this. Psychologists have shown that smokers are actually more stressed than non-smokers as smoking has an immediate effect on stress because it relieves the withdrawal symptoms, it has an on-going effect from smoking that increases stress. The fact that the self-medication model states that psychological stress causes addictive behaviour has been supported. A psychologist found that sexually abused women were more likely to be addicted to alcohol and other drugs as a way of forgetting the abuse. However, it fails to explain why, in many cases, addictive behaviour is not solely caused by psychological problems. Another explanation is through the rational choice theory which is consistent with the idea that peope choose to take part in an activity as a way of weighing up the costs and benefits. The activity is only seen to be out of control if it is unusually frequent or if the costs are high. The theory

uses the idea of utility, in which they measure the level of satisfaction coming from a consumption of a particular good. People weigh up the costs gained against the benefits they are likely to receive. From this view, addiction is experienced as an increase in the consumption of goods i.e. drugs, because the person has made a rational choice concerning the level of satisfaction of drug taking