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Unit 1 Psychology Revision Guide
(Schizophrenia and Mood Disorders)
Specification:
Schizophrenia
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Classification of schizophrenia, including sub-types
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Explanations, including Biological and socio-cultural (labelling and family dysfunction)

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Treatments of schizophrenia, including anti-psychotic drugs, and psychotherapy
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Evaluation of these treatments
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Symptoms and diagnosis of unipolar and bipolar depression
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Treatments of mood disorders, including biological and cognitive
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Classification of Schizophrenia
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The DSM-5 diagnostic criteria: symptoms must be present for six months and include at least
one month of active symptoms
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At least one of these must be (1), (2), or (3):
1
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Hallucinations
3
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Grossly disorganised behaviour or catatonic behaviour
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Negative symptoms
Definitions of Symptoms

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Delusions: false beliefs
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Delusions of grandeur: powerful or important

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Delusions of guilt: you caused something that you didn’t
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Hallucinations: disruptions of perception
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The voices are usually threaten,
critical or give demands
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g
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Tactile: e
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feeling of tingling or burning
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g
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Disorganised speech: illogical speech which is difficult to follow and jumps topics without
coherence
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Grossly disorganised or catatonic behaviour: the schizophrenic may display bizarre and
unpredictable behaviour
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Catatonic behaviour can include:
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Catatonic rigidity: maintain a rigid upright posture

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Catatonic posturing: assuming awkward positions for long periods of time

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Catatonic stupor: remaining motionless for long periods of time
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g
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Negative symptoms: diminished emotional activity – blunted and flat-affect where no emotion
is shown
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Other symptoms include
poverty of speech (alogia) and social withdraw
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Sub-types of Schizophrenia
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Disorganised schizophrenia: symptoms include disorganised & unintelligible speech, bizarre
behaviour, absence of emotion (flat affect), social withdrawal and apparent loss of interest in
everyday life

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Catatonic schizophrenia: either excessive motor activity (grimacing, repeating again & again
what another says, copying movements of others) or fixed, rigid posture for hours on end
(catatonic stupor)

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Paranoid schizophrenia: delusions & hallucinations are common
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No disorganised speech or catatonic behaviour
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Symptoms may be from all of these
categories
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Residual symptoms may include social
withdrawal, bizarre thoughts and flat emotional affect
Classification of schizophrenia – evaluation

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Rosenhen 1973: The issues of reliability and validity of the diagnosis of schizophrenia was
highlighted by Rosenhan’s (1973) classic study
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On the basis of this alone, each was diagnosed as having
schizophrenia and admitted to 11 of the hospitals
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For example grandiose delusions may be seen in people with bipolar disorder
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Prognosis varies greatly
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Empirical research has indicated that certain ethnic groups may be diagnosed with
schizophrenia more often than other groups
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Biological explanations
(Genetics)
The genetic explanation suggests that there is a gene that can be inherited that predisposes the
individual to develop schizophrenia
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The closer you are related to someone with schizophrenia, the greater your likelihood of
developing the disorder
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However, the closer you are genetically to someone, the closer your environments are
likely to be
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Adoption studies e
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Tienari et al compared rates of schizophrenia occurring in children who
were adopted (before the age of 4yrs) who either : Had biological mothers with schizophrenia or
had biological mothers who did not have schizophrenia
Tienari (1991):
Additional evidence from twin studies:
- Cardno et al (1999) found a 40% concordance in MZs, 5
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- Gottesman and Shields (1972) used 22 MZ twin pairs and 33 DZ twin pairs
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g
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- Genetic explanations do not account for cases of schizophrenia which appear in families
with no history of the disorder
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Neurotransmitters travel between neurons across synapses and are taken up
by another cell using receptors
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The main neurotransmitter
that has been implicated is Dopamine: The Dopamine Hypothesis
It is believed that neurons that use the neurotransmitter dopamine, fire too often and transmit
too many messages, producing the symptoms of the disorder
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Some theorists claim that
excessive dopamine activity contributes primarily to the positive symptoms of schizophrenia e
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delusions and hallucinations
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It was only later discovered that these drugs block dopamine receptors in
the brain
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Parkinson’s sufferers were known to have abnormally low levels of
dopamine
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Community Care V Psychiatric hospitals
Historically, people with mental illnesses such as were cared for in large psychiatric hospitals /
asylums
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Over the next 20 years the vast majority of
asylums were closed down
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Now the NHS use community mental health teams to support those with schizophrenia
- The goal of the CMHT is to provide day-to-day support and treatment while ensuring the
client has as much independence as possible
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Other professionals in the
team include:
 Social workers
 Community mental health nurses
 Pharmacists
 Counsellors and psychotherapists
 Psychologists
Community care involves sufferers receiving treatment whilst remaining in the community
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It may involve sheltered living arrangements (in a
supervised house) or living at home
- Community care is not a treatment, but a ‘care option’
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Evaluation:

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The basic idea behind care in the community, which aims to move mental health
patients out of old-fashioned mental institutions, was broadly welcomed by health
professionals when it was launched in 1990
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 Schizophrenic Christopher Clunis stabbed musician Jonathan Zito, 27, at a
London Underground station in 1992
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The Trust claims
that approximately two people every month are murdered because of the
failure to provide adequate care services
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Carr had been detained in a psychiatric hospital before
the killing but doctors decided he could be discharged
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- Allows agencies to work together
Weakness:
- High cost: good community care is expensive
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- If community care fails – results can be disastrous – e
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murder of Johnathan Zito
- Lack of consistent monitoring by medical professionals may lead to lapses in medication
and thence to relapse
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- It’s ‘normal but not normal’ – ostensibly a more normal environment but a small group
living together is still an enclave
- Social isolation still possible – patients in community care may be ostracised by the local
community because of fear/lack of understanding
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Psychotherapy’s we cover: CBT and Family Therapy
CBT: To identify non-adaptive thoughts and replace with more realistic and helpful ways of
thinking
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Help
sufferers develop coping strategies
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Family Therapy: Emphasis on inclusion and sharing information
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The therapist provides information about disorder
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Also aims to provide whole family with
coping skills
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They are taught to concentrate
on any good things that happen
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They are also trained to recognise early signs of relapse, so
they can respond rapidly
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- Huge support
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E families
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- Psychological therapies and family intervention can help develop social skills and
confidence to live normally in their community
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Drug treatment
Conventional anit-psychotics:
- Discovered in the 1950s, a group of drugs called phenothiazines were found to have a
calming effect on patients
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- It acts by blocking dopamine receptor sites, reducing dopamine activity
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The drug group took
chlorpromazine for 6 weeks and the control group took a placebo
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Atypical anti-psychotics
- A new generation of drugs have been developed that work on both positive and
negative symptoms known as atypical anti-psychotics
- They block both dopamine and serotonin receptors
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- E
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Clozapine is effective in some schizophrenics whose symptoms do not improve on
conventional antipsychotics
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- The drugs significantly improve life for sufferers and families
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g
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g
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Some of these side effects can be reduced if the person is also prescribed
anti-parkinson drugs at the same time
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 Clozapine (aytpical anti-psychotic) is associated with potentially fatal lowering of
the white blood count and required regular blood tests
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- If they only keep symptoms at bay, and do not totally eradicate them, then we can
question the effectiveness of drug treatment for schizophrenia BECAUSE it shows that
the drugs are not curing the cause of disorder, only dealing with the symptoms
- If the patient stops taking the medication, the positive symptoms return quickly, often
requiring urgent hospitalisation
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- This treatment option does not address the social factors that could be the cause of
schizophrenia
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- There are other treatments (e
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Psychotherapy) and a combination approach can work
best
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We all experience fluctuations in mood
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Unipolar Depression:
- The most common form of depression
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The
prevalence – 5% lifetime risk
The DSM 5 criteria:
- Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning: at least one of the symptoms
is either (1) or (2)
1
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Markedly diminished interest or pleasure in all, or almost all, activities
3
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Insomnia or hypersomnia
5
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Fatigue or loss of energy
7
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Diminished ability to think or concentrate, or indecisiveness
9
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Blazer et al (1994) found the percentage of those with depression varies in different age groups
– highest incidence is between 15-24 yrs and 33-44 yrs
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With extreme unipolar depression, symptoms may include delusions and hallucinations
Many people diagnosed with unipolar depression also have other psychological problems,
including substance abuse (e
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alcoholism), eating disorders and panic attacks (Blazer et al,
1994)
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The prevalence – 1%
lifetime risk
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DSM 5 states that the manic episode may have been preceded by a depressive
episode
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a distinct period of abnormality and persistently elevated, expansive or irritable
mood and abnormally and persistently increased goal-directed activity or energy,
lasting at least 1 week
 B
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Inflated self-esteem or grandiosity
2
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More talkative
4
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Distractibility
6
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Excessive involvement in activities that have a high potential for painful consequences
(e
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engaging in unrestrained buying sprees, sexual indiscretions, or fooling business
investments)
Bipolar disorder has the same rates of occurrence in men and women, different social classes
and different ethnic groups
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It is very rare for bipolar to first occur after the age of 40
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Suicide rates of people with bipolar are high, around 12-15% (Rihmer & Pestality 1999)
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Biological Explanation
(Genetics)
Many researchers believe it is possible to inherit a predisposition towards depression,
particularly bipolar
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Family study – Harrington et al (1993) estimate that up to 29% of the relatives of people
diagnosed with depression are also effected, compared to a rate of between 5% -10% in the
general population
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The
present view is that there is a complex interaction between many genes and
environmental influences
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Research indicates that serotonin may regulate noradrenalin levels so any abnormality in
serotonin activity would have an effect on noradrenalin activity
In unipolar depression it is thought that serotonin and noradrenalin levels are low
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Evaluation:
- The drug reserpine, a treatment for high blood pressure, causes depression in some
people
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- Monoamine oxidase inhibitors (MAOIs) are a group of drugs that act as antidepressants
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- Another group of antidepressants, known as tricyclics also increase levels of serotonin
and noradrenalin (through inhibiting reuptake)
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 E
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aspirin can cure a headache but it does not mean that a lack of aspirin caused
the headache (Eysenck 2000)
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- Kety (1975) found very high levels of compounds derived from noradrenalin in the urine
of patients suffering from mania
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A causal relationship has
not been established
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Cognition precedes an emotional response i
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we don’t feel unhappy unless we think we are
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- Beck hypothesised that depression is characterised by a cognitive triad of negative
thinking comprising a negative view of:
1
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the world
3
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This is faulty information
processing
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- New information has to be fitted into this negative self view and so we tend to interpret
even good things happening to us as being due to luck and that we don’t deserve it and
that it will end soon
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- Dysfunctional beliefs do not necessarily lead to depression; the individual will become
depressed, according to Beck, only if they encounter a critical life event (e
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death of
loved one, divorce, loss of employment)
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Evaluation:
Using this theory, Beck developed a commonly used and successful psychological
treatment for depression – Beck’s cognitive behavioural therapy
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If the
treatment based on the theory works, this suggests that the theory can explain the
development of the disorder
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Depressed people do not seem to
have a distorted perception of their own abilities
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- Rippere (1994) challenges the view that negative thinking is irrational, since it may well
be a rational belief brought on by depressing circumstances such as ill health or
discrimination
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g
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If a theory is not clear in its
explanation, it lacks credibility – may be the case for Cog theory
Cognitive theory 2 Attribution- Helplessness model (Abramson et al 1978):
- Abramson, Seligman & Teasdale (1978) looked at the way we attribute (assign) causes
to events
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- 3 dimensions of judgement:
1
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environment)
2
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Global-Specific (specific to this situation or all situations)
- This pattern of attributions results in a lowering of self-esteem and a lack of motivation
to change leading to a state of depression
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It
presents people with 12 hypothetical situations for which a cause has to be indicated
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g
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You have been
looking for a job unsuccessfully for some time
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Depressed people show
an attribution style where positive events are seen as caused by other people and
negative events are caused by themselves
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This gives the approach credibility when explaining the
development of mood disorders
- The cognitive approach cannot explain the manic phase in bipolar disorder
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According to Damasio (2000) neuro-imaging techniques have shown that emotional
processing can occur before cognitive, suggesting emotions might be controlling
cognitions rather than the other way around
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If
the therapies based on the explanation are successful, it supports the view that the
disorder was caused by disordered thinking in the first place
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Therefore it is not a comprehensive theory that can account for all
aspects of the disorder

Psychodynamic Explanation
Freud noticed the similarity between clinical depression and grief e
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weeping, loss of appetite,
difficulty sleeping etc
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- In the oral stage a child is totally dependent on their parents, and unable to distinguish
themselves from their parents
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- Due to this introjection, they direct all their feelings towards the loved one, including
sadness and anger, towards themselves
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- Freud believed that orally fixated people are more likely to suffer from depression
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- Thus they will feel a greater sense of loss when a loved one dies (or they are rejected)
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g Klein & Bowlby) stressed the importance of the mother-child
relationship
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Bipolar:
- According to Freud, the depressive phase occurs when the individual's superego or
conscience is dominant
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Evaluation:

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Jones and Brown (1981) found that depressed patients experienced more stressful life
events than normal controls in the year before onset of the depression, and most of
these were loss events
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Klein et al (2002) identified personality traits shown by depressed people and this
included dependency on others
Comer (2013) suggests that research shows that less than 10% of people who
experience major losses in life become depressed
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Typically involves 20 sessions over a 10 week period
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The client is encouraged to be more active and confident by preparing a detailed plan
of activities for the coming week
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- The client is taught to recognise and record their automatic thoughts as they occur (i
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keep a diary) and bring a list to each session
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The client maybe set homework
tasks / goals to complete between sessions to test the reality behind their negative
thoughts
Evaluation:
- There are many studies that have shown cognitive therapy to be useful in treating
depression e
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Hollon et al (2006) showed that cognitive therapy is as effective as drug
therapy for treating people with moderate to severe depression
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g
- Robinson et al (1990) performed a meta-analysis of 57 studies that researched the
efficacy of a variety of therapies for depression
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Tricyclics:
- Developed in the 1950s
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Thus increasing the activity of
these neurotransmitters which are associated with mood
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These include serotonin, dopamine
and noradrenaline
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Selective serotonin reuptake inhibitors (SSRIs)
- These are the most recent types of antidepressants
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When ingested, lithium becomes widely distributed in the CNS and has the
effect of decreasing noradrenaline levels and increasing serotonin levels
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Evaluation:
- Drug therapies have consistently been shown to be effective in reducing the symptoms
of mood disorders e
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- Thase & Kupfer (1996) reviewed numerous studies comparing antidepressant treatment
with placebos in controlled blind trials
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g
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- Side effects: all of the drugs mentioned have negative side effects:
 SSRIs are generally preferred over Tricyclics and MAOIs as they have less side
effects
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 MAOIs have a number of dangerous side effects including potentially lethal
dietary interactions (with foods such as cheese and red wine) which can cause
cerebral haemorrhaging
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 SSRIs are safer in overdose than tricyclics!
 Lithium is toxic: patients need to be monitored for kidney and thyroid function
as it interferes with the regulation of sodium and water levels in the body
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- Due to the unpleasant side effects, patients do not like taking the drug however if they
stop taking it they are likely to suffer a full blown manic episode
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- Anti-depressants take approximately 2-4 weeks to work, thus patients may stop taking
them prematurely, particularly as there are negative side effects
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Antidepressants do not deal with the root cause
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Anti-depressants do not offer a cure for depression, they simply alleviate symptoms
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ECT

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Electro Convulsive Therapy:
- The patient's brain is stimulated, using electrodes placed at precise locations on the
patient's head, with a brief controlled series of electrical pulses (lasting up to a second)
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- Before the shocks, the patient is anaesthetised and given a muscle relaxant
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- Baker (1995) - Approximately 20,000 people receive ECT in England every year
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- Mainly used for treatment of severe depression, when other interventions such as
psychotherapy or medication fail
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Scientists believe ECT acts by temporarily altering
some of these processes
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- Abrams (1988) patients recovering from ECT exhibit abnormalities of thinking, feeling &
behaving including; disturbed memory, impaired comprehension, automatic
movements, a dazed expression and motor restlessness
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- Some patients report a partial loss of memory for events that occurred during the days,
weeks, and months preceding ECT
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Evaluation:
- ECT works faster than drugs and is useful when there is a risk of suicide
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(2000) found 93% of depressed patients receiving combined ECT and drug
therapy remained symptom free, but only 52% of those receiving drugs alone
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(1992) Improvement in depressive symptoms is not sustained beyond 4
weeks
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- 2 - 4
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- Can be viewed as unethical, in particular, as in extreme cases it can be administered
against a person’s will

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