Understanding the Biological and Social Causes of Schizophrenia

How much do we really understand about
Schizophrenia and to what extent is society
responsible as a whole?

Contents Page:
Subject Page number
- Abstract 4
- Introduction 4
- Rationale/Background 4
- Keywords 5
- Definition 5
- What is SZ? 6
- Symptoms 6
- Biological Explanations 7
o Structure of the Brain 7
o Genetic Inheritance 8
o Mapping of Chromosomal loci causing SZ 9
o Connection between SZ and Bipolar disorder 12
o Biochemical Factors 13
- Psychological Explanations 14
o Family Models 14
o Cognitive Models 14
o Societal Attitude to SZ 15
o Myths About SZ 15
 Schizophrenics are dangerous 15
 Schizophrenic have split personalities 16
 SZ never get better 16
- Biological Therapies 17
o Drug Therapy (Chemotherapy) 17
- Psychological Therapies 17
o CBT (Cognitive-Behavioural Therapy) 17
o Family Interventions 18
- Conclusion 18
- Appendix 1: Consent Form + Questionnaire 19-20
- Appendix 2: Research Methods 21-23
- Appendix 3: Analysis 24-26

Figure 1: PET scans 7
Figure 2: MZ Twins 8
Figure 3: Loci with a role in SZ 10
Table 1: Genes identified with a role in
susceptibility to SZ
11
Figure 4: Neurotransmitter release 13
Figure 5: 19th
Century mental asylum 15
Figure 6: Pre-frontal lobotomy 17
Figure 7: Bar Chart for analysis 25

Abstract
Schizophrenia (SZ) affects a quarter of a million people in the UK. SZ is a psychotic
disorder and unmedicated patients are unable to sustain relationships and become
unable to present themselves appropriately thus have difficulty with employment
may have hallucinations, delusions, social withdrawal, loss of sense of pleasure,
apathy, loss of concentration, behaviour outside the social norm.
This essay focuses on biological, psychological and environmental influences that
have a role in an individual developing SZ. Brain development and brain injury play a
part in susceptibility to SZ and better understanding of brain function is needed.
Studies are however, difficult to replicate and more work needs to be done in this
area. Inheritance is importance in SZ but it is not 100% based on genetic heritability.
What genes will do is increases or decreases the risk of developing the disease in a
given set of circumstances. Monozygotic twins have a 48% risk, children with two
carrier parents have a 46% risk, dizygotic twins have a 17% risk, which falls to 4.5%
risk of second-degree relatives compare to 1% risk in the population. 27 genes have
been identified with SZ to date; interestingly dopamine was not among them,
although the dopamine receptor is. Dopamine has been implicated by biochemical
studies and its role has been elucidated by looking at the effect of drugs altering
dopamine levels in inducing or supressing SZ.
Drugs and psychiatric therapies can be effective in some cases but the drugs have
side effects and the talking therapies are not guaranteed to work. Emotional
environment is important and families need to be supported and educated in
successful parenting strategies.However, modern treatments that understand the
cognitive deficits of SZ would be more effective than existing drug and talking
therapies. Any future cure is likely to be based on understanding a person’s risk
both genetic and environmental and targeting specific care (Insel 2010). Society
should take responsibility for these people and make sure that they can be useful
and fulfilled.
Introduction
This essay will analyse what the mental disorder SZ is, examining in detail medical
research including things such as; symptoms and behaviour of patients, how to
identify this mental disorder what type of treatment is available. Furthermore it will
explore society’s behaviour towards this disorder and scrutinising the question ‘To
what extent are we responsible for the nurture and care of vulnerable individuals?’
Rationale/Background
In 2010, I travelled abroad to work in a hospital in Turkey. The hospital I had worked
at treated mentally unstable patients ranging from OCD patients to severely affected
Schizophrenic patients. I learned to manage and observe their behaviour. I was

inspired to understand the cause of this disorder and how disruptions to the biology
of the brain could lead to such symptoms. Understanding this better should lead to
better treatments to help the young people involved and their families. This disease
looks at the interface between biology, the chemistry of biology and psychology so
my A levels in psychology, biology and chemistry student are very appropriate. I
studied disorders last year within my psychology A-level course includingSZ. This
illness seems to me an area that is not well understood and where there is much on-
going research.
This essay will discuss the diagnosis of the disorder by symptoms, the cause of the
disorder including genetics and environment and the treatment including talking
therapies and drugs.
Keywords:
- SZ: Schizophrenia
- Psychosis: a severe mental disorder where cognitive processes are impaired
with severe reduction in occupational and social functionality.
- Monozygotic (MZ) twins: Genetically identical twins
- Dizygotic (DZ) twins: Non- genetically identical twins
- Concordance rate: statistical analysis in twin studies which identifies the
statistical probability of a trait occurring in both twins.
- Polymorphism: difference in DNA sequence
- Positive symptoms: Hallucinations, delusions and behaviour outside social
norm.
- Negative symptoms: social withdrawal, apathy, inability to experience
pleasure and defects in attention control.
Definition
SZ is a psychotic disorder that includes a number of subtypes. Patients may suffer
from confused cognitive processes i.e. thinking, confused emotions and behavior out
side the norm. Schizophrenic patients cannot process sensory stimuli and can
experience exaggerated perceptions of sound, colours and other normal
environmental events. Paranoid delusions can lead to difficult interactions with
other people and most unmedicated schizophrenic patients will be unable to sustain
relationships. Furthermore they may become unable to present themselves
appropriately i.e. have minimal personal hygiene and unable to look after
themselves on a day-to-day level.

What is SZ?
There are many ways that SZ can be characterised. Biological causes, psychological
descriptions and environmental influences help describe and also understand SZ
from different aspects. These different approachesmay then further lead to the
future refinement of drug and psychological therapies for schizophrenics.
In this easy I shall be analysing the biological explanation of SZ, which is a complex
approach that I will be breaking into sections.
Symptoms
SZ usually begins in early adulthood. It comes with a set of symptoms including
hallucinations and delusions described as psychotic symptoms and other symptoms
like severely inappropriate emotional responses, disordered thinking, lack of or too
much concentration, erratic behavior together with social and job related
deterioration (OMIM).
Early in the history of describing SZ (1902) subtypes were identified:
1) Hebephrenic (silly mannerisms and laughter together with delusions and
regressive behavior)
2) Catatonic (stupor, repetitive behavior, mania, and stiffness or extreme
floppiness of legs and arms), and
3) Paranoid behaviour (extreme or irrational fear). How useful and valid these
subtypes are has been much debated especially since there is variation in
their occurrence in affected families.
It is now understood that these elements are part of a spectrum of symptoms.
Crow, in 1985 defined two types of SZ with different underlying pathology;
Type I SZ is defined as a genetically inherited disorder where there is
overproduction of dopamine and generally results in symptoms such as
hallucinations and delusions.
Type II SZ is defined as a neurodevelopmental disorder resulting from prenatal
insults (factors affecting baby whilst in the womb) or perinatal insults (problems
around birth e.g. obstetric complications) and generally results in symptoms such
as apathy, social withdrawal.
Involvement of brain structure due to malformation or injury has been heavily
implicated in the development of SZ. Later research has shown that in some
individuals identified with a first episode of SZ there is decreased volume of the
frontal lobe and increased volume of the intersulcal cerebrospinal fluid (fluid
bathing the brain) compared to controls matched for age, height, weight,
parental social class and parental education. Abnormal eye movements are seen
in between 40- 80% of patients and also in 25- 40% of their unaffected first-
degree relatives but in fewer than 10% of healthy control subjects (OMIM).

Biological Explanations Of SZ
Structure of the Brain
Understanding the role of brain development and injury in SZ is key to its treatment,
management and prevention. Imbalances in the neurotransmitter dopamine were
thought to be the prime cause of SZ however studies involving brain structure have
helped understand abnormalities in the brain structure of individuals with SZ and
show that SZ is a more complex disorder.
Frontal lobe
Research in 1990 showed by using PET scans that there is a reduced cerebral blood
flow in the regions of the frontal lobe (important role in higher intellectual
functioning and fluent expressions) compared to unaffected individuals. The reduced
blood flow to this region causes symptoms such as an altered gait and posture and
abnormal eye movements. (Figure 1)
Figure 1 – PET scans which show the
reduced level of function in the frontal
lobe. The different coloured areas
represent different levels of activity in the
brain. Red indicates high level of activity.
Activity decreases as you go down the
colour bar.
Limbic system
Scientists in 1991 demonstrated there was also a disturbance in the limbic system
(involves emotion) cause symptoms such as agitation in individuals.
Auditory system)
Scientists (from NISAD in Australia) have found abnormalities within the auditory
system (enables humans to hear and understand speech). In schizophrenic
individuals there is an over activity within the Wernicke area (speech area within the
brain) which can create auditory hallucinations (voices are heard which are thought
to be real by the patient).
Although much research has been carried out indicating that abnormalities within
the brain may have some causal effect inSZ,on the other hand research into SZ is
hard to conduct, interpret, and contradictory results have been published.
Specifically what has caused a problem within the research community has been that
results found within a study based on abnormalities of brain structure in a particular
SZ individual are not found in other SZ individuals. This will only be resolved by

carrying out more extensive and longitudinal studies working with families and the
community at large.
Genetic Inheritance:
Both genetic family studies in the 1980s and 1990s and psychological studies have
suggested that genetic inheritance has a role in SZ (Gottesman, 1991, Kendler &
Diehl, 1985, Moldin, 1998). These methodological studies have provided us with
strong evidence that SZ is a highly inheritable disorder. Depending on how the
disorder is characterised, which family groups were studied and the numbers
examined; SZ has a heritability of approximately 0.7: complete heritability is 1.0.
The gold standard of testing for inheritance is to look at the likelihood of
monozygotic twins (Figure 2)rose in different adopted families. These studies are
hard to undertake and the numbers are not great but they do give strong indications
of the degree to which gene play a part in the development of a disease. By
highlighting that the risk for a particular individual developing SZ is higher in relatives
of an affected individual with SZ, many studies followed. Moldin, 1998 suggested
that the amount of genes shared is proportional to development of SZ and showed:
(a) MZ (monozygotic) twins have a 48% risk (b) Children with two carrier parents
have a 46% risk. (c) DZ (Dizygotic) twins or a child with one carrier parent have a 17%
risk. (d) Second-Degree Relatives i.e. grandmother have a 4.25% risk. (e) 1% risk for
the whole population
These points made by (Moldin, 1998) have allowed further research into the
difference in the percentage of risk. A number of twin
studies (Gottessman, 1991) have helped us understand
why the concordance rate for MZ twins will be higher than
DZ twins.
MZ twins have the same DNA and so a disorder that was
completely genetic would be expected to be expressed in
the phenotype of both twins to exactly the same degree
irrespective of how or where they were brought up. In
reality this is rarely the case since genetics interacts with
the environment in most cases to some degree. In the case of SZ this degree appears
to be around 80% genetic and 20% environment using measures of heritability.
Many studies support the idea of a strong genetic link but with important
environmental input.
Even though research into MZ and DZ twins have provided us strong evidence for the
genetic heritability of SZ there are still problems with this type of research;
- Sample sizes are small due to the lack of being able to finding
schizophrenic MZ twins
Fig 2: MZ twins

The same diagnostic criteria cannot be used for twin studies so a
comparison cannot be made therefore ‘different definitions produce
different concordance rates (McGuffin et al.1984)’
- Different criteria may be used to diagnose SZ in MZ & DZ twins so
comparisons may be flawed.
Although twin studies have demonstrated high heritability, there is not a 100%
chance even when the relative is identical. Furthermore this concludes that SZ is a
complex disease which interlinks with other factors i.e. more genes involved -27
genes are listed as having a role in the disorder on OMIM- or other environmental
factors. SZ is not 100% based on genetic heritability, what genes will do is increase or
decrease the risk of developing the disease in a given set of circumstances.
Mapping of chromosomal loci causing SZ:
Genes for diseases are mapped and located by analysing DNA from normal and
affected individuals. Scientists have looked at families where they had both affected
and unaffected relatives. Regions of DNA that were inherited by only affected
individuals were then examined for candidate genes. This was done using genetic
markers such as repeat regions similar to those used in forensic science. In the post
genomic era, the genetic markers of choice are single nucleotide polymorphisms or
SNPs and these can also be used to identify candidate regions in large unrelated
populations. If groups of patients are compared to normal individuals, regions of the
genome inherited more often by the affected group are analysed using the
completed human gene map and then candidate genes can be examined for
alterations that might be causative. These can be small or large changes i.e. single
nucleotide mutations that then alter the triplet code and change a single amino acid
or deletions that result in a truncated protein, duplications that result in too much
protein being expressed in cells or other mutations that alter the transcription
process.
Studies have revealed many genetic loci that are involved in the progression of the
disorder (Figure 1) A study written up in the American Journal of Psychiatry in 2001
showed that there were four loci with a role in SZ and another four with a shared
role in Bipolar disorder and SZ. It is interesting that these psychiatric disorders share
loci and suggests that they may be part of the same disorder spectrum
Recently in a paper published in 2011, more loci have been identified that make the
brain more likely to suffer to SZ. Mutations in the following genes have been
identified as important in: DISC1, DISC 2 (1 and 2 involved in neuron growth and
cortical development in the brain), NRG1 (Glial growth factor), DTNBP1 (involved in
formation of organelles), RGS4 (activates GTPase), KCNH2 (potassium channel),
COMT (guanine nucleotide binding protein), AKT1 (role in the developing nervous

system). Even with these added to the genes identified in 2001 and all the others in
Table 1, totaling 27, they still only explain the disease for a very small number of
patients. To make things more complicated scientists find it hard to find the same
loci in different study groups. This is the same problem that scientists have come
across when trying to relate brain injury and development to SZ. Brain development
is driven by gene expression and so the scientists in different fields need to integrate
their findings more to advance the current understanding.
Figure 3: This picture came from the American Journal of Psychiatry and showed that
there were four loci with a role in SZ and another four with a shared role in Bipolar
disorder and SZ in 2001.

Table 1: Genes that have been identified as having a possible role in susceptibility to
SZ. (http://us-east.omim.org)
Location Gene/Locus Gene function
1 1p36.2 SCZD12
2 1p36.22 MTHFR
3 1q32.1 CHI3L1
4 1q42.2 DISC1 Involved in neuron growth and cortical
development in the brain
5 1q42.2 DISC2 Involved in neuron growth and cortical
development in the brain
6 3p25.2 SYN2
7 3q13.31 DRD3 Dopamine receptor
8 5q23-q35 SCZD1
9 6p23 SCZD3
10 6p22.3 DTNBP1 Involved in formation of organelles
11 6q13-q26 SCZD5
12 7q36.1 KCHN2 Potassium channel
13 8p21 SCZD6 (NRG1) Glial growth factor
14 10q22.3 SCZD11
15 11p14.1 GPR48
16 11q14-q21 SCZD2
17 12q24.11 DAO
18 13q14.2 HTR2A
19 13q32 SCZD7
20 13q33.2 DAOA
21 14q32.33 AKT1 Role in the developing nervous system
22 15q15 SCZD10
23 18p SCZD8
24 22q11.21 COMT Guanine nucleotide binding protein
25 22q11.21 RTN4R
26 22q12.3 APOL4
27 22q12.3 APOL2

If the whole field is reviewed as can be found on the OMIM website (http://us-
east.omim.org) fourteen chromosomes to date have been found to have loci on
them that may have a role in the disease. These are chromosomes 1,
3,5,6,7,8,10,11,12,13,14,15,18 and 22. This may be because most human genes are
expressed in the brain during fetal and neonatal development and disturbances in
different areas of neural development may result in similar symptoms. The genetic
studies have not suggested that dopamine levels are the only important factor in
looking at causes of SZ, though the metabolism of dopamine may be disturbed by
alterations of many different expressed proteins. Interestingly, no loci have been
found on either the X or the Y chromosome, which fits with the observation that this
disease affects males and females equally. Strikingly, dopamine (DBH) itself has not
been identified as a susceptibility locus in the studies to date, although a dopamine
receptor (DRD3) has.
Connection between SZ and Bipolar disorder and others
SZ and bipolar disorder are mostly considered to be different, but patients who show
many symptoms of both disorders can be described as having schizoaffective
disorder. This supports the idea that SZ and bipolar disorder are variant expressions
of a spectrum in addition to having similar disease frequencies, ages of onset and no
link to gender (OMIM).

Biochemical Factors:
Dopamine is a key neurotransmitter (Figure 3). There have been many
neurotransmitters associated with SZ, however recent research into dopamine has
been very promising for the future of SZ individuals. According to scientiststhe role
of dopamine in SZ has resultsin an excess of dopamine activity at certain synaptic
sites. Post-mortem examinations have shown that individuals with SZ have an
increase of dopamine in parts of the brain (Seeman, 1987).
The importance of dopamine is supported by various studies that examine how
drugs utilised to treat SZ or resulting in SZ type symptoms function. The
antipsychotic drug phenothiazine blocks the uptake of dopamine at the synapse and
this helps ease some of the major symptoms in SZ. The drug L-dopa, used in the
treatment of Parkinson’s disease, acts by increasing dopamine levels, this drug
however produces symptom of SZ in some previously unaffected individuals.
Amphetamines, which are psycho-stimulants, used clinically and recreationally also
increase dopamine levels and can cause symptoms of SZ in some previously
unaffected individuals.
As has been discussed in the section on genetics, however, dopamine is not the
whole story. Drugs that act on dopamine may not work with every affected SZ
individual. There is not an association with dopamine in all SZ patients although
there is a strong correlation. Evidence from post-mortem examinations may not be
easy to extrapolate to a wide range of individuals since they tend to involve
individuals who have undertaken antipsychotic (neuroleptic) drugs for years. So the
increase in dopamine levels may not beentirely caused due to the disorder.
Figure 4:
Neurotransmitter
release (dopamine) in
brain neuronal
synapse
(http://cmbi.cjmu.edu.
cn)

Psychological Explanations Of Schizophrenia
Family Models
Based on the theory of the double-blind technique (Bateson, 1956) a child
undergoes repeated experiences with one or more family members. A parent may
expose the child to contradictory messages such as ‘go play with your sisters’ this
may indicate the parent is being caring however the way it is said (tone, body
language) may show the parent wants to get rid of the child. Confusion in the child’s
mind may lead to self-deception and a false concept of reality along with inability to
communicate effectively. Research has shown that there is increase risk, above the
population norm of 1%, of SZ in what psychiatrists may label as ‘dysfunctional
families’. This can be described as a family environment where children experience
an excess of familyconflict;they misbehave at home or at school, and often endure
abuse from family members continually and regularly, leading themselves and other
members to become accustomed to such events.
Cognitive Models
Psychiatrists suggest that poor emotional environments alter the way people
process information and have put forward cognitive models to explain normal and
impaired information processing. One cognitive model deals with the impaired
thought processes in SZ, explaining this impairment in terms of attentional
impairment. This means that mechanisms within the brain of SZ individuals have
defective processing systems; these systems should filter out incoming stimuli and
find meaning. Research has been conducted which shows that schizophrenics show
poor performance in information processing tasks specifically visual tracking, size
estimation and short term memory usage
The points of these models is so that psychiatrists can try to identify how deficits
arose and then treat them or advise families and/or their carershow to avoid
increasing risk to their offspring
Societal Attitudes to SZ
Societal attitudes to mental illness have changed a great deal in the last 100 or so
years. Individuals were poorly diagnosed and grouped together with widely differing
diagnoses in prison-like conditions (Figure 3). The terms of diagnosis were crude and
have passed into our language as derogatory terms like ‘cretin’ and ‘mongoloid.
Figure 5: 19th century mental asylum

Myths About Schizophrenia
Arising from past attitudes schizophrenics have been labeled many horrible words
such as; lunatics, madmen, raving maniacs, unhinged, deranged and demented.
These words have caused people who have been diagnosed with the disorder to be
labeled as dangerous people, unpredictable, impossible to understand and
completely out of control. Furthermore these words or descriptions do not reflect
the true character of an individual schizophrenic and has caused unhelpful
stereotyping among society.
There has been three popular myths about SZ patients, these are;
· Schizophrenics are always dangerous
· Schizophrenics have split personalities
· Once a schizophrenic always a schizophrenic as they never get better
Schizophrenics Are Dangerous
People diagnosed with the disorder may often yell, scream or even occasionally hurt
someone however, it is not clear whether these problems arise from the disorder
itself, whether it is a reaction to society for being treated in a particular way whether
these are responsesto the use of drugs or alcohol or if aggression is a side effects of
some treatments. Society assumes that criminals are less dangerous than
schizophrenics however in reality this is untrue and it rests mainly on ignorance and
fear as schizophrenics. Affected individuals, instead of being dangerous, are
generally withdrawn from society and preoccupied with their own problems (Nature
editorial 2010).
Schizophrenics Have Split Personalities
This misconception of split personalities is an omnipresent myth about the disorder,
generally this myth is maintained in the news, movies and television shows which
does not help overcome the misunderstanding of Schizophrenic behaviour. This idea
of split personalities was thought to have derived from the origins of the word
schizophrenia; schizo = split, phreno = mind. Eugen Bleuler in the 20th
century came
up with the idea that psychological functions that most ‘normal’ people have are
divided in Schizophrenics which causes them to have splitting in emotions and
thoughts. Bleuler’s view is no longer as widely believed by psychiatrists but still
persists in the general population.

Schizophrenics Never Get Better
Treatments that have been used for over 50 years have no offered the hoped for
cure. At present the diagnosis is made late in the development of the disease, when
psychosis is obvious and treatment aims only reducing psychotic symptoms (insel
2010). In some individuals this is extremely successful and they only experience one
psychotic episode in their lifetime.
Some people think that questionnaires for teenagers can predict risk for SZ but this
has worried other people since it may stigmatize them and runs the risk of treating
people who don’t need that treatment. Other people feel it is better to over
diagnose than to let people suffer the disease (Dobbs 2010).
Society at the moment is not investing enough in research into developing new
drugs, pharmaceutical companies are pulling out of the search because the work is
difficult and expensive and the drugs often have bad side effects (Abbot 2010).
Modern treatments that understand the cognitive deficits of SZ would be more
effective. In the future it would be ideal to find a cure and this is likely to be based
on understanding a person’s risk both genetic and environmental and targeting
specific care (insel 2010). Society should take responsibility for those people and
make sure that they can be useful and fulfilled.
Biological Therapies
Before the 50’s individuals who were diagnosed with SZ were institutionalised into
overcrowded, unhygienic and unstimulating environments. For treatment in the
cases of SZ often straitjackets were used to minimise movement, procedures called
the prefrontal lobotomy (Moniz, 1936) – the frontal lobes which involves emotions,
reasoning, planning, movement and parts of speech – where the frontal lobes were
removed. This however led to severe cognitive and emotional impairment.
Drug Therapy (Chemotherapy)
Antipsychotic drugs (neuroleptics) such as Chlorpromazine have updated the
treatment for SZ. Founded by Delay & Deniker (1952) chlorpromazine has been a
success in reducing psychotic symptoms of hallucination and delusions. The drug
works by blocking the excessive release of dopamine and so the positive symptoms
are controlled. With the use of neuroleptics SZ patients are able to live outside
institutions.
However, the drugs do not work against negative symptoms of SZ and long-term use

is required, as symptoms may appear when medication is not taken. Furthermore,
the drugs are not successful with every patient, 30% of patients may not have
reduced symptoms or may not want to take neuroleptics. Also some drugs produce
some distressing and sometimes irreversible side effects (drowsiness, dehydration,
depression). Usage of neuroleptics over 7 years may also induce the disorder Tardive
Dyskinesia (irreversible and produces uncontrollable lip and tongue movement)
Psychological Therapies
Treatments that involve both drugs and psychological
interventions have been the most successful way in treating SZ
patients. Psychological interventions help patients not to be re-
hospitalised due to poor social function.
CBT (Cognitive Behavioural Therapy:
CBT therapies underline the cause of distress made by feelings and pattern of
thinking from the individual. The individual is encouraged to search for any feelings
or incidents within the patient’s life that may of triggered stress causing SZ to evolve.
Research has found that CBT improves short-term mental state however CBT is
costly and highly trained professionals are needed to conduct this form of therapy.
Although evidence for CBT how some decrease in relapse rates and also increase
short-term mental state this evidence is to little to generalise and does not mean it is
effective for all patients with SZ.
Family Interventions:
Family interventions were included as part of biological treatment, as they help
social functioning with the family of the patient and within society. Family
Interventions try to reduce stress within the patient’s life by helping family members
and also the patient understand what the disorder is and how it can be dealt with
rather than overcome. The main goals of the sessions involve providing family
members with skills that enable them to cope with a SZ individual within their family.
Studies have shown that family interventions are successful in reducing relapse of
the disorder as the individual and both family members are able to deal with and
understand the disorder.
Conclusion:
In conclusion SZ is now clearly defined than it was 100 years ago, making it easier to
diagnose and to study affected individuals and their families. These studies have
been done looking at brain structure, brain biochemistry, genetic and via
psychological analysis. Research has suggested that dopamine is important in the
Figure 6: Pre-frontal
Lobotomy

brain, brain injury may be a cause of SZ and that genetic inheritance is important for
some individuals. Psychological studies suggest that the home environment is
important in changing someone’s status from being susceptible to being affected.
Drugs and psychiatric therapies can be effective in some cases but the drugs have
side effects and the talking therapies are not guaranteed to work. Emotional
environment is important and families need to be supported and educated in
successful parenting strategies.However, modern treatments that understand the
cognitive deficits of SZ would be more effective than existing drug and talking
therapies. Any future cure is likely to be based on understanding a person’s risk
both genetic and environmental and targeting specific care (Insel 2010). Society
should take responsibility for these people and make sure that they can be useful
and fulfilled. My questionnaire have suggested that people do feel that society
should take responsibility for looking after vulnerable individuals and this is hopeful
for the future of individuals with SZ.

Appendix 1: Consent form + Questionnaire
Consent Form:
I am carrying out a research that will look at how much society really knows
and feels about Schizophrenia as a mental disorder. I am interested in belief based
or experienced views and how this reflects as our actions or thoughts into
Schizophrenia
I will be asking you to fill out a questionnaire, which will be analysed in my
research paper. If you agree to take part you can withdraw at any time and your data
can be withdrawn any time up until the date of publication. Your data will be
anonymous and all of your personal details will be kept fully confidential.
If you agree please sign the consent form

Questionnaire On Schizophrenia:
Age: Gender:
1) How much do you know about mental disorders?
a. Can you list or give me any examples you know?
b. Do you know the symptoms of the disorder you have just named me?
2) Have you heard of the mental disorder Schizophrenia?
a. If you have where have you found this information?
b. What do you think are the symptoms of Schizophrenia?
3) Given that there are about 62 million people in Britain. How many people in
Britain do you think have been diagnosed with schizophrenia?
(Circle your answer)
a. Quarter of a million people
b. 1 million people
c. 2.2 million people
d. 6-12 million people
4) Case Scenario:
How would you feel if you saw someone talking to his or herself?
(Circle your answer)
a. Sad
b. Embarrassed
c. Walk Away
d. Funny
5) Do you think that society is responsible for mentally unstable patients? If so,
why / why not? To what extent?

Appendix 2:
Primary Resources:
Questionnaires:
My aim by using a questionnaire is to gather a large sample of views from the public
on a specific topic such as Schizophrenia. I wanted to establish what people do and
think in relation to my topic which enables me to further analyse different views. I
have also included a consent form for participants allowing their fully informed
consent, agreeing me to publish their results in my dissertation. My target audience
is based on anyone above the age of 18, I have added some lines above my
questionnaire which identifies the gender and age of my participants, this may give
me further insight into different attitudes which may be affected by age.
In my questionnaire I used two types of questions; Open-ended questions and closed
questions (Fixed choice questions). The advantages of using an open-ended
question I was able to gather detailed and rich data, which encouraged the individual
to express their feelings creating a realistic answer. The advantages of using a closed
question endorsed me to quantitatively collect the data that allowed further
statistical analysis.
However, my using a questionnaire also has disadvantages such as social desirability,
untruthful responses and different interpretations of questions.
Online Forum:
http://www.facebook.com/groups/301806969848006/
I created an online forum that would enable me reach out to a wider audience to
access a wider range of opinions. I have made the forum public so that anyone can
access and fill out the questionnaire online. I hope that I will have conflicting ideas
within some people which will lead to a debate, this may help me compare and
contrast different viewpoints in detail.
Participants are able to join or withdraw any time, and any results will be sent back
to me by a email or a document this is so that answers are kept confidential. Some
weaknesses of this type of source may be social desirability as some participants
may want acceptance by others therefore they will not put forward their truthful
views and beliefs.
Online Chat:
http://www.schizophrenia-online.com/
Entering this website I found myself talking and asking question with people who
have Schizophrenia. This enabled me to gather personal views from individuals who
suffer from this disorder. By asking questions within this online chat I also had quick
responses.
Case Studies:
I have looked into a case study based on the famous mathematician John Forbes
Nash, Jr. By looking into a case study it provides rich, meaningful qualitative data
involving the production of a case history this may be a longitudinal or retrospective
study. There are many advantages of case studies such as; high levels of ecological

validity as it is realistic this may result in challenging established thinking and may
lead to new psychological insights.
Furthermore using case studies also has some limitations; they are difficult to
replicate therefore difficult to establish the reliability of the data found from the
case study, due to it’s idiographic nature it is difficult to generalise the results
beyond the individual or group being studied which leads to a low population
validity, in addition the possibility of researcher bias is high which further calls into
question its scientific credibility.
Secondary Research:
Books:
A2 Psychology: -
I am using my psychology book as it has a lot of information within chapter 34 based
on abnormalities such as Schizophrenia I will also be using some aspects within
Chapter 30-31 based on attitudes to media; this will help me address the issue of
Advanced Psychology: Atypical Behaviour: -
This book goes hand in hand with my A2 psychology book however it provides more
detailed text and insight into topics including Schizophrenia within chapter 3.5 on
page 70
Schizophrenia by Daniel R. Weinberger & Paul J. Harrison: -
I will be using the first chapter of this book which I had found on Google books which
discusses the past, present and futuristic view on schizophrenia. It is also very
recently published, 2011, which helps me gain the most up-to-date information.
Overview Booklets:
I have gathered some booklets from the NIMH – National Institute of Mental Health
which gives me a 15 page overview about schizophrenia, this again like the books I
have picked up from the library etc. provides me with the same basic knowledge
however it is more condensed and allows me to read some information quicker than
for example using a book.
Newspaper Articles:
I have gathered some newspaper articles from www.psychminded.co.uk, The
Guardian, The Observer. These articles can range from actually creating a positive
view or a negative one towards the public. They article or the newspaper company
may be bias against e.g. biological treatments.
Leaflets:
The use of leaflets helps me summarise a clear idea of what Schizophrenia is in a
range of 2-4 pages. This helps individual who are unclear of what Schizophrenia is
understand in basic terms what the disorder is, who it affects, what they could do
about it, their next steps, understanding of definitions related to the disorder.

Websites:
Generally I found most of my relevant information through websites on the Internet.
The use of internet has many advantages; by providing me information from any
date ranging from old information to any up to date recent information, it is a fast
way to find information and communicate to organizations or people. It is also easy
to get information on a particular subject if you enter a key term and furthermore it
is a cheap and environmentally friendly way of accessing information.
Like many sources the Internet also has disadvantages. There can be an
overdose/overkill of information and it may be difficult and time consuming to be
able to find any relevant information. Reliability of any source from the Internet can
be doubtful and some information may be bias.
The websites I have used are listed below with reasons in why I have used them and
also discuss some possible strengths and weaknesses of each website;
www.wikipedia.co.uk
Wikipedia is a credible website which does have information from most aspects of
schizophrenia which may be valid and written from people within the medical arena
however I have found some sources to be false or incorrect on Wikipedia which
questions the reliability of the sources found on this website.
www.schizophrenia.com
This website provides a lot of information such as symptoms, causes, brain pictures,
success stories etc. Furthermore it also provides some personal insight into some
people’s stories which may be very nice for someone with schizophrenia actually
searching for some insight about their disorder. Links from this website are also
listed as primary evidence – success stories
www.omim.org/entry/613025
This website represents the cytogenetic location of schizophrenia in our body and
how this genetic change expresses itself in the phenotype. As I am a biologist and
chemist I loved this website as it pin pointed the exact biological aspect of this
mental disorder.
http://omim.org/entry/181500
The website used here is the same website above however this entry features a
variety of aspects in schizophrenia. I liked this entry compared to any sort of book or
website I had read. This text unlike others gave additional information such as some
psychologists who have looked further into the topic discussed or found an evidence
from experiments which may support or go against any pre-findings.
http://www.clivir.com/lessons/show/schizophrenia-statistics-facts-and-
information.html
This website offered me a range of statistics and facts based on schizophrenic
patients, this was useful as I am going to be able to use this information in my
discussion and analysis for particular topics such as; how many people are
diagnosed, how many of these diagnosed patients are fully treated etc. Also on this
website it discusses some new treatments. This expands on current knowledge and
presents new up to date findings which is a positive aspect of this particular website.

Appendix 3: Analysis
In my primary research I chose to give out questionnaires to the public to
understand public opinion and answer the question ‘How much do people
understand about SZ?’ I emailed my questionnaire to thirty members of the public,
both males and females at an age range of 16 and over, however I only had
20responses. I wanted to understand (a) what were the commonest disorders that
people had heard of and how aware they were of the symptoms and how accurate
their descriptions were. I was particularly interested in people’s conceptions of SZ
and whether they were aware of the symptoms, in addition to how accurate these
conceptions were. I also wanted to know if people were aware of the prevalence of
this condition.
Question 4 and 5 were focused on people’s attitude to SZ and whether they thought
that we were all responsible for helping these vulnerable individuals or that this was
a problem that was nothing to do with them.
In my questionnaire I used different types of questions including open and closed
questions allowing the public to give both a quick representation of their opinion
with limited choices of answers and also some detailed answers allowing me to
deepen my understanding of their opinions. This was a more efficient way to gather
my results and it was not too time consuming.
The limitations of my methodology are that the subjects chosen were people for
whom I knew the email address and tended to be from an educated background and
relatively high socioeconomic grouping. The opinions from this group may not
represent the general opinions in the UK.
The data obtained will be quantitatively analysed except for question 5. The scorer
of high numbers of points will be most aware of SZ and the lowest number of points
will represent individuals who are least aware. I will evaluate the questions by
allocating points as follows:
1.
a. 1 point for SZ in the answer and 1 for any other disorder mentioned
up to 3
b. 1 point for each correct symptom of SZ mentioned out of:
hallucinations, delusions, social withdrawal, loss of sense of pleasure,
apathy, loss of concentration, behaviour outside the social norm, up
to a maximum of 5
- Similarly for other disorders mentioned.
Total possible score 18
2.
a. Possible sources will be scored as: Web (2), Media (films magazines,
news papers, journals)(3), Education (4), Friends and relatives or has
condition (5), other (1)
b. Score for symptoms as above but no points for repeated information.

3. 1 point for ‘Quarter of a million people’.
4. Points as follows: -
a. Sad (3)
b. Embarrassed (1)
c. Walk Away (2)
d. Funny (0)
For questions 1-4 the scores will be banded as
0 -8 Low
9 – 18 Medium
19-27 High
5. Will be scored as
Society is responsible and should help SZ individuals:
Disagree strongly (0)
Disagree (1)
Neutral (2)
Agree (3)
Agree strongly (4)
The band for 1-4 will be compared to question 5 scores and any correlation will be
identified using a bar chart.
The hypothesis that I am testing is that the more highly educated and aware an
individual is about SZ the more likely that they will take a sympathetic view towards
affected individuals and believe that society should support them.
Figure 1: Score for question 1-4 plotted as a bar chart against score for question 5
and ranked in numerical order.
0
1
2
3
4
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Scoringpoints
Number of Participants
Score band compared to Question 5
Scoring
Score band
Q5 score
Figure 7:
Bar chart.
Score band
compared to
Q5 scoring.

The analysis of my data is inconclusive however; this is probably due to there begin a
small sample number. From my study most people believe that society is responsible
for looking after people with schizophrenia. The data may look different if the
questionnaire was given to people from varied socio-economic background, as most
of my sample was from university-educated people. To improve this study a sample
of 200 people on the street might be a better way to gather reliable data.

Understanding the Biological and Social Causes of Schizophrenia

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Understanding the Biological and Social Causes of Schizophrenia