Psychology – A Level specialist option – Clinical Psychology | e-Consult
A Level specialist option – Clinical Psychology (1 questions)
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Answer:
Biopsychosocial explanations
- Biological: dopamine dysregulation (hyperactivity in mesolimbic pathway), glutamate NMDA receptor hypofunction, genetic vulnerability (e.g., COMT, DISC1 genes), neurodevelopmental abnormalities.
- Psychological: cognitive deficits (working memory, executive function), maladaptive coping, stress‑vulnerability model – stressful life events can trigger psychosis in vulnerable individuals.
- Social: urban upbringing, migration, social isolation, low socioeconomic status, family expressed emotion (high criticism) that can exacerbate relapse.
Treatment approaches
- Antipsychotic medication (pharmacological)
- Mechanism: primarily dopamine D2 receptor antagonism (typical antipsychotics) or combined serotonin‑dopamine antagonism (atypical antipsychotics) reducing positive symptoms.
- Effectiveness: robust evidence for reducing hallucinations and delusions; atypicals (e.g., risperidone, olanzapine) also improve negative symptoms and have a lower risk of extrapyramidal side‑effects.
- Limitations: side‑effects (weight gain, metabolic syndrome, tardive dyskinesia) can affect adherence.
- Cognitive‑behavioural therapy for psychosis (CBTp)
- Mechanism: targets maladaptive beliefs about voices/hallucinations, improves coping strategies, reduces distress associated with symptoms.
- Effectiveness: meta‑analyses show moderate effect sizes for reducing symptom severity and improving insight when combined with medication.
- Limitations: requires trained therapists; benefits are less pronounced for acute positive symptoms compared with medication.
Overall, a combined pharmacological and psychological approach offers the best outcomes, addressing both neurochemical and psychosocial contributors to schizophrenia.