psychology research topics on schizophrenia

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Research articles

Association of cytokines levels, psychopathology and cognition among CR-TRS patients with metabolic syndrome

• Yeqing Dong
• Minghuan Zhu

Racial disparities with PRN medication usage in inpatient psychiatric treatment

• Areef S. Kassam
• Peter Karalis
• E. Ann Cunningham

Variations to plasma H 2 O 2 levels and TAC in chronical medicated and treatment-resistant male schizophrenia patients: Correlations with psychopathology

• Haidong Yang
• Xiaobin Zhang

Transplantation of gut microbiota derived from patients with schizophrenia induces schizophrenia-like behaviors and dysregulated brain transcript response in mice

• Mingliang Ju

The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study

• Yohannes Gebreegziabhere
• Kassahun Habatmu
• Atalay Alem

Further clarification of cognitive processes of prospective memory in schizophrenia by comparing eye-tracking and ecologically-valid measurements

• Chuan-Yue Wang

Visualizing threat and trustworthiness prior beliefs in face perception in high versus low paranoia

• Antonia Bott
• Hanna C. Steer
• Tania M. Lincoln

Association of homocysteine with white matter dysconnectivity in schizophrenia

• Koichi Tabata
• Shuraku Son
• Makoto Arai

Smoking affects symptom improvement in schizophrenia: a prospective longitudinal study of male patients with first-episode schizophrenia

Exploring functional dysconnectivity in schizophrenia: alterations in eigenvector centrality mapping and insights into related genes from transcriptional profiles

• Mengjing Cai

Mapping the landscape: a bibliometric analysis of resting-state fMRI research on schizophrenia over the past 25 years

• Remilai Aximu

Cortical white matter microstructural alterations underlying the impaired gamma-band auditory steady-state response in schizophrenia

• Daisuke Koshiyama
• Ryoichi Nishimura
• Kiyoto Kasai

Genetic overlap between schizophrenia and cognitive performance

• Jianfei Zhang
• Yanmin Peng

The relationship between visual hallucinations, functioning, and suicidality over the course of illness: a 10-year follow-up study in first-episode psychosis

• Isabel Kreis
• Kristin Fjelnseth Wold
• Ingrid Melle

Reduction of N-acetyl aspartate (NAA) in association with relapse in early-stage psychosis: a 7-Tesla MRS study

• Marina Mihaljevic
• Yu-Ho Chang

Changes in kynurenine metabolites in the gray and white matter of the dorsolateral prefrontal cortex of individuals affected by schizophrenia

• Nico Antenucci
• Giovanna D’Errico
• Giuseppe Battaglia

Parkinson’s disease and schizophrenia interactomes contain temporally distinct gene clusters underlying comorbid mechanisms and unique disease processes

• Kalyani B. Karunakaran
• Sanjeev Jain
• Madhavi K. Ganapathiraju

Transitions in health insurance among continuously insured patients with schizophrenia

• Brittany L. Ranchoff
• Chanup Jeung
• Kimberley H. Geissler

Dance/movement therapy for improving metabolic parameters in long-term veterans with schizophrenia

• Zhaoxia Zhou
• Hengyong Guan
• Fengchun Wu

Linking childhood trauma to the psychopathology of schizophrenia: the role of oxytocin

• Yuan-Jung Chen
• Mong-Liang Lu
• Kah Kheng Goh

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Schizophrenia

What is schizophrenia.

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available. Many people who receive treatment can engage in school or work, achieve independence, and enjoy personal relationships.

What are the signs and symptoms of schizophrenia?

It’s important to recognize the symptoms of schizophrenia and seek help as early as possible. People with schizophrenia are usually diagnosed between the ages of 16 and 30, after the first episode of psychosis . Starting treatment as soon as possible following the first episode of psychosis is an important step toward recovery. However, research shows that gradual changes in thinking, mood, and social functioning often appear before the first episode of psychosis. Schizophrenia is rare in younger children.

Schizophrenia symptoms can differ from person to person, but they generally fall into three main categories: psychotic, negative, and cognitive.

Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. People with psychotic symptoms may lose a shared sense of reality with others and experience the world in a distorted way. For some people, these symptoms come and go. For others, the symptoms become stable over time. Psychotic symptoms include:

• Hallucinations : When a person sees, hears, smells, tastes, or feels things that are not actually there. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
• Delusions : When a person has strong beliefs that are not true and may seem irrational to others. For example, individuals experiencing delusions may believe that people on the radio and television are sending special messages that require a certain response, or they may believe that they are in danger or that others are trying to hurt them.
• Thought disorder : When a person has ways of thinking that are unusual or illogical. People with thought disorder may have trouble organizing their thoughts and speech. Sometimes a person will stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning.
• Movement disorder : When a person exhibits abnormal body movements. People with movement disorder may repeat certain motions over and over.

Negative symptoms include loss of motivation, loss of interest or enjoyment in daily activities, withdrawal from social life, difficulty showing emotions, and difficulty functioning normally.

Negative symptoms include:

• Having trouble planning and sticking with activities, such as grocery shopping
• Having trouble anticipating and feeling pleasure in everyday life
• Talking in a dull voice and showing limited facial expression
• Avoiding social interaction or interacting in socially awkward ways
• Having very low energy and spending a lot of time in passive activities. In extreme cases, a person might stop moving or talking for a while, which is a rare condition called catatonia .

These symptoms are sometimes mistaken for symptoms of depression or other mental illnesses.

Cognitive symptoms include problems in attention, concentration, and memory. These symptoms can make it hard to follow a conversation, learn new things, or remember appointments. A person’s level of cognitive functioning is one of the best predictors of their day-to-day functioning. Health care providers evaluate cognitive functioning using specific tests.

Cognitive symptoms include:

• Having trouble processing information to make decisions
• Having trouble using information immediately after learning it
• Having trouble focusing or paying attention

The Centers for Disease Control and Prevention (CDC)  has recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19. Learn more about getting help and finding a health care provider .

Risk of violence

Most people with schizophrenia are not violent. Overall, people with schizophrenia are more likely than those without the illness to be harmed by others. For people with schizophrenia, the risk of self-harm and of violence to others is greatest when the illness is untreated. It is important to help people who are showing symptoms to get treatment as quickly as possible.

Schizophrenia vs. dissociative identity disorder

Although some of the signs may seem similar on the surface, schizophrenia is not dissociative identity disorder (which used to be called multiple personality disorder or split personality). People with dissociative identity disorder have two or more distinct identities that are present and that alternately take control of them.

What are the risk factors for schizophrenia?

Several factors may contribute to a person’s risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, just because one family member has schizophrenia, it does not mean that other members of the family also will have it. Studies suggest that many different genes may increase a person’s chances of developing schizophrenia , but that no single gene causes the disorder by itself.

Environment: Research suggests that a combination of genetic factors and aspects of a person’s environment and life experiences may play a role in the development of schizophrenia. These environmental factors that may include living in poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Research shows that people with schizophrenia may be more likely to have differences in the size of certain brain areas and in connections between brain areas. Some of these brain differences may develop before birth. Researchers are working to better understand how brain structure and function may relate to schizophrenia.

How is schizophrenia treated?

Current treatments for schizophrenia focus on helping people manage their symptoms, improve day-to-day functioning, and achieve personal life goals, such as completing education, pursuing a career, and having fulfilling relationships.

Antipsychotic medications

Antipsychotic medications can help make psychotic symptoms less intense and less frequent. These medications are usually taken every day in a pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month.

If a person’s symptoms do not improve with usual antipsychotic medications, they may be prescribed clozapine. People who take clozapine must have regular blood tests to check for a potentially dangerous side effect that occurs in 1-2% of patients.

People respond to antipsychotic medications in different ways. It is important to report any side effects to a health care provider. Many people taking antipsychotic medications experience side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects may go away over time, while others may last.

Shared decision making  between health care providers and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose. To find the latest information about antipsychotic medications, talk to a health care provider and visit the U.S. Food and Drug Administration (FDA) website  .

Psychosocial treatments

Psychosocial treatments help people find solutions to everyday challenges and manage symptoms while attending school, working, and forming relationships. These treatments are often used together with antipsychotic medication. People who participate in regular psychosocial treatment are less likely to have symptoms reoccur or to be hospitalized.

Examples of this kind of treatment include types of psychotherapy such as cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions.

Education and support

Educational programs can help family and friends learn about symptoms of schizophrenia, treatment options, and strategies for helping loved ones with the illness. These programs can help friends and family manage their distress, boost their own coping skills, and strengthen their ability to provide support. The National Alliance on Mental Illness website has more information about support groups and education   .

Coordinated specialty care

Coordinated specialty care (CSC) programs are recovery-focused programs for people with first episode psychosis, an early stage of schizophrenia. Health care providers and specialists work together as a team to provide CSC, which includes psychotherapy, medication, case management, employment and education support, and family education and support. The treatment team works collaboratively with the individual to make treatment decisions, involving family members as much as possible.

Compared with typical care, CSC is more effective at reducing symptoms, improving quality of life, and increasing involvement in work or school.

Assertive community treatment

Assertive community treatment (ACT)  is designed especially for people with schizophrenia who are likely to experience multiple hospitalizations or homelessness. ACT is usually delivered by a team of health care providers who work together to provide care to patients in the community.

Treatment for drug and alcohol misuse

It is common for people with schizophrenia to have problems with drugs and alcohol. A treatment program that includes treatment for both schizophrenia and substance use is important for recovery because substance use can interfere with treatment for schizophrenia.

How can I find help for schizophrenia?

If you’re not sure where to get help, your health care provider is a good place to start. Your health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist who has experience treating schizophrenia. Find tips to help prepare for and get the most out of your visit and information about getting help .

The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online treatment locator  to help you find mental health services in your area. SAMHSA also has an Early Serious Mental Illness Treatment Locator for finding mental health treatment facilities and programs  .

It can be difficult to know how to help someone who is experiencing psychosis.

Here are some things you can do:

• Help them get treatment and encourage them to stay in treatment.
• Remember that their beliefs or hallucinations seem very real to them.
• Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior.
• Look for support groups and family education programs, such as those offered by the National Alliance on Mental Illness   .

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline   at 988 or chat at 988lifeline.org   . In life-threatening situations, call 911 .

How can I find a clinical trial for schizophrenia?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage : Information about participating in clinical trials
• Clinicaltrials.gov: Current Studies on Schizophrenia  : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
• Join a Study: Schizophrenia : List of studies being conducted on the NIH Campus in Bethesda, MD

Where can I learn more about schizophrenia?

Free brochures and shareable resources.

• Schizophrenia : This brochure on schizophrenia offers basic information on signs and symptoms, treatment, and finding help. Also available en español .
• Understanding Psychosis : This fact sheet presents information on psychosis, including causes, signs and symptoms, treatment, and resources for help. Also available en español .
• Digital Shareables on Schizophrenia : These digital resources, including graphics and messages, can be used to spread the word about schizophrenia and help promote schizophrenia awareness and education in your community.

Research and statistics

• Accelerating Medicines Partnership® Program - Schizophrenia (AMP® SCZ) : This AMP   public-private collaborative effort aims to promote the development of effective, targeted treatments for those at risk of developing schizophrenia. More information about the program is also available on the AMP SCZ website   .
• Early Psychosis Intervention Network (EPINET) : This broad research initiative aims to develop models for the effective delivery of coordinated specialty care services for early psychosis.
• Journal Articles:  This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Psychotic Disorders Research Program : This program supports research into the origins, onset, course, and outcome of schizophrenia spectrum disorders and other psychotic illnesses.
• Risk and Early Onset of Psychosis Spectrum Disorders Program : This program supports research on childhood and adolescent psychosis and thought disorders.
• Recovery After an Initial Schizophrenia Episode (RAISE) : The NIMH RAISE research initiative included two studies examining different aspects of coordinated specialty care treatments for people who were experiencing early psychosis.
• Statistics: Schizophrenia : This webpage provides the statistics currently available on the prevalence and treatment of schizophrenia among people in the United States.
• NIMH Experts Discuss Schizophrenia : Learn the signs and symptoms, risk factors, treatments of schizophrenia, and the latest NIMH-supported research in this area.

Last Reviewed: May 2023

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

Schizophrenia Research: A Progress Report

Affiliations.

• 1 Medical College of Georgia, Georgia Regents University, 1120 15th Street, AA-1006, Augusta, GA 30912, USA. Electronic address: [email protected].
• 2 Department of Psychiatry, Georgia Regents University, 1120 15th Street, AA-1006, Augusta, GA 30912, USA.
• PMID: 26300028
• DOI: 10.1016/j.psc.2015.05.001

This overview highlights the current hot topics in schizophrenia research. One major drawback to progress is the ability to define and focus on the right patient group. Schizophrenia is a biased and heterogeneous (group of) condition(s), the boundaries of which remain uncertain. An initiative that will focus attention away from (mere) symptoms of the illness and toward its underlying neurobiological construct(s) is the Research Domain Criteria. A preliminary analysis from a large neurobiological study suggests that 3 distinct biological phenotypes underlie the clinical expression of 1 major psychosis. A firmer neurobiologically based foundation is needed to advance this field.

Keywords: Antipsychotics; Autoimmune diseases; Early intervention; Head trauma; Regenerative medicine; Research discoveries; Schizophrenia; Treatment approaches.

Copyright © 2015 Elsevier Inc. All rights reserved.

Publication types

• Adult Survivors of Child Adverse Events / psychology*
• Antipsychotic Agents / therapeutic use
• Autoimmune Diseases / epidemiology*
• Drugs, Investigational / therapeutic use
• Early Medical Intervention
• Genome-Wide Association Study
• Regenerative Medicine
• Schizophrenia / drug therapy
• Schizophrenia / genetics*
• Schizophrenia / immunology*
• Schizophrenia / physiopathology
• Antipsychotic Agents
• Drugs, Investigational

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Two key brain systems are central to psychosis, Stanford Medicine-led study finds

When the brain has trouble filtering incoming information and predicting what’s likely to happen, psychosis can result, Stanford Medicine-led research shows.

April 11, 2024 - By Erin Digitale

People with psychosis have trouble filtering relevant information (mesh funnel) and predicting rewarding events (broken crystal ball), creating a complex inner world. Emily Moskal

Inside the brains of people with psychosis, two key systems are malfunctioning: a “filter” that directs attention toward important external events and internal thoughts, and a “predictor” composed of pathways that anticipate rewards.

Dysfunction of these systems makes it difficult to know what’s real, manifesting as hallucinations and delusions. 

The findings come from a Stanford Medicine-led study , published April 11 in  Molecular Psychiatry , that used brain scan data from children, teens and young adults with psychosis. The results confirm an existing theory of how breaks with reality occur.

“This work provides a good model for understanding the development and progression of schizophrenia, which is a challenging problem,” said lead author  Kaustubh Supekar , PhD, clinical associate professor of psychiatry and behavioral sciences.

The findings, observed in individuals with a rare genetic disease called 22q11.2 deletion syndrome who experience psychosis as well as in those with psychosis of unknown origin, advance scientists’ understanding of the underlying brain mechanisms and theoretical frameworks related to psychosis.

During psychosis, patients experience hallucinations, such as hearing voices, and hold delusional beliefs, such as thinking that people who are not real exist. Psychosis can occur on its own and isa hallmark of certain serious mental illnesses, including bipolar disorder and schizophrenia. Schizophrenia is also characterized by social withdrawal, disorganized thinking and speech, and a reduction in energy and motivation.

It is challenging to study how schizophrenia begins in the brain. The condition usually emerges in teens or young adults, most of whom soon begin taking antipsychotic medications to ease their symptoms. When researchers analyze brain scans from people with established schizophrenia, they cannot distinguish the effects of the disease from the effects of the medications. They also do not know how schizophrenia changes the brain as the disease progresses. 

To get an early view of the disease process, the Stanford Medicine team studied young people aged 6 to 39 with 22q11.2 deletion syndrome, a genetic condition with a 30% risk for psychosis, schizophrenia or both. 

Kaustubh Supekar

Brain function in 22q11.2 patients who have psychosis is similar to that in people with psychosis of unknown origin, they found. And these brain patterns matched what the researchers had previously theorized was generating psychosis symptoms.

“The brain patterns we identified support our theoretical models of how cognitive control systems malfunction in psychosis,” said senior study author  Vinod Menon , PhD, the Rachael L. and Walter F. Nichols, MD, Professor; a professor of psychiatry and behavioral sciences; and director of the  Stanford Cognitive and Systems Neuroscience Laboratory .

Thoughts that are not linked to reality can capture the brain’s cognitive control networks, he said. “This process derails the normal functioning of cognitive control, allowing intrusive thoughts to dominate, culminating in symptoms we recognize as psychosis.”

Cerebral sorting  

Normally, the brain’s cognitive filtering system — aka the salience network — works behind the scenes to selectively direct our attention to important internal thoughts and external events. With its help, we can dismiss irrational thoughts and unimportant events and focus on what’s real and meaningful to us, such as paying attention to traffic so we avoid a collision.

The ventral striatum, a small brain region, and associated brain pathways driven by dopamine, play an important role in predicting what will be rewarding or important. 

For the study, the researchers assembled as much functional MRI brain-scan data as possible from young people with 22q11.2 deletion syndrome, totaling 101 individuals scanned at three different universities. (The study also included brain scans from several comparison groups without 22q11.2 deletion syndrome: 120 people with early idiopathic psychosis, 101 people with autism, 123 with attention deficit/hyperactivity disorder and 411 healthy controls.) 

The genetic condition, characterized by deletion of part of the 22nd chromosome, affects 1 in every 2,000 to 4,000 people. In addition to the 30% risk of schizophrenia or psychosis, people with the syndrome can also have autism or attention deficit hyperactivity disorder, which is why these conditions were included in the comparison groups.

The researchers used a type of machine learning algorithm called a spatiotemporal deep neural network to characterize patterns of brain function in all patients with 22q11.2 deletion syndrome compared with healthy subjects. With a cohort of patients whose brains were scanned at the University of California, Los Angeles, they developed an algorithmic model that distinguished brain scans from people with 22q11.2 deletion syndrome versus those without it. The model predicted the syndrome with greater than 94% accuracy. They validated the model in additional groups of people with or without the genetic syndrome who had received brain scans at UC Davis and Pontificia Universidad Católica de Chile, showing that in these independent groups, the model sorted brain scans with 84% to 90% accuracy.

The researchers then used the model to investigate which brain features play the biggest role in psychosis. Prior studies of psychosis had not given consistent results, likely because their sample sizes were too small. 

Vinod Menon

Comparing brain scans from 22q11.2 deletion syndrome patients who had and did not have psychosis, the researchers showed that the brain areas contributing most to psychosis are the anterior insula (a key part of the salience network or “filter”) and the ventral striatum (the “reward predictor”); this was true for different cohorts of patients.

In comparing the brain features of people with 22q11.2 deletion syndrome and psychosis against people with psychosis of unknown origin, the model found significant overlap, indicating that these brain features are characteristic of psychosis in general.

A second mathematical model, trained to distinguish all subjects with 22q11.2 deletion syndrome and psychosis from those who have the genetic syndrome but without psychosis, selected brain scans from people with idiopathic psychosis with 77.5% accuracy, again supporting the idea that the brain’s filtering and predicting centers are key to psychosis.

Furthermore, this model was specific to psychosis: It could not classify people with idiopathic autism or ADHD.

“It was quite exciting to trace our steps back to our initial question — ‘What are the dysfunctional brain systems in schizophrenia?’ — and to discover similar patterns in this context,” Menon said. “At the neural level, the characteristics differentiating individuals with psychosis in 22q11.2 deletion syndrome are mirroring the pathways we’ve pinpointed in schizophrenia. This parallel reinforces our understanding of psychosis as a condition with identifiable and consistent brain signatures.” However, these brain signatures were not seen in people with the genetic syndrome but no psychosis, holding clues to future directions for research, he added.

Applications for treatment or prevention

In addition to supporting the scientists’ theory about how psychosis occurs, the findings have implications for understanding the condition — and possibly preventing it.

“One of my goals is to prevent or delay development of schizophrenia,” Supekar said. The fact that the new findings are consistent with the team’s prior research on which brain centers contribute most to schizophrenia in adults suggests there may be a way to prevent it, he said. “In schizophrenia, by the time of diagnosis, a lot of damage has already occurred in the brain, and it can be very difficult to change the course of the disease.”

“What we saw is that, early on, functional interactions among brain regions within the same brain systems are abnormal,” he added. “The abnormalities do not start when you are in your 20s; they are evident even when you are 7 or 8.”

Our discoveries underscore the importance of approaching people with psychosis with compassion.

The researchers plan to use existing treatments, such as transcranial magnetic stimulation or focused ultrasound, targeted at these brain centers in young people at risk of psychosis, such as those with 22q11.2 deletion syndrome or with two parents who have schizophrenia, to see if they prevent or delay the onset of the condition or lessen symptoms once they appear. 

The results also suggest that using functional MRI to monitor brain activity at the key centers could help scientists investigate how existing antipsychotic medications are working. 

Although it’s still puzzling why someone becomes untethered from reality — given how risky it seems for one’s well-being — the “how” is now understandable, Supekar said. “From a mechanistic point of view, it makes sense,” he said.

“Our discoveries underscore the importance of approaching people with psychosis with compassion,” Menon said, adding that his team hopes their work not only advances scientific understanding but also inspires a cultural shift toward empathy and support for those experiencing psychosis. 

“I recently had the privilege of engaging with individuals from our department’s early psychosis treatment group,” he said. “Their message was a clear and powerful: ‘We share more similarities than differences. Like anyone, we experience our own highs and lows.’ Their words were a heartfelt appeal for greater empathy and understanding toward those living with this condition. It was a call to view psychosis through a lens of empathy and solidarity.”

Researchers contributed to the study from UCLA, Clinica Alemana Universidad del Desarrollo, Pontificia Universidad Católica de Chile, the University of Oxford and UC Davis.

The study was funded by the Stanford Maternal and Child Health Research Institute’s Uytengsu-Hamilton 22q11 Neuropsychiatry Research Program, FONDEYCT (the National Fund for Scientific and Technological Development of the government of Chile), ANID-Chile (the Chilean National Agency for Research and Development) and the U.S. National Institutes of Health (grants AG072114, MH121069, MH085953 and MH101779).

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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30 schizophrenia research topics, rachel r.n..

• September 9, 2022
• Essay Topics and Ideas

Schizophrenia is a mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although there is no cure for schizophrenia, it can be treated with medication, therapy, and support. In this article, we will provide an overview of some current research topics in schizophrenia.

What You'll Learn

Thirty Schizophrenia Research Topics

1. The causes of schizophrenia. 2. The symptoms of schizophrenia. 3. The relationship between schizophrenia and creativity. 4. The link between schizophrenia and violence. 5. The role of genetics in schizophrenia. 6. The role of the environment in schizophrenia. 7. The prevalence of schizophrenia in different cultures. 8. The impact of schizophrenia on the family. 9. The economic cost of schizophrenia. 10. The treatment options for schizophrenia. 11. The effectiveness of medication for treating schizophrenia. 12. Alternative treatments for schizophrenia. 13..The challenges of living with schizophrenia. 14..How to cope with the symptoms of schizophrenia 

15..The role of support groups in managing schizophrenia 16. The importance of early diagnosis and treatment of schizophrenia 17. The long-term outlook for people with schizophrenia 18. The impact of schizophrenia on employment 19. The effect of schizophrenia on relationships 20. Having a baby when you have schizophrenia21. Parenting with schizophrenia 22. Schizophrenia and substance abuse 23. Schizophrenia and self-harm 24. Schizophrenia and suicide 25. The role of the media in reporting on schizophrenia 26. The use of service user involvement in mental health research 27. The experiences of people from black and minority ethnic groups with schizophrenia 28. The experiences of carers of people with schizophrenia 29. Improving access to services for people with schizophrenia 30. Developing new treatments for schizophrenia

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50+ Research Topics for Psychology Papers

How to Find Psychology Research Topics for Your Student Paper

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

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Are you searching for a great topic for your psychology paper ? Sometimes it seems like coming up with topics of psychology research is more challenging than the actual research and writing. Fortunately, there are plenty of great places to find inspiration and the following list contains just a few ideas to help get you started.

Finding a solid topic is one of the most important steps when writing any type of paper. It can be particularly important when you are writing a psychology research paper or essay. Psychology is such a broad topic, so you want to find a topic that allows you to adequately cover the subject without becoming overwhelmed with information.

I can always tell when a student really cares about the topic they chose; it comes through in the writing. My advice is to choose a topic that genuinely interests you, so you’ll be more motivated to do thorough research.

In some cases, such as in a general psychology class, you might have the option to select any topic from within psychology's broad reach. Other instances, such as in an  abnormal psychology  course, might require you to write your paper on a specific subject such as a psychological disorder.

As you begin your search for a topic for your psychology paper, it is first important to consider the guidelines established by your instructor.

Research Topics Within Specific Branches of Psychology

The key to selecting a good topic for your psychology paper is to select something that is narrow enough to allow you to really focus on the subject, but not so narrow that it is difficult to find sources or information to write about.

One approach is to narrow your focus down to a subject within a specific branch of psychology. For example, you might start by deciding that you want to write a paper on some sort of social psychology topic. Next, you might narrow your focus down to how persuasion can be used to influence behavior .

Other social psychology topics you might consider include:

• Prejudice and discrimination (i.e., homophobia, sexism, racism)
• Social cognition
• Person perception
• Social control and cults
• Persuasion, propaganda, and marketing
• Attraction, romance, and love
• Nonverbal communication
• Prosocial behavior

Psychology Research Topics Involving a Disorder or Type of Therapy

Exploring a psychological disorder or a specific treatment modality can also be a good topic for a psychology paper. Some potential abnormal psychology topics include specific psychological disorders or particular treatment modalities, including:

• Eating disorders
• Borderline personality disorder
• Seasonal affective disorder
• Schizophrenia
• Antisocial personality disorder
• Profile a  type of therapy  (i.e., cognitive-behavioral therapy, group therapy, psychoanalytic therapy)

Topics of Psychology Research Related to Human Cognition

Some of the possible topics you might explore in this area include thinking, language, intelligence, and decision-making. Other ideas might include:

• False memories
• Speech disorders
• Problem-solving

Topics of Psychology Research Related to Human Development

In this area, you might opt to focus on issues pertinent to  early childhood  such as language development, social learning, or childhood attachment or you might instead opt to concentrate on issues that affect older adults such as dementia or Alzheimer's disease.

Some other topics you might consider include:

• Language acquisition
• Media violence and children
• Learning disabilities
• Gender roles
• Child abuse
• Prenatal development
• Parenting styles
• Aspects of the aging process

Do a Critique of Publications Involving Psychology Research Topics

One option is to consider writing a critique paper of a published psychology book or academic journal article. For example, you might write a critical analysis of Sigmund Freud's Interpretation of Dreams or you might evaluate a more recent book such as Philip Zimbardo's  The Lucifer Effect: Understanding How Good People Turn Evil .

Professional and academic journals are also great places to find materials for a critique paper. Browse through the collection at your university library to find titles devoted to the subject that you are most interested in, then look through recent articles until you find one that grabs your attention.

Topics of Psychology Research Related to Famous Experiments

There have been many fascinating and groundbreaking experiments throughout the history of psychology, providing ample material for students looking for an interesting term paper topic. In your paper, you might choose to summarize the experiment, analyze the ethics of the research, or evaluate the implications of the study. Possible experiments that you might consider include:

• The Milgram Obedience Experiment
• The Stanford Prison Experiment
• The Little Albert Experiment
• Pavlov's Conditioning Experiments
• The Asch Conformity Experiment
• Harlow's Rhesus Monkey Experiments

Topics of Psychology Research About Historical Figures

One of the simplest ways to find a great topic is to choose an interesting person in the  history of psychology  and write a paper about them. Your paper might focus on many different elements of the individual's life, such as their biography, professional history, theories, or influence on psychology.

While this type of paper may be historical in nature, there is no need for this assignment to be dry or boring. Psychology is full of fascinating figures rife with intriguing stories and anecdotes. Consider such famous individuals as Sigmund Freud, B.F. Skinner, Harry Harlow, or one of the many other  eminent psychologists .

Psychology Research Topics About a Specific Career

​Another possible topic, depending on the course in which you are enrolled, is to write about specific career paths within the  field of psychology . This type of paper is especially appropriate if you are exploring different subtopics or considering which area interests you the most.

In your paper, you might opt to explore the typical duties of a psychologist, how much people working in these fields typically earn, and the different employment options that are available.

Topics of Psychology Research Involving Case Studies

One potentially interesting idea is to write a  psychology case study  of a particular individual or group of people. In this type of paper, you will provide an in-depth analysis of your subject, including a thorough biography.

Generally, you will also assess the person, often using a major psychological theory such as  Piaget's stages of cognitive development  or  Erikson's eight-stage theory of human development . It is also important to note that your paper doesn't necessarily have to be about someone you know personally.

In fact, many professors encourage students to write case studies on historical figures or fictional characters from books, television programs, or films.

Psychology Research Topics Involving Literature Reviews

Another possibility that would work well for a number of psychology courses is to do a literature review of a specific topic within psychology. A literature review involves finding a variety of sources on a particular subject, then summarizing and reporting on what these sources have to say about the topic.

Literature reviews are generally found in the  introduction  of journal articles and other  psychology papers , but this type of analysis also works well for a full-scale psychology term paper.

Topics of Psychology Research Based on Your Own Study or Experiment

Many psychology courses require students to design an actual psychological study or perform some type of experiment. In some cases, students simply devise the study and then imagine the possible results that might occur. In other situations, you may actually have the opportunity to collect data, analyze your findings, and write up your results.

Finding a topic for your study can be difficult, but there are plenty of great ways to come up with intriguing ideas. Start by considering your own interests as well as subjects you have studied in the past.

Online sources, newspaper articles, books , journal articles, and even your own class textbook are all great places to start searching for topics for your experiments and psychology term papers. Before you begin, learn more about  how to conduct a psychology experiment .

What This Means For You

After looking at this brief list of possible topics for psychology papers, it is easy to see that psychology is a very broad and diverse subject. While this variety makes it possible to find a topic that really catches your interest, it can sometimes make it very difficult for some students to select a good topic.

If you are still stumped by your assignment, ask your instructor for suggestions and consider a few from this list for inspiration.

• Hockenbury, SE & Nolan, SA. Psychology. New York: Worth Publishers; 2014.
• Santrock, JW. A Topical Approach to Lifespan Development. New York: McGraw-Hill Education; 2016.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

• Frontiers in Psychiatry
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Neuroimaging in Psychiatry 2023: Schizophrenia

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Schizophrenia A-level Revisions Notes

Bruce Johnson

A-level Psychology Teacher

B.A., Educational Psychology, University of Exeter

Bruce Johnson is an A-level psychology teacher, and head of the sixth form at Caterham High School.

Learn about our Editorial Process

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

On This Page:

What do the examiners look for?

• Accurate and detailed knowledge
• Clear, coherent, and focused answers
• Effective use of terminology (use the “technical terms”)

In application questions, examiners look for “effective application to the scenario” which means that you need to describe the theory and explain the scenario using the theory making the links between the two very clear. If there is more than one individual in the scenario you must mention all of the characters to get to the top band.

Difference between AS and A level answers

The descriptions follow the same criteria; however you have to use the issues and debates effectively in your answers. “Effectively” means that it needs to be clearly linked and explained in the context of the answer.

Read the model answers to get a clearer idea of what is needed.

Exam Advice

You MUST revise everything – because the exam board could choose any question, however, it does make sense to spend more time on those topics which have not appeared for a while.

With these particular questions there is a sizeable risk that people don’t understand the difference between the questions, and then write about the wrong thing.

Make sure you know which is which, for example do you understand the difference between “genetic explanation” and “neural correlates explanation”, and do you have a model essay for each?

Schizophrenia is a severe mental illness where contact with reality and insight are impaired, an example of psychosis.

Section 1: Diagnosis and Classification of Schizophrenia

Classification is the process of organising symptoms into categories based on which symptoms cluster together in sufferers. Psychologists use the DSM and ICD to diagnose a patient with schizophrenia.

Diagnosis refers to the assigning of a label of a disorder to a patient. The ICD-10 (only negative symptoms need to be present) is used worldwide and the DSM-5 (only positive symptoms need to be present) is used in America.

In order to diagnose Schizophrenia the Mental Health Profession developed the DSM (Diagnostic and Statistical Manual) still used today as a method of classifying mental disorders (particularly in the USA).

It is also used as a basis for the ICD (International Classification of Diseases) used by the World Health Organisation in classifying all disorders (mental and physical).

Note: you may come across the terms DSM-IV and ICD-10. These refer to the latest editions of the two classification systems.

Positive Symptoms

an excess or distortion of normal functions: including hallucinations and delusions.

Positive symptoms are an excess or distortion of normal functions, for example hallucinations, delusions and thought disturbances such as thought insertion.

• Hallucinations are usually auditory or visual perceptions of things that are not present. Imagined stimuli could involve any of the senses. Voices are usually heard coming from outside the person’s head giving instructions on how to behave. • Delusions are false beliefs. Usually the person has convinced him/herself that he/she is someone powerful or important, such as Jesus Christ, the Queen (e.g. Delusions of Grandeur). There are also delusions of being paranoid, worrying that people are out to get them. • Psychomotor Disturbances: Stereotypyical – Rocking backwards and forwards, twitches, & repetitive behaviors. Catatonia- staying in position for hours/days on end, cut off from the world.

Negative Symptoms

where normal functions are limited: including speech poverty and avolition.

Negative symptoms are a diminution or loss of normal functions such as psychomotor disturbances, avolition (the reduction of goal-directed behavior), disturbances of mood and thought disorders.

• Thought disorder in which there are breaks in the train of thought and the person appears to make illogical jumps from one topic to another (loose association). Words may become confused and sentences incoherent (so called ‘word salad). Broadcasting is a thought disorder whereby a person believes their thoughts are being broadcast to others, for example over the radio or through TV. Alogia – aka speech poverty – is a thought disorder were correct words are used but with little meaning. • Avolition: Lack of volition (i.e. desire): in which a person becomes totally apathetic and sits around waiting for things to happen. They engage in no self motivated behavior. Their get up and go has got up and gone!

Classification

Slater & Roth (1969) say that hallucinations are the least important of all the symptoms, as they are not exclusive to schizophrenic people.

Classification and diagnosis does have advantages as it allows doctors to communicate more effectively about a patient and use similar terminology when discussing them. In addition, they can then predict the outcome of the disorder and suggest related treatment to help the patient.

Scheff (1966) points out that diagnosis classification labels the individual, and this can have many adverse effects, such as a self-fulfilling prophecy (patients may begin to act how they are expected to act), and lower self-esteem.

Ethics – do the benefits of classification (care, treatment, safety) outweigh the costs (possible misdiagnosis, mistreatment, loss of rights and responsibility, prejudice due to labelling).

Reliability and Validity in Diagnosis and Classification of Schizophrenia

with reference to co-morbidity, culture and gender bias and symptom overlap.

Reliability

For the classification system to be reliable, differfent clinicians using the same system (e.g. DSM) should arrive at the same diagnosis for the same individual.

Reliability is the level of agreement on the diagnosis by different psychiatrists across time and cultures; stability of diagnosis over time given no change in symptoms.

Diagnosis of schizophrenia is difficult as the practitioner has no physical signs but only symptoms (what the patient reports) to make a decision on.

Jakobsen et al. (2005) tested the reliability of the ICD-10 classification system in diagnosing schizophrenia. A hundred Danish patients with a history of psychosis were assessed using operational criteria, and a concordance rate of 98% was obtained. This demonstrates the high reliability of the clinical diagnosis of schizophrenia using up-to-date classification.

Comorbidity describes people who suffer from two or more mental disorders. For example, schizophrenia and depression are often found together. This makes it more difficult to confidently diagnose schizophrenia. Comorbidity occurs because the symptoms of different disorders overlap. For example, major depression and schizophrenia both involve very low levels of motivation. This creates problems of reliability. Does the low motivation reflect depression or schizophrenia, or both?

Gender bias: Loring and Powell (1988) found that some behavior which was regarded as psychotic in males was not regarded as psychotic in females.

Validity – the extent to which schizophrenia is a unique syndrome with characteristics, signs and symptoms.

For the classification system to be valid it should be meaningful and classify a real pattern of symptoms, which result from a real underlying cause.

The validity of schizophrenia as a single disorder is questioned by many. This is a useful point to emphasise in any essay on the disorder. There is no such thing as a ‘normal’ schizophrenic exhibiting the usual symptoms.

Since their are problems with the validity of diagnois classification, unsuitable treatment may be administered, sometimes on an involuntary basis. This raises practical and ethical issues when selecting different types of tretment.

Problems of validity: Are we really testing what we think we are testing? In the USA only 20% of psychiatric patients were classed as having schizophrenia in the 1930s but this rose to 80% in the 1950s . In London the rate remained at 20%, suggesting neither group had a valid definition of schizophrenia.

Neuropsychologist Michael Foster Green suggests that neurocognitive deficits in basic functions such as memory, attention, central executive and problem solving skills may combine to have an outcome which we are labelling “Schizophrenia” as if it was the cause when in fact it is simply an umbrella term for a set of effects.

Predictive validity. If diagnosis leads to successful treatment, the diagnosis can be seen as valid. But in fact some Schizophrenics are successfully treated whereas others are not. Heather (1976) there is only a 50% chance of predicting what treatment a patient will receive based on diagnosis, suggesting that diagnosis is not valid.

Aetiological validity – for a diagnosis to be valid, all patients diagnosed as schizophrenic should have the same cause for their disorder. This is not the case with schizophrenia: The causes may be one of biological or psychological or both.

David Rosenhan (1973) famous experiment involving Pseudopatients led to 8 normal people being kept in hospital despite behaving normally. This suggests the doctors had no valid method for detecting schizophrenia. They assumed the bogus patients were schizophrenic with no real evidence. In a follow up study they rejected genuine patients whom they assumed were part of the deception.

Culture – One of the biggest controversies in relation to classification and diagnosis is to do with cultural relativism and variations in diagnosis. For example in some Asian countries people are not expected to show emotional expression, whereas in certain Arabic cultures public emotion is encouraged and understood. Without this knowledge a person displaying overt emotional behavior in a Western culture might be regarded as abnormal. Cochrane (1977) reported that the incidence of schizophrenia in the West Indies and the UK is 1 %, but that people of Afro-Caribbean origin are seven times more likely to be diagnosed as schizophrenic when living in the UK.

Cultural bias – African Americans and those of Afro-carribean descent are more likely to be diagnosed than their white counterparts but diagnostic rates in Africa and the West Indies is low – Western over diagnosis is a result of cultural norms and the diagnosis lacks validity.

Section 2: Biological Explanations for Schizophrenia

Family studies find individuals who have schizophrenia and determine whether their biological relatives are similarly affected more often than non-biological relatives.

There are two types of twins – identical (monozygotic) and fraternal (dizygotic). To form identical twins, one fertilised egg (ovum) splits and develops two babies with exactly the same genetic information.

• Gottesman (1991) found that MZ twins have a 48% risk of getting schizophrenia whereas DZ twins have a 17% risk rate. This is evidence that the higher the degree of genetic relativeness, the higher the risk of getting schizophrenia. • Benzel et al. (2007) three genes: COMT, DRD4, AKT1 – have all been associated with excess dopamine in specific D2 receptors, leading to acute episodes, positive symptoms which include delusions, hallucinations, strange attitudes. • Research by Miyakawa et al. (2003) studied DNA from human families affected by schizophrenia and found that those with the disease were more likely to have a defective version of a gene, called PPP3CC which is associated with the production of calcineurin which regulates the immune system. Also, research by Sherrington et al. (1988) has found a gene located on chromosome 5 which has been linked in a small number of extended families where they have the disorder. • Evidence suggests that the closer the biological relationship, the greater the risk of developing schizophrenia. Kendler (1985) has shown that first-degree relatives of those with schizophrenia are 18 times more at risk than the general population. Gottesman (1991) has found that schizophrenia is more common in the biological relatives of a schizophrenic, and that the closer the degree of genetic relatedness, the greater the risk.

Very important to note genetics are only partly responsible, otherwise identical twins would have 100% concordance rates.

One weakness of the genetic explanation of schizophrenia is that there are methodological problems. Family, twin and adoption studies must be considered cautiously because they are retrospective, and diagnosis may be biased by knowledge that other family members who may have been diagnosed. This suggests that there may be problems of demand characteristics.

A second weakness is the problem of nature-v-Nurture. It is very difficult to separate out the influence of nature-v-nurture. The fact that the concordance rates are not 100% means that schizophrenia cannot wholly be explained by genes and it could be that the individual has a pre-disposition to schizophrenia and simply makes the individual more at risk of developing the disorder. This suggests that the biological account cannot give a full explanation of the disorder.

A final weakness of the genetic explanation of schizophrenia is that it is biologically reductionist. The Genome Project has increased understanding of the complexity of the gene. Given that a much lower number of genes exist than anticipated, it is now recognised that genes have multiple functions and that many genes behavior.

Schizophrenia is a multi-factorial trait as it is the result of multiple genes and environmental factors. This suggests that the research into gene mapping is oversimplistic as schizophrenia is not due to a single gene.

The Dopamine Hypothesis

• Dopamine is a neurotransmitter. It is one of the chemicals in the brain which causes neurons to fire. The original dopamine hypothesis stated that schizophrenia suffered from an excessive amount of dopamine. This causes the neurons that use dopamine to fire too often and transmit too many messages. • High dopamine activity leads to acute episodes, and positive symptoms which include: delusions, hallucinations, confused thinking. • Evidence for this comes from that fact that amphetamines increase the amounts of dopamine . Large doses of amphetamine given to people with no history of psychological disorders produce behavior which is very similar to paranoid schizophrenia. Small doses given to people already suffering from schizophrenia tend to worsen their symptoms. • A second explanation developed, which suggests that it is not excessive dopamine but that fact that there are more dopamine receptors. More receptors lead to more firing and an over production of messages. Autopsies have found that there are generally a large number of dopamine receptors (Owen et al., 1987) and there was an increase in the amount of dopamine in the left amygdale (falkai et al. 1988) and increased dopamine in the caudate nucleus and putamen (Owen et al, 1978).

One criticism of the dopamine hypothesis is there is a problem with the chicken and egg. Is the raised dopamine levels the cause of the schizophrenia, or is it the raised dopamine level the result of schizophrenia?

It is not clear which comes first. This suggests that one needs to be careful when establishing cause and effect relationships in schizophrenic patients.

One of the biggest criticisms of the dopamine hypothesis came when Farde et al found no difference between schizophrenics’ levels of dopamine compared with ‘healthy’ individuals in 1990.

Noll (2009) also argues around one third of patients do not respond to drugs which block dopamine so other neurotransmitters may be involved.

A final weakness of the dopamine hypothesis is that it is biologically deterministic. The reason for this is because if the individual does have excessive amounts of dopamine then does it really mean that thy ey will develop schizophrenia? This suggests that the dopamine hypothesis does not account for freewill.

Neural Correlates

• Neural correlates are patterns of structure or activity in the brain that occur in conjunction with schizophrenia • People with schizophrenia have abnormally large ventricles in the brain . Ventricles are fluid filled cavities (i.e. holes) in the brain that supply nutrients and remove waste. This means that the brains of schizophrenics are lighter than normal. The ventricles of a person with schizophrenia are on average about 15% bigger than normal (Torrey, 2002).

A strength is that the research into enlarged ventricles and neurotransmitter levels have high reliability. The reason for this is because the research is carried out in highly controlled environments, which specialist, high tech equipment such as MRI and PET scans.

These machines take accurate readings of brain regions such as the frontal and pre-frontal cortex, the basil ganglia, the hippocampus and the amygdale. This suggests that if this research was tested and re-tested the same results would be achieved.

Supporting evidence for the brain structure explanation comes from further empirical support from Suddath et al. (1990). He used MRI (magnetic resonance imaging) to obtain pictures of the brain structure of MZ twins in which one twin was schizophrenic.

The schizophrenic twin generally had more enlarged ventricles and a reduced anterior hypothalamus. The differences were so large the schizophrenic twins could be easily identified from the brain images in 12 out of 15 pairs.

This suggests that there is wider academic credibility for enlarged ventricles determining the likelihood of schizophrenia developing.

A second weakness of the neuroanatomical explanations is that it is biologically deterministic. The reason for this is because if the individual does have large ventricles then does it really mean that they will develop schizophrenia? This suggests that the dopamine hypothesis does not account for freewill.

Section 3: Psychological Explanations for Schizophrenia

Family dysfunction.

Family Dysfunction refers to any forms of abnormal processes within a family such as conflict, communication problems, cold parenting, criticism, control and high levels of expressed emotions. These may be risk factors for the development and maintenance of schizophrenia.

• Laing and others rejected the medical / biological explanation of mental disorders. They did not believe that schizophrenia was a disease. They believed that schizophrenia was a result of social pressures from life. Laing believed that schizophrenia was a result of the interactions between people, especially in families. • Bateson et al. (1956) suggested the double bind theory, which suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia. For example parents who say they care whilst appearing critical or who express love whilst appearing angry. They did not believe that schizophrenia was a disease. They believed that schizophrenia was a result of social pressures from life. • Prolonged exposure to such interactions prevents the development of an internally coherent construction of reality; in the long run, this manifests itself as typically schizophrenic symptoms such as flattening affect, delusions and hallucinations, incoherent thinking and speaking, and in some cases paranoia. • Another family variable associated with schizophrenia is a negative emotional climate, or more generally a high degree of expressed emotion (EE). EE is a family communication style that involves criticism, hostility and emotional over-involvement. The researchers concluded that this is more important in maintaining schizophrenia than in causing it in the first place, (Brown et al 1958). Schizophrenics returning to such a family were more likely to relapse into the disorder than those returning to a family low in EE. The rate of relapse was particularly high if returning to a high EE family was coupled with no medication.

One strength of the double bind explanation comes from further empirical support provided by Berger (1965). They found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics.

However, evidence may not be reliable as patient’s recall may be affected by their schizophrenia. This suggests that there is wider academic credibility for the idea of contradictory messages causing schizophrenia.

A second strength of the research into expressed emotion (EE) is that it has practical applications. For example Hogarty (1991) produced a type of therapy session, which reduced social conflicts between parents and their children which reduced EE and thus relapse rates.

This suggests that gaining an insight into family relationships allows psychiatric professionals to help improve the quality of patient’s lives.

Individual differences – EE is associated with relapse but not all patients who live in high EE families relapse and not all patients in low EE families avoid relapse – Family dysfunction is an incomplete explanation for schizophrenia.

A weakness of the family relationsships appraoch is that there is a problem of cause and effect. Mischler & Waxler (1968) found significant differences in the way mothers spoke to their schizophrenic daughters compared to their normal daughters, which suggests that dysfunctional communication may be a result of living with the schizophrenic rather than the cause of the disorder.

This suggests that there is a problem of the chicken and egg scenario in relation to expressed emotion causing schizophrenia.

A second weakness of the double bind theory is that there are ethical issues. There are serious ethical concerns in blaming the family, particularly as there is little evidence upon which to base this.

Gender bias is also an issue as the mother tends to be blamed the most, which means such research is highly socially sensitive. This suggests that the research therefore does not protect individuals from harm.

Cause and effect – It remains unclear whether cognitive factors cause schizophrenia or if schizophrenia causes these cognitions – Family dysfunction may not be a valid explanation for schizophrenia.

Cognitive explanations

including dysfunctional thought processing.

Cognitive approaches examine how people think, how they process information. Researchers have focused on two factors which appear to be related to some of the experiences and behaviors of people diagnosed with schizophrenia.

First, cognitive deficits which are impairments in thought processes such as perception, memory and attention. Second, cognitive biases are present when people notice, pay attention to, or remember certain types of information better than other.

Cognitive Deficits

• There is evidence that people diagnosed as schizophrenic have difficulties in processing various types of information, for example visual and auditory information. Research indicates their attention skills may be deficient – they often appear easily distracted. • A number of researchers have suggested that difficulties in understanding other people’s behavior might explain some of the experiences of those diagnosed as schizophrenic. Social behavior depends, in part, on using other people’s actions as clues for understanding what they might be thinking. Some people who have been diagnosed as schizophrenic appear to have difficulties with this skill. • Cognitive deficits have been suggested as possible explanations for a range of behaviors associated with schizophrenia. These include reduced levels of emotional expression, disorganised speech and delusions.

Cognitive Biases

• Cognitive biases refer to selective attention. The idea of cognitive biases has been used to explain some of the behaviors which have been traditionally regarded as ‘symptoms’ of ‘schizophrenia’. • Delusions: The most common delusion that people diagnosed with schizophrenia report is that others are trying to harm or kill them – delusions of persecution. Research suggests that these delusions are associated with specific biases in reasoning about and explaining social situations. Many people who experience feelings of persecution have a general tendency to assume that other people cause the things that go wrong with their lives.

A strength of the cognitive explanation is that it has practical applications. Yellowless et al. (2002) developed a machine that produced virtual hallucinations, such as hearing the television telling you to kill yourself or one person’s face morphing into another’s.

The intention is to show schizophrenics that their hallucinations are not real. This suggests that understanding the effects of cognitive deficits allows psychologists to create new initiatives for schizophrenics and improve the quality of their lives.

A final strength is that it takes on board the nurture approach to the development of schizophrenia. For example, it suggests that schizophrenic behavior is the cause of environmental factors such as cognitive factors.

One weakness of the cognitive explanation is that there are problems with cause and effect. Cognitive approaches do not explain the causes of cognitive deficits – where they come from in the first place.

Is it the cognitive deficits which causes the schizophrenic behavior or is the schizophrenia that causes the cognitive deficits? This suggests that there are problems with the chicken and egg problem.

A second weakness of the cognitive model is that it is reductionist. The reason for this is because the approach does not consider other factors such as genes.

It could be that the problems caused by low neurotransmitters creates the cognitive deficits. This suggests that the cognitive approach is oversimplistic when consider the explanation of schizophrenia.

Section 4: Drug Therapy: typical and atypical antipsychotics

Drug therapy is a biological treatment for schizophrenia. Antipsychotic drugs are used to reduce the intensity of symptoms (particularly positive symptoms).

Typical Antipsychotics

• First generation Antipsychotics are called “Typical Antipsychotics” Eg. Chlorpromazine and Haloperidol. • Typical antipsychotic drugs are used to reduce the intensity of positive symptoms, blocking dopamine receptors in the synapses of the brain and thus reducing the action of dopamine. • They arrest dopamine production by blocking the D2 receptors in synapses that absorb dopamine, in the mesolimbic pathway thus reducing positive symptoms, such as auditory hallucinations. • But they tended to block ALL types of dopamine activity, (in other parts of the brain as well) and this caused side effects and may have been harmful.

Atypical Antipsychotics

• Newer drugs, called “atypical antipsychotics” attempt to target D2 dopamine activity in the limbic system but not D3 receptors in other parts of the brain. • Atypical antipsychotics such as Clozapine bind to dopamine, serotonin and glutamate receptors. • Atypical antipsychotic drugs work on negative symptoms, improving mood, cognitive functions and reducing depression and anxiety. • They also have some effect on other neurotransmitters such as serotonin . They generally have fewer side effects eg. less effect on movement Eg. Clozapine, Olazapine and Risperidone.

Since the mid-1950s antipsychotic medications have greatly improved treatment. Medications reduce positive symptoms particularly hallucinations and delusions; and usually allow the patient to function more effectively and appropriately.

Antipsychotic drugs are highly effective as they are relatively cheap to produce, easy to administer and have a positive effect on many sufferers. However they do not “cure” schizophrenia, rather they dampen symptoms down so that patients can live fairly normal lives in the community.

Kahn et al. (2008) found that antipsychotics are generally effective for at least one year, but second- generation drugs were no more effective than first-generation ones.

Some sufferers only take a course of antipsychotics once, while others have to take a regular dose in order to prevent symptoms from reappearing.

There is a sizeable minority who do not respond to drug treatment. Pills are not as helpful with other symptoms, especially emotional problems.

Older antipsychotics like haloperidol or chlorpromazine may produce side effects Sometimes when people with schizophrenia become depressed, so it is common to prescribe anti-depressants at the same time as the anti-psychotics.

All patients are in danger of relapsing but without medication the relapses are more common and more severe which suggests the drugs are effective.

Clozapine targets multiple neurotransmitters, not just dopamine, and has been shown to be more effective than other antipsychotics, although the possibility of severe side effects – in particular, loss of the white blood cells that fight infection.

Even newer antipsychotic drugs, such as risperidone and olanzapine are safer, and they also may be better tolerated. They may or may not treat the illness as well as clozapine, however.

Meta–analysis by Crossley Et Al (2010) suggested that Atypical antipsychotics are no more effective, but do have less side effects.

Recovery may be due to psychological factors – The placebo effect is when patients’ symptoms are reduced because they believe that it should.

However, Thornley et al carried out a meta-analysis comparing the effects of Chlorpromazine to placebo conditions and found Chlorpromazine to be associated with better overall functioning – Drug therapy is an effective treatment for SZ.

RWA – Offering drugs can lead to an enhanced quality of life as patients are given independence – Positive impact on the economy as patients can return to work and no longer need to be provided with institutional care.

Ethical issues – Antipsychotics have been used in hospitals to calm patients and make them easier for staff to work with rather than for the patients’ benefit – Can lead to the abuse of the Human Rights Act (no one should be subject to degrading treatment).

Severe side effects – Long term use can result in tardive dyskinesia which manifests as involuntary facial movements such as blinking and lip smacking – While they may be effective, the severity of the side effects mean the costs outweigh the benefits therefore they are not an appropriate treatment.

In most cases the original “typical antipsychotics” have more side effects, so if the exam paper asks for two biological therapies you can write about typical anti-psychotics and emphasise the side effects, then you can write about the atypical antipsychotics and give them credit for having less side effects.

Section 5: Psychological Therapies for Schizophrenia

Family therapy.

Family therapy is a form of therapy carried out with members of the family with the aim of improving their communication and reducing the stress of living as a family.

Family Therapy aims to reduce levels of expressed emotion, and reduced the likelihood of relapse.

Aims of Family Therapy

• To educate relatives about schizophrenia. • To stabilize the social authority of the doctor and the family. • To improve how the family communicated and handled the situation. • To teach patients and carers more effective stress management techniques.

Methods used in Family Therapy

• Pharoah identified examples of how family therapy works: It helps family members achieve a balance between caring for the individual and maintaining their own lives, it reduces anger and guilt, it improves their ability to anticipate and solve problems and forms a therapeutic alliance. • Families taught to have weekly family meetings solving problems on family and individual goals, resolve conflict between members, and pinpoint stressors. • Preliminary analysis: Through interviews and observation the therapist identifies strengths and weaknesses of family members and identifies problem behaviors. • Information transfer – teaching the patient and the family the actual facts about the illness, it’s causes, the influence of drug abuse, and the effect of stress and guilt. • Communication skills training – teach family to listen, to express emotions and to discuss things. Additional communication skills are taught, such as “compromise and negotiation,” and “requesting a time out” . This is mainly aimed at lowering expressed emotion.

A study by Anderson et al. (1991) found a relapse rate of almost 40% when patients had drugs only, compared to only 20 % when Family Therapy or Social Skills training were used and the relapse rate was less than 5% when both were used together with the medication.

Pharaoh et al. (2003) meta – analysis found family interventions help the patient to understand their illness and to live with it, developing emotional strength and coping skills, thus reducing rates of relapse.

Pharoah identified examples of how family therapy works: It helps family members achieve a balance between caring for the individual and maintaining their own lives, it reduces anger and guilt, it improves their ability to anticipate and solve problems and forms a therapeutic alliance.

Economic Benefits: Family therapy is highly cost effective because it reduces relapse rates, so the patients are less likely to take up hospital beds and resources. The NICE review of family therapy studies demonstrated that it was associated with significant cost savings when offered to patients alongside the standard care – Relapse rates are also lower which suggests the savings could be even higher.

Lobban (2013) reports that other family members felt they were able to cope better thanks to family therapy. In more extreme cases the patient might be unable to cope with the pressures of having to discuss their ideas and feelings and could become stressed by the therapy, or over-fixated with the details of their illness.

Token Economy

• Token economies aim to manage schizophrenia rather than treat it. • They are a form of behavioral therapy where desirable behaviors are encouraged by the use of selective reinforcement and is based on operant conditioning. • When desired behavior is displayed eg. Getting dressed, tokens (in the form of coloured discs) are given immediately as secondary reinforcers which can be exchanged for rewards eg. Sweets and cigarettes. • This manages schizophrenia because it maintains desirable behavior and no longer reinforces undesirable behavior. • The focus of a token economy is on shaping and positively reinforcing desired behaviors and NOT on punishing undesirable behaviors. The technique alleviates negative symptoms such as poor motivation, and nurses subsequently view patients more positively, which raises staff morale and has beneficial outcomes for patients. • It can also reduce positive symptoms by not rewarding them, but rewarding desirable behavior instead. Desirable behavior includes self-care, taking medication, work skills, and treatment participation.

Paul and Lentz (1977) Token economy led to better overall patient functioning and less behavioral disturbance, More cost-effective (lower hospital costs)

Upper and Newton (1971) found that the weight gain associated with taking antipsychotics was addressed with token economy regimes. Chronic schizophrenics achieved 3lbs of weight loss a week.

McMonagle and Sultana (2000) reviewed token economy regimes over a 15-year period, finding that they did reduce negative symptoms, though it was unclear if behavioral changes were maintained beyond the treatment programme.

It is difficult to keep this treatment going once the patients are back at home in the community. Kazdin et al. Found that changes in behavior achieved through token economies do not remain when tokens are with¬drawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure.

There have also been ethical concerns as such a process is seen to be dehumanising, subjecting the patient to a regime which takes away their right to make choices.

In the 1950s and 60s nurses often “rewarded” patients with cigarettes. Due to the pivotal role of dopamine in schizophrenia this led to a culture of heavy smoking an nicotine addiction in psychiatric hospitals of the era.

Ethical issues – Severely ill patients can’t get privileges because they are less able to comply with desirable behaviors than moderately ill patients – They may suffer from discrimination

Cognitive Behavioral Therapy

In CBT, patients may be taught to recognise examples of dysfunctional or delusional thinking, then may receive help on how to avoid acting on these thoughts. This will not get rid of the symptoms of schizophrenia but it can make patients better able to cope with them.

Central idea: Patients problems are based on incorrect beliefs and expectations. CBT aims to identify and alter irrational thinking including regarding:

• General beliefs.
• Self image.
• Beliefs about what others think.
• Expectations of how others will act.
• Methods of coping with problems.

In theory, when the misunderstandings have been swept away, emotional attitudes will also improve.

Assessment : The therapist encourages the patient to explain their concerns.

• describing delusions • reflecting on relationships • laying out what they hope to achieve through the therapy.

Engagement :

The therapist wins the trust of the patient, so they can work together. This requires honesty, patience and unconditional acceptance. The therapist needs to accept that the illusions may seem real to the patient at the time and should be dealt with accordingly.

ABC : Get the patients to understand what is really happening in their life:

A: Antecedent – what is triggering your problem ? B: behavior – how do you react in these situations ? C: Consequences – what impact does that have on your relationships with others?

Normalisation :

Help the patient realise it is normal to have negative thoughts in certain situations. Therefore there is no need to feel stressed or ashamed about them.

Critical Collaborative Analysis :

Carrying on a logical discussion till the patient begins to see where their ideas are going wrong and why they developed. Work out ways to recognise negative thoughts and test faulty beliefs when they arise, and then challenge and re-think them.

Developing Alternative Explanations :

Helping the patient to find logical reasons for the things which trouble them Let the patient develop their own alternatives to their previous maladaptive behavior by looking at coping strategies and alternative explanations.

Another form of CBT: Coping Strategy Enhancement (CSE)

• Tarrier (1987) used detailed interview techniques, and found that people with schizophrenia can often identify triggers to the onset of their psychotic symptoms, and then develop their own methods of coping with the distress caused. These might include things as simple as turning up the TV to drown out the voices they were hearing! • At least 73% of his sample reported that these strategies were successful in managing their symptoms. • CSE aims to teach individuals to develop and apply effective coping strategies which will reduce the frequency, intensity and duration of psychotic symptoms and alleviate the accompanying distress. There are two components: 1. Education and rapport training: therapist and client work together to improve the effectiveness of the client’s own coping strategies and develop new ones. 2. Symptom targeting: a specific symptom is selected for which a particular coping strategy can be devised Strategies are practised within a session and the client is helped through any problems in applying it. They are then given homework tasks to practice, and keep a record of how it worked.

CBT does seem to reduce relapses and readmissions to hospital (NICE 2014). However, the fact that these people were on medication and having regular meetings with doctors would be expected to have that effect anyway.

Turkington et al. (2006) CBT is highly effective and should be used as a mainstream treatment for schizophrenia wherever possible.

Tarrier (2005) reviewed trials of CBT, finding evidence of reduced symptoms, especially positive ones, and lower relapse rates.

Requires self-awareness and willingness to engage – Held back by the symptoms schizophrenics encounter – It is an ineffective treatment likely to lead to disengagement.

Lengthy – It takes months compared to drug therapy that takes weeks which leads to disengaged treatment as they don’t see immediate effects – A patient who is very distressed and perhaps suicidal may benefit better in the short term from antipsychotics.

Addington and Addington (2005) claim that CBT is of little use in the early stages of an acute schizophrenic episode, but perhaps more useful when the patient is more calm and beginning to worry about how life will be after they recover. In other words, it doesn’t cure schizophrenia, it just helps people get over it.

Research in Hampshire, by Kingdon and Kirschen (2006) found that CBT is not suitable for all patients, especially those who are too thought disorientated or agitated, who refuse medication, or who are too paranoid to form trusting alliances with practitioners.

As there is strong evidence that relapse is related to stress and expressed emotion within the family, it seems likely that CBT should be employed alongside family therapy in order to reduce the pressures on the individual patient.

Section 6: Interactionist Approach

The Interactionist approach acknowledges that there are a range of factors (including biological and psychological) which are involved in the development of schizophrenia.

The Diathesis-stress Model

• The diathesis-stress model states that both a vulnerability to SZ and a stress trigger are necessary to develop the condition. • Zubin and Spring suggest that a person may be born with a predisposition towards schizophrenia which is then triggered by stress in everyday life. But if they have a supportive environment and/or good coping skills the illness may not develop. • Concordance rates are never 100% which suggests that environmental factors must also play a role in the development of SZ. MZ twins may have the same genetic vulnerability but can be triggered by different stressors. • Tienari Et. A. (2004): Adopted children from families with schizophrenia had more chance of developing the illness than children from normal families. This supports a genetic link. However, those children from families schizophrenia were less likely to develop the illness if placed in a “good” family with kind relationships, empathy, security, etc. So environment does play a part in triggering the illness.

Holistic – Identifies that patients have different triggers, genes etc. – Patients can receive different treatments for their SZ which will be more effective.

Falloon et al (1996) stress – such as divorce or bereavement, causes the brain to be flooded with neurotransmitters which brings on the acute episode.

Brown and Birley (1968) 50% people who had an acute schizophrenic episode had experienced a major life event in 3 weeks prior.

Substance abuse: Amphetamine and Cannabis and other drugs have also been identified as triggers as they affect serotonin and glutamate levels.

Vasos (2012) Found the risk of schizophrenia was 2.37 times greater in cities than it was in the countryside, probably due to stress levels. Hickling (1999) the stress of urban living made African-Carribean immigrants in Britain 8 to 10 times more likely to experience schizophrenia.

Faris and Dunham (1939) found clear pattern of correlation between inner city environments and levels of psychosis. Pederson and Mortensen (Denmark 2001) found Scandanavian villages have very LOW levels of psychosis, but 15 years of living in a city increased risk.

Fox (1990): It is more likely that factors associated with living in poorer conditions (e.g. stress) may trigger the onset of schizophrenia, rather than individuals with schizophrenia moving down in social status.

Bentall’s meta-analysis (2012) shows that stress arising from abuse in childhood increases the risk of developing schizophrenia.

Toyokawa, Et. Al (2011) suggest many aspects of urban living – ranging from life stressors to the use of drugs, can have an effect on human epigenetics. So the stressors of modern living could cause increased schizophrenia in future generations.

Finding Contentment With Schizophrenia

A personal perspective: schizophrenia made me want to go back in time..

Posted April 14, 2024 | Reviewed by Jessica Schrader

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I am an advocate for schizophrenia recovery and know what it is like to live with the diagnosis. As I meet struggling families who contact me for advice and support, I understand the challenges and loss their loved ones face. I remember in 2007, it really looked like I would never recover and a return to school would not be possible. Every day I grieved for what I had lost, and was desperate to go back in time. But today, I have peace and live in the present.

High school

When I was in high school, I had big dreams . Most of my time was spent thinking about where I would attend college, and what I would study. Dropping out of college due to schizophrenia, and even becoming homeless, was not remotely a part of my wildest imagination for the future.

My teenage life was about practicing the violin and studying. My goal to join the Cleveland Orchestra Youth Orchestra, which was one of the top five in the country, was achieved at age 13. That year, I also became a student of a violin professor at the Cleveland Institute of Music. I practiced four to five hours every day. No matter how well I did, I was always striving to do better.

In high school, I also did well academically. At 15 years old, I started a special program, enrolling as a full-time college student at the Cleveland area’s Lakeland Community College. I was able to take classes including calculus, economics, literature, general chemistry, and even music theory. Because students at Lakeland wanted to be there, there were no behavior problems. It was exciting to have professors, rather than high school teachers, for all my classes. My life was always centered around my future.

I scored high on my SAT exam and won a half-tuition scholarship to study at my dream school, USC, in Los Angeles, after my graduation. By the time I arrived there, I was set on doing research as a molecular biologist for my career .

My first mental health symptoms appeared right about the time I had achieved my goal and made it to university. I could not realize that life at USC was the perfect fulfillment of all I had hoped and worked for. The academic rigor I had always wanted was part of every class. My first semester there, I took classes including East Asian Societies, and was fascinated by the material. Other students in the dorm were passionate like me, the scenery on campus was beautiful and the food excellent. All I had to do was focus on my dream at USC and study as I had always loved to do, but from the very start, something was clearly wrong with me.

Ravaged by schizophrenia, not only would I drop out of USC, but would become homeless for four years in the LA area. Convinced that I did not need my degree, instead I believed my delusions and expected to become a prophet.

Looking back

I find it ironic that I spent so many years looking ahead to my future. But once I got there, I was unable to enjoy it. Then, after developing schizophrenia, I found myself constantly looking back to the past. I longed to be a student at Lakeland again, or rewind time to begin again at USC.

I was not diagnosed with schizophrenia until 2007, though I believe there were warning signs during my first semester at USC, in 1999. Thankfully, in 2008, I made a full recovery on an underutilized antipsychotic medication , which I now hope to take for the rest of my life. Thanks to my recovery, which involved adherence to treatment, I was able to transfer to the University of Cincinnati (near my parents’ home) and finally finish my molecular biology degree Magna cum Laude. But I still found myself looking back. At the University of Cincinnati, I attend classes part-time. I remembered that when I was in high school, I was taking a full-time course load and was practicing violin four hours a day.

Living in the present

This year, in 2024, I finally find myself content with my life and do not look back every day to my past, wishing things had turned out differently.

I am deeply grateful to the psychiatrist who treated me in 2008, Dr. Henry Nasrallah, for convincing me to return to college, where I would thrive again at the University of Cincinnati. He was the motivation behind the writing of my memoir, which I published in 2014. He was also the force behind the charitable foundation that he and I established together in 2016. Today, I work for the foundation, and these days, I am extremely busy and fulfilled.

Schizophrenia can be a thief, robbing young people of dreams and forcing us to significantly alter the plans we made for our lives.

As I write this, I would like to say I am deeply grateful for my recovery thanks to treatment. And at the same time, I do stand in solidarity with young people who are grieving over what they have lost.

My biggest piece of advice would be this: always adhere to treatment. You never know how life will turn out or what promising and unexpected turns your life will take. With treatment, there is always hope for the future, and even a return to what you loved most in the past.

However, I fully understand the wonderful life I live today is 100% contingent on staying in treatment. I realize that if I discontinue my medication, and restart it, it may become less effective, even at higher dosages. And every psychotic episode does more damage to the brain.

Today, I enjoy living in the present, where I am finding contentment, grateful for every day. I usually am too busy to look back.

I encourage those struggling with schizophrenia to dream again and not settle for partial recovery. Adherence to effective treatment is the key.

Bethany Yeiser is the author of Mind Estranged: My Journey from Schizophrenia and Homelessness to Recovery.

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Metacognitive abilities like reading the emotions and attitudes of others may be more influenced by environment than genetics

Twin studies have proven invaluable for teasing out the effects of both genetics and the environment on human biology. In a study published April 2 in Cell Reports , researchers studied pairs of twins to look at how the interplay of genetics and environment affect cognitive processing -- the way that people think. They found that some cognitive abilities appear to be regulated more by environmental factors than by genetics.

"Past research has suggested that general intelligence -- often referred to as intelligence quotient or IQ -- has a heritability ranging from 50% to 80%," says senior and corresponding author Xiaohong Wan of Beijing Normal University in China. "Our study may be the first to demonstrate that a different kind of cognitive ability, known as metacognition and mentalizing, might be much more influenced by environment."

Cognitive functions such as perception, attention, memory, language, and planning are considered to be the basis for general intelligence. These functions regulate the way that people organize and process new information. By contrast, metacognition looks at how well people understand and control their cognitive processes.

Metacognition is important for developing learning strategies and is believed to be a predictor of an individual's successes in school and social achievements. Mentalizing describes the process of recognizing and understanding mental states like emotions and attitudes, both in ourselves and in other people.

For this research, the investigators recruited 57 pairs of adult monozygotic (identical) twins and 48 pairs of dizygotic (fraternal) twins from the Beijing Twin Study (BeTwiSt). This is an ongoing, long-term study established in 2006 that includes extensive data like brain images and psychological surveys, as well as genetic information, on pairs of twins.

The twins were asked to perform tasks related to metacognition. These tasks consisted of watching a cluster of moving dots on a screen and making a perceptual judgement on the net direction of the dots. They were also asked to rate their confidence about their decisions. To measure mentalizing, the participants were asked to evaluate a partner's confidence in their decision-making abilities.

The investigators found that pairs of twins who had parents with higher levels of education and higher family incomes have similar results to each other, regardless of whether they were identical or fraternal. These observations suggested that familial environment was more likely to influence metacognitive abilities than genetics.

"Our findings were outside our expectations," Wan says. "Decades of extensive research utilizing the classical twin paradigm have consistently demonstrated the heritability of nearly all cognitive abilities so far investigated. Our findings emphasize that these shared family environmental factors, such as parental nurturing and the transmission of cultural values, likely play a significant role in shaping the mental state representations in metacognition and mentalizing."

The researchers acknowledge that there are limitations to this research and that many more studies are needed. They plan to continue their research in this area, including using population studies to further investigate what kind of specific parental nurturing factors and sociocultural values affect individuals' metacognitive and mentalizing abilities.

This research was supported by the Ministry of Science and Technology of the People's Republic of China, the National Natural Science Foundation of China, the Interdisciplinary Innovation Team of the Chinese Academy of Sciences, and the BeTwiSt of Institute of Psychology, Chinese Academy of Sciences.

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Materials provided by Cell Press . Note: Content may be edited for style and length.

Journal Reference :

• Shaohan Jiang, Fanru Sun, Peijun Yuan, Yi Jiang, Xiaohong Wan. Distinct genetic and environmental origins of hierarchical cognitive abilities in adult humans . Cell Reports , 2024; 43 (4): 114060 DOI: 10.1016/j.celrep.2024.114060

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‘Like a film in my mind’: hyperphantasia and the quest to understand vivid imaginations

Research that aims to explain why some people experience intense visual imagery could lead to a better understanding of creativity and some mental disorders

W illiam Blake’s imagination is thought to have burned with such intensity that, when creating his great artworks, he needed little reference to the physical world. While drawing historical or mythical figures, for instance, he would wait until the “spirit” appeared in his mind’s eye. The visions were apparently so detailed that Blake could sketch as if a real person were sitting before him.

Like human models, these imaginary figures could sometimes act temperamentally. According to Blake biographer John Higgs , the artist could become frustrated when the object of his inner gaze casually changed posture or left the scene entirely. “I can’t go on, it is gone! I must wait till it returns,” Blake would declaim.

Such intense and detailed imaginations are thought to reflect a condition known as hyperphantasia, and it may not be nearly as rare as we once thought, with as many as one in 30 people reporting incredibly vivid mind’s eyes.

Just consider the experiences of Mats Holm, a Norwegian hyperphantasic living in Stockholm. “I can essentially zoom out and see the entire city around me, and I can fly around inside that map of it,” Holm tells me. “I have a second space in my mind where I can create any location.”

This once neglected form of neurodiversity is now a topic of scientific study, which could lead to insights into everything from creative inspiration to mental illnesses such as post-traumatic stress disorder and psychosis.

Francis Galton – better known as a racist and the “father of eugenics” – was the first scientist to recognise the enormous variation in people’s visual imagery. In 1880, he asked participants to rate the “illumination, definition and colouring of your breakfast table as you sat down to it this morning”. Some people reported being completely unable to produce an image in the mind’s eye, while others – including his cousin Charles Darwin – could picture it extraordinarily clearly.

“Some objects quite defined. A slice of cold beef, some grapes and a pear, the state of my plate when I had finished and a few other objects are as distinct as if I had photos before me,” Darwin wrote to Galton.

Unfortunately, Galton’s findings failed to fire the imagination of scientists at the time. “The psychology of visual imagery was a very big topic, but the existence of people at the extremes somehow disappeared from view,” says Prof Adam Zeman at Exeter University. It would take more than a century for psychologists such as Zeman to take up where Galton left off.

Even then, much of the initial research focused on the poorer end of the spectrum – people with aphantasia , who claim to lack a mind’s eye. Within the past five years, however, interest in hyperphantasia has started to grow, and it is now a thriving area of research.

To identify where people lie on the spectrum, researchers often use the Vividness of Visual Imagery Questionnaire (VVIQ), which asks participants to visualise a series of 16 scenarios, such as “the sun rising above the horizon into a hazy sky” and then report on the level of detail that they “see” in a five-point scale. You can try it for yourself. When you picture that sunrise, which of the following statements best describes your experience?

1. No image at all, you only “know” that you are thinking of the object 2. Vague and dim 3. Moderately clear and lively 4. Clear and reasonably vivid 5. Perfectly clear and as vivid as real seeing

The final score is the sum of all 16 responses, with a maximum of 80 points. In large surveys, most people score around 55 to 60 . Around 1% score just 16; they are considered to have extreme aphantasia; 3%, meanwhile, achieve a perfect score of 80, which is extreme hyperphantasia.

The VVIQ is a relatively blunt tool, but Reshanne Reeder, a lecturer at Liverpool University, has now conducted a series of in-depth interviews with hyperphantasic people – research that helps to delineate the peculiarities of their inner lives. “As you talk to them, you start to realise that this is a very different experience from most people’s experience,” she says. “It’s extremely immersive, and their imagery affects them very emotionally.”

Some people with hyperphantasia are able to merge their mental imagery with their view of the world around them. Reeder asked participants to hold out a hand and then imagine an apple sitting in their palm. Most people feel that the scene in front of their eyes is distinct from that inside their heads. “But a lot of people with hyperphantasia – about 75% – can actually see an apple in the hand in front of them. And they can even feel its weight.”

As you might expect, these visual abilities can influence career choices. “Aphantasia does seem to bias people to work in sciences, maths or IT – those Stem professions – whereas hyperphantasia nudges people to work in what are traditionally called creative professions,” says Zeman. “Though there are many exceptions.”

Reeder recalls one participant who uses her hyperphantasia to fuel her writing. “She said she doesn’t even have to think about the stories that she’s writing, because she can see the characters right in front of her, acting out their parts,” Reeder recalls.

H yperphantasia can also affect people’s consumption of art. Novels, for example, become a cinematic experience. “For me, the story is like a film in my mind,” says Geraldine van Heemstra , an artist based in London. Holm offers the same description. “When I listen to an audiobook, I’m running a movie in my head.”

This is not always an advantage. Laura Lewis Alvarado, a union worker who is also based in London, describes her disappointment at watching The Golden Compass, the film adaptation of the first part of Philip Pullman’s His Dark Materials . “I already had such a clear idea of how every character looked and acted,” she says. The director’s choices simply couldn’t match up.

Zeman’s research suggests that people with hyperphantasia enjoy especially rich autobiographical memories. This certainly rings true for Van Heemstra. When thinking of trips in the countryside, she can recall every step of her walks, including seemingly inconsequential details. “I can picture even little things, like if I dropped something and picked it up,” she says.

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Exactly where these abilities come from is unknown. Aphantasia is known to run in families, so it’s reasonable to expect that hyperphantasia may be the same. Like many other psychological traits, our imaginative abilities probably come from a combination of nature and nurture, which will together shape the brain’s development from infancy to old age.

Zeman has taken the first steps to investigate the neurological differences that underpin the striking variation in the mind’s eye. Using fMRI to scan the brains of people at rest, he has found that hyperphantasic people have greater connectivity between the prefrontal cortex, which is involved in “higher-order” thinking such as planning and decision-making, and the areas responsible for visual processing, which lie towards the back of the skull.

“My guess is that if you say ‘apple’ to somebody with hyperphantasia, the linguistic representation of ‘apple’ in the brain immediately transmits the information to the visual system,” says Zeman. “For someone with aphantasia, the word and concept of ‘apple’ operate independently of the visual system, because those connections are weaker.”

Further research will no doubt reveal the nuances in this process. Detailed questionnaires by Prof Liana Palermo at the Magna Graecia University in Catanzaro, Italy, for instance, suggest that there may be two subtypes of vivid imagery . The first is object hyperphantasia, which, as the name suggests, involves the capacity to imagine items in extreme detail.

The second is spatial hyperphantasia, which involves an enhanced ability to picture the orientation of different items relative to one another and perform mental rotations. “They also report a heightened sense of direction,” Palermo says. This would seem to match Holm’s descriptions of the detailed 3D cityscape that allows him to find a route between any two locations.

Many mysteries remain. A large survey by Prof Ilona Kovács, at Eötvös Loránd University in Hungary, suggests that hyperphantasia is far more common among children, and fades across adolescence and into adulthood. She suspects that this may reflect differences in how the brain encodes information. In infancy, our brains store more sensory details, which are slowly replaced by more abstract ideas. “The child’s memories offer a more concrete appreciation of the world,” she says – and it seems that only a small percentage of people can maintain this into later life.

Reeder, meanwhile, is interested in studying the consequences of hyperphantasia for mental health. It is easy to imagine how vivid memories of upsetting events could worsen the symptoms of anxiety or post-traumatic stress disorder, for example.

Reeder is also investigating the ways that people’s mental imagery may influence the symptoms of illnesses such as schizophrenia . She suspects that, if someone is already at risk of psychosis, then hyperphantasia may lead them to experience vivid hallucinations, while aphantasia may increase the risk of non-sensory delusions, such as fears of persecution.

For the moment, this remains an intriguing hypothesis, but Reeder has shown that people with more vivid imagery in daily life are also more susceptible to seeing harmless “ pseudo-hallucinations ” in the laboratory. She asked participants to sit in a darkened room while watching a flickering light on a screen – a set-up that gently stimulates the brain’s visual system. After a few minutes, many people will start to see simple illusions, such as geometric shapes. People with higher VVIQ scores, however, tended to see far more complex scenes – such as a stormy beach, a medieval castle or a volcano. “It was quite psychedelic,” says Lewis Alvarado, who took part in the experiment.

Reeder emphasises that the participants in her study were perfectly able to recognise that these pseudo-hallucinations were figments of their imagination. “If someone never has reality discrimination issues, then I don’t think they’re going to be more prone to psychosis.” For those with mental illness, however, a better understanding of the mind’s eye could offer insights into the patient’s experiences.

For now, Reeder hopes that greater awareness of hyperphantasia will help people to make the most of their abilities. “It’s a skill that could be tapped,” she suggests.

Many of the people I have interviewed are certainly grateful to know a little more about the mind’s eye and the way theirs differs from the average person’s.

Lewis Alvarado, for instance, only came across the term when she was listening to a podcast about William Blake, which eventually led her to contact Reeder. “For the first month or so I couldn’t get it out of my head,” she says. “It’s not something I talk about loads, but I think it has helped me to realise why I experience things more intensely, which is comforting.”

David Robson is the author of The Laws of Connection: 13 Social Strategies That Will Transform Your Life , published by Canongate on 6 June (£18.99). To support the Guardian and Observer , order your copy at guardianbookshop.com . Delivery charges may apply

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Bringing Psychology Students Closer to People with Schizophrenia at Pandemic Time: A Study of a Distance Anti-stigma Intervention With In-presence Opportunistic Control Group

Lorenza magliano.

Department of Psychology, Lorenza Magliano, University of Campania “Luigi Vanvitelli”, Viale Ellittico 31, 81100 Caserta, Italy

Associated Data

The data that support the findings of this study are available from the corresponding author upon reasonable request, which must include a protocol and statistical analysis plan and not be in conflict with her publication plan.

Declaration.

Psychology students are a target population to increase the likelihood that Persons With Schizophrenia (PWS) will receive evidence-based psycho-social interventions in the future. The willingness of future psychologists to care for PWS can be supported through anti-stigma educational interventions. During the pandemic, university education was delivered largely at-distance, which was later combined with in-presence education. This study explored whether an At-Distance Educational Intervention (ADEI), addressing stigma in schizophrenia via scientific evidence and testimony: would improve psychology students' views of PWS, at the one-month post intervention re-assessments; would be more effective of the same In-Presence Educational Intervention (IPEI). ADEI was delivered online to students of two Master’s degrees in Psychology at the University of Campania “Luigi Vanvitelli”, Caserta, Italy. IPEI was administered to a similar group of 76 students in the pre-pandemic era. Participants completed an anonymous questionnaire about their views on schizophrenia before the intervention (two three-hour sessions one week apart) and one month after its completion. Compared to their pre-intervention assessments, at post-intervention reassessments the 65 ADEI students were: more confident in the recovery and the usefulness of psychological therapies; surer of the PWS awareness and capability to report health problems to professionals; more skeptical about PWS dangerousness, social distance, and affective difficulties; more uncertain on the opportunity to discriminate PWS in hospital and psychology practices. ADEI was more effective than IPEI in five of the ten dimensions analyzed and similarly effective in the remaining others. ADEI may represent a valuable alternative to IPEI for improving future psychologists' view of PWS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40737-022-00308-1.

Introduction

Despite the key role of psychologists in the development of evidence-based psychosocial interventions for schizophrenia (McDonagh et al. 2022 ; Mc Glanaghy et al. 2021 ; Mueser et al. 2013 ; Reddy et al. 2010 ), the involvement of these professionals in the care of persons with this disorder is still limited (O'Connor and Yanos 2021 ). This is one of the reasons why the availability of non-pharmacological interventions for people with schizophrenia (PWS) remains insufficient in routine clinical settings (Corrao et al. 2022 ; Ince et al. 2016 ). Poor involvement of psychologists in schizophrenia can be partially explained by limited training in psychosocial approaches to this disorder in the psychology studies (Buck et al. 2014 ; Ince et al. 2016 ; Mojtabai et al. 2011 ; Roe et al. 2006 ) and negative attitudes towards PWS among psychologists (Servais & Saunders 2007 ; Valery & Prouteau 2020 ). The prevalence of biogenetic causal models of schizophrenia in the psychological field (Deacon 2013 ) further directs treatment toward an almost exclusively medical-pharmacological pathway (Corrao et al. 2022 ; Magliano et al. 2017a ; Read et al. 2013 ). Biogenetic models also feed into the view of schizophrenia as an incurable disorder whose symptoms are poorly controllable by the will of the affected person, reinforcing professionals' perception of PWS as dangerous, unpredictable and to be kept at a distance (Harangozo et al. 2014 ; Read et al. 2013 ).

Psychology students are a target population to increase the likelihood that PWS will receive integrated evidence-based interventions in the future. Studies reveal that psychology students, similar to students of other health disciplines (LLerena et al. 2002 ; Magliano et al. 2011 ; Mannarini et al. 2020 ; Masedo et al. 2021 ), sometimes have negative attitudes towards PWS, and that students’ attitudes do not invariably improve during university studies (Economou et al. 2012 ; Magliano et al. 2013 , 2016a ; Maranzan 2016 ). Research shows that it is possible to improve students’ attitudes towards PWS through anti-stigma educational interventions that: include direct or indirect contact with people with this disorder and their involvement as testimonials; frame schizophrenia according to a balanced bio-psycho-social causal model; and refer to a recovery-oriented therapeutic approach (Cangas et al. 2017 ; Clement et al. 2012 ; Friedrich et al. 2013 ; Griffiths et al. 2014 ; Lincoln et al. 2008 ; Pingani et al. 2021 ; Stubbs 2014 ; Yamaguchi et al. 2013 , 2019 ). In 2011, an anti-stigma educational intervention for health disciplines students, entitled “Social dangerousness and incurability of schizophrenia: prejudices and scientific evidences”, was developed at the University of Campania “Luigi Vanvitelli”, Caserta, Italy (Magliano et al. 2014 ). When administered to 211 medical and psychology students, the intervention was successful in reducing students’ perception of PWS as dangerous, unpredictable, and affected by an incurable disorder at the immediate follow-up reassessment (Magliano et al. 2014 ). In a further study at the same University (Magliano et al.  2016b ), the intervention was evaluated in a randomly selected sample of 76 psychology students vs. a 112-psychology students’ control group. Compared with their baseline assessment, at one-month post-intervention reassessment, the educated students: endorsed more psychosocial causes and more of them recommended psychologists in the treatment of schizophrenia; were surer about recovery and the usefulness of drug and psychological treatments; and were more skeptical about the unpredictability of PWS. Compared to controls, at one-month re-assessment educated students were more optimistic about recovery and more skeptical regarding unpredictability of PWS.

In the past two years of the pandemic, university learning has been largely based on the usage of distance education, later combined with face-to-face education (Naciri et al. 2021 ; Dedeilia et al. 2020 ; Dhawan 2020 ). Studies examining the effects of at-distance education applied to courses previously delivered in-person found that e-education did not decrease examination scores (Kronenfeld et al. 2021 ) and it was also well accepted by students (Abdull Mutalib et al. 2022 ; Dedeilia et al. 2020 ). Costs and time-saving benefits and difficulties due to unfamiliarity with the e-education approach were reported (Monteduro, 2021 ; Sharaievska et al. 2022 ). Few studies examined the capacity of at-distance education to improve future psychologists’ attitudes toward PWS. A controlled study examined the impact of a virtual program to reduce the stigma of severe mental disorders among students of health disciplines (Rodríguez-Rivas et al. 2021 ). The online program, including project-based learning, clinical simulations with standardized patients and E-Contact with real patients, was found effective in reducing students’ stereotypes, perception of dangerousness, and lack of solidarity toward PWS. A pilot study explored the effects of the Magliano et al. ( 2014 ) educational intervention when delivered at-distance (At-Distance Educational Intervention—ADEI) to psychology students (Magliano et al. 2021 ). Compared to the pre-intervention evaluations, at the one-month follow-up, the participants were: more optimistic about recovery and the usefulness of psychological therapies in schizophrenia; and, more confident in the ability of PWS to behave appropriately when interacting with other people. Given the ongoing pandemic, it would be worth further investigating whether at-distance education improves students’ attitudes toward PWS and whether at-distance education is, in some cases, preferable to in-presence education.

In this study, the effect of ADEI on views of PWS was examined in a sample of 142 psychology students from two master’s degrees at the University of Campania “Luigi Vanvitelli”, Caserta, , Italy, using paired pre-post assessments matched by an anonymous code (primary study aim). Furthermore, the effect of ADEI on students’ attitudes was compared with that of the same intervention delivered in-presence (In-Presence Educational Intervention, IPEI) to the 76-student sample of the Magliano et al.  2016b study (opportunistic control group, secondary study aim).

The study’s primary aim was investigated by measuring the following views in the ADEI sample: 1–2) usefulness of pharmacological and psychological therapies; 3) need of long-term pharmacological therapies; 4) possibility of recovery in schizophrenia; 5) insight of PWS; 6) capacity of PWS to report their health conditions to medical doctors; 7) perception of unpredictability and others’ need for social distance from PWS; 8) perception of dangerousness of PWS; 9) discriminatory behaviors to be adopted with PWS in non-psychiatric hospital wards; 10) difficulties of PWS in having romantic relationships; 11) capacities of PWS to report their mental health problems to psychologists; and, 12) discriminatory behaviors to be adopted with PWS in the psychologist’s office.

It was hypothesized that, compared to their paired baseline assessment, at one-month post intervention re-assessment, ADEI students were: more convinced of the usefulness of pharmacological and psychological treatments and the possibility of recovery in schizophrenia; more skeptical about life-long drugs for the treatment of this disorder; more confident of the awareness of PWS on their own health status and of PWS capacity to report their health problems to physicians and psychologists; more doubtful about the opportunity to adopt discriminatory behaviors against PWS in non-psychiatric hospital wards and in the psychologists' offices; and, more skeptical regarding the dangerousness of, and social distance from, PWS and the difficulties these persons experience in emotional relationships.

As the study secondary aim, it was hypothesized that ADEI would be more effective than IPEI to improve psychology students’ views of schizophrenia at the one-month re-assessment. ADEI and IPEI groups were compared in all the above-mentioned views, except views n. 11 and n. 12 (not collected in the IPEI sample). The IPEI data used in this study had not been analyzed previously, except for six single items included in the 2–3 and 7–8 subscales views listed above.

Study Design

The ADEI was scheduled within the laboratory activities included in the Psychiatry course for psychology students of the master’s degrees in "Clinical Psychology" (2nd semester of the 1st year) and in "Applied Psychology" (1st semester of the 2nd year) at the University of Campania “Luigi Vanvitelli”, Caserta, Italy. Before the start of the ADEI, students (expected participants: N = 99 per course) were invited to participate in an online voluntary evaluation of their views of mental disorders to be repeated one month after the ADEI completion. Students who accepted were asked to complete online the Opinions on mental illness Questionnaire—revised version (OQ; Magliano et al. 2017b ), after reading an ICD-10 clinical description of schizophrenia. Students were also asked to report on the OQ an anonymous code to be used for matching their baseline and one-month post-intervention re-assessments. Participants completed the OQ online via their own digital devices, using a link posted on the Microsoft Teams channel dedicated to the psychiatry course. Answers were collected using the Google forms app. The possibility to stop the completion of the questionnaire and delete the answers was guaranteed by the online mode (just closing the Internet page without saving). The ADEI was delivered in October–November 2020 and in March–May 2021. The IPEI control group had received the intervention in March–April 2012 and March–April 2013 (see Magliano et al. 2016b , for further details). The study was approved by the ethics committee of the Department of Psychology of the University of Campania “Luigi Vanvitelli”, Caserta, Italy, approval released to the IPEI study protocol, being only changed the intervention delivery mode.

Contents of the Educational Intervention

The educational intervention consisted of two three-hour sessions with an interval of a week between them. The first session covered the following topics: a) definitions of stigma; b–c) research studies and personal stories on stigma and its effects; d) stigma and the media; e) stigma and mental health problems; f) stigma against persons with mental disorders in health contexts; g) stigma in schizophrenia. The second session focused on: a–c) scientific evidence on dangerousness in “at risk” minority social groups, persons with mental disorders, and particularly schizophrenia; d) subjective and objective dimensions of recovery; e) evidences on recovery in schizophrenia; and f) empowerment-oriented mental health services. Scientific reports, media articles, and video materials from anti-stigma campaigns were used in both sessions. In addition, four people who have been recovered or experienced stigma related to their mental health problems provided audio testimonies of their personal stories. ADEI was delivered on Microsoft Teams platform. Participants were prompted to intervene in plenary discussions, verbally, by using the audio link with or without video, or in writing on the chat.

Assessment Instrument

The OQ included: a) 16 yes/no items exploring factors involved in the development of schizophrenia; b) 4 yes/no items about which professionals should be involved in the care of PWS; c) 23 items grouped into 10 subscales and addressing respondent’s views on: 1–2) usefulness of pharmacological and psychological therapies; 3) need of long-term pharmacological therapies; 4) possibility of recovery; 5) insight of PWS; 6) capacity of PWS to report their health conditions to medical doctors; 7) perception of social distance from PWS; 8) perception of dangerousness; 9) discriminatory behaviors to be adopted with PWS in non-psychiatric hospital wards; and 10) difficulties of PWS in having romantic relationships. Section c items are rated on a 3-point scale, from 1 = “not true” to 3 = “completely true”. The psychometric properties of OQ section C, were preliminary tested and found to be satisfactory (Confirmatory Factor Analysis: model χ 2  = 320.35, df 188, N = 387, p  < 0.05; NNFI = 0.95; CFI = 0.97; RMSEA = 0.04 (0.03; 0.05); SRMR = 0.04; all factor loadings significant for p  < 0.001; Cronbach’s alpha values of the factors ranging from 0.65 to 0.83; Magliano et al. 2017b ). For the purposes of this study, a further 5 items were added to examine respondent views of: 11) capacities of PWS to report their mental health problems to psychologists; and 12) discriminatory behaviors to be adopted with PWS in psychologist’ office. In this study sample, Cronbach’s alpha values computed on OQ section c, and two additional subscales ranged from 0.61 to 0.94 (OQ a–b sections not analysed).

Statistical Analysis

Descriptive statistics were computed on OQ single items and participants’ demographic characteristics (age and gender). Pre-post data were matched using the anonymous code that students were asked to report on the questionnaire. In the ADEI group, General Linear Model (GLM) for repeated measures was computed to explore differences in pre vs. one-month post-intervention mean scores of the OQ section c and additional subscales (within subject factor: pre-post paired assessment). The same analysis was used to compare pre-post mean score of the 10 OQ section c factors in the ADEI vs. IPEI group (within subject factor: pre post paired assessment; between subject: type of education: ADEI vs. IPEI). GLM analyses were adjusted for age and gender, as appropriate. The statistical significance level was set at p  < 0.05. Analyses were performed using Statistical Package for the Social Sciences (SPSS) Version 21.

Flow and Socio-demographic Characteristics of ADEI and IPEI Participants

As shown in the flowchart (Fig.  1 ), 142 out of the 198 expected ADEI participants completed the OQ at baseline and 142 participants completed the same questionnaire at the one-month post intervention (participation rate: 71.7%; 131, 92.3% female, average age 24.1 ± 3.5 (sd) years). Sixty-five participants provided a matchable code and 77 did not (40 “can’t remember the code”, 37 blank/non matchable, attrition rate: 54.2%). Of the 65 students providing a matchable code, 63 (96.9%) were female and 2 (3.1%) were male, and they had and average age of 24.2 ± 3.3 (sd) years. Non-matchable students were similar to matchable ones for sex and age. The IPEI control group included 76 students of the Applied Psychology Master’s degree who completed the paired pre- and one-month post-intervention assessment (attrition rate: 11.6%) and provided an anonymous matchable code. Of these, 66 (86.8%) were female and 10 (13.2%) were male, and they had and average age of 26.9.2 ± 5.8 (sd) years. Of the 141 students with paired pre-post matchable assessments (ADEI 65 and IPEI 76), 91.5% were female and they had an average age of 25.7 ± 4.9 (sd) years. Compared to the 65 ADEI students, the 76 IPEI students were slightly more frequently male (2 vs. 10, χ 2 4.6, df 1, p  < 0.03, Yates’ correction for continuity: 3.4, df 1, p  = 0.07), and they had a higher average age ( F  = 10.7, df 1, 138, p  < 0.001). As the distribution of the age variable was positively skewed (skewness = 3.7, ex 0.20; kurtosis = 165.0, ex 0.20), in the multivariate analyses normalized age score was used. Furthermore, given the very low number of male students (2 in ADEI and 10 in IPEI), GLM was only adjusted for normalized age score.

Participant Flow Diagram

Views of Schizophrenia in ADEI Students: Pre-intervention Descriptive Results

Of the 142 ADEI students who completed their pre-intervention assessment, 22.9% firmly stated that PWS could recover, 25.2% believed that these persons had to take drugs life-long, and 38.0% were convinced that psychological treatments were useful in schizophrenia (complete data in Supplementary File 1, additional Table ​ Table1). 1 ). Seventy-three percent of respondents felt that PWS were kept at a distance, and 16.9% perceived these persons as being dangerous to others. Twelve percent of students thought that PWS should be separated from other patients in non-psychiatric hospital wards and 19.5% believed that PWS should be accompanied when going to psychology offices.

Psychology Students’ Views of Schizophrenia: Paired Comparisons of Baseline Versus One-Month Reassessment in the ADEI group (N = 65)

ADEI At-distance Eeducational Iintervention; PWS Persons With Schizophrenia;

a p  < 0.005; b p  < 0.0001;

* F values refer to individual comparisons

Analysis adjusted for age (normalized score);

Views of Schizophrenia in ADEI Students: Paired Comparisons of Pre-intervention Versus One-month Post-intervention Assessments

The GLM performed on the paired ADEI data ( N  = 65) is shown in Table ​ Table1. 1 . GLM revealed a significant effect of the intervention on all OQ section c and two additional subscales (Wilks’ λ  = 0.25, F (overall df 12, 52) = 12.7, p  < 0.0001). The effect of the covariate age was not significant (age: Wilks’ λ  = 0.74, F (overall df 12, 52) = 1.5, p  = 0.15; age x intervention: Wilks’ λ  = 0.83, F (overall df 12, 52) = 0.90, p  = 0.55). C ompared to their pre-intervention assessment, at post-intervention students were surer that PWS could recover and that psychological therapies were useful in schizophrenia. Moreover, students were more skeptical about the need of life-long drug therapies in schizophrenia. At one-month reassessment, students were surer that PWS were aware of their disorder and capable to report their problems to professionals. Students were also less convinced that PWS were dangerous and kept at a distance and that they had difficulties in romantic relationships. Finally, at post interventions students were more uncertain on the opportunity to discriminate PWS in non-psychiatric wards and psychology offices.

Pre-post Paired Comparisons of Views of Schizophrenia in ADEI Versus IPEI Student Groups

As reported in Table ​ Table2, 2 , GLM performed on the 65 ADEI vs. the 76 IPEI students revealed statistical significant effects on students' views of the intervention (pre-post assessments: Wilks’ λ  = 0.30, F (overall df 10, 129) = 29.8, p  < 0.0001), the delivery mode (ADEI vs. IPEI: Wilks’ λ  = 0.64, F (overall df 10, 129) = 7.1, p  < 0.0001) and the interaction between them (Wilks’ λ  = 0.79, F (overall df 10, 129) = 3.41, p  < 0.001). The effect of the covariate was not significant (age: Wilks’ λ  = 0.91, F (overall df 10, 129) = 1.26, p  = 0.26; age x intervention: Wilks’ λ  = 0.96, F (overall df 10, 129) = 0.50, p  = 0.88). The interaction between delivery mode and the intervention revealed changes in favor of the ADEI group as far as: students’ views of recovery in schizophrenia; reliability of PWS in reporting their disorders to MDs; and, dangerousness, social distance and discrimination of PWS in non-psychiatric hospital wards.

Psychology Students’ Views of Schizophrenia: Paired comparisons of baseline versus one-month reassessment in the ADEI (N = 65) vs. IPEI groups (N = 76)

ADEI At-Distance Educational Intervention; IPEI In-Presence Educational Iintervention; PWS Persons With Schizophrenia;

a p  < 0.05; b p  < 0.01; c p  < 0.001; d p  < 0.000;

Critical Comments of the Data

The results of this study confirm that ADEI is able to change students' views on PWS, which may influence the relationship between psychologists and PWS in the future. Furthermore, the study revealed a superiority of the ADEI over the IPEI in five of the ten analyzed dimensions and a substantial equality of effect in the remaining ones. These encouraging results may be partially related to the characteristics of the intervention, as it was based on indirect contact with people who recounted their experience of mental disorders, emphasizing the support received from families and friends and the health professionals in the recovery process (Soundy et al. 2015 ). Recounting these aspects may have contributed to participants’ increased acknowledgement of the usefulness of psychological therapies and the role of psychologists in the care of the disorder. For instance, a user highlighted the importance of psychotherapy in her recovery process as well as “the luck” of having a “human” relationship with mental health professionals (Tibaldi & Govers 2012 ). She also outlined the beneficial effects of antipsychotics on symptoms without denying the side effects of the long-term use of such drugs (Magliano et al.  2016b ).

At one-month follow up reassessment, students were more confident regarding recovery in schizophrenia. This result is likely related to testimonies confirming that recovery is possible and the use of literature findings on favorable outcomes of schizophrenia, especially when biopsychosocial treatments are provided (Huxley et al. 2021 ; Levine et al. 2010 ; Tibaldi & Govers 2012 ). Emphasizing the usefulness of psychological therapies in the recovery process is of great importance in the management of schizophrenia, as it may influence future psychologists’ willingness to work with clients with this disorder (Magliano et al.  2016a ; Servais & Saunders 2007 ). At the one month follow up re-assessment, participants were more skeptical regarding the dangerousness and social distance of PWS and the need to discriminate PWS in hospital and psychology practice. These views might have been influenced by discussing experiences and research revealing that the risk of aggressive behaviors is modest in PWS, particularly when these persons receive appropriate treatments and are not in an acute psychotic episode (Fazel et al. 2009 ; Large et al. 2009 ). Change in perceived dangerousness might have had an indirect impact on students’ conviction about the opportunity to treat these persons differently from the others in health contexts (Corrigan et al. 2002 ; Magliano et al. 2017c ). Furthermore, the fact that the educational intervention addressed stigma from a social perspective, inscribed PWS’ difficulties into those experienced by other stigmatized groups (stigma against people with developmental disabilities, and against LGBT + , nomad and migrant people), thus avoiding fueling 'a stigma within stigma'. At follow-up re-assessment, students tend to give PWS more credit for awareness of their disorders and the ability to discuss their health problems with doctors and psychologists. This is probably related to testimonies showing that having a mental disorder is not a pervasive experience that invalidates the critical capabilities of the individual as a whole, e.g., by demonstrating that one is able to present one's story as that of people with problems rather than patients.

In terms of the way the educational intervention is delivered, the extensive use of audio and video materials makes it particularly suitable for online use. In the ADEI, participants were prompted to intervene in plenary discussions via chat or using audio only. These options may have facilitated the participation of those shyest students who would have felt uncomfortable intervening in person in the classroom. It should also be considered that ADEI students were likely more attentive due to less tiredness, due to no travel time and distraction by classmates (Dedeilia et al. 2020 ; Naciri et al. 2021 ).

Strengths and Weaknesses of the Study

This is the first study on the effects of an ADEI on psychology students' views of PWS in Italy. Among the strengths of the study, there are: having considered the impact of the intervention on a range of opinions covering respondents’ views of schizophrenia and the relationship of future psychologists with PWS. These opinions were collected online using a validated questionnaire, which may facilitate the replication of the study in other students’ contexts; the use of an opportunistic control group of students who had received the same intervention in attendance. This allows any differences between the groups to be attributed primarily to the delivery mode, contributing to clarify whether at-distance education can be valued as an alternative to in-presence education; the implementation of the ADEI after the first six months of the pandemic, so as to assess the effectiveness of the intervention on learning net of the effect of students’ initial adaptation to remote education. The study has a number of limitations suggesting caution in the interpretation of its results, such as: the sample including predominantly female students (2 male students in ADEI and 10 male students in IPEI), a situation that reflects the high number of female students attending psychology degree courses in Italy (Consorzio Alma Laurea, 2022 ) and makes the data non-generalizable to male students; the opportunistic control group that had received IPEI about eight years earlier. Within eight years, the content of some psychology courses may have changed in favor of a more biogenetically oriented model of schizophrenia (Deacon, 2013 ) and this may have influenced participants' interest in PWS. Furthermore, the one-month follow-up reassessment does not allow to understand if changes are maintained over time. Another weakness is the high number of non-matchable questionnaires in the ADEI group, which may have increased the magnitude of differences between groups. Indeed at post-intervention, non-matchable ADEI students showed higher level of social distance (2.2 ± 0.4 vs. 2.4 ± 0.3, F  = 4.3, p  < 0.04), perceived dangerousness (1.6 ± 0.4 vs. 1.7 ± 0.4, F  = 7.3, p  < 0.008) and prognostic pessimism (2.9 ± 0.2 vs. 2.8 ± 0.4, F  = 10.4, p  < 0.002; MANOVA, Wilkins’s λ 0.84, F = 2.06, df 12, 129, p  < 0.02) than matchable students. However, the comparison of the 142 ADEI students (matchable + non-matchable participants) with the 76 IDEI students at post-intervention re-assessment confirmed statistical significant differences in favor of ADEI, Wilkins’s λ 0.87, F = 2,96, df 10, 207, p < 0.002) in the subscales’ mean scores of insight (1.4 ± 0.5 vs. 1.6 ± 0.4, F  = 7.8, df1, p  < 0.006), reliability (2.3 ± 0.5 vs. 2.1 ± 0.3, F  = 10.9, df1, p  < 0.001) and dangerousness of PWS (1.6 ± 0.4 vs. 1.8 ± 0.4, F  = 7.6, df1, p  < 0.006), and recovery (2.8 ± 0.3 vs. 2.6 ± 0.5, F  = 13.9, df1, p  < 0.0001). These results support the evidence of the superiority of ADEI vs. IPEI, even considering the attrition rate. Finally, it should be considered that, as most research on anti-stigma interventions, this study evaluated attitudes and not behaviors towards PWS. To be able to measure the practical effects of such interventions, research is needed to ascertain whether psychologists exposed to anti-stigma interventions during their university career are more often engaged in therapeutic relationships with PWS.

Conclusions

Despite the weaknesses listed above, this study suggests that ADEI may be useful in improving future psychologists' views of PWS, and that ADEI is a valuable alternative to IPEI. More generally, the results of this study support the potential usefulness of at-distance education in university training for future psychologists. The foreseeable reduction in training costs and the possibility of extending the student population to include those unable to attend in person, suggest the advisability of investing more in this didactive modality in terms of digital infrastructure and university staff training. Such investments are even more necessary given the subsequent waves of pandemics and the likely need to maintain hybrid education, also as a strategy of contagion containment.

Below is the link to the electronic supplementary material.

Acknowledgements

The author would like to thank: the Professors Giovanna Nigro and Gaetana Affuso, Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta (Italy), for their comments and statistical advice on the final draft of the manuscript; the participating students for giving her their time.

Author contribution

The author personally conducted all phases of the study and drafted the manuscript.

Open access funding provided by Università degli Studi della Campania Luigi Vanvitelli within the CRUI-CARE Agreement. The author did not receive support from any organization for the submitted work.

Availability of data and material

Declarations.

The author has no relevant financial or non-financial interests to disclose.

Informed consent for participation and anonymous data publication was requested orally from each participant via Microsoft Teams platform.

The study was approved by the ethics committee of the Department of Psychology of the Campania University “Luigi Vanvitelli,” by referring to the authorization released to the In-Presence Educational Intervention study protocol (in Magliano et al. 2016b ), being only changed the intervention delivery mode. The study was carried out in accordance with the principles of the Declaration of Helsinki.

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