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Chapter 12 - Schizophrenia

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1 Chapter 12 - Schizophrenia

2 Psychosis Psychosis: a loss of contact with reality
Ability to perceive and respond to the environment significantly disturbed; functioning impaired Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs)

3 Schizophrenia Individuals must show a deterioration in their work, social relations, and ability to care for themselves Six months or more

4 Schizophrenia Affects approximately 1 in 100 people in the world
Financial & emotional costs: enormous Increased risk of suicide and physical – often fatal – illness

5 Schizophrenia appears in all socioeconomic groups, but is found more frequently in the lower levels “downward drift”

6 Schizophrenia average age of onset for ♂ is 23 years, compared to 27 years for ♀; book states = numbers; other sources ♂ > ♀ Rates of diagnosis differ by marital status

7 The Clinical Picture symptoms, triggers, and course vary greatly
Some argue: group of distinct disorders that share common features

8 Pathological excesses - bizarre additions to a person’s behavior
Positive Symptoms Excess or distortion in normal repertoire of behavior and experience Pathological excesses - bizarre additions to a person’s behavior

9 Delusions Delusions Erroneous belief
Fixed and firmly held despite clear contradictory evidence Disturbance in the content of thought Grandeur Persecution Reference Nihilistic Thought Broadcasting Delusions

10 Hallucinations Hallucinations
False Sensory experiences/Perceptual disturbances Seems real but occurs in absence of any external perceptual stimulus Can occur in any sensory modality Hallucinations

11 Disorganized Speech Disorganized speech Failure to make sense
Despite conforming to semantic and syntactic rules of speech Disturbance in form (not content) of thought Disorganized speech

12 Disorganized Behavior
Impairment of goal-directed activity Occurs in areas of daily functioning Catatonia Catatonia stupor Inappropriate affect Disorganized and Catatonic Behavior

13 Absence or deficit of normally present behaviors
Negative Symptoms Affective flattening, Blunted affect Anhedonia Apathy Both a symptom and coping strategy Avolition Alogia Absence or deficit of normally present behaviors

14 Neurocognition Neurocognitive deficits found in people with schizophrenia Attentional and working memory deficits Eye-tracking dysfunctions

15 Course usually first appears between late teens and mid-30s
three phases: Prodromal Active Residual

Current thinking emphasizes interplay Multiple genetic factors Environmental factors

17 CAUSES TWIN STUDIES ADOPTION STUDIES The average concordance rate for MZ twins is 48%, whereas the comparable figure for DZ twins is 17%. Suggests strong genetic factors. Also compelling evidence for the importance of environment. Genain quadruplets Genetic factors play role in development of the disorder (Heston).

18 Biological Views

19 Biological Views Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities: Biochemical abnormalities Abnormal brain structure

20 BIOLOGICAL CAUSES Current research focuses many neurotransmitters:
Interactions of multiple neurotransmitters The dopamine hypothesis Focuses on the function of dopamine in the limbic area of the brain. Hypothesis grew out of attempts to understand how antipsychotic drugs improve adjustment. Current research focuses many neurotransmitters: Dopamine Serotonin Glutamate

21 Prenatal Exposures Prenatal exposures: Prenatal viral infection
Early nutritional deficiencies and maternal stress Pregnancy and birth complications

22 Overall organization of cells in brain may be compromised
Cytoarchitecture Overall organization of cells in brain may be compromised

23 Biological Views Abnormal brain structure enlarged ventricles
enlargement may be a sign of poor development or damage in related brain regions smaller temporal and frontal lobes, smaller amounts of grey matter, and abnormal blood flow to certain brain areas


25 Sociocultural Views Social labeling
Many sociocultural theorists believe that the features influenced by diagnosis itself Society labels people who fail to conform to certain norms of behavior Once assigned, label becomes a self-fulfilling prophecy The dangers of social labeling have been well demonstrated Example: Rosenhan’s 1973 “pseudo-patient” study

26 Sociocultural Views Family dysfunctioning
often linked to family stress: Parents of people with the disorder often: Display more conflict Have greater difficulty communicating Are more critical of and overinvolved Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism and hostility and intrude on each other’s privacy Individuals who are trying to recover almost four times more likely to relapse if they live with such a family

27 Treatment: Antipsychotic Drugs
the discovery of antipsychotic drugs in 1950s that revolutionized treatment for those suffering from schizophrenia

28 Have a relatively specific effect- reduce psychotic symptoms
Work as dopamine antagonist Positive symptoms respond better than negative symptoms. reduce symptoms in at least 65% of patients

29 Extrapyramidal symptoms Tardive dyskinesia
Motor Side Effects (parkinsonian symptoms) Extrapyramidal symptoms Tardive dyskinesia

30 Second-Generation Antipsychotics
Atypical antipsychotics Work on both serotonin and dopamine Impact both positive and negative symptoms Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, and Abilify

31 Newer Antipsychotic Drugs
appear more effective than conventional antipsychotic drugs, especially for negative symptoms cause few extrapyramidal side effects and seem less likely to case tardive dyskinesia Some, however, do produce significant undesirable effects of their own

32 Cognitive-behavioral therapy
Clinicians employ techniques that seek to change how individuals view and react to their hallucinatory experiences, including: Provide education and evidence of the biological causes of hallucinations Challenge clients’ inaccurate ideas about the power of their hallucinations and delusions

33 Family therapy Over 50% of persons recovering from schizophrenia and other severe disorder live with family members This creates significant family stress Those who live with relatives who display high levels of expressed emotion are at greater risk for relapse than those who live with more positive or supportive families

34 Family therapy Family therapy
Family therapy attempts to create more realistic expectations and provide psychoeducation about the disorder

35 Social Therapy Treatment should include techniques that address social and personal difficulties include: practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing

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