Chapter 13 Schizophrenia and Other Psychotic Disorders ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 13 Schizophrenia and Other Psychotic Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychosis Schizophrenia Significant loss of contact with reality © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Perspectives on Schizophrenia Schizophrenia vs. psychosis Psychosis – broad term (e.g., hallucinations, delusions) Schizophrenia – a type of psychosis Psychosis and schizophrenia are heterogeneous Disturbed thought, emotion, behavior

Schizophrenia Schizophrenia Affects people from all walks of life Characterized by an array of diverse symptoms Usually begins in late adolescence or early adulthood © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

FIGURE 12.2  The longitudinal course of schizophrenia is depicted starting at birth through old age. The severity of the symptoms is shown on the left axis, and the changes in symptoms across each phase (premorbid, prodromal, onset, and chronic) are labeled. (Adapted from Lieberman, J. A., Perkins, D., Belger, A., Chakos, M., Jarskog, F., Boteva, K., & Gilmore, J., 2001. The early stages of schizophrenia: Speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biological Psychiatry, 50, p. 885).

Origins of the Schizophrenia Construct “splitting of the mind” First clinical description appeared in 1810 Emil Kraepelin used term dementia praecox to refer to mental deterioration at early age Eugen Bleuler introduced term “schizophrenia” in 1911 (1857-1939) (1856-1926) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Risk Epidemiology Lifetime prevalence Age of father – 45 or higher Country Onset age – late adolescence or early adulthood Gender – worse in men © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 13.1: Age Distribution of Onset of Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Disorganized speech and behavior Hallmark symptoms Clinical Picture Delusions Hallucinations Disorganized speech and behavior Hallmark symptoms © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Delusions Delusions Erroneous belief Fixed and firmly held despite clear contradictory evidence Disturbance in the content of thought Delusions of reference Delusions of persecution Delusions of grandeur Delusions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Hallucinations Hallucinations Sensory experience Seems real but occurs in absence of any external perceptual stimulus Can occur in any sensory modality Hallucinations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

SPECT study on auditory hallucination

The disorganized symptoms disorganized speech Cognitive slippage – illogical and incoherent speech Tangentiality – “going off on a tangent” disorganized affect Inappropriate emotional behavior disorganized behavior Catatonia spectrum Poor personal hygiene, disregard for safety, unusual dress

Positive symptoms of schizophrenia Excess or distortion in normal repertoire of behavior and experience Examples Positive symptoms of schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Disorganized Symptoms Speech Affect Behavior Disorganized symptoms of schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Negative symptoms of schizophrenia Absence or deficit of normally present behaviors Examples Negative symptoms of schizophrenia Avolition Alogia anhedonia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Other Psychotic Disorders Schizoaffective disorder Schizophreniform disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Other psychotic disorders Let’s take a few minutes to define each of these. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Risk and Causal Factors True or false? Genetic factors are clearly implicated in schizophrenia. True. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Risk and Causal Factors The following slide shows that having a relative with the disorder significantly raises a person’s risk of developing schizophrenia. Let’s look and see. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 13.2: Risk of Developing Schizophrenia Based on Shared Genes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Genetic Factors Monozygotic twins (of people with schizophrenia) are much more likely to develop schizophrenia than are dizygotic twins. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Genetic Factors The influence of genetics Twin studies Adoption studies Studies of molecular genetics © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Prenatal Exposures Prenatal exposures: Prenatal infection Rhesus incompatibility Early nutritional deficiencies and maternal stress Pregnancy and birth complications © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Genes and Environment in Schizophrenia: A Synthesis Current thinking emphasizes interplay Multiple genetic factors Environmental factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

A Neurodevelopmental Perspective Brain lesion lies dormant until normal developmental changes occur Changes expose problems resulting from this brain abnormality Developmental precursors may include variety of abnormalities © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Other Biological Factors Many brain areas are abnormal in schizophrenia Decreased brain volume Enlarged ventricles Frontal lobe dysfunction Reduced volume of the thalamus Abnormalities in temporal lobe areas © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Other Biological Factors Implicated in Schizophrenia Neurotransmitters Dopamine Glutamate Cytoarchitecture Overall organization of cells in brain may be compromised © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 13.8: Cytoarchitecture and Neural Development © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Neurocognition Neurocognitive deficits found in people with schizophrenia Attentional and working memory deficits Eye-tracking dysfunctions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 13.11: A Diathesis-Stress Model of Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychosocial and cultural factors The role of stress May activate underlying vulnerability May also increase risk of relapse Family interactions Families – show ineffective communication patterns Schizophrenogenic mother Double blind communication High expressed emotion (EE)– associated with relapse

Psychosocial and Cultural Aspects Families and relapse Urban living Immigration Cannabis abuse © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments and Outcomes Treatment and outcomes Prognosis before 1950s Introduction of antipsychotic drugs in 1950s 15-25 years outcomes Long-term institutionalization rate © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Pharmacological Approaches First-generation antipsychotic drugs Second-generation antipsychotics Side effects © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychosocial Approaches Family therapy Case management Social-skills training Cognitive remediation Cognitive-behavioral therapy Other forms of individual treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues What is the best way to prevent schizophrenia? By improving prenatal care for women with schizophrenia in their biological families? By reducing cannabis abuse in teens? By identifying and intervening with people at high risk for developing schizophrenia? By intervening early with people who have developed schizophrenia? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.