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

16. DIATHESIS STRESS MODEL: A Synthesis
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