1. 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.

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

3. 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.

4. Origins of the Schizophrenia Construct
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
Schizophrenia as split personality is a major misconception
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

5. Schizophrenia as split personality is a major misconception
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

6. Risk Epidemiology Lifetime prevalence: 1% Age of father: 45-50+
Country: Afro-Caribbean living in UK
Onset age: late adolescence/early adulth
Gender: more common/severe in males
Lifetime risk for developing schizophrenia is about 1%
Risk is higher for those with older fathers and in certain countries
Typically begins in late adolescence or early adulthood
Schizophrenia tends to be more common and severe in men than women
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

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

8. 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.

9. Delusions Delusions Erroneous belief
Fixed and firmly held despite clear contradictory evidence
Disturbance in the content of thought
Examples
Delusions
Examples
Made feelings or impulses
Thought broadcasting
Thought insertion or withdrawal
Delusions of reference
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

10. Examples of delusions
Made feelings or impulses: that one’s thoughts, feelings or actions are being controlled by others
Thought broadcasting: one’s private thoughts are broadcast indiscriminately to others
Thought insertion or withdrawal: thoughts are being inserted into one’s brain by some external agency; or that some external agency has robbed one’s thoughts
Delusions of reference: a song on the radio or TV program has a special/personal meaning intended only for the person.
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

11. Hallucinations Hallucinations
Sensory experience: auditory is most common
Seems real but occurs in absence of any external perceptual stimulus
Can occur in any sensory modality. PET, fMRI suggests auditory hallucinations maybe misperceived subvocal speech
Hallucinations
Can occur in any sensory modality
Auditory is most common
PET and fMRI studies suggest that auditory hallucinations may be misperceived subvocal speech
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

12. 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
“Cognitive slippage,” “loosening” of associations, or “incoherence”
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

13. Disorganized Behavior
Impairment of goal-directed activity
Occurs in areas of daily functioning
Catatonia
Catatonia stupor
Disorganized and Catatonic Behavior
Occurs in areas of daily functioning
Work
Social relations
Self-care (hygiene, safety, dress)
Catatonia involves almost no movement at all, sometimes in an unusual posture
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

14. Occurs in areas of daily functioning
Work
Social relations
Self-care (hygiene, safety, dress)
Catatonia involves almost no movement at all, sometimes in an unusual posture
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

15. Positive and Negative Symptoms
Excess or distortion in normal repertoire of behavior and experience
Examples: delusions, hallucinations, disorg speech and behavior
Positive symptoms of schizophrenia
disExamples
Delusions
Hallucinations
Disorganized speech
Disorganized behavior
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

16. Positive and Negative Symptoms
Absence or deficit of normally present behaviors
Examples: flat/blunted emotional expressiveness alogia, avolition
Negative symptoms of schizophrenia
Examples
Flat or blunted emotional expressiveness
Alogia
Avolition
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

17. Examples Flat or blunted emotional expressiveness
Alogia: very little speech
Avolition: inability to initiate or persist in goal- directed activities
Neologisms: new and made-up words
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

18. Other Psychotic Disorders
Schizoaffective disorder: hybrid of schiz & mood disorder
Schizophreniform disorder: like schiz but only 1-6 months
Delusional disorder, but otherwise normal behavior
Brief psychotic disorder: usually lasts only a matter of days
Shared psychotic disorder: a 2nd person believes delusion of 1st person
Other psychotic disorders
Other psychotic disorders include:
Schizoaffective disorder
Hybrid of schizophrenia and mood disorder
Schizophreniform disorder
Like schizophrenia but only 1-6 months long
Delusional disorder
Delusions but otherwise normal behavior
Brief psychotic disorder
Usually lasts only a matter of days
Shared psychotic disorder
A second person believes delusions of the first
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

19. 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.

20. 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.

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

22. 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.

23. Genetic Factors Twin studies
The influence of genetics
Twin studies
Adoption studies
Studies of molecular genetics
Twin studies
Higher concordance rate for MZ than DZ twins
Adoption studies
Schizophrenia more common in biological than adoptive families of adoptees
Studies of molecular genetics
Unlikely that schizophrenia is linked to only one gene
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

24. Studies of molecular genetics
Twin studies
Higher concordance rate for MZ than DZ twins
Adoption studies
Schizophrenia more common in biological than adoptive families of adoptees
Studies of molecular genetics
Unlikely that schizophrenia is linked to only one gene
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

25. Prenatal Exposures Prenatal exposures: Prenatal infection
Rhesus incompatibility: Rh- Mo carrying Rh+ fetus
Early nutritional deficiencies and maternal stress
Pregnancy and birth complications
Other factors that have been implicated in the development of schizophrenia
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

26. 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.

27. Genes and Environment in Schizophrenia: A Synthesis
Can you fill in the blanks?
Schizophrenia is genetically ________ but not genetically ________!
Schizophrenia is genetically influenced but not genetically determined
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

28. 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
A lesion in the brain is thought to lie dormant until normal developmental changes occur
These changes expose the problems that result from this brain abnormality
Developmental precursors may include motor abnormalities, low positive facial emotion, and high negative facial emotion
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

29. A lesion in the brain is thought to lie dormant until normal developmental changes occur
These changes expose the problems that result from this brain abnormality
Developmental precursors may include motor abnormalities, low positive facial emotion, and high negative facial emotion
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

30. 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 such as the hippocampus, amygdala
Abnormalities in temporal lobe areas such as the hippocampus and amygdala
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

31. Other Biological Factors
True or false?
Brain abnormalities are found in all patients.
False
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

32. 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.

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

34. Neurocognition
Neurocognitive deficits found in people with schizophrenia
Attentional and working memory deficits
Eye-tracking dysfunctions
In general, people with schizophrenia struggle to attend well on demand
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

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

36. Psychosocial and Cultural Factors
Do “bad families” cause schizophrenia?
Support your response from information in your text.
Many theories about bad families causing schizophrenia have not stood the test of time including:
The idea of the “schizophrenic mother”
The double-bind hypothesis
Instead, communication problems may be the result of having a schizophrenic in the family
Patients with schizophrenia are more likely to relapse if their families are high in expressed emotion
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

37. Many theories about bad families causing schizophrenia have not stood the test of time including:
The idea of the “schizophrenic mother”
The double-bind hypothesis “shut your mouth and eat”
Instead, communication problems may be the result of having a schizophrenic in the family
Patients with schizophrenia are more likely to relapse if their families are high in expressed emotion
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

38. Psychosocial and Cultural Aspects
Families and relapse
Urban living
Immigration
Cannabis abuse
A large body of evidence indicates that the lower the socioeconomic status, the higher the prevalence of schizophrenia
Immigrants have higher rates of schizophrenia than natives
People with schizophrenia are twice as likely than the general population to smoke cannabis
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

39. Immigrants have higher rates of schizophrenia than natives
A large body of evidence indicates that the lower the socioeconomic status, the higher the prevalence of schizophrenia
Immigrants have higher rates of schizophrenia than natives
People with schizophrenia are twice as likely than the general population to smoke cannabis
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

40. Treatments and Outcomes
Treatment and outcomes
Prognosis before 1950s
Introduction of antipsychotic drugs in 1950s
15-25 years outcomes
Long-term institutionalization rate
Before the 1950s, the prognosis for schizophrenia was bleak
Antipsychotic drugs, introduced in the 1950s, dramatically improved the prognosis
Currently, about 38% of people diagnosed with schizophrenia function well years later
Long-term institutionalization is necessary for about 12%
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

41. Before the 1950s, the prognosis for schizophrenia was bleak
Antipsychotic drugs, introduced in the 1950s, dramatically improved the prognosis
Currently, about 38% of people diagnosed with schizophrenia function well years later
Long-term institutionalization is necessary for about 12%
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

42. Pharmacological Approaches
First-generation antipsychotic drugs
Second-generation antipsychotics
Side effects
Antipsychotic drugs work by blocking dopamine receptors
Patients taking second-generation antipsychotics
Have fewer extrapyramidal (motor abnormality) side effects
Tend to do better overall
Side effects can be very troubling
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

43. Antipsychotic drugs work by blocking dopamine receptors
Patients taking second-generation antipsychotics
Have fewer extrapyramidal (motor abnormality) side effects
Tend to do better overall
Side effects can be very troubling
© 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

44. 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.

45. 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.