Chapter 12 - Schizophrenia

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)

Schizophrenia◦Individuals must show a deterioration in their work, social relations, and ability to care for themselves

◦Six months or more

Schizophrenia◦Affects approximately 1 in 100 people in the world

◦Financial & emotional costs: enormous◦Increased risk of suicide and physical – often fatal – illness

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

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

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

Positive Symptoms

• Excess or distortion in normal repertoire of behavior and experience

Pathological excesses -

bizarre additions to a

person’s behavior

Delusions• Erroneous belief• Fixed and firmly held

despite clear contradictory evidence

• Disturbance in the content of thought• Grandeur• Persecution• Reference• Nihilistic• Thought Broadcasting

Delusions

Hallucinations

• False Sensory experiences/Perceptual disturbances

• Seems real but occurs in absence of any external perceptual stimulus

• Can occur in any sensory modality

Hallucinations

Disorganized Speech

• Failure to make sense • Despite conforming to

semantic and syntactic rules of speech

• Disturbance in form (not content) of thought

Disorganized speech

Disorganized Behavior

• Impairment of goal-directed activity

• Occurs in areas of daily functioning

• Catatonia • Catatonia stupor• Inappropriate affect

Disorganized and Catatonic Behavior

Negative Symptoms• Affective

flattening, Blunted affect

• Anhedonia• Apathy

• Both a symptom and coping strategy

• Avolition• Alogia

Absence or deficit

of normally present behavior

s

NeurocognitionNeurocognitiv

e deficits found in

people with schizophrenia

Attentional and working

memory deficits

Eye-tracking dysfunctions

Course· usually first appears between late teens and mid-30s

· three phases:· Prodromal · Active · Residual

DIATHESIS STRESS MODEL:A Synthesis

Current thinking emphasizes interplay

Multiple genetic factors

Environmental factors

CAUSESTWIN 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).

Biological Views

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

BIOLOGICAL CAUSES

The dopamine hypothesis Interactions of multiple neurotransmitters

◦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

Prenatal Exposures

Pre

nata

l e

xp

osu

res:

Prenatal viral infection

Early nutritional deficiencies and maternal stress

Pregnancy and birth complications

Cytoarchitecture

• Overall organization of cells in brain may be compromised

Biological ViewsAbnormal 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

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

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

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

◦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

Motor Side Effects (parkinsonian symptoms)

○Extrapyramidal symptoms

○Tardive dyskinesia

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

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

·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

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

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

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