Chapter 12 Schizophrenia and Other Psychotic Disorders PSY 440: Abnormal Psychology Rick Grieve Western Kentucky University psychotic disorders disorders so severe that the person has essentially lost touch with reality schizophrenia (a psychotic disorder) is characterized by the disruption of: Nature of Schizophrenia and Psychosis: An Overview Schizophrenia vs. Psychosis Psychosis Broad term referring to hallucinations and/or delusions; noted in several disorders Schizophrenia A type of psychosis with disturbed thought, language, and behavior Historical Background Emil Kraeplin Used the term dementia praecox, loss of the inner unity of thought, feeling, and acting. Eugen Bleuler Introduced the term schizophrenia or splitting of the mind ; the 4 As: Associations, Affect, Ambivalence, Autism Nature of Schizophrenia and Psychosis: An Overview cont.)
Schneider first rank vs. second rank symptoms Contemporary practice Complex syndrome heterogeneous Identified by clusters of symptoms Several subtypes Separate diagnoses that look like or share some of the same symptoms as schizophrenia but are separate psychotic disorders Schizophrenia: The Positive Symptom Cluster The Positive Symptoms-Active manifestations of abnormal behavior, distortions of normal behavior Delusions: Gross misrepresentations of reality Persecution out to get me Reference talking about me Being controlled aliens make my body move Grandeur I invented rock and roll Typically have a bizarre quality implausible, not understandable, not based on ordinary life experiences Schizophrenia: The Positive Symptom Cluster (cont.) Hallucinations: Experience of sensory events without environmental input; type of perceptual disturbance Can involve all senses; auditory most common 70% Not unique to schizophrenia Typically hear voices Schizophrenia: The Negative Symptom Cluster The Negative Symptoms -Absence or insufficiency of normal behavior Examples are emotional/social withdrawal, apathy, and poverty of thought/speech Spectrum of Negative Symptoms Avolition (or apathy) Refers to the inability to initiate and persist in activities
Alogia Refers to the relative absence of speech Anhedonia Lack of pleasure, or indifference to pleasurable activities Affective flattening Show little expressed emotion, but may still feel emotion Schizophrenia: The Disorganized Symptom Cluster The Disorganized Symptoms-Include severe and excess disruptions in speech, behavior, and emotion Examples include rambling speech, erratic behavior, and inappropriate affect Disorganized Speech Cognitive slippage Refers to illogical and incoherent speech Tangentiality Going off on a tangent and not answering a question directly Loose associations or derailment Taking conversation in unrelated directions Disorganized Symptoms Thought disorders can lead to the formation of: Clang Associations Perseveration Word Salad Schizophrenia: Disorganized Symptom Cluster (cont.) Nature of Disorganized Affect Inappropriate emotional behavior (e.g., crying when one should be laughing) Nature of Disorganized Behavior -includes a variety of unusual behaviors Catatonia Spectrum from wild agitation, waxy flexibility, to complete immobility Difficulties performing activities of daily living More Disorganized Symptoms Attentional Deficits Social Problems DSM Diagnosis: Characteristic symptoms
Social/Educational/Occupational dysfunction Duration Differential Diagnoses Relationship with PDD Subtypes of Schizophrenia Paranoid Type Intact cognitive skills and affect, and do not show disorganized behavior Hallucinations (auditory) and delusions center around a theme (grandeur or persecution) The best prognosis of all types of schizophrenia Disorganized Type Marked disruptions in speech and behavior, flat or inappropriate affect Hallucinations and delusions have a theme, but tend to be fragmented This type develops early, tends to be chronic, lacks periods of remissions Subtypes of Schizophrenia (cont.) Catatonic Type Show unusual motor responses and odd mannerisms (e.g., echolalia, echopraxia) This subtype tends to be severe and quite rare Undifferentiated Type Wastebasket category Major symptoms of schizophrenia, but fail to meet criteria for another type Residual Type One past episode of schizophrenia Continue to display less extreme residual symptoms (e.g., odd beliefs) Other Disorders with Psychotic Features Schizophreniform Disorder Schizophrenic symptoms for a few months Associated with good premorbid functioning; most resume normal lives Schizoaffective Disorder Other Disorders with Psychotic Features (cont.)
Delusional Disorder Delusions that are contrary to reality without other major schizophrenia symptoms Many show other negative symptoms of schizophrenia Type of delusions include erotomanic, grandiose, jealous, persecutory, and somatic This condition is extremely rare, with a better prognosis than schizophrenia Additional Disorders with Psychotic Features Brief Psychotic Disorder Experience one or more: delusions, hallucination, disorganized speech or grossly disorganize or catatonic behavior - positive symptoms of schizophrenia Usually precipitated by extreme stress or trauma Tends to remit on its owns Schizotypal Personality Disorder May reflect a less severe form of schizophrenia Schizophrenia: Facts and Statistics Onset and Prevalence of Schizophrenia About 1% population Onset in early adulthood, but can emerge at any time Schizophrenia Is Generally Chronic Most suffer with lifelong moderate-to-severe impairment Life expectancy is slightly less than average Schizophrenia Gender Differences Females tend to have a better long-term prognosis Onset males 18-25 years; females 25-35 years & after 40 Men more negative symptoms; women more affective, positive Strong Genetic Component Figure 13.2 Gender differences in onset of schizophrenia in a sample of 470 patients
Causes: Findings From Genetic Research Family Studies Inherit a tendency for schizophrenia, not a specific form of schizophrenia Other family members are at increased risk Twin Studies Risk of schizophrenia in monozygotic twins is 48% Risk of schizophrenia drops to 17% for fraternal (dizygotic) twins Adoption Studies Risk of schizophrenia remains high in adopted children with a biological parent suffering from schizophrenia Causes:Findings From Genetic Research (cont.) Summary of Genetic Research Risk of schizophrenia increases as a function of genetic relatedness One need not show symptoms of schizophrenia to pass on relevant genes Schizophrenia has a strong genetic component, but genes alone are not enough Figure 13.6 Risk for schizophrenia among children of twins Genetic & Behavioral Markers of Schizophrenia The Search for Genetic Markers: Linkage and Association Studies Search for genetic markers is still inconclusive Schizophrenia is likely to involve multiple genes Causes of Schizophrenia: Neurotransmitter Influences
Neurobiology and Neurochemistry: The Dopamine Hypothesis Drugs that increase dopamine (agonists), result in schizophrenic-like behavior Drugs that decrease dopamine (antagonists), reduce schizophrenic-like behavior Examples include neuroleptics and L-Dopa for Parkinson s disease The dopamine hypothesis proved problematic and overly simplistic Current theories emphasize several neurotransmitters and their interaction Causes: Other Neurobiological Influences Structural and Functional Abnormalities in the Brain Enlarged ventricles and reduced tissue volume Hypofrontality Less active frontal lobes (a major dopamine pathway) Viral Infections During Early Prenatal Development The relation between early viral exposure and schizophrenia is inconclusive Conclusions About Neurobiology and Schizophrenia Schizophrenia is associated with diffuse Neurobiological Dysregulation Structural and functional abnormalities in the brain are not unique to Schizophrenia Causes of Schizophrenia The Role of Stress May activate underlying vulnerability and/or increase risk of relapse Family Interactions Families of people with schizophrenia show ineffective communication patterns communication deviance High expressed emotion in the family is associated with relapse The Role of Psychological Factors Psychological factors likely exert only a minimal effect in producing schizophrenia CAUSES OF SCHIZOPHRENIA ENVIRONMENTAL CONTRIBUTIONS SCHIZOPHRENIA AND SOCIAL CLASS CLINICAL COURSE clinical course specific pattern of changes in symptomatology over time prodromal phase active phase
residual phase TYPICAL COURSES FOR SCHIZOPHRENIA TYPICAL COURSES FOR SCHIZOPHRENIA TYPICAL COURSES FOR SCHIZOPHRENIA Treatments Neuroleptic drugs are begun first stabilizes and reduces symptoms Psychosocial treatments come next Prevent relapse Compensate for skills deficits Improve medication compliance Medical Treatment of Schizophrenia Antipsychotic (Neuroleptic) Medications Medication treatment is often the first line treatment for schizophrenia Began in the 1950s Most reduce or eliminate the positive symptoms of schizophrenia Acute and permanent extrapyramidal and Parkinson-like side effects are common Compliance with medication is often a problem Psychosocial Treatment of Schizophrenia Psychosocial Approaches: Overview and Goals Behavioral (i.e., token economies) on inpatient units Community care programs Social and living skills training Behavioral family therapy Vocational rehabilitation Psychosocial Approaches Are Usually a Necessary Part of Medication Therapy TREATING SCHIZOPHRENIA HOSPITALIZATION AND BEYOND