PowerPoint  Lecture Notes Presentation
Chapter 11
Schizophrenia
Abnormal Psychology, Eleventh Edition
by
Ann M. Kring, Gerald C. Davison, John M. Neale,
& Sheri L. Johnson
Schizophrenia


One of the psychotic disorders
Major disturbances in:
» Thought
» Emotion
» Behavior


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
Disordered thinking
Faulty perception and attention
Inappropriate or flat emotions
Disturbances in movement or behavior
Disrupted interpersonal relationships
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Schizophrenia

Disorder impacts families & friends
» Difficult to live with someone who experiences
delusions, hallucinations, and paranoia.
» Social skills deficits common
– Isolation, few social contacts

Symptoms impact employability
» Often lead to unemployment & homelessness

Substance abuse & suicide rates high
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Schizophrenia
Lifetime prevalence ~1%
 Affects men slightly more often than
women
 Onset typically late adolescence or early
adulthood

» Men diagnosed at a slightly earlier age

Diagnosed more frequently in African
Americans
» May reflect diagnostic bias
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DSM-IV-TR Criteria

Two or more symptoms lasting for at least 1
month
»
»
»
»
»
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Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Social and occupational functioning have
declined since onset
Signs of disturbance for at least 6 mos
» At least 1 mo. for delusions
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Clinical Description of
Schizophrenia

No single essential symptom
» Heterogeneity of symptoms across patients
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Positive Symptoms: Behavioral
excesses

Delusions
» Firmly held beliefs
» Contrary to reality
» Resistant to disconfirming
evidence

Persecutory delusions
common

» Sensory experiences in
the absence of sensory
stimulation

Other common forms :
»
»
»
»
Thought insertion
Thought broadcasting
Grandiose delusions
Ideas of reference
Types of hallucinations
» Audible thoughts
» Voices commenting
» Voices arguing
– “The CIA planted a
listening device in my
head”

Hallucinations

Increased levels of
activity in Broca’s area
during hallucinations
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Negative Symptoms: Behavioral
deficits

Avolition
» Lack of interest; apathy

Alogia
» Reduction in speech

Anhendonia
» Inability to experience
pleasure
– Consummatory pleasure
– Anticipatory pleasure


Negative symptoms
predict poor quality
of life posthospitalization (Ho
et al., 1998)
Flat affect
» Exhibits little or no affect in
face or voice

Asociality
» Inability to form close
personal relationships
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Disorganized Symptoms

Disorganized speech (Formal thought
disorder)
» Incoherence
– Inability to organize ideas
» Loose associations (derailment)
– Rambles, difficulty sticking to one topic

Disorganized behavior
» Odd or peculiar behavior
– Silliness, agitation, unusual dress

e.g., wearing several heavy coats in hot weather
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Other Symptoms

Catatonia
» Motor abnormalities
» Repetitive, complex gestures
– Usually of the fingers or hands
» Excitable, wild flailing of limbs

Catatonic immobility
» Maintain unusual posture for long periods of time
– e.g., stand on one leg

Waxy flexibility
» Limbs can be manipulated and posed by another
person
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Other Symptoms

Inappropriate affect
» Emotional responses inconsistent with
situation
– e.g., laugh uncontrollably at a funeral
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Schizophrenia in DSM-IV-TR

Two or more of the following symptoms for at
least 1 month:
»
»
»
»
»


Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Declining social and occupational functioning
Signs of disturbance for at least 6 months
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DSM-IV-TR Schizophrenia
Subtypes

Disorganized
» Incoherence, disorganized speech and
behavior
» Flat or inappropriate affect

Catatonic
» Prolonged immobility or purposeless
agitation
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DSM-IV-TR Schizophrenia
Subtypes

Paranoid
» Delusions, hallucinations related to persecution or
grandiosity
» Ideas of reference
– Assigning personal significance to trivial or neutral events


e.g., newscast on TV is about me
Undifferentiated
» Meet criteria for schizophrenia but not for a
subtype

Residual
» No longer meets criteria for schizophrenia but still
exhibits signs of the disorder
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Evaluation of Subtypes

Diagnosis of subtypes difficult
» Reliability low
Poor predictive validity
 Overlap of symptoms among subtypes

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Other Psychotic Disorders

Schizophreniform Disorder
» Symptom duration greater than 1 month but less
than 6 months

Brief Psychotic Disorder
» Symptom duration of 1 day to 1 month
» Often triggered by extreme stress

Schizoaffective Disorder
» Symptoms of both mood disorder and
schizophrenia
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Other Psychotic Disorders

Delusional Disorder
» Delusions may include:
– Jealousy, erotomania, & somatic delusions
» No other symptoms of schizophrenia
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Table 11.3 Family and Twin
Genetic Studies
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Table 11.4 Characteristics of Adopted Offspring
of Mothers with Schizophrenia

Insert Table 11.4 HERE (Table 11.3 in
previous edition)
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Molecular Genetics Research


Not likely that disorder caused by single gene
Linkage studies
» A number of chromosomes implicated
» Results inconsistent and marked by a failure to replicate

Association studies
» Two genes identified
– DTNGP1
– NGR1

Genome-wide scans
» Identification of gene mutations
» Several identified but results need to be replicated
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Etiology of Schizophrenia: Evaluation
of Genetic Research

Genetics doesn’t completely explain the
disorder

Diathesis-stress model
» Genetic factors constitute underlying predisposition
» Stress triggers onset


Schizophrenia may be genetically heterogeneous
from person to person
Genetic research doesn’t reveal what is inherited
» Eye tracking studies
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Etiology of Schizophrenia:
Neurotransmitters

Dopamine Theory
» Disorder due to excess levels of dopamine
– Drugs that alleviate symptoms reduce dopamine activity
– Amphetamines, which increase dopamine levels, can
induce a psychosis

Theory revised
» Excess numbers of dopamine receptors or
oversensitive dopamine receptors
» Localized mainly in the mesolimbic pathway

Dopamine abnormalities mainly related to
positive symptoms
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Figure 11.1 The Brain and
Schizophrenia
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Figure 11.2 Dopamine Theory of
Schizophrenia
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Etiology of Schizophrenia: Evaluation
of Dopamine Theory

Dopamine theory doesn’t completely explain
disorder
» Antipsychotics block dopamine rapidly but
symptom relief takes several weeks
» To be effective, antipsychotics must reduce
dopamine activity to below normal levels

Other neurotransmitters involved:
» Serotonin
» GABA
» Glutamate
– Medication that targets glutamate shows promise
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Etiology of Schizophrenia: Brain
Structure and Function

Enlarged Ventricles
» Implies loss of brain cells
» Correlate with
– Poor performance on cognitive tests
– Poor premorbid adjustment
– Poor response to treatment

Reduced activity in prefrontal cortex
» Involved in speech, executive functions,
goal-directed behavior
» May be related to dopamine underactivity
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Etiology of Schizophrenia: Brain
Structure and Function

Prefrontal Cortex
» Many behaviors disrupted by schizophrenia
(e.g., speech, decision making) are governed
by prefrontal cortex
» Individuals with schizophrenia show
impairments on neuropsychological tests of
prefrontal cortex (e.g., memory)
» Individuals with schizophrenia show low
metabolic rates in prefrontal cortex.
– Failure to show frontal activated related to negative
symptoms
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Figure 11.3 Micrograph of a
Neuron
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Etiology of Schizophrenia: Brain
Structure and Function

Congenital Factors
» Damage during gestation or birth
– Obstetrical complications rates high in patients with
schizophrenia

Reduced supply of oxygen during delivery may result in
loss of cortical matter
» Viral damage to fetal brain
– In Finnish study, schizophrenia rates higher when
mother had flu in second trimester of pregnancy
(Mednick et al., 1988)
– Maternal exposure to parasite associated with
higher rates of schizophrenia in their offspring
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Etiology of Schizophrenia: Brain
Structure and Function

Developmental Factors
» Prefrontal cortex matures in adolescence or early
adulthood
» Dopamine activity also peaks in adolescence
» Stress activates HPA system which triggers
cortisol secretion
– Cortisol increases dopamine activity

May explain why symptoms appear in late
adolescence but brain damage occurs early in
life
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Etiology of Schizophrenia:
Psychological Stress

Reaction to stress
» Individuals with schizophrenia and their firstdegree relatives more reactive to stress
– Greater decreases in positive mood and increases in
negative mood

Socioeconomic status
» Highest rates of schizophrenia among urban poor.
– Sociogenic hypothesis

Stress of poverty causes disorder
– Social selection theory

Downward drift in socioeconomic status
» Research supports social selection
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Etiology of Schizophrenia: Family
Factors

Schizophrenogenic mother
» Cold, domineering, conflict inducing
» No support for this theory

Communication deviance (CD)
» Hostility and poor communication
– Family CD predicted onset in one longitudinal
study (Norton, 1982)
– CD not specific to families of schizophrenic
patients
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Etiology of Schizophrenia:
Families and Relapse


Family environment impacts rehospitalization
Expressed Emotion (EE; Brown et al., 1966)
» Hostility, critical comments, emotional
overinvolvement

Bi-directional association
» Unusual patient thoughts → increased critical
comments
» Increased critical comments → unusual patient
thoughts
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Etiology of Schizophrenia:
Developmental Studies

Developmental histories of children who
later developed schizophrenia
» Lower IQ
» More often delinquent and withdrawn

Coding of home movies
» Poorer motor skills
» More expression of negative emotion
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Etiology of Schizophrenia:
Developmental Studies

High risk studies
» Danish children with a schizophrenic mother who later
developed disorder (Mednick & Schulsinger, 1968)
– Negative symptom patients
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More pregnancy birth complications
Failure to show electrodermal responding
– Positive symptom patients


Family instability
Australian study (Yung et al., 1995)
» Reduced gray matter volume predicted later
development of psychotic disorder

North American Prodrome Longitudinal
Study (NAPLS)
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Treatment of Schizophrenia:
Medications

First generation antipsychotic medications
(Neuroleptics; 1950s)
» Phenothiazines (Thorazine), butyrophenones
(Haldol), thioxanthenes (Navane)
– Reduce agitation, violent behavior
– Block dopamine receptors
– Little effect on negative symptoms

Extrapyramidal side effects
» Tardive Dyskinesia

Maintenance dosages to prevent relapse
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Treatment of Schizophrenia:
Medications

Second generation antipsychotics
» Clozapine (Clozaril)
– Impacts serotonin receptors
» Fewer motor side effects
» Less treatment noncompliance
» Reduces relapse

Side effects
» Can impair immune symptom functioning
» Seizures, dizziness, fatigue, drooling, weight gain

Newer medications may improve cognitive function:
» Olanzapine (Zyprexa)
» Risperidone (Risperdal)
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Table 11.5 Summary of Major
Schizophrenia Drugs

Insert Table 11.5 (previously numbered
11.4)
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Psychological Treatments


Patient Outcomes Research Team
(PORT; Lehman et al., 2004) treatment
recommendation:
» Medication PLUS psychosocial intervention
Social skills training
» Teach skills for managing interpersonal situations
– Completing a job application
– Reading bus schedules
– Make appointments
» Involves role-playing and other practice
exercises, both in group and in vivo
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Psychological Treatments

Family therapy to reduce Expressed Emotion
» Educate family about causes, symptoms, and
signs of relapse
» Stress importance of medication
» Help family to avoid blaming patient
» Improve family communication and problemsolving
» Encourage expanded support networks
» Instill hope
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Psychological Treatments

Cognitive behavioral therapy
» Recognize and challenge delusional beliefs
» Recognize and challenge expectations associated
with negative symptoms
– e.g., “Nothing will make me feel better so why bother?”

Cognitive enhancement therapy (CET)
» Improve attention, memory, problem solving and
other cognitive based symptoms
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COPYRIGHT
Copyright 2009 by John Wiley & Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
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