Chapter 12: Schizophrenia (Sz)
I. Clinical Features

Are there symptoms unique to the disorder, or that define it?
 _% of adult Cdn population

Gender differences?
 Culture …

Most cases = slower more gradual decline
 Stigma
DSM-IV: Diagnostic Criteria for Sz
A.
Characteristic symptoms: 2 or more of the following, each present for a sig period of time during a 1-month period (or less if successfully treated):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms
B.
Social/occupational dysfunction
C.
Duration: Continuous signs of the disturbance must persist for at least 6 months.
D.
Schizoaffective and mood disorder exclusion
E.
Substance/medical exclusion
F.
Relationship to pervasive dvptal disorder: If there is a history of autistic disorder or another pervasive dvptal disorder, the additional diagnosis of Sx is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated)

Related Disorders
1.
Delusional disorder

1 or more non-bizarre delusions, but do NOT have other characteristic schizophrenic symptoms
- functioning is usually not markedly impaired
- behaviour is not obviously unusual apart from delusions
2.
Schizoaffective disorder

Person displays sufficient symptoms for BOTH an affective episode
(depression, mania or mixed) and Sz
3.
Substance-induced psychotic disorder

Prominent hallucinations and delusions that result from the ingestion of a chemical substance
4.
Brief psychotic disorder

Sudden onset of at least 1 prominent psychotic symptom

Duration: 1 day - 1 mo, followed by a full return to premorbid levels of functioning
5.
Schizophreniform disorder

Presence of symptoms similar to those of Sz

Duration: 1 mo - 6 mo
Disturbances of Thought & Speech
A.
Delusions = ____________________________________________________
Several types
- Persecution / Paranoid
- Religious
- Grandiose / Grandeur
- Thought broadcasting
- Thought insertion
- Thought withdrawal
- Somatic delusions - Delusions of reference
- Of being controlled
B.
Thought Disorder

Looseness of associations / derailment
 Poverty of speech

Neologisms

Perseveration
 Clanging (rhyming …)
2. Attentional Deficiencies

Difficulty filtering out irrelevant distracting stimuli

Hypervigilance

3. Hallucinations = ___________________________________________________

Command hallucinations

Any sensory modality; most common …
4. Emotional Disturbances

Flat affect
–
Do they experience emotion but fail to express them?
________________

Inappropriate affect
5. Catatonia
 characterized by:
Stupor
Excitement
Waxy flexibility
Rigidity
Posturing
Echopraxia
Echolalia
6. Other Types of Impairment
 avolition
 anhedonia
 asociality
Positive Symptoms Negative Symptoms
Onset
Intellectual Ability
Response to Medication
Why?
Type I (+) Type II (-)

Subtypes of Schizophrenia …
Paranoid
Disorganized
Catatonic
Undifferentiated
II. Theoretical Perspectives
(A) Genetic Factors

PP who are more closely related to pp with Sz are at increased risk
– if both parents have Sz, child’s chances of Sz : __%
– MZ twins: concordance rate: __%

However, genetic component alone is not sufficient to explain the incidence of Sz
( B) Biochemical Influence
 Neurotransmitter: ________________________ …
– Evidence:
•
Neuroleptics
• Amphetamines
(C) Viral Infections

Pre- or post-natal

Viral infections …

Inconclusive

(D) Brain Abnormalities

Ventricle enlargement …

Structural damage --- probably prenatally or early in life …

Brain areas:
•
•
•
Tying it Together

Diathesis-stress model …
Evidence…
–
Stress (e.g., sociocultural factors) predicts initial onset in geneticallyvulnerable pp
–
Gene-environment interactions
• cannabis use may trigger Sz in genetically-vulnerable pp
(cause-effect?)
–
Adoptee studies
–
Longitudinal studies of high-risk children (pp. 450-1)
(E) Family Theories
 Early theories: schizophrenogenic mother

2 sources of family stress:
1. Deviant Communications
–
Double-bind communications
–
Vague, disruptive, fragmented; attack ...
2. Expressed Emotion

III. Treatment
Pharmacotherapy
Therapy Based on
Learning Models
Psychosocial
Rehabilitation
Family Therapy
Neuroleptics (antipsychotic agents)
–
Block _______________________

Do not cure Sz

Help some but not all pp with Sz

Do they work better on positive vs negative symptoms?

Do they affect relapse rates?

Produce side-effects , which often lead to noncompliance:
 tardive dyskinesia…
 Newer medications …
 Recommendation: combine w other treatments …

Interventions include:

Selectively reinforcing appropriate behaviour

Token economies

Social skills training

Self-help groups

Multiservice rehab centres