Abnormal Psychology in a
Changing World
SEVENTH EDITION
Jeffrey S. Nevid / Spencer A. Rathus / Beverly Greene
Chapter 12
(Pp 422-426)
Schizophrenia and
Other Psychotic
Disorders
Treatment Approaches
Biological Approaches
The advent in the 1950’s of antipsychotic drugs (also
referred to as tranquilizers or neuroleptics)
revolutionized the treatment of schizophrenia
TRUTH or FICTION
We now have drugs that not only treat
schizophrenia but also can cure it in many
cases.
How Antipsychotics (Neuroleptics) Work
Antipsychotic drugs work by blocking receptor sites for dopamine, thus reducing
the effects of dopamine in regions of the brain – antagonist for dopamine
How Antipsychotics (Neuroleptics) Work
• Research suggests that in order for antipsychotic drugs to
be effective a blockade of 65% of D2 neurons are needed.
• Any drug that blocks more than 70% of D2 neurons cause
an increased risk of side effects – Psychiatrists have to
experiment with the dosage for each patient.
Antipsychotic Medications
• Two classes of antipsychotic medications: Typical
(older) and Atypical (newer) medications
• The Typical antipsychotics work only on Type I (positive)
symptoms of schizophrenia.
• Atypical antipsychotics work better with Type I
symptoms, but also have some benefits for Type II
(negative) symptoms
Typical vs. Atypical
Antipsychotic Medications
• Typical antipsychotics work on both D1 and D2
producing neurons, thus have more side effects – some of
which are permanent – dirty drug
• Atypical antipsychotic drugs work either exclusively
on D2 neurons; some of the newer atypical drugs work
also on blocking the reuptake of serotonin, thus give
some relief to the negative symptoms of schizophrenia.
Less side effects.
Table 15.7
Hockenbury: Psychology, Fourth Edition
Copyright © 2005 by Worth Publishers
Side Effects of Antipsychotic Drugs
Tardive dyskinesia (TD) - A disorder characterized by
involuntary movements of the face, mouth, neck, trunk, or
extremities and caused by long-term use of antipsychotic
medication.
Psuedoparkinson’s symptoms: hand tremors, shuffling
of the feet, and face tremors.
Final Notes on Antipsychotic Drugs
Antipsychotic medication helped control the more flagrant
behavior patterns of schizophrenia and reduced the need for
long-term hospitalization when taken on a maintenance or
continuing basis after an acute episode.
Yet for many patients with chronic schizophrenia, entering a
hospital is like going through a revolving door: they are
repeatedly admitted and discharged.
Many are simply discharged to the streets once they are
stabilized on medication and receive little if any follow-up
care.
Sociocultural Factors in Treatment
Ethnicity may also play a role in the family’s involvement in
treatment.
In a study of 26 Asian Americans and 26 non-Hispanic White
Americans with schizophrenia, family members of the Asian
American patients were more frequently involved in the
treatment program.
For example, family members were more likely to accompany
the Asian American patients to their medication evaluation
sessions.
Psychodynamic Therapy
Freud did not believe that traditional psychoanalysis was well
suited to the treatment of schizophrenia.
The withdrawal into a fantasy world that typifies
schizophrenia prevents the individual with schizophrenia
from forming a meaningful relationship with the
psychoanalyst.
The techniques of classical psychoanalysis, Freud wrote, must
“be replaced by others; and we do not know yet whether we
shall succeed in finding a substitute”.
Learning-Based Therapies
Therapy methods include the following:
1. Selective reinforcement of behavior, such as providing
attention for appropriate behavior and extinguishing bizarre
verbalizations through withdrawal of attention.
2. Token economy, in which individuals on inpatient units are
rewarded for appropriate behavior with tokens, such as
plastic chips, that can be exchanged for tangible reinforcers
such as desirable goods or privileges.
3. Social skills training, in which clients are taught
conversational skills and other appropriate social behaviors
through coaching, modeling, behavior rehearsal, and
feedback.
Psychosocial Rehabilitation
People with schizophrenia typically have difficulties
functioning in social and occupational roles and performing
work that depends upon basic cognitive abilities involving
attention and memory.
These problems limit their ability to adjust to community life,
even in the absence of overt psychotic behavior.
Recently, promising results were reported for cognitive
rehabilitation training to help schizophrenia patients
strengthen such basic cognitive skills as attention and
memory.
Family Intervention Programs
Family conflicts and negative family interactions can heap
stress on family members with schizophrenia, increasing the
risk of recurrent episodes.
Researchers and clinicians have worked with families of
people with schizophrenia to help them cope with the burdens
of care and assist them in developing more cooperative, lessconfrontational ways of relating to others.
In sum, no single treatment approach meets all the needs of
people with schizophrenia.
OTHER FORMS OF PSYCHOSIS
Brief Psychotic Disorder
A psychotic disorder lasting from a day to a
month and is characterized by at least one of the
following features: delusions, disorganized
speech, disorganized behavior or catatonic
behavior
Often follows exposure to a major stressor.
Schizophreniform Disorder
A psychotic disorder lasting less than 6 months
in duration, with features that resemble
schizophrenia.
Delusional Disorder
A relatively uncommon psychotic disorder
characterized by persistent, clearly delusional
beliefs, often involving paranoid themes.
Schizoaffective Disorder
A type of psychotic disorder in which individuals
experience both severe mood disturbance and
features associated with schizophrenia.
Diagnostic Criteria for Schizoaffective Disorder
A. An uninterrupted period of illness during which, at some time, there is
either a Major Depressive Episode, a Manic Episode, or a Mixed Episode
concurrent with symptoms that meet Criterion A for Schizophrenia.
B. During the same period of illness, there have been delusions or
hallucinations for at least 2 weeks in the absence of prominent mood
symptoms.
C. Symptoms that meet criteria for a mood episode are present for a
substantial portion of the total duration of the active and residual periods
of the illness.
D. The disturbance is not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical
condition.
A Beautiful Mind
In the movie A Beautiful Mind, Russell Crowe portrayed Nobel Prize
winner John Nash (shown here), a brilliant mathematician whose mind
captured the beautiful intricacies of mathematical formulations but was
also twisted by the delusions and hallucinations of schizophrenia.
The End