The word schizophrenia is less than 100 years old,
but the illness has probably accompanied mankind
through its history.
Schizophrenia can be traced in written documents to
the old Pharaonic Egypt, as far back as the second
millennium before Christ
Depression, dementia, as well as thought
disturbances found in schizophrenia are described in
detail in the Book of Hearts.
The psychical illnesses were regarded as symptoms
of the heart and the uterus and originating from the
blood vessels or from purulence, fecal matter, a poison
or demons. In most cases the Egyptians apparently
looked upon the mental diseases as physical illnesses.
The treatment comprised temple sleep, also called
incubation. The ill persons spent the night in a holy
place.
The History of Schizophrenia
 Characterized
by distortions: perception,
thought, language, emotions
•Greece – Hippocrates had knowledge of the
basic symptoms.
•Eugen Bleuler – Swiss psychiatrist – coined
“schizophrenia”
•Greek words for “split mind” - separation of
cognitive and emotional functions – mental
confusion, inappropriate or absent emotional
expression.
•Not the same as multiple personality disorder
•Heinz Leshmann – chlorpromazine, first modern
anti-psychotic drug – made positive symptoms
disappear.
 Familiar things like colors, sounds, or
tastes may appear altered in a strange
way.
At first, symptoms may include mild
feelings of tension, inability to sleep or
concentrate, and a loss of interest in
school, work, or friends.
The symptoms of schizophrenia vary
from one person to another, and they can
appear either gradually or suddenly
As the illness progresses, people with
schizophrenia experience symptoms that
include psychosis. The person incorrectly
evaluates the accuracy of his or her
perceptions and thoughts and makes
incorrect conclusions about reality.
Symptoms
• Positive symptoms: common schizophrenia behaviors
– Delusions: false beliefs kept despite contrary evidence. (believing
you are the Virgin Mary)
– Hallucinations: false perceptions (usually hearing voices)
– mental disturbance: illogical thought, incoherent speech, word
usage shifts.
• Negative Symptoms: absence of expected behavior
–
–
–
–
Physical immobility
No emotional expression
Little speech
Withdrawal from social world
What are the symptons
associated with the different
types of schizophrenia?
Paranoid Schizophrenia
• Delusions, hallucinations, misinterpretation of facts
• Violent, suicidal behavior - high risk
• Ex: patient images that he is someone else or
someone is trying to harm him.
• Imaginary voices
Disorganized Schizophrenia
• Confused functions
• Incoherent
speech/thought
• Improper emotional
expression
• Act silly/bizarre
• Withdrawal from world
Catatonic Schizophrenia
•
•
•
•
•
•
Negative Symptoms
Abnormal posture/movements
Repeated motions
Motionlessness
Inactivity/Excitement periods
Impulsiveness
Residual
Schizophrenia
• Moderate
symptoms which
occur after partial
recovery of an
acute episode of
schizophrenia
• Less severe
symptoms: flat
affect, Absence of
emotion, limited
speech
Undifferentiated Schizophrenia
• Decrease in outside
interests/relationships
• Absence of mental activity
• Lack of emotion
• Mixture of symptoms
• Does not fit any of the categories
What exactly might be the cause of Schizophrenia? Is there a concrete
explanation? The biological, cognitive, and behaviorist approaches all
have their different theories to resolve a cure for this disorder. Research
is revealing that schizophrenia is indeed a environmental impact during
the the development of the brain during pregnancy and childhood.
Another prediction is that is a result of the interaction of certain
variations of genes. These would be the damaged portions of genes.
“The Behaviourist Approach interprets abnormal behavior as simply
maladaptive learning.”
From this, the behaviourist approach would then say that
Schizophrenia is not regarded at all differently to other forms of
abnormal behaviour.
In other words, the behaviourist approach would actually see the
term Schizophrenia as having no etiological value.
Although the behaviourist approach does not believe that there
seems to be an etiology for this disorder, it does have a number of
different treatments for it, such as token economy.
It seems that Identical Twins hold the highest risk percentage to
obtain this disorder…might this have a biological connection?
The biological approach closely looks at the interaction between
the environment and genetics. Some might say that the biological
perspective is too radical, and reductionist, but it seems that
genetics due play a major role in the involvement of this disorder.
Research nowadays proposes the idea that schizophrenia is caused
by a genetic vulnerability which is coupled with the environmental
and psychological stressors. This is also known as the diathesisstress model. The idea basically says that whether the person
develops the disorder or not, for the most part it is determined by
the vulnerability.
In overall, as said before…the biological approach closely looks at
the genetic factors, and how they apply to the disorder. In this case,
if there is a genetic vulnerability, it is more likely for the person to
develop Schizophrenia.
The Medical Model
Explains Schizophrenia in
terms of genetic and
psychological processes
Emphasizes
environmental influences
Try to identify individuals
who are defined as being at
risk, and observe whether
they in fact develop
schizophrenia
In that case the results
are correlational
Explanations of
schizophrenia :
•Genetic predisposition
•Structural brain
abnormalities
(smaller frontal cortex)
•Neurotransmitter
abnormalities
(the dopamine hypothesis)
•Prenatal abnormalities
•The vulnerability (Stress
Approach)
It seems that Identical Twins hold the highest risk percentage to
obtain this disorder…might this have a biological connection?
Biological Perspective
•
Dopamine hypothesis – theory that schizophrenia is related to over activity in
neural pathways which depend on dopamine as a neurotransmitter.
– Not all patients respond to chlorpromazine.
– Even though drugs reach brain after ingestion, it takes days or weeks before
improvement. If excess dopamine alone was the problem, behavior should
change as soon as dopamine levels drop.
– Clozapine – better than chlorpromazine, affects more non-dopamine than
dopamine pathways.
– Glutamate and serotonin may be involved.
– Brain scans have showed less frontal lobe activity in Schizophrenic patients.
Also differences in brain structures.
– Heredity factor
– Identical twins raised together, 50% concordance rate – not purely
hereditary.
– ‘two hit’ model Mednick – model proposes that first ‘hit’ occurs during second
trimester of pregnancy. Genetic defect possibly
– i.e. Mother contracting the flu during this stage of pregnancy.
– Second ‘hit’ - environmental stress, trauma during birth, negative rearing
conditions.
– Diathesis-stress model of abnormal behavior – abnormal behavior arises as
a result of the combination of a predisposition and a stressful environment.
– No stressor, predisposition is not manifested.
The biological approach closely looks at the interaction between
the environment and genetics. Some might say that the biological
perspective is too radical, and reductionist, but it seems that
genetics due play a major role in the involvement of this disorder.
Research nowadays proposes the idea that schizophrenia is caused
by a genetic vulnerability which is coupled with the environmental
and psychological stressors. This is also known as the diathesisstress model. The idea basically says that whether the person
develops the disorder or not, for the most part it is determined by
the vulnerability.
In overall, as said before…the biological approach closely looks at
the genetic factors, and how they apply to the disorder. In this case,
if there is a genetic vulnerability, it is more likely for the person to
develop Schizophrenia.
Therapies
Technique
application
effectiveness
PSYCHOSURGERY
Traditionally – crude
lobotomy;
precise bundles of
nerve fibers are
destroyed,
Traditionally for
schizophrenia;
mainly as a last
resort for severe
depression
It can be effective for
certain disorders, e.g.
severe depression.
ELECTROCONVULSIVE
Electro shock of
approx. 100 volts to
induce a seizure At
least six times
repeated over 3-4
weeks.
Traditionally for
schizophrenia;
Today – to treat
severe depression
(drugs having
failed);
60-80% relief cases in
depression;
destroy neurons
responsible for
emotions,
affect the balance of
neurotransmitters
involved in emotions,
act as punishment,
produce memory loss
and restructuring of
thoughts.
DRUG
THERAPY
Anti-psychotics:
Block dopamine or
serotonin
Anti-anxiety drugs:
(minor tranquillisers,
e.g. valium) – reduce
anxiety and panic
attacks.
Reduced the need for
institutionalization
Anti-anxiety drugs (e.g.
valium) – effective
against generalised
anxiety
Best studies with placebo
groups and double blind
assessment techniques.
Appropriateness
Side effects: profound
changes in personality,
motivation, 1-4%
likelihood of death.
Side effects:
Memory loss,
3 / 10,000 mortality risk,
ethical problem, matter
of control,
it can save lives.
Side-effects:
Dryness of mouth,
Drowsiness,
Weight gain or loss,
body spasm,
involuntary mouth / tongue movements,
Dangerous blood conditions,
Psych&physical addiction,
“pharmacological strait-jackets” (based
on symptom control, does not cure causes)
Biological Treatment:
Medication
• Antipsychotic drugs do not “cure” schizophrenia, they
just treat it.
• Are very effective in treating hallucinations and
delusions.
• Work differently from individual to individual.
• Examples: Clozaril, Risperdal, Zyprexa, Haldol,
Thorazine, Seroquel.
• Long-acting injectable forms. No need to take pills.
Eg: Haldol, Prolixin, Trilafon.
• Side effects: Drowsiness, restlessness, muscle
spasms, tremor, dry mouth, blurring of vision, Tardive
dyskinesia, weight gain, social withdrawal and
symptoms resembling Parkinson's Disease.
Behaviorists interpret abnormal behavior in terms of faulty learning.
Focus on behavior rather than mental processes
Reinforcement (Encouraging or gradually shaping desirable responses. )
Positive reinforcement – socially rewarding stimuli (e.g. attention and prize),
educational feedback (good grades), token systems (merit points, star charts), liked
activities
Not Regarded as any different from other forms of abnormal behavior
Social and environmental stressors can make the disorder worse
Although learning by reinforcement is a well demonstrated general principal there is no
direct evidence for the acquisition of Schizophrenic Behavior.
Environmental Determinism: We are controlled by external forces
According to behaviorists, we are determined by rewards and punishments;
social learning psychologists will add social models we observe and imitate
“blank slate” concept
Skinner: “Free will is an illusion” – implications for psychology and societies:
behaviour control, therapies, creating an ideal state and society
Watson: “Give me a dozen of healthy infants ...”)
Learning Perspective
•
•
•
•
•
•
•
•
•
•
•
•
This perspective has many weaknesses in explaining
Schizophrenic parent – children – OK - , but how does separated parent
children develop disease.
Particular combinations of symptoms occurs regularly.
Model does not clearly explain the causes
Reinforcement can be used to improve behavior.
Treatment : Shaping behavior of wards, token economy.
Atthowe and Krasner study : patients who were hospitalized for a median
duration of 22 years: 90% per cent of the 87 men participated and improved
in a two year.
With the discovery of chlorpromazine hospitalization dropped since the
1950 because of its questionable morality of rewarding passivity of patients.
Behaviors modified in studies may be due to institutionalization, not
schizophrenia.
Fall of institutions decreased opportunity to implement reinforcement
strategies.
Certain behaviors can be modified by reinforcement, and help schizophrenic
individuals function better
But learning based in reinforcement does not even come close to explaining
the origins of schizophrenia.
“The Behaviourist Approach interprets abnormal behavior as simply
maladaptive learning.”
From this, the behaviourist approach would then say that
Schizophrenia is not regarded at all differently to other forms of
abnormal behaviour.
In other words, the behaviourist approach would actually see the
term Schizophrenia as having no etiological value.
Although the behaviourist approach does not believe that there
seems to be an etiology for this disorder, it does have a number of
different treatments for it, such as token economy.
Therapies
technique
application
effectiveness
Appropriateness
Classical
Conditioning
Gradual relaxation
e.g. Little Albert
and rats – rabbits
phobia,
Very successful
Ethical
SYSTEMATIC
DESENSITISATION
(Joseph Wolpe)
Classical
Conditioning
FLOODING AND
IMPLOSION
Relaxation
techniques,
Slowly but surely...
Phobias from
persecutions and
allusions
Forced reality
testing,
Continual and
dramatic
presentation,
Forced Reality to
withdraw patients
from false beliefs
exhaustion effect.
Quick and cheap,
Ethical problems of
suffering and
withdrawal.
Positively
reinforcing (e.g.
food) successive
approximations to
the desired
behavior.
Social interaction
and speech for
disorganized
patients with
schizophrenia
effective
Only superficial short
term effects for
serious psychoses like
schizophrenia.
(imagination)
Operant
Conditioning
Behavior
modification
BEHAVIOUR
SHAPING
Operant
Conditioning
Behavior
Modificationg
TOKEN
ECONOMY
PROGRAMMES
Tokens act as
secondary
reinforcers,
exchangeable
for primary
reinforcers.
In psychiatric
institutions
Improvements on Problems with
self care and pro- transferring
social behaviour, improved
behavior and
skills to the
outside world.
Careful planning
and structured
environment.
We learn by association from the environment – the contribution to
education involves guidelines on how to alter environmental stimuli, e.g.
classroom conditions, presentation of info, teacher behaviour, etc. to
provide positive conditioned emotional responses.
Also, providing positive consequences (reinforcement) for correct
responses and pointing out associations between new and old stimuli will
encourage correct responses. However, teachers can never control all the
competing sources of punishment and reinforcement in the learning
environment, e.g. from peers and influences outside the classroom.
PSYCHOSOCIAL TREATMENTS
• Psychosocial treatments help most with psychological,
social, and occupational problems.
• Useful for patients with less severe symptoms or for
patients whose psychotic symptoms are under control.
• Focus on improving the patient's social functioning.
REHABILITATION
• Includes a wide range of non-medical interventions.
• Social and vocational training helps patients overcome
difficulties.
• Vocational counseling, job training, problem-solving
and money management skills, use of public
transportation, and social skills training.
• Provided by Partial Hospital or Day Treatment
Programs (4 to 6 hrs per day, several days per week).
• Learning is both educational and experiential.
COGNITIVE BEHAVIORAL
PSYCHOTHERAPY
• More effective than other types of psychotherapy in treating
depression and panic attacks.
• Two approaches combine to effectively treat schizophrenia.
• Cognitive treatment helps treat distorted perceptions of the
world, including self, and disordered or disorganized thinking.
• Behavioral therapy is used within a structured psychosocial
rehabilitation program rather than individually because
schizophrenia is seen as a life-long illness.
• Behavior therapy teaches the social skills never learned, and
helps understand when to apply those skills to problems in the
world.
• Examples of training: Stress Management Training,
Assertiveness Training, Communication Skills Training, Problem
Solving Skills.
FAMILY EDUCATION
• It is important for family members to lern all they
can about schizophrenia when they have to take care
of a family member who has been discharged from
the hospital.
• Family psycho education includes teaching various
coping strategies and problem-solving skills. It is a
cognitive-behavioral treatment approach to family
therapy.
• This approach helps families to deal more effectively
with their ill relative and to contribute to an improved
outcome for the patient.
SELF-HELP GROUPS
• Members provide continuing mutual support as well as
comfort in knowing that they are not alone in the
problems they face.
• Families working together can more effectively serve
as supporters for needed research and hospital and
community treatment programs.
• Patients acting as a group rather than individually may
be better able to dismiss dishonor and draw public
attention to such abuses as discrimination against the
mentally ill.
• Groups are very active and provide useful information
and assistance for patients and families of patients
with schizophrenia.
COMMUNITY AND SOCIAL
SUPPORT
• Patients with schizophrenia may need help from
people in their family or community.
• Ensuring that a person with schizophrenia continues
to get treatment after hospitalization is important.
• Encouraging the patient to continue treatment and
assisting him or her in the treatment process can
positively influence recovery.
• A positive approach may be helpful and perhaps more
effective in the long run than criticism.
Focuses on analyzing the various types of symptom and
suggests information based on the faulty cognitive processing.
Suggests interesting insights into the nature of schizophrenic
behavior
There are specifically three aspects it focuses on:
Delusions, language, and thought disturbances.
Cognitive Symptoms of Schizophrenia
Cognitive symptoms refer to the difficulties with concentration
and memory. These can include:
disorganized thinking
slow thinking
difficulty understanding
poor concentration
poor memory
difficulty expressing thoughts
difficulty integrating thoughts, feelings and behavior
Cognitive Perspective
•
•
•
•
Faulty cognitive processing
Delusions , beliefs contradictory to reality, Roger Brown, found 3 people, believing they were
Jesus Christ, each convinced the others were deluded.
– Delusional individuals usually recognize false delusions of other patients. Loss of reality
only in specifics.
Language – picture of infantile speech is not accurate,
– Roger Brown - no child like utterances , words used in incoherent ways. Words have
specific meaning to person. Words suggest many connotations, meanings… which might
be confused.
– A model to explain this use of language is impossible.
Thought disturbances
– Faulty references, misinterpretation of significance of stimulus and events. Person
attributes meaning to event which most people would not.
– Logical errors – lapses in reasoning.
– Silvano Arieti – person uses different kind of reasoning. “The Virgin Mary is a virgin. I am a
virgin. Therefore I am the virgin Mary.” Logical using unconventional rule of reasoning.
– Individuals problem of defective attention - difficulty in selecting and attending to the
relevant stimuli in a situation.
– Individuals who develop schizophrenia reported early symptoms such as memorizing
details, distraction, misinterpreting instructions. Unable to control.
– The negative responses o other people would aggravate the social impact of the initial
problem of defective attention.
– Common mechanism underlying many unrelated symptoms.
– Explains why schizophrenic can function normally in some respect and have other bizarre
behaviors.
Therapies
(THESE ARE
COGNITIVE –
BEHAVIOURAL
THERAPIES!!!!!)
applications
effectiveness
Appropriateness
Beck’s cognitive
restructuring therapy
(gently challenging faulty
thinking patterns);
Ellis’s rational emotive
behaviour therapy
(forcible persuasion and
reality testing, fight
awfulizing!);
Meichenbaum’s selfinstructional training
(substituting maladaptive
and self-defeating inner
dialogues for better inner
statements – extended
Bandura’s concepts of
imitation to imitation of
thought processes).
Depression;
Anxiety
disorders.
Depression
Personality
disorders
Panic disorder
and anxiety
Eating
disorders
Impulsive
children
(dialogues of selfcontrol),
Stress
management
Effective with
anxiety disorders;
With depressions
– as effective as
drug therapies;
Lower relapse
rates are gained,
if cognitive
therapy is
combined with
medication.
Complete in their
approach to the
problem (e.g. Ellis’s
ABC:
A – activating event,
e.g. a stressor,
B – intervening belief,
C – emotional
consequence.
Directive (ethical issue
of control).
INDIVIDUAL PSYCHOTHERAPY
• Involves regularly scheduled talks between the
patient and a mental health professional (psychiatrist,
psychologist, psychiatric social worker, nurse).
• Talks focus on current or past problems, experiences,
thoughts, feelings and relationships.
• Individuals gradually come to understand more about
themselves and their problems.
• Psychotherapy is not a substitute for antipsychotic
medication.
• It is most helpful once a patient’s psychotic
symptoms have first been relieved by drug treatment.
Credits
http://encarta.msn.com/medias_761552061/Schizophrenia.html
http://www.hubin.org/facts/history/history_schizophrenia_en.html
http://www.psychologyinfo.com/schizophrenia/treatment.htm
Newton, David; Olendorf, Donna; Jeryan, Cristine; Boyden,
Karen "SCHIZOPHRENIA."
SICK! – Diseases and
Disorders, Injuries and Infections. 2000.
http://www.schizophrenia.com/schizpictures.html
Glassman: Approaches to Psychology