Psychotic Disorders - People Server at UNCW

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 13: Schizophrenia and Other Psychotic Disorders

Chapter 13

Schizophrenia and Other Psychotic Disorders



Nature of Schizophrenia and Psychosis: An Overview

 Schizophrenia vs. Psychosis

 Psychosis – Broad term (e.g., hallucinations, delusions)

 Schizophrenia – A type of psychosis

 Psychosis and Schizophrenia are heterogeneous

 Disturbed thought, emotion, behavior



Nature of Schizophrenia and

Psychosis: History and Current Thinking

 Historical Background

 Benedict Morel – Introduced dementia praecox

 Demence (loss of mind) precoce (early, premature)

 Emil Kraepelin – Used the term dementia praecox

 Focused on subtypes of schizophrenia

 Eugen Bleuler – Introduced the term “schizophrenia”

 “Splitting of the mind”

 Impact of Early Ideas on Current Thinking

 Many of Kraeplin and Bleuler’s ideas are still with us

 Understanding onset and course considered important



Table 13.1

Table 13.1 Early Figures in the History of Schizophrenia



Schizophrenia: The “Positive” Symptom Cluster

 The Positive Symptoms

 Active manifestations of abnormal behavior

 Distortions of normal behavior

 Delusions: The Basic Feature of Madness

 Gross misrepresentations of reality

 Include delusions of grandeur or persecution

 Hallucinations: Auditory and/or Visual

 Experience of sensory events without environmental input

 Can involve all senses

 Findings from SPECT studies



Etta



Schizophrenia: The “Positive” Symptom

Cluster (cont.)

Figure 13.1

Major areas of functioning of the cerebral cortex. In most people, only the left hemisphere is specialized for language.



Schizophrenia: The “Negative” Symptom Cluster

 The Negative Symptoms

 Absence or insufficiency of normal behavior

 Spectrum of Negative Symptoms

 Avolition (or apathy) – Lack of initiation and persistence

 Alogia – Relative absence of speech

 Anhedonia – Lack of pleasure, or indifference

 Affective flattening – Little expressed emotion



Schizophrenia: The “Disorganized” Symptom Cluster

 The Disorganized Symptoms

 Include severe and excess disruptions

 Speech, behavior, and emotion

 Nature of Disorganized Speech

 Cognitive slippage – Illogical and incoherent speech

 Tangentiality – “Going off on a tangent”

 Loose associations – Conversation in unrelated directions

 Nature of Disorganized Affect

 Inappropriate emotional behavior

 Nature of Disorganized Behavior

 Includes a variety of unusual behaviors

 Catatonia – Spectrum

 Wild agitation, waxy flexibility, immobility



Subtypes of Schizophrenia

 Paranoid Type

 Intact cognitive skills and affect

 Do not show disorganized behavior

 Hallucinations and delusions – 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 – Tend to be fragmented

 Develops early, tends to be chronic, lacks remissions



Subtypes of Schizophrenia (cont.)

 Catatonic Type

 Show unusual motor responses and odd mannerisms

 Examples include echolalia and echopraxia

 Tends to be severe and quite rare

 Undifferentiated Type

 Wastebasket category

 Major symptoms of schizophrenia

 Fail to meet criteria for another type

 Residual Type

 One past episode of schizophrenia

 Continue to display less extreme residual symptoms



Other Disorders with Psychotic Features

 Schizophreniform Disorder

 Schizophrenic symptoms for a few months

 Associated with good premorbid functioning

 Most resume normal lives

 Schizoaffective Disorder

 Symptoms of schizophrenia and a mood disorder

 Both disorders are independent of one another

 Prognosis is similar for people with schizophrenia

 Such persons do not tend to get better on their own



Other Disorders with Psychotic Features (cont.)

 Delusional Disorder

 Delusions that are contrary to reality

 Lack other positive and negative symptoms

 Types of delusions include

 Erotomanic

 Grandiose

 Jealous

 Persecutory

 Somatic

 Extremely rare

 Better prognosis than schizophrenia



Additional Disorders with Psychotic Features

 Brief Psychotic Disorder

 One or more positive symptoms of schizophrenia

 Usually precipitated by extreme stress or trauma

 Tends to remit on its owns

 Shared Psychotic Disorder

 Delusions from one person manifest in another person

 Little is known about this condition

 Schizotypal Personality Disorder

 May reflect a less severe form of schizophrenia



Classification Systems and Their Relation to

Schizophrenia

 Process vs. Reactive Distinction

 Process – Insidious onset, biologically based, negative symptoms, poor prognosis

 Reactive – Acute onset (extreme stress), notable behavioral activity, best prognosis

 Good vs. Poor Premorbid Functioning in Schizophrenia

 Focus on functioning prior to developing schizophrenia

 No longer widely used

 Type I vs. Type II Distinction

 Type I – Positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment

 Type II – Negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments



Schizophrenia: Some Facts and Statistics

 Onset and Prevalence of Schizophrenia worldwide

 About 0.2% to 1.5% (or about 1% population)

 Often develops in early adulthood

 Can emerge at any time

 Schizophrenia Is Generally Chronic

 Most suffer with moderate-to-severe lifetime impairment

 Life expectancy is slightly less than average

 Schizophrenia Affects Males and Females About Equally

 Females tend to have a better long-term prognosis

 Onset differs between males and females

 Schizophrenia has a Strong Genetic Component



Schizophrenia: Some Facts and Statistics (cont.)

Figure 13.2

The natural history of schizophrenia: a 5-year follow-up. Copyright 1989 by Cambridge University Press. Reprinted with the permission of Cambridge

University Press.



Causes of Schizophrenia:

Findings From Genetic Research

 Family Studies

 Inherit a tendency for schizophrenia

 Do not inherit specific forms of schizophrenia

 Risk increases with genetic relatedness

 Twin Studies

 Monozygotic twins – Risk for schizophrenia is 48%

 Fraternal (dizygotic) twins – Risk drops to 17%

 Adoption Studies -- Risk for schizophrenia remains high

 Cases where a biological parent has schizophrenia

 Summary of Genetic Research

 Risk for schizophrenia increases with genetic relatedness

 Risk is transmitted independently of diagnosis

 Strong genetic component does not explain everything




Findings From Genetic Research (cont).

Figure 13.4

Risk for schizophrenia among children of twins.



Search for Genetic and

Behavioral Markers of Schizophrenia

 Genetic Markers: Linkage and Association Studies

 Search for genetic markers is still inconclusive

 Schizophrenia is likely to involve multiple genes

 Behavioral Markers: Smooth-Pursuit Eye Movement

 The procedure – Eye-tracking a moving object

 Tracking deficits – Schizophrenics and their relatives



Causes of Schizophrenia: Neurotransmitter

Influences

 The Dopamine Hypothesis

 Drugs that increase dopamine (agonists)

 Result in schizophrenic-like behavior

 Drugs that decrease dopamine (antagonists)

 Reduce schizophrenic-like behavior

 Examples – Neuroleptics, L-Dopa for Parkinson’s disease

 Dopamine hypothesis is problematic and overly simplistic

 Current theories – Emphasize many neurotransmitters



Causes of Schizophrenia: Neurotransmitter

Influences (cont.)

Figure 13.6

Some ways drugs affect neurotransmission.




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

 Findings are inconclusive

 Conclusions About Neurobiology and Schizophrenia

 Schizophrenia – Diffuse neurobiological dysregulation

 Structural and functional brain abnormalities

 Not unique to schizophrenia




Other Neurobiological Influences (cont.)

Figure 13.7

Location of the cerebrospinal fluid in the human brain. This extracellular fluid surrounds and cushions the brain and spinal cord. It also fills the four interconnected cavities (cerebral ventricles) within the brain and the central canal of the spinal cord.




Psychological and Social Influences

 The Role of Stress

 May activate underlying vulnerability

 May also increase risk of relapse

 Family Interactions

 Families – Show ineffective communication patterns

 High expressed emotion – Associated with relapse

 The Role of Psychological Factors

 Exert only a minimal effect in producing schizophrenia



Cultural Differences

Figure 13.8

Cultural differences in expressed emotion (EE).



Medical Treatment of Schizophrenia

 Historical Precursors

 Development of Antipsychotic (Neuroleptic) Medications

 Often the first line treatment for schizophrenia

 Began in the 1950s

 Most reduce or eliminate positive symptoms

 Acute and permanent side effects are common

 Extrapyramidal and Parkinson-like side effects

 Tardive dyskinesia

 Compliance with medication is often a problem

 Transcranial Magnetic Stimulation

 Relatively untested procedure for hallucinations



Schizophrenia Drug



Table 13.2

Table 13.2 Commonly Used Antipsychotic



Psychosocial Treatment of Schizophrenia

 Historical Precursors

 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

 A necessary part of medication therapy



Studies on Treatment

Figure 13.9

Studies on treatment of schizophrenia from 1980 to 1992

(from Falloon, Brooker, & Graham-Hole, 1992).



Summary of Schizophrenia and Psychotic

Disorders

 Schizophrenia – Spectrum of Dysfunctions

 Affecting cognitive, emotional, and behavioral domains

 Positive, negative, and disorganized symptom clusters

 DSM-IV and DSM-IV-TR

 Five subtypes of schizophrenia

 Includes other disorders with psychotic features

 Several Bio-Psycho-Social Variables are Involved

 Successful Treatment Rarely Includes Complete

Recovery



Exploring Schizophrenia



Exploring Schizophrenia (cont.)
















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