Abnormal Psychology in a
Changing World
SEVENTH EDITION
Jeffrey S. Nevid / Spencer A. Rathus / Beverly Greene
Chapter 12
(Pp 396-410)
Schizophrenia and
Other Psychotic
Disorders
Schizophrenia
Schizophrenia - A chronic psychotic disorder characterized
by disturbed behavior, thinking, emotions, and perceptions.
Acute episodes of schizophrenia are characterized by
delusions, hallucinations, illogical thinking, incoherent
speech, and bizarre behavior.
Between acute episodes, people with schizophrenia may still
be unable to think clearly, may speak in a flat tone, may have
difficulty perceiving emotions in other people’s facial
expressions, and may show little if any facial expressions of
emotions themselves.
Course of Development
Schizophrenia typically develops during a person’s late teens
or early 20s, a time when the brain is reaching full
maturation.
In about three of four cases, the first signs of schizophrenia
appear by the age of 25.
In some cases, the onset of the disorder is acute and occurs
suddenly, within a few weeks or months.
Then a rapid transformation in personality and behavior
leads to an acute psychotic episode.
Prodromal phase - In schizophrenia, the period of decline
in functioning that precedes the first acute psychotic episode.
Residual phase - In schizophrenia, the phase that follows
an acute phase, characterized by a return to the level of
functioning of the prodromal phase.
These cognitive and social deficits can impede the ability of
schizophrenia patients to function effectively in social and
occupational roles even more severely than the severe
hallucinations and delusions of the psychotic episode.
Prevalence
About 1% of the adult population in the United States is
affected by schizophrenia, more than 2 million people in total.
The WHO estimates that about 24 million people worldwide
suffer from schizophrenia.
Nearly 1 million people in the United States receive treatment
for schizophrenia each year, with about a third of these
requiring hospitalization.
Men tend to have a slightly higher risk of developing
schizophrenia than women.
Women tend to develop the disorder somewhat later than
men do, with onset occurring most commonly between age 25
and the mid-30s in women and between age 18 and 25 in men
(APA, 2000).
Women also tend to achieve a higher level of functioning
before the onset of the disorder and to have a less severe
course of illness than do men.
Overview of Schizophrenia
Diagnostic Features
Schizophrenia is a pervasive disorder that affects a wide range
of psychological processes involving cognition, affect, and
behavior.
The DSM-IV criteria for schizophrenia require that psychotic
behaviors be present at some point during the course of the
disorder and that signs of the disorder be present for at least 6
months.
People with briefer forms of psychosis receive other
diagnoses, such as brief psychotic disorder.
TRUTH or FICTION
Both the course of schizophrenia and its
features can vary among cultures
People with schizophrenia show a marked decline in occupational and
social functioning.
Positive symptoms -are those symptoms that are more “active” such
as; hallucinations and delusions that cause behavior, uncontrollable fear
or other emotions, loose associations and disturbed thinking. (Related to
excessive amount of dopamine in the prefrontal cortex in D2 neurons.)
Negative symptoms -Flat emotional affect, social withdrawal, catatonic
stupors and extreme social withdrawal. (Related to loss of brain tissue in
the hippocampus, Basil Ganglia and frontal cortex. Larger than normal
ventricles in the brain.)
Symptoms may shift from Positive to Negative symptoms
in chronic cases.
Aberrant Content of Thought:
Delusions
Delusions of Reference- belief that things such as TV or radio broadcasts refer
to them.
Delusions of Influence- “others” are trying to influence their thoughts and
behavior.
Paranoid Delusions- people or other entities are “out to get them”.
Thought Broadcasting- others can read their thoughts.
Delusions of Grandeur- belief that they are “all powerful”, “God”, famous
person etc.. .
Nihilistic Delusions- belief that they “live in a shadow world” or that they are a
“spirit.
Somatic Delusions- false belief about being “poison” or having a strange
disease condition that really does not exist.
Aberrant Forms of Thought
Unless we are engaged in daydreaming or purposefully letting
our thoughts wander, our thoughts tend to be tightly knit
together.
The connections (or associations) between our thoughts tend
to be logical and coherent.
Thought disorder - A disturbance in thinking characterized
by the breakdown of logical associations between thoughts.
A painting by a schizophrenia patient
Paintings or drawings by schizophrenia patients often express
the bizarre quality of their thought patterns.
Attentional Deficiencies
To read this you must screen out background noises and other
environmental stimuli.
Attention, the ability to focus on relevant stimuli and ignore
irrelevant ones, is basic to learning and thinking.
People with schizophrenia often have difficulty filtering out
irrelevant stimuli, making it nearly impossible for them to
focus their attention, organize their thoughts, and filter out
unessential information.
Filtering out extraneous stimuli
You probably have little difficulty filtering out unimportant stimuli, such as street
sounds. But people with schizophrenia may be distracted by irrelevant stimuli and
be unable to filter them out. Consequently, they may have difficulty focusing their
attention and organizing their thoughts.
Eye Movement Dysfunction
About one in three chronic schizophrenia patients shows
evidence of eye movement dysfunction (Ross, 2000).
Patients with this dysfunction (also called eye tracking
dysfunction) have abnormal movements of the eyes when
they track a moving target across their field of vision.
Rather than steadily tracking the target, the eyes fall back and
then catch up in a kind of jerky movement.
Abnormal Event-Related Potentials
Researchers have also studied brain wave patterns, called
event-related potentials, or ERPs, that occur in response
to external stimuli like sounds and flashes of light.
ERPs can be broken down into various components that
emerge at different intervals following the presentation of a
stimulus.
Schizophrenia patients also show reduced levels of lateroccurring ERPs.
These later-occurring ERPs are believed to be involved in the
process of focusing attention on a stimulus in order to extract
meaningful information.
Perceptual Disturbances
Hallucinations - Perceptions occurring in the absence of
external stimuli that become confused with reality which can
involve any of the senses.
TRUTH or FICTION
Auditory, not visual, hallucinations are the
most common type of hallucinations
among people with schizophrenia
Types of Hallucinations
Auditory hallucinations (“hearing voices”) are most common,
affecting about three of four schizophrenia patients.
Tactile hallucinations (such as tingling, electrical, or burning
sensations).
Somatic hallucinations (such as feeling like snakes are crawling inside
one’s belly).
Visual hallucinations (seeing things that are not there)
Gustatory hallucinations (tasting things that are not present),
Olfactory hallucinations (sensing odors that are not present) are rarer.
TRUTH or FICTION
It is normal for people to hallucinate nightly.
Notes on Hallucinations
Hallucinations are not unique to schizophrenia.
People with major depression and mania sometimes
experience hallucinations.
Nor are hallucinations invariably a sign of psychopathology.
They are common and socially valued in some cultures
Emotional Disturbances
Disturbances of affect or emotional response in
schizophrenia may involve negative symptoms, such as a loss
of normal affect or emotional expression, which is labeled
blunted affect or flat affect.
Flat affect is inferred from the absence of emotional
expression in the face and voice.
People with schizophrenia may speak in a monotone and
maintain an expressionless face, or “mask.”
A young man diagnosed with
disorganized schizophrenia.
One of the characteristic features of disorganized schizophrenia is
grossly inappropriate affect, as shown by this patient, who
continually giggles and laughs for no apparent reason.
Other Types of Impairment
People who suffer from schizophrenia may become confused
about their personal identities—the cluster of attributes and
characteristics that define themselves as individuals and give
meaning and direction to their lives.
They may fail to recognize themselves as unique individuals
and be unclear about how much of what they experience is
part of themselves.
In psychodynamic terms, this phenomenon is sometimes
referred to as loss of ego boundaries.
Other Types of Impairment
Disturbances of volition are most often seen in the
residual or chronic state.
People with schizophrenia may show highly excited or wild
behavior or may slow to a state of stupor.
People with schizophrenia also show significant impairment
in interpersonal relationships.
Subtypes of Schizophrenia
The DSM-IV lists three specific types of schizophrenia:
disorganized, catatonic, and paranoid.
People with schizophrenia who display active psychotic
features, such as hallucinations, delusions, incoherent
speech, or confused or disorganized behavior, but who do
not meet the specifications of the other types, are considered
to be of an undifferentiated type.
Others who have no prominent psychotic features at the time
of evaluation but have some residual features (for example,
social withdrawal, peculiar behavior, blunted or inappropriate
affect, strange beliefs or thoughts) would be classified as
having a residual type of schizophrenia.
Disorganized Type
Disorganized type - The subtype of schizophrenia
characterized by disorganized behavior, bizarre delusions,
and vivid hallucinations.
People with disorganized schizophrenia display silliness and
giddiness of mood, giggling and talking nonsensically.
They often neglect their appearance and hygiene and lose
control of their bladders and bowels.
Paranoid Type
Paranoid type - The subtype of schizophrenia characterized
by hallucinations and systematized delusions, commonly
involving themes of persecution.
The behavior and speech of someone with paranoid
schizophrenia does not show the marked disorganization
typical of the disorganized type, nor is there a prominent
display of flattened or inappropriate affect or catatonic
behavior.
The delusions often involve themes of grandeur, persecution,
or jealousy.
Paranoid Schizophrenia
People with paranoid schizophrenia hold systematized delusions that
commonly involve themes of persecution and grandeur. They usually do
not show the degree of confusion, disorganization, or disturbed motor
behavior seen in people with catatonic or disorganized schizophrenia.
Unless they are discussing the areas in which they are delusional, their
thought processes can appear to be relatively intact.
Catatonic Type
Catatonic type - The subtype of schizophrenia characterized
by gross disturbances in motor activity, such as catatonic
stupor.
People with catatonic schizophrenia may show unusual
mannerisms or grimacing or maintain bizarre, apparently
strenuous postures for hours, although their limbs become
stiff or swollen.
A striking but less common feature is waxy flexibility, which
involves adopting a fixed posture into which they have been
positioned by others.
A person diagnosed with catatonic
schizophrenia
People with catatonic schizophrenia remain in unusual, difficult
positions that can last for hours, even though their limbs become stiff or
swollen. They seem oblivious to their environment during these episodes,
even to people who are talking about them. Some sufferers later say that
they heard what was being said. Periods of stupor commonly alternate
with periods of agitation.
Type I versus Type II Schizophrenia
Type I schizophrenia is characterized by the more flagrant or positive
symptoms of schizophrenia we describe earlier, such as hallucinations,
delusions, and looseness of associations, as well as by an abrupt onset,
preserved intellectual ability, and a more favorable response to
antipsychotic medication due to biochemical (dopamine) imbalances.
Type II schizophrenia corresponds to a pattern consisting largely of the
deficit or negative symptoms of schizophrenia, such as lack of emotional
expression, low or absent levels of motivation, loss of ability to experience
pleasure, social withdrawal, and poverty of speech, as well as by a more
gradual onset, intellectual impairment, and poorer response to
antipsychotic drugs because impairment in the brain is due to actual brain
tissue damage or loss not biochemical imbalances.
The End