chapter 12 - schizophrenia
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Chapter 12 - Schizophrenia
Psychosis· Psychosis: a loss of contact with reality
· Ability to perceive and respond to the environment significantly disturbed; functioning impaired
· Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs)
Schizophrenia◦Individuals must show a deterioration in their work, social relations, and ability to care for themselves◦Six months or more
Schizophrenia◦Affects approximately 1 in 100 people in the world◦Financial & emotional costs: enormous◦Increased risk of suicide and physical – often fatal – illness
Schizophrenia·appears in all socioeconomic groups, but is found more frequently in the lower levels·“downward drift”
Schizophrenia · average age of onset for ♂ is 23 years, compared to 27 years for ♀; book states = numbers; other sources ♂ > ♀
· Rates of diagnosis differ by marital status
The Clinical Picture◦symptoms, triggers, and course vary greatly◦Some argue: group of distinct disorders that share common features
Positive Symptoms
• Excess or distortion in normal repertoire of behavior and experience
Pathological excesses -
bizarre additions to a
person’s behavior
Delusions• Erroneous belief• Fixed and firmly held
despite clear contradictory evidence
• Disturbance in the content of thought• Grandeur• Persecution• Reference• Nihilistic• Thought BroadcastingDelusions
Hallucinations• False Sensory
experiences/Perceptual disturbances
• Seems real but occurs in absence of any external perceptual stimulus
• Can occur in any sensory modalityHallucination
s
Disorganized Speech• Failure to make sense • Despite conforming to
semantic and syntactic rules of speech
• Disturbance in form (not content) of thought Disorganize
d speech
Disorganized Behavior• Impairment of goal-
directed activity• Occurs in areas of daily
functioning• Catatonia • Catatonia stupor• Inappropriate affect
Disorganized and Catatonic Behavior
Negative Symptoms• Affective flattening, Blunted
affect• Anhedonia• Apathy
• Both a symptom and coping strategy
• Avolition• Alogia
Absence or deficit
of normally present behavior
s
NeurocognitionNeurocognitiv
e deficits found in
people with schizophrenia
Attentional and working
memory deficits
Eye-tracking dysfunctions
Course·usually first appears between late teens and mid-30s
·three phases:·Prodromal ·Active ·Residual
DIATHESIS STRESS MODEL:A Synthesis
Current thinking emphasizes interplay
Multiple genetic factors
Environmental factors
CAUSESTWIN STUDIES ADOPTION STUDIES
· The average concordance rate for MZ twins is 48%, whereas the comparable figure for DZ twins is 17%.
· Suggests strong genetic factors.
· Also compelling evidence for the importance of environment.
· Genain quadruplets
◦Genetic factors play role in development of the disorder (Heston).
Biological Views
Biological ViewsGenetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities:◦Biochemical abnormalities◦Abnormal brain structure
BIOLOGICAL CAUSESThe dopamine hypothesis Interactions of multiple
neurotransmitters
◦Focuses on the function of dopamine in the limbic area of the brain.◦Hypothesis grew out of attempts to understand how antipsychotic drugs improve adjustment.
◦Current research focuses many neurotransmitters:◦Dopamine◦Serotonin ◦Glutamate
Prenatal Exposures
Pren
atal
exp
osur
es: Prenatal viral infection
Early nutritional deficiencies and maternal stress
Pregnancy and birth complications
Cytoarchitecture• Overall organization of cells in brain may be compromised
Biological ViewsAbnormal brain structure
· enlarged ventricles · enlargement may be a sign of poor development or damage in related brain regions
· smaller temporal and frontal lobes, smaller amounts of grey matter, and abnormal blood flow to certain brain areas
Sociocultural Views· Social labeling
· Many sociocultural theorists believe that the features influenced by diagnosis itself· Society labels people who fail to conform to certain norms of behavior
· Once assigned, label becomes a self-fulfilling prophecy
· The dangers of social labeling have been well demonstrated· Example: Rosenhan’s 1973 “pseudo-patient” study
Sociocultural Views· Family dysfunctioning
· often linked to family stress:· Parents of people with the disorder often:
· Display more conflict· Have greater difficulty communicating · Are more critical of and overinvolved · Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism and hostility and intrude on each other’s privacy
· Individuals who are trying to recover almost four times more likely to relapse if they live with such a family
Treatment: Antipsychotic Drugs◦the discovery of antipsychotic drugs in 1950s that revolutionized treatment for those suffering from schizophrenia
◦Have a relatively specific effect- reduce psychotic symptoms◦Work as dopamine antagonist◦Positive symptoms respond better than negative symptoms.
·reduce symptoms in at least 65% of patients
Motor Side Effects (parkinsonian symptoms)
○Extrapyramidal symptoms
○Tardive dyskinesia
Second-Generation Antipsychotics○ Atypical antipsychotics○Work on both serotonin and dopamine○ Impact both positive and negative
symptoms○ Examples: Clozaril, Risperdal, Zyprexa,
Seroquel, Geodon, and Abilify
Newer Antipsychotic Drugs· appear more effective than conventional antipsychotic drugs, especially for negative symptoms
· cause few extrapyramidal side effects and seem less likely to case tardive dyskinesia
· Some, however, do produce significant undesirable effects of their own
·Cognitive-behavioral therapy· Clinicians employ techniques that seek to change how individuals view and react to their hallucinatory experiences, including:· Provide education and evidence of the biological causes of hallucinations
· Challenge clients’ inaccurate ideas about the power of their hallucinations and delusions
Family therapy◦Over 50% of persons recovering from schizophrenia and other severe disorder live with family members◦This creates significant family stress◦Those who live with relatives who display high levels of expressed emotion are at greater risk for relapse than those who live with more positive or supportive families
Family therapy◦Family therapy◦Family therapy attempts to create more realistic expectations and provide psychoeducation about the disorder
Social Therapy· Treatment should include techniques that address social and personal difficulties
· include: practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing
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