Copyright 2010 Allyn & Bacon This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: PowerPoint for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville Copyright 2010 Allyn & Bacon Chapter 13 Schizophrenia and Other Psychotic Disorders Copyright 2010 Allyn & Bacon 3 SchizophreniaSchizophrenia The hallmark of schizophrenia is psychosisa significant loss of contact with reality Schizophrenia Affects people from all walks of life Is about as prevalent as epilepsy Usually begins in late adolescence or early adulthood The hallmark of schizophrenia is psychosisa significant loss of contact with reality Schizophrenia Affects people from all walks of life Is about as prevalent as epilepsy Usually begins in late adolescence or early adulthood Copyright 2010 Allyn & Bacon 4 Origins of the Schizophrenia Construct First clinical description appeared in 1810 Emil Kraepelin used term dementia praecox to refer to mental deterioration at early age Eugen Bleuler introduced term schizophrenia in 1911 Schizophrenia as split personality is a major misconception First clinical description appeared in 1810 Emil Kraepelin used term dementia praecox to refer to mental deterioration at early age Eugen Bleuler introduced term schizophrenia in 1911 Schizophrenia as split personality is a major misconception Copyright 2010 Allyn & Bacon 5 EpidemiologyEpidemiology Lifetime risk for developing schizophrenia is about 1% Risk is higher for those with older fathers and in certain countries Typically begins in late adolescence or early adulthood Schizophrenia tends to be more common and severe in men than women Lifetime risk for developing schizophrenia is about 1% Risk is higher for those with older fathers and in certain countries Typically begins in late adolescence or early adulthood Schizophrenia tends to be more common and severe in men than women Copyright 2010 Allyn & Bacon 6 Figure 13.1: Age Distribution of Onset of Schizophrenia Copyright 2010 Allyn & Bacon 7 Clinical Picture Hallmark symptoms include: Delusions Hallucinations Disorganized speech Disorganized and catatonic behavior Hallmark symptoms include: Delusions Hallucinations Disorganized speech Disorganized and catatonic behavior Copyright 2010 Allyn & Bacon 8 DelusionsDelusions An erroneous belief that is fixed and firmly held despite clear contradictory evidence Disturbance in the content of thought Examples include: Made feelings or impulses Thought broadcasting Thought insertion or withdrawal Delusions of reference An erroneous belief that is fixed and firmly held despite clear contradictory evidence Disturbance in the content of thought Examples include: Made feelings or impulses Thought broadcasting Thought insertion or withdrawal Delusions of reference Copyright 2010 Allyn & Bacon 9 HallucinationsHallucinations A sensory experience that seems real but occurs in the absence of any external perceptual stimulus Can occur in any sensory modality Auditory is most common PET and fMRI studies suggest that auditory hallucinations may be misperceived subvocal speech A sensory experience that seems real but occurs in the absence of any external perceptual stimulus Can occur in any sensory modality Auditory is most common PET and fMRI studies suggest that auditory hallucinations may be misperceived subvocal speech Copyright 2010 Allyn & Bacon 10 Disorganized Speech Failure to make sense despite conforming to semantic and syntactic rules of speech Cognitive slippage, loosening of associations, or incoherence A disturbance in the form (not content) of thought Failure to make sense despite conforming to semantic and syntactic rules of speech Cognitive slippage, loosening of associations, or incoherence A disturbance in the form (not content) of thought Copyright 2010 Allyn & Bacon 11 Disorganized and Catatonic Behavior Impairment of goal-directed activity Occurs in areas of daily functioning Work Social relations Self-care (hygiene, safety, dress) Catatonia involves almost no movement at all, sometimes in an unusual posture Impairment of goal-directed activity Occurs in areas of daily functioning Work Social relations Self-care (hygiene, safety, dress) Catatonia involves almost no movement at all, sometimes in an unusual posture Copyright 2010 Allyn & Bacon 12 Positive and Negative Symptoms Positive symptoms of schizophrenia reflect an excess or distortion in a normal repertoire of behavior and experience such as: Delusions Hallucinations Disorganized speech Disorganized behavior Positive symptoms of schizophrenia reflect an excess or distortion in a normal repertoire of behavior and experience such as: Delusions Hallucinations Disorganized speech Disorganized behavior Copyright 2010 Allyn & Bacon 13 Positive and Negative Symptoms Negative symptoms reflect an absence or deficit of behaviors that are normally present Flat or blunted emotional expressiveness Alogia Avolition Negative symptoms reflect an absence or deficit of behaviors that are normally present Flat or blunted emotional expressiveness Alogia Avolition Copyright 2010 Allyn & Bacon Subtypes of Schizophrenia Subtypes of schizophrenia include: Paranoid type Disorganized type Catatonic type Undifferentiated type Residual type Subtypes of schizophrenia include: Paranoid type Disorganized type Catatonic type Undifferentiated type Residual type 14 Copyright 2010 Allyn & Bacon 15 Other Psychotic Disorders Other psychotic disorders include: Schizoaffective disorder Hybrid of schizophrenia and mood disorder Schizophreniform disorder Like schizophrenia but only 1-6 months long Delusional disorder Delusions but otherwise normal behavior Brief psychotic disorder Usually lasts only a matter of days Shared psychotic disorder A second person believes delusions of the first Other psychotic disorders include: Schizoaffective disorder Hybrid of schizophrenia and mood disorder Schizophreniform disorder Like schizophrenia but only 1-6 months long Delusional disorder Delusions but otherwise normal behavior Brief psychotic disorder Usually lasts only a matter of days Shared psychotic disorder A second person believes delusions of the first Copyright 2010 Allyn & Bacon 16 Risk and Causal Factors Genetic factors are clearly implicated in schizophrenia As the following slide shows, having a relative with the disorder significantly raises a persons risk of developing schizophrenia Genetic factors are clearly implicated in schizophrenia As the following slide shows, having a relative with the disorder significantly raises a persons risk of developing schizophrenia Copyright 2010 Allyn & Bacon 17 Figure 13.2: Risk of Developing Schizophrenia Based on Shared Genes Copyright 2010 Allyn & Bacon Genetic Factors Monozygotic twins (of schizophrenics) are much more likely to develop schizophrenia than are dizygotic twins 18 Copyright 2010 Allyn & Bacon 19 Genetic Factors The influence of genetics is revealed by Twin studies Higher concordance rate for MZ than DZ twins Adoption studies Schizophrenia more common in biological than adoptive families of adoptees Studies of molecular genetics Unlikely that schizophrenia is linked to only one gene The influence of genetics is revealed by Twin studies Higher concordance rate for MZ than DZ twins Adoption studies Schizophrenia more common in biological than adoptive families of adoptees Studies of molecular genetics Unlikely that schizophrenia is linked to only one gene Copyright 2010 Allyn & Bacon 20 Prenatal Exposures Other factors that have been implicated in the development of schizophrenia include: Prenatal infection Rhesus incompatibility Early nutritional deficiencies Perinatal birth complications Other factors that have been implicated in the development of schizophrenia include: Prenatal infection Rhesus incompatibility Early nutritional deficiencies Perinatal birth complications Copyright 2010 Allyn & Bacon 21 Genes and Environment in Schizophrenia: A Synthesis Current thinking emphasizes the interplay between multiple genetic and environmental factors Schizophrenia is genetically influenced but not genetically determined Current thinking emphasizes the interplay between multiple genetic and environmental factors Schizophrenia is genetically influenced but not genetically determined Copyright 2010 Allyn & Bacon 22 A Neurodevelopmental Perspective A lesion in the brain is thought to lie dormant until normal developmental changes occur These changes expose the problems that result from this brain abnormality Developmental precursors may include motor abnormalities, low positive facial emotion, and high negative facial emotion A lesion in the brain is thought to lie dormant until normal developmental changes occur These changes expose the problems that result from this brain abnormality Developmental precursors may include motor abnormalities, low positive facial emotion, and high negative facial emotion Copyright 2010 Allyn & Bacon 23 Other Biological Factors Many brain areas are abnormal in schizophrenia including: Decreased brain volume Enlarged ventricles Frontal lobe dysfunction Reduced volume of the thalamus Abnormalities in temporal lobe areas such as the hippocampus and amygdala Abnormalities are not found in all patients Many brain areas are abnormal in schizophrenia including: Decreased brain volume Enlarged ventricles Frontal lobe dysfunction Reduced volume of the thalamus Abnormalities in temporal lobe areas such as the hippocampus and amygdala Abnormalities are not found in all patients Copyright 2010 Allyn & Bacon 24 Figure 13.6: Enlarged Brain Ventricles in Schizophrenic Twin Copyright 2010 Allyn & Bacon 25 Other Biological Factors Neurotransmitters implicated in schizophrenia include: Dopamine Glutamate Cytoarchitecture, or overall organization of cells in the brain, may be compromised Neurotransmitters implicated in schizophrenia include: Dopamine Glutamate Cytoarchitecture, or overall organization of cells in the brain, may be compromised Copyright 2010 Allyn & Bacon 26 Figure 13.9: Cytoarchitecture and Neural Development Copyright 2010 Allyn & Bacon NeurocognitionNeurocognition Neurocognitive deficits found in people with schizophrenia include: Attentional deficits Eye-tracking dysfunctions In general, people with schizophrenia struggle to attend well on demand Neurocognitive deficits found in people with schizophrenia include: Attentional deficits Eye-tracking dysfunctions In general, people with schizophrenia struggle to attend well on demand 27 Copyright 2010 Allyn & Bacon 28 Figure 13.11: A Diathesis-Stress Model of Schizophrenia Copyright 2010 Allyn & Bacon 29 Psychosocial and Cultural Factors Many theories about bad families causing schizophrenia have not stood the test of time including: The idea of the schizophrenic mother The double-bind hypothesis Instead, communication problems may be the result of having a schizophrenic in the family Patients with schizophrenia are more likely to relapse if their families are high in expressed emotion Many theories about bad families causing schizophrenia have not stood the test of time including: The idea of the schizophrenic mother The double-bind hypothesis Instead, communication problems may be the result of having a schizophrenic in the family Patients with schizophrenia are more likely to relapse if their families are high in expressed emotion Copyright 2010 Allyn & Bacon 30 Psychosocial and Cultural Aspects A large body of evidence indicates that the lower the socioeconomic status, the higher the prevalence of schizophrenia Immigrants have higher rates of schizophrenia than natives People with schizophrenia are twice as likely than the general population to smoke cannabis A large body of evidence indicates that the lower the socioeconomic status, the higher the prevalence of schizophrenia Immigrants have higher rates of schizophrenia than natives People with schizophrenia are twice as likely than the general population to smoke cannabis Copyright 2010 Allyn & Bacon 31 Figure 13.12: Cannabis Use in Adolescence and Psychosis in Adulthood Copyright 2010 Allyn & Bacon 32 Treatments and Outcomes Before the 1950s, the prognosis for schizophrenia was bleak Antipsychotic drugs, introduced in the 1950s, dramatically improved the prognosis Currently, about 38% of people diagnosed with schizophrenia function well years later Long-term institutionalization is necessary for about 12% Before the 1950s, the prognosis for schizophrenia was bleak Antipsychotic drugs, introduced in the 1950s, dramatically improved the prognosis Currently, about 38% of people diagnosed with schizophrenia function well years later Long-term institutionalization is necessary for about 12% Copyright 2010 Allyn & Bacon Pharmacological Approaches Antipsychotic drugs work by blocking dopamine receptors Patients taking second-generation antipsychotics Have fewer extrapyramidal (motor abnormality) side effects Tend to do better overall Side effects can be very troubling Antipsychotic drugs work by blocking dopamine receptors Patients taking second-generation antipsychotics Have fewer extrapyramidal (motor abnormality) side effects Tend to do better overall Side effects can be very troubling 33 Copyright 2010 Allyn & Bacon 34 Psychosocial Approaches Psychosocial approaches include: Family therapy Case management Social-skills training Cognitive remediation Cognitive-behavioral therapy Other forms of individual treatment Psychosocial approaches include: Family therapy Case management Social-skills training Cognitive remediation Cognitive-behavioral therapy Other forms of individual treatment Copyright 2010 Allyn & Bacon 35 Unresolved Issues Can schizophrenia be prevented? By improving prenatal care for women with schizophrenia in their biological families? By reducing cannabis abuse in teens? By identifying and intervening with people at high risk for developing schizophrenia? By intervening early with people who have developed schizophrenia? Can schizophrenia be prevented? By improving prenatal care for women with schizophrenia in their biological families? By reducing cannabis abuse in teens? By identifying and intervening with people at high risk for developing schizophrenia? By intervening early with people who have developed schizophrenia? Copyright 2010 Allyn & Bacon End of Chapter 13