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Chapter 12
Schizophrenia and Other Psychotic Disorders
PSY 440: Abnormal Psychology
Rick Grieve
Western Kentucky University
psychotic disorders –
disorders so severe that the person has essentially lost
touch with reality
schizophrenia (a psychotic disorder) is characterized
by the disruption of:
Nature of Schizophrenia and Psychosis:
An Overview
Schizophrenia vs. Psychosis
Psychosis – Broad term referring to hallucinations and/or delusions; noted in
several disorders
Schizophrenia – A type of psychosis with disturbed thought, language, and
behavior
Historical Background
Emil Kraeplin – Used the term dementia praecox, “loss of the inner unity of
thought, feeling , and acting”.
Eugen Bleuler – Introduced the term “schizophrenia” or “splitting of the
mind”; the 4 As:
Associations, Affect, Ambivalence, Autism
Nature of Schizophrenia and
Psychosis: An Overview cont.)
Schneider – first rank vs. second rank symptoms
Contemporary practice –
Complex syndrome – heterogeneous
Identified by clusters of symptoms
Several subtypes
Separate diagnoses that “look like” or share some of the same
symptoms as schizophrenia – but are separate psychotic
disorders
Schizophrenia: The “Positive” Symptom
Cluster
The Positive Symptoms-Active manifestations of abnormal
behavior, distortions of normal behavior
Delusions: Gross misrepresentations of reality
Persecution – “out to get me”
Reference – “talking about me”
Being controlled – “aliens make my body move”
Grandeur – “I invented rock and roll”
Typically have a “bizarre” quality – implausible, not understandable, not
based on ordinary life experiences
Schizophrenia: The “Positive” Symptom
Cluster (cont.)
Hallucinations: Experience of sensory events without
environmental input; type of perceptual disturbance
Can involve all senses; auditory most common 70%
Not unique to schizophrenia
Typically hear voices
Schizophrenia: The “Negative” Symptom
Cluster
The Negative Symptoms -Absence or insufficiency of normal behavior
Examples are emotional/social withdrawal, apathy, and poverty of
thought/speech
Spectrum of Negative Symptoms
Avolition (or apathy) – Refers to the inability to initiate and persist in
activities
Alogia – Refers to the relative absence of speech
Anhedonia – Lack of pleasure, or indifference to pleasurable activities
Affective flattening – Show little expressed emotion, but may still feel emotion
Schizophrenia: The “Disorganized”
Symptom Cluster
The Disorganized Symptoms-Include severe and excess disruptions in
speech, behavior, and emotion
Examples include rambling speech, erratic behavior, and inappropriate affect
Disorganized Speech
Cognitive slippage – Refers to illogical and incoherent speech
Tangentiality – “Going off on a tangent” and not answering a question directly
Loose associations or derailment – Taking conversation in unrelated
directions
Disorganized Symptoms
Thought disorders can lead to the formation of:
Clang Associations
Perseveration
Word Salad
Schizophrenia: “Disorganized”
Symptom Cluster (cont.)
Nature of Disorganized Affect
Inappropriate emotional behavior (e.g., crying when one
should be laughing)
Nature of Disorganized Behavior -includes a variety of
unusual behaviors
Catatonia – Spectrum from wild agitation, waxy flexibility,
to complete immobility
Difficulties performing activities of daily living
More Disorganized Symptoms
Attentional Deficits
Social Problems
DSM Diagnosis:
Characteristic symptoms
Social/Educational/Occupational dysfunction
Duration
Differential Diagnoses
Relationship with PDD
Subtypes of Schizophrenia
Paranoid Type
Intact cognitive skills and affect, and do not show disorganized behavior
Hallucinations (auditory) and delusions center around a theme (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 have a theme, but tend to be fragmented
This type develops early, tends to be chronic, lacks periods of remissions
Subtypes of Schizophrenia (cont.)
Catatonic Type
Show unusual motor responses and odd mannerisms (e.g., echolalia,
echopraxia)
This subtype tends to be severe and quite rare
Undifferentiated Type
Wastebasket category
Major symptoms of schizophrenia, but fail to meet criteria for another type
Residual Type
One past episode of schizophrenia
Continue to display less extreme residual symptoms (e.g., odd beliefs)
Other Disorders with Psychotic
Features
Schizophreniform Disorder
Schizophrenic symptoms for a few months
Associated with good premorbid functioning; most resume
normal lives
Schizoaffective Disorder
Other Disorders with Psychotic
Features (cont.)
Delusional Disorder
Delusions that are contrary to reality without other major
schizophrenia symptoms
Many show other negative symptoms of schizophrenia
Type of delusions include erotomanic, grandiose, jealous,
persecutory, and somatic
This condition is extremely rare, with a better prognosis than
schizophrenia
Additional Disorders with Psychotic
Features
Brief Psychotic Disorder
Experience one or more: delusions, hallucination, disorganized
speech or grossly disorganize or catatonic behavior - positive
symptoms of schizophrenia
Usually precipitated by extreme stress or trauma
Tends to remit on its owns
Schizotypal Personality Disorder
May reflect a less severe form of schizophrenia
Schizophrenia:
Facts and Statistics
Onset and Prevalence of Schizophrenia
About 1% population
Onset in early adulthood, but can emerge at any time
Schizophrenia Is Generally Chronic
Most suffer with lifelong moderate-to-severe impairment
Life expectancy is slightly less than average
Schizophrenia – Gender Differences
Females tend to have a better long-term prognosis
Onset –males 18-25 years; females – 25-35 years & after 40
Men more negative symptoms; women more affective, positive
Strong Genetic Component
Figure 13.2
Gender differences in onset of schizophrenia in a sample of 470 patients
Causes: Findings From Genetic
Research
Family Studies
Inherit a tendency for schizophrenia, not a specific form of schizophrenia
Other family members are at increased risk
Twin Studies
Risk of schizophrenia in monozygotic twins is 48%
Risk of schizophrenia drops to 17% for fraternal (dizygotic) twins
Adoption Studies
Risk of schizophrenia remains high in adopted children with a biological
parent suffering from schizophrenia
Causes:Findings From Genetic Research
(cont.)
Summary of Genetic Research
Risk of schizophrenia increases as a function of genetic
relatedness
One need not show symptoms of schizophrenia to pass on
relevant genes
Schizophrenia has a strong genetic component, but genes
alone are not enough
Figure 13.6
Risk for schizophrenia among children of twins
Genetic & Behavioral Markers of
Schizophrenia
The Search for Genetic Markers: Linkage and Association
Studies
Search for genetic markers is still inconclusive
Schizophrenia is likely to involve multiple genes
Causes of Schizophrenia:
Neurotransmitter Influences
Neurobiology and Neurochemistry: The Dopamine Hypothesis
Drugs that increase dopamine (agonists), result in schizophrenic-like behavior
Drugs that decrease dopamine (antagonists), reduce schizophrenic-like
behavior
Examples include neuroleptics and L-Dopa for Parkinson’s disease
The dopamine hypothesis proved problematic and overly simplistic
Current theories emphasize several neurotransmitters and their interaction
Causes: 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
The relation between early viral exposure and schizophrenia is inconclusive
Conclusions About Neurobiology and Schizophrenia
Schizophrenia is associated with diffuse Neurobiological Dysregulation
Structural and functional abnormalities in the brain are not unique to
Schizophrenia
Causes of Schizophrenia
The Role of Stress
May activate underlying vulnerability and/or increase risk of relapse
Family Interactions
Families of people with schizophrenia show ineffective communication
patterns – communication deviance
High expressed emotion in the family is associated with relapse
The Role of Psychological Factors
Psychological factors likely exert only a minimal effect in producing
schizophrenia
CAUSES OF SCHIZOPHRENIA
ENVIRONMENTAL CONTRIBUTIONS
SCHIZOPHRENIA AND SOCIAL CLASS
CLINICAL COURSE
clinical course –
specific pattern of changes in symptomatology over
time
prodromal phase
active phase
residual phase
TYPICAL COURSES FOR SCHIZOPHRENIA
TYPICAL COURSES FOR SCHIZOPHRENIA
TYPICAL COURSES FOR SCHIZOPHRENIA
Treatments
Neuroleptic drugs are begun first – stabilizes and reduces
symptoms
Psychosocial treatments come next
Prevent relapse
Compensate for skills deficits
Improve medication compliance
Medical Treatment of Schizophrenia
Antipsychotic (Neuroleptic) Medications
Medication treatment is often the first line treatment for
schizophrenia
Began in the 1950s
Most reduce or eliminate the positive symptoms of schizophrenia
Acute and permanent extrapyramidal and Parkinson-like side
effects are common
Compliance with medication is often a problem
Psychosocial Treatment of Schizophrenia
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 Are Usually a Necessary Part of Medication
Therapy
TREATING SCHIZOPHRENIA
HOSPITALIZATION AND BEYOND