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Schizophrenia and Other Psychotic
Disorders
Chapter 10
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Psychotic Disorders
Characterized by unusual thinking,
distorted perceptions, and odd behaviors
Psychosis – a severe mental condition
characterized by a loss of contact with reality
Delusion – a false belief
Hallucination – a false sensory perception
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What Is Schizophrenia?
A severe
psychological
disorder
characterized by
disorganization in
thought,
perception, and
behavior
-First defined over 100 years ago
by German psychiatrist Emil
Kraepelin
-Dementia praecox
-Dementia (pervasive
disturbances of perceptual and
cognitive faculties)
-Praecox (early life onset)
-Schizophrenia vs. DID
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Schizophrenia in Depth: Positive
Symptoms
Group of symptoms including unusual
thoughts, feelings, and behaviors
Persecutory delusions
Delusions of influence
Loose associations
Thought blocking
Clang associations
Catatonia and waxy flexibility
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Schizophrenia in Depth: Negative
Symptoms
Behaviors, emotions, or thought processes that
are absent in people with schizophrenia
Blunted affect
Anhedonia
Avolition
Alogia
Psychomotor retardation
Cognitive impairments
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Functional Impairment of
Schizophrenia
Symptom severity equals the level of
impairment
Significant human toll on the individual and
the family (quality of life)
One of the top ten most debilitating conditions
in the world (DALY)
In 2002 schizophrenia
Cultural factors
cost $62.7 billion dollars.
Violence
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Epidemiology of Schizophrenia
 Prevalence rates averages  Gradual onset (some
1% to 0.3 to 1.6% of
deterioration of functioning)
U.S. general population
 Prodromal phase (social
 16 to 40 of every
withdrawal or deterioration
100,000 people develop
in hygiene)
schizophrenia
 Acute phase (starts to
exhibit positive symptoms)
 Residual phase (psychotic
The onset for schizophrenia could be
acute or gradual, meaning the individual
symptoms are no longer
could have the disorder for years before
present but negative
actively showing psychotic symptoms.
How do you explain that?
symptoms remain)
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Sex, Race, Ethnicity, and Development
Women (develop schizophrenia at a later age and tend to
have milder forms)
Paranoid Schizophrenia is the most
common subtype at 39.8% and
Catatonic subtype is more rare at
6.7%.
Developmental factors
Hormonal and sociocultural implications
Symptoms common across racial and ethnic
groups
African Americans (more likely to be diagnosed than
white and Latino patients)
EOS (schizophrenia that develops before the
age of 18)
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Etiology
Biological
-Dopamine hypothesis (the presence of too much
dopamine in the neural synapse)
-Neurotransmitters
-Genetics
-Neuroanatomy (structural and functional abnormalities
in the brain)
-Viral theories and prenatal stressors
-Synaptic pruning (process in which weaker synaptic
contacts in the brain are eliminated and stronger
connections strengthened)
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Genetics and Environment: Schizophrenia
How might you explain these
differences?
Let’s examine the
evidence
1. A research study found
that 36.8% of the
biological children of
schizophrenic mothers
who were raised in
“disordered” family
environment developed
a “schizophrenic
spectrum disorder.”
Fact: Both genetic and
environmental factors increase the
risk of psychotic disorders, but
even without the genetic risk and
“healthy family environment,”
4.8% of individuals still develop
the disorder.
Evidence: The research shows
both factors play a role.
How would you explain this study to a
female patient who wants to have a child?
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Figure 10.1 Ventricles of the Brain
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Figure 10.2 Neurodevelopmental Model of
Schizophrenia
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Etiology
Family Influences
-The cause of the disorder is not the same as what
people believe is responsible for their suffering
-Expressed emotion (describes the level of emotional
involvement and attitudes that exist within a family
of a patient with schizophrenia)
-A variety of cultural explanations for the disorder
(biological, social, supernatural, and family
environment)
-Gene-environment correlation (the same person who
provides one’s genetic make-up also provides the
environment in which one lives)
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Treatment of Schizophrenia
Pharmacological
-Antipsychotics (a
class of medications
that block dopamine
receptors)
-Typical antipsychotics
(medications that
reduce the positive
symptoms)
-Atypical antipsychotics
(medications that treat
positive symptoms, less
likely to produce side effects,
and affect negative symptoms
and cognitive impairments)
-Side effects
-Tardive dyskinesia (abnormal
and involuntary motor
movements of the face,
mouth, limbs, and trunk)
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Treatment of Schizophrenia
Psychosocial
-Psychoeducation
(both patient and
family members are
educated about
disorder)
-CBT (used to reduce
or eliminate
psychotic symptoms)
-Social skills training (teaches
the basics of social
interaction and both verbal
and nonverbal skills)
-Supported employment (a
psychosocial intervention that
provides job skills)
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Research Hot Topic: Transcranial
Magnetic Stimulation (TMS)
 Goal (provide stimulation to a
targeted area of the cerebral
cortex to change brain activity)
 Use of small coil placed over
the scalp to induce electrical
current
 Based on neuroimaging studies
 Decreases (temporarily) the
frequency of hallucinations
 Reduction in positive
symptoms (reduced
frequency of voices and
reduced distraction)
 Does not reduce
delusions
 Time-limited results
and need for further
studies
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