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Chapter 9: Schizophrenia o Beliefs contrary to reality and

firmly held in spite of
ü Schizophrenia: Disorder characterized by disconfirming evidence
disturbances in thought, emotion, and o Forms
behavior § Thought insertion:
o Disorder thinking – ideas are not Thoughts have been placed
logically related by an external source
o Faulty perception and attention § Thought broadcasting:
o Lack of or inappropriate emotional Thoughts are transmitted
expressiveness so others know what they
o Disturbances in movement and are thinking
behavior § External force controls
ü Substance abuse and suicide rates are feelings or behaviors
high § Grandiose delusion:
ü Slightly more men than women Exaggerated sense of their
ü More on African Americans (not really own importance, power,
conclusive) knowledge, or identity
ü Sometimes begin in childhood but usually § Ideas of reference:
appears in late adolescence/early Incorporating unimportant
adulthood events within a delusional
o Somewhat earlier in men than in framework and reading
women personal significance into
trivial activities of others
Clinical Descriptions of Schizophrenia o Delusions are also found in BD,
ü DSM-5 Criteria Depression with psychotic
o 2 or more of the ff symptoms for features, and delusional disorder
at least 1 month; 1 symptoms ü Hallucinations and other Disturbances of
should be either 1, 2, or 3: Perception
§ Delusions o Hallucinations: Sensory
§ Hallucinations experiences in absence of any
§ Disorganized speech relevant stimulation from the
§ Disorganized (or catatonic) environment (most dramatic
behavior distortions of perceptions)
§ Negative symptoms § Auditory > Visual
(diminished motivation or § Longer, louder, more
emotional expression) frequent, and in 3rd Person
o Functioning in work, relationships, = more unpleasant
or self-care has declined since o Theorists propose people who
onset have auditory hallucinations
o Signs of disorder for at least 6 misattribute their own voice as
months; or, if during prodromal or being someone else’s voice
residual phase § fMRI: Greater activity in
§ Negative symptoms or two Broca’s Area/temporal
or more of symptoms 1-4 in lobes
less severe form
Negative Symptoms
Positive Symptoms (Excesses and Distortions; ü Avolition/Apathy: Lack of motivation and
Acute Episodes of Schizophrenia) a seeming absence of interest/inability to
ü Delusions persist in routine activities

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ü Asociality: Severe impairments in social o No subtypes -> questionable
relationships usefulness, poor reliability,
ü Anhedonia: Loss of interest/lessening of overlaps, and poor predictive
experience of pleasure validity
o Consummatory pleasure: Amount ü Schizophrenia Spectrum and Other
of pleasure experienced in-the- Disorders
moment (Not deficit) o Brief psychotic disorders
o Anticipatory pleasure: Amount of § Schizophreniform disorder:
anticipated pleasure from future Last only from 1-6 months
events or activities (Deficit) § Brief psychotic disorder:
ü Blunted affect: Lack of outward expression Lasts from 1 day to 1
of emotion (X person’s inner experience) month and is brought by
ü Alogia: Significant reduction in speech extreme stress
ü Two domains § Must include
o Experience: Motivation, emotional hallucinations, delusions,
experience, and sociality or disorganized speech
o Expression: Outward expression of o Schizoaffective disorder: Mixture
emotion and vocalization of symptoms of schizophrenia and
mood disorder
Disorganized Symptoms § Requires either depressive
ü Disorganized speech/Formal thought or manic episode
disorder: Problems in organizing ideas and o Delusional disorder: Troubled by
speaking so that a listener can understand persistent delusions of persecution
o Loose associations/derailment: or by delusional jealousy
Difficulty sticking to one topic § Erotomania: Believing that
o Associated with problems called one is loved by some other
executive functioning (problem person
solving, planning, etc.) and ability ü Conditions for further study
to perceive semantic information o Attenuated psychosis syndrome
ü Disorganized Behavior
o Lose ability to organize their Etiology of Schizophrenia
behavior and make it conform to
community standards Genetic Factors
ü Schizophrenia is genetically
Movement Symptoms heterogeneous (indication)
ü Catatonia: Several motor abnormalities ü Behavior Genetics Research
(Unusual increase in overall level in o Family studies
activity) § Relatives of people with
o Waxy flexibility: another person schizophrenia are at
can move the patient’s limbs into increased risk (especially if
positions that the patient will genetic relationship is
maintain for a long time closer)
ü Catatonic/Immobility: People adopt § More negative symptoms
unusual postures and maintain them for § Shared genetic
very long time vulnerability between
ü Misdiagnosed as encephalitis lethargica schizophrenia and BD
(sleeping sickness) o Twin studies
§ Identical > Fraternal
Schizophrenia and the DSM-5 § Negative > Positive
ü Key changes symptoms

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§ Common environment methyl-D-aspartate) -> for
could account for some myelination
portion of increased risk § COMT: Associated with
(shared, nonshared, and executive functions that
intrauterine) rely on prefrontal cortex
o Adoption studies § BDNF: Cognitive function
§ A study showed that • Has polymorphism
biological relatives of the called Val66Met (2
group with schizophrenia Val alleles/2 Met
were diagnosed more often alleles/1 Val and 1
than were members of the Met allele)
general population • Verbal memory was
(adoptive relatives were better for people
not) who had two Val
o Familial High-Risk studies alleles
§ Begins with 1-2 biological o Genome-wide association (GWAS)
parents with schizophrenia studies: Identifies rare mutations
and follows their offspring § 50 rare CNV mutations that
longitudinally were 3x more common
§ In order to identify how among people with
many will develop schizophrenia
schizophrenia and what • Mutations were
types of childhood factors associated with NT
may predict disorder’s glutamate and
onset proteins that
§ Positive and negative promote proper
symptoms may have placement of
different etiologies neurons in brain
• Negative: during development
Pregnancy and birth § SNPs -> not well conducted
complications, and • SNPs associated
failure to show with schizophrenia
electrodermal are also associated
response to stimuli with BD
• Positive: History of § Implications
family instability • Mutations are rare
ü Molecular Genetics Research • Small number of
o Research was initially focused on people with these
genes associated with the mutations have
dopamine D2 receptor (mixed schizophrenia
findings) • Mutations are not
o Four candidate genes specific to
§ DTNBP1: Encodes a protein schizophrenia
called dysbindin -> impacts
dopamine and glutamate The Role of Neurotransmitters
NT in the brain -> ü Dopamine Theory: Excess activity of
connection to dopamine is related to schizophrenia
schizophrenia o Antipsychotic drugs, in treating
§ NGR1: Linked to NT some symptoms of schizophrenia,
Glutamate’s NMDA (N- produce side effects resembling

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symptoms of Parkinson’s disease § PCP can induce both + and
(low levels of dopamine) – symptoms in people by
§ Block a postsynaptic interfering with
dopamine receptors called glutamate’s receptors
D2 receptors § A decrease in glutamate
o Amphetamine psychosis: Produce inputs from either
a state closely resembles prefrontal or hippocampus
schizophrenia in people who do to the corpus striatum
not have and can exacerbate could result in increased
symptoms of those who have dopamine activity
o Assumed excess of dopamine § Symptoms of
caused schizophrenia - simple! disorganization may be
§ Excess number or related to deficits involving
oversensitive dopamine NMDA
receptors
§ Excess receptors appears to Brain Structure and Function
be related mainly to + ü Enlarged ventricles
symptoms o Having larger fluid-filled spaces
o Excess dopamine activity is implies a loss of brain cells
localized in the mesolimbic o Aspects of brain abnormalities in
pathway schizophrenia progress over time
§ Therapeutic effects of o Also evident in other disorders
antipsychotics on positive ü Factors involving the Prefrontal Cortex
symptoms occur by o Known to play a role in speech,
blocking dopamine decision making, emotion, and
receptors in this pathway goal-directed behavior (disrupted
§ Prefrontal cortex -> in schizo)
dopamine neurons may be o Gray matter shows reductions in
underactive and fail to volume but not number of neurons
exert inhibitory control § Dendritic spines are loss ->
over dopamine neurons in communications among
subcortical brain areas (e.g. neurons are disrupted
amygdala) (disconnection syndrome)
§ Prefrontal cortex -> - o Low metabolic rates in the area
symptoms o Failure to show frontal activation is
ü Other NT related to severity of - symptoms
o Newer drugs block serotonin ü Problems in Temporal Cortex and
receptor (5HT2) Surrounding Region
o Dopamine neurons modulate o Reduced cortical gray matter in
activity of GABA neurons in temporal and frontal regions
prefrontal cortex o Reduced volume in basal ganglia
o Glutamate (caudate nucleus), hippocampus,
§ Low levels in CSF of people and limbic structures)
with schizophrenia § Hippocampal volume may
§ Elevated levels of reflect combination of
Homocysteine (interact genetic and environmental
with NMDA receptor factors
among people with § HPA axis is disrupted in
schizophrenia) schizophrenia (they react
more to stress) =

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reductions in hippocampal § Communicate more
volume vaguely with one another
and higher levels of conflict
Environmental Factors Influencing the Brain § Reared in a disturbed
ü Damage during gestation or birth family environment
o Reduced supply of oxygen = loss of o Families and Relapse
cortical gray matter § Expressed emotion (EE) –
ü Maternal infections critical comments, hostility,
o Parasite toxoplasma gondii and emotional
o Influenza overinvolevment = more
ü Development of brains of people with relapses
schizophrenia goes awry very early but § Bidirectionality between
disorder begins many years later? • High EE-unusual
o Prefrontal cortex matures late thoughts
o Dopamine and cortisol activity • HPA activation-
peaks in adolescence dopamine activity
o Loss of synapses due to excessive Developmental Factors
pruning ü Retrospective studies
ü Marijuana use o Poor IQ and motor skills, more
o Worsens the symptoms negative expressions
o Mixed results (increased risk or ü Prospective studies
only those who are genetically o Low IQ in childhood predicted
vulnerable) onset of disorder
o With COMT (increased risk) o Clinical high-risk study: Design that
identifies people with attenuated
Psychological Factors signs of schizophrenia, molder
ü Vulnerable to daily stress forms of the symptoms that cause
ü SES and Urban Living impairment
o Sharp upturn in prevalence of
schizophrenia in people of the Treatment of Schizophrenia (Need insight!)
lowest SES
§ Sociogenic hypothesis: Medications
Stressors associated with ü Antipsychotic drugs/Neuroleptics: Produce
SES and urban contribute similar effects similar to symptoms of a
to the development neurological disease – help alleviate
§ Social selection hypothesis: symptoms of schizophrenia
People become poor o Made it possible for people to live
because illness impairs outside the hospital
their earning power ü First-Generation Antipsychotics and Side
§ SSH > SH effects
ü Family-related factors o Phenothiazines (Thorazine),
o Schizophrenogenic mother: Cold Butyrophenones (Haldod), and
and dominant, conflict-inducing Thioxanthenes (Navane)
parent who was said to produce § Reduced + and
schizophrenia in her offspring disorganized symptoms
(induced blame game) § Block dopamine D2
o How do families influence receptors
Schizophrenia? o Side effects

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§ Extrapyramidal side effects § Tend not to be used among
(symptoms of Parkinson’s people of color
disease) § May be effective in
§ Dystonia: Muscular rigidity improving cognition
§ Dyskinesia: Abnormal
motion of muscles Psychological Treatments
§ Akasthesia: Inability to ü PORT: Medications + psychosocial
remain still interventions
§ Tardive Dyskinesia: Mouth ü Social Skills Training: Designed to teach
muscles involuntarily make people how to successfully manage a wide
sucking, lip-smacking, and variety of interpersonal situations
chin-wagging motions o Help them achieve fewer relapses,
§ Neuroleptic malignant better social functioning, and
syndrome: Severe muscular higher quality of life
rigidity develops ü Families Therapies
accompanied by fever -> o Education about schizophrenia
coma o Information about antipsychotic
o Second Generation and Side medication
Effects o Blame avoidance and reduction
§ Clozapine (Clozaril) o Communication and problem-skills
• 5HT receptors within the family
• impair function of o Social network expansion
immune system by o Hope
lowering WBC ü Cognitive Behavior Therapy
(Agranulocytosis) o Test delusional beliefs
§ Olanzapine (Zyprexa) and o Can reduced – symptoms by
Risperidone (Risperdal) channeling beliefs structures tied
§ Equally effective as 1st to avolition and low expectations
generation in reducing + for pleasure and hallucinations and
and disorganized delusions
symptoms ü Cognitive Remediation Therapies
§ Clinical Antipsychotic Trials o Cognitive enhancement therapy
of Intervention (CET)
Effectiveness (CATIE) o Enhance basic cognitive functions
• 2nd Gen were not o Effective in reducing symptoms
more effective than and improving cognitive abilities –
1st Gen linked to good functional
• 2nd Gen did not outcomes
produce fewer X ü Psychoeducation
side effects ü Case Management
• ¾ of people stopped o Brokers of services – get people
taking medication with schizophrenia into contact
before 18 months with providers of whatever
§ Side effects services they required
• Extrapyramidal side ü Residential Treatment
effects o Vocational rehabilitation: Learn
• Weight gain marketable skills that help them
• Increased glucose secure employment and increase
and cholesterol chances of remaining in the
(Type 2 Diabetes) community