Schizophrenia Powerpoint

abnormalpsychology
Eighth Edition
Chapter 13
Schizophrenia
Spectrum and Other
Psychotic Disorders
Abnormal Psychology, Eighth Edition Copyright ©2015, 2012, 2010 by Pearson Education, Inc.
Thomas F. Oltmanns | Robert E. Emery All rights reserved.
Learning Objectives
• Why do clinical scientists say that

schizophrenia is a "heterogeneous"
disorder?
• How should long-term outcome be
measured in schizophrenia?
• Why are some personality disorders
considered to be schizophrenia
spectrum disorders?
Learning Objectives
• Why can't we use brain imaging to

diagnose schizophrenia?
• What characteristics would define a
useful marker of vulnerability to
schizophrenia?
• What aspects of schizophrenia are
addressed most directly by
psychosocial treatments?
Overview
• The most common symptoms of

schizophrenia include changes in the
way a person thinks, feels, and relates
to other people and the outside
environment.
• No single symptom or specific set of
symptoms is characteristic of all
schizophrenic patients.
Overview
• Schizophrenia is a devastating disorder

for both the patients and their families
(Bowie et al., 2010).
• Among mental disorders, it is the
second leading cause of disease
burden.
Overview
• Onset of schizophrenia typically occurs

during adolescence or early adulthood.
• The period of risk for the development
of a first episode is between the ages
of 15 and 35.
Overview
• Problems of most patients can be

divided into three phases of
variable/unpredictable duration:
 Prodromal, marked by obvious
deterioration in role functioning
 Active
 Residual
Symptoms
• Positive Symptoms
 Also called psychotic symptoms
 Hallucinations
- Perceptual disturbances
- Can occur in any of the senses
- Persistent over time
 Delusional Beliefs
- Idiosyncratic beliefs that are rigidly held
in spite of their preposterous nature
Symptoms
• Negative Symptoms
 Affective and Emotional Disturbances
- Responses or functions that appear to
be missing from a person's behavior
- Affective and Emotional Disturbances
• Diminished emotional expression,
or blunted affect
• Anhedonia
 Inability to experience pleasure
Symptoms
• Negative Symptoms
 Avolition and Alogia
- Many people with schizophrenia become
socially withdrawn.
• Both a symptom and coping strategy
- Avolition
• Lack of will, becomes apathetic
- Alogia
• Impoverished thinking, poverty of
speech
Symptoms
• Disorganization
 Thinking Disturbances
- Involve disorganized speech, saying
things that do not make sense
• Irrelevant responses to questions,
disconnected ideas, using words in
peculiar ways (Berenbaum & Barch,
1995)
Symptoms
• Disorganization
 Thinking Disturbances
- Involve disorganized speech, saying
things that do not make sense
• Loose associations or derailment
 Shifting topics too abruptly
• Perseveration
 Persistently repeating the same word
or phrase over and over
Symptoms
• Disorganization
 Abnormal Motor Behavior
- Catatonic behavior
• Immobility and marked muscular
rigidity; excitement and overactivity
• Also associated with a stuporous state;
reduced responsiveness
- Inappropriate affect
• Incongruity and lack of adaptability in
emotional expression
Diagnosis
• DSM-5 takes into account:

- Person's level of functioning
- Duration of the disorder
- Requires decline in person's social
functioning
- Presence of disturbed behavior over a
continuous period of at least six months
Diagnosis
• Subtypes
 Related Psychotic Disorders
- Delusional disorder
• Do not meet the full symptomatic
criteria for schizophrenia; preoccupation
for at least one month with delusions
that are not bizarre
Diagnosis
• Subtypes
 Related Psychotic Disorders
- Brief psychotic disorder
• Exhibit psychotic symptoms one day
to one month
- Schizoaffective disorder
• Symptoms of patients fall on the
boundary between schizophrenia and
mood disorders
Diagnosis
• Course and Outcome

 Schizophrenia beginning in adolescence
typically has a poor outcome.
 Few patients are able to achieve
successful aging.
Diagnosis
• Frequency
 Gender Differences
- Current evidence suggests that men are
30 to 40% more likely to develop
schizophrenia than women.
Diagnosis
• Frequency
- Widely recognized differences between
male and female onset, symptoms, and
course of the disorder.
Diagnosis
• Frequency
- Two hypotheses:
• Schizophrenia is a single disorder and is
expressed differently in men and
women.
• There are two qualitatively distinct
subtypes of schizophrenia with
differences in onset.
Diagnosis
• Cross-Cultural Comparisons
 The more favorable clinical outcome
observed in India and Nigeria is a
product of the greater tolerance and
acceptance extended to people with
psychotic symptoms in developing
countries.
Diagnosis
• Cross-Cultural Comparisons
 Cross-cultural data certainly testify to
the important influence of culture in
shaping the experience and expression
of psychotic symptoms (Thakker &
Ward, 1998; Whaley & Hall, 2009).
Causes
• Biological Factors
 Genetics
- First-degree relatives
- 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
Causes
 Family Studies, Twin Studies, Adoption
Studies
- Leonard Heston's longitudinal study
(1966) indicate genetic factors play a
role in development of the disorder.
- Catechol O-methyltransferase (COMT)
Figure 13.1 Rates of schizophrenia among relatives of patients with schizophrenia Lifetime risk of
developing schizophrenia increases as a function of percent of genes shared with a person who has been
diagnosed with the disorder.
Source: Based on data from I.I. Gottesman (1991). Schizophrenia genesis: The origins of madness, p. 96.
Freeman.
Causes
 Pregnancy and Birth Complications
- People with schizophrenia are more
likely than the general population to
have been exposed to various problems
during their mother's pregnancy, and to
have suffered birth injuries.
- Dietary factors
- Birth complications
Causes
 Viral Infections
- People who develop schizophrenia are
somewhat more likely than other people
to have been born during the winter
when viral infections are more
promising.
Causes
 Neuropathology: Structural Brain
Imaging
- Studies indicate that a number of brain
areas, and connections among areas,
are involved in schizophrenia.
• A decrease in brain tissue total volume
• Mildly to moderately enlarged lateral
ventricles
Causes
 Neuropathology: Structural Brain
Imaging
- Studies indicate that a number of brain
areas, and connections among areas,
are involved in schizophrenia.
• Decreased size of hippocampus,
amygdala, and thalamus
- See Figure 13.2.
Figure 13.2 Structures of the Brain Implicated in Schizophrenia Structural imaging procedures indicate
reduced size of temporal lobe structures, such as the hippocampus and amygdala, among some patients with
schizophrenia.
Causes
 Functional Brain Imaging
- Use of positron emission tomography
(PET) technique indicates schizophrenics
have:
• Dysfunction in various neural circuits in
some regions of prefrontal cortex,
regions of temporal lobes
 Smaller hippocampus
 Smaller amygdala
 See Figure 13.3.
Figure 13.3 Areas of Brain Function Implicated in Schizophrenia Neural circuits in the dorsolateral
prefrontal cortex may function improperly in schizophrenia.
Causes
 The Dopamine Hypothesis
- Focuses on the function of specific
dopamine pathways in the limbic area
of the brain
- Hypothesis grew out of attempts to
understand how antipsychotic drugs
improve the adjustment of
schizophrenic patients.
Causes
 Interactions of Multiple
Neurotransmitters
- Current research focuses on a broad
array of neurotransmitters
• Serotonin pathways
• GABA and glutamate
Causes
• Social Factors
 Social Class
- The evidence supporting an inverse
relationship between social class
and schizophrenia is substantial.
Causes
• Social Factors
 Social Class
- Social causation
• Harmful events associated with
membership in the lowest social classes,
such as stress, social isolation, and poor
nutrition, play a causal role in the
development of the disorder.
Causes
• Social Factors
 Migrant Studies
- Higher rates of schizophrenia have been
found repeatedly among people who
have migrated to a new country
(Cantor-Graae & Selton, 2005).
- One possible explanation for this
phenomenon is that social adversity
increases risk for schizophrenia.
Causes
• Psychological Factors
 Expressed Emotion (EE)
- The family environment does have
a significant impact on the course
(as opposed to the etiology) of
schizophrenia.
- In a study, male patients who
relapsed seemed to negatively
react to some feature of their
close relationship with their wives
or mothers.
Causes
• Psychological Factors
 Understanding family attitudes
- Several disorders are impacted by living
in a family with high expressed emotion
(EE).
• Schizophrenia, mood disorders, eating
disorders, panic disorder with
agoraphobia, and OCD
- High EE more common in Westernized
societies
Causes
• The Search for Markers of Vulnerability

 Endophenotypes
- The proposed marker must distinguish
people who already have schizophrenia,
and those who do not.
- Second, the marker should be a stable
characteristic over time.
Causes
• The Search for Markers of Vulnerability

 Endophenotypes
- Third, the proposed measure of
vulnerability should identify more people
among the biological relatives of
schizophrenic patients than among
people in the general population.
Causes
• Working Memory Impairment

 Schizophrenic patients differ from other
people in their cognitive performance.
- This fulfills a criteria for an index of
vulnerability.
Causes
• Eye-Tracking Dysfunction
 Schizophrenic patients show
dysfunctions in smooth-pursuit eye
movement.
 Frequent interruptions
 Poor tracking may be associated
with predisposition to
schizophrenia.
 See figure 13.4.
Figure 13.4 Eye-Tracking Patterns This illustration contrasts smooth-pursuit eyetracking patterns of
normal subjects with those of schizophrenic patients. Part (A) shows the actual target. Part (B) illustrates the
pattern for people without schizophrenia, and part (C) shows the pattern for people with schizophrenia.
Source: Based on Levy DL, Holzman PS, Matthysse S, Mendell NR. Eye tracking dysfunction and schizophrenia: A
critical perspective. Schizophrenia Bulletin. 1993; 19: 461–536.
Treatment
• Antipsychotic Medications
 Have relatively specific effects to reduce
psychotic symptoms
 Usually takes two to three weeks before
improvement is seen with regard to
psychotic symptoms (Kutscher, 2008).
Treatment
 Positive symptoms respond better
than negative symptoms.
 A substantial minority of patients,
perhaps 25%, do not improve on
classical antipsychotic drugs
(Conley & Kelly, 2001).
Treatment
 Motor Side Effects
- Extrapyramidal symptoms
• Muscular rigidity, tremors, restless
agitation, peculiar involuntary postures,
and motor inertia
• EPS may diminish spontaneously after
three or four months of continuous
treatment.
Treatment
 Motor Side Effects
- Tardive dyskinesia
• Syndrome consists of abnormal
involuntary movements of the
mouth and face, such as tongue
protrusion, chewing, and lip
puckering, as well as spasmodic
movements of the limbs and trunk
of the body
Treatment
 Second-Generation Antipsychotics
- Atypical antipsychotics
• Less likely to produce motor side effects
• As effective as typical antipsychotics for
treatment of positive symptoms
• Not significantly more effective for
negative symptoms
Treatment
• Psychosocial Treatment
 Family-Oriented Aftercare
- Attempts to improve the coping skills
of family members
- Includes an educational component
- Emphasis on improving
communication and problem-solving
Treatment
 Social Skills Training
- Structured, educational approach
that involves modeling, role-playing,
and social reinforcement
Treatment
 Cognitive Therapy
- Specialized cognitive treatments
• Cognitive enhancement therapy
(CET)
 Designed for patients who have
recovered from active symptoms, but
continue to exhibit cognitive disability
Treatment
 Cognitive Therapy
- Assertive Community Treatment
• Delivered by interdisciplinary team
• Institutional programs and brief periods
of hospitalization

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abnormalpsychology

• Why do clinical scientists say that

• Why can't we use brain imaging to

• The most common symptoms of

• Schizophrenia is a devastating disorder

• Onset of schizophrenia typically occurs

• Problems of most patients can be

• DSM-5 takes into account:

• Course and Outcome

• The Search for Markers of Vulnerability

• The Search for Markers of Vulnerability

• Working Memory Impairment

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