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Chapter 15

Chapter 15. Schizophrenia. Perspectives on Schizophrenia. Schizophrenia vs. psychosis Psychosis – broad term (e.g., hallucinations, delusions) Schizophrenia – a type of psychosis Psychosis and schizophrenia are heterogeneous Disturbed thought, emotion, behavior.

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Chapter 15

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  1. Chapter 15 Schizophrenia

  2. Perspectives on Schizophrenia • Schizophrenia vs. psychosis • Psychosis – broad term (e.g., hallucinations, delusions) • Schizophrenia – a type of psychosis • Psychosis and schizophrenia are heterogeneous • Disturbed thought, emotion, behavior

  3. Schizophrenia: The “Positive” Symptom Cluster • The positive symptoms • Excess or distortion of normal behavior • Delusions: The basic feature of madness • Gross misrepresentation of reality • Include delusions of grandeur (mistaken belief that one is famous or powerful) • or delusions of persecution (others out to get me • Delusions of reference (belief that there is some link between you and things in the environment when there isn’t)

  4. Schizophrenia: The “Positive” Symptom Cluster • Hallucinations • Experience of sensory events without environmental input • Can involve all senses

  5. SPECT study on auditory hallucination

  6. Schizophrenia: • The negative symptoms • Absence or insufficiency of normal behavior • Spectrum of negative symptoms • Avolition (or apathy) – lack of initiation and persistence • Alogia – relative absence of speech • Anhedonia – lack of pleasure, or indifference • Affective flattening – little expressed emotion

  7. Schizophrenia: • The disorganized symptoms • Severe and excess speech, behavior, and emotion • disorganized speech • Cognitive slippage – illogical and incoherent speech • Tangentiality – “going off on a tangent” • disorganized affect • Inappropriate emotional behavior • disorganized behavior • Catatonia spectrum

  8. Subtypes of Schizophrenia: • Paranoid type • Intact cognitive skills and affect • Do not show disorganized behavior • Hallucinations and delusions – grandeur or persecution • The best prognosis

  9. Subtypes of Schizophrenia: • Disorganized type • Marked disruptions in speech and behavior • Flat or inappropriate affect • Hallucinations and delusions – tend to be fragmented • Develops early, tends to be chronic, lacks remissions

  10. Subtypes of Schizophrenia: • Catatonic type • Show unusual motor responses, grimacing • Examples include echolalia and echopraxia • Tends to be severe and quite rare

  11. Subtypes of Schizophrenia: • Undifferentiated type • Wastebasket category • Major symptoms of schizophrenia • Fail to meet criteria for another type • Residual type • One past episode of schizophrenia • Continue to display less extreme residual symptoms

  12. Schizophrenia: Statistics • about 1% population) • Often develops in early adulthood but can emerge at any time • Most have moderate-to-severe lifetime impairment • Life expectancy is slightly less than average • Schizophrenia affects males and females about equally • Females tend to have a better long-term prognosis • Onset differs between males and females

  13. Causes of Schizophrenia:Findings From Genetic Research • Genetic factors • Family studies • Inherit a tendency for schizophrenia, not forms of schizophrenia • Risk increases with genetic relatedness

  14. Causes of Schizophrenia:Findings From Genetic Research • Twin studies • Monozygotic twins (48%) • Fraternal (dizygotic) twins (17%) • Adoption studies – risk for schizophrenia remains high but less if adopted in good functioning home

  15. Causes of Schizophrenia: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

  16. Causes of Schizophrenia:Psychological and Social Influences • The role of stress • May activate underlying vulnerability • May also increase risk of relapse • Family interactions • Families – show ineffective communication patterns

  17. Medical Treatment of Schizophrenia • Historical precursors • Development of antipsychotic (neuroleptic) medications • Often the first line treatment for schizophrenia • Began in the 1950s • Most reduce or eliminate positive symptoms

  18. Psychosocial Treatment of Schizophrenia • Psychosocial approaches: • Behavioral (i.e., token economies) on inpatient units • Community care programs • Social and living skills training • Behavioral family therapy • Vocational rehabilitation • Cultural considerations • Prevention

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