Chapter 12 - Schizophrenia

1. Chapter 12 - Schizophrenia

2. Psychosis: a loss of contact with reality Ability to perceive and respond to the environment significantly disturbed; functioning impaired Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs) Psychosis

3. Individuals must show a deterioration in their work, social relations, and ability to care for themselves Six months or more Schizophrenia

4. Affects approximately 1 in 100 people in the world Financial & emotional costs: enormous Increased risk of suicide and physical – often fatal – illness Schizophrenia

5. appears in all socioeconomic groups, but is found more frequently in the lower levels “downward drift” Schizophrenia

7. average age of onset for ♂ is 23 years, compared to 27 years for ♀; book states = numbers; other sources ♂ > ♀ Rates of diagnosis differ by marital status Schizophrenia

8. symptoms, triggers, and course vary greatly Some argue: group of distinct disorders that share common features The Clinical Picture

9. Positive Symptoms

10. Delusions

11. Hallucinations

12. Disorganized Speech

13. Disorganized Behavior

14. Negative Symptoms

15. Neurocognition

16. usually first appears between late teens and mid-30s three phases: Prodromal Active Residual Course

17. fuller recovery from the disorder is more likely in people: good premorbid functioning Whose disorder triggered by stress abrupt onset later onset (during middle age) receive early treatment Course

18. DIATHESIS STRESS MODEL:A Synthesis

19. ADOPTION STUDIES CAUSES TWIN STUDIES 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. Genain quadruplets Genetic factors play role in development of the disorder (Heston).

20. Biological Views

21. Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities: Biochemical abnormalities Abnormal brain structure Biological Views

22. Interactions of multiple neurotransmitters BIOLOGICAL CAUSES The dopamine hypothesis Focuses on the function of dopamine in the limbic area of the brain. Hypothesis grew out of attempts to understand how antipsychotic drugs improve adjustment. Current research focuses many neurotransmitters: Dopamine Serotonin Glutamate

23. Prenatal Exposures

25. Abnormal brain structure enlarged ventricles enlargement may be a sign of poor development or damage in related brain regions smaller temporal and frontal lobes, smaller amounts of grey matter, and abnormal blood flow to certain brain areas Biological Views

27. Social labeling Many sociocultural theorists believe that the features influenced by diagnosis itself Society labels people who fail to conform to certain norms of behavior Once assigned, label becomes a self-fulfilling prophecy The dangers of social labeling have been well demonstrated Example: Rosenhan’s 1973 “pseudo-patient” study Sociocultural Views

28. Family dysfunctioning often linked to family stress: Parents of people with the disorder often: Display more conflict Have greater difficulty communicating Are more critical of and overinvolved Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism and hostility and intrude on each other’s privacy Individuals who are trying to recover almost four times more likely to relapse if they live with such a family Sociocultural Views

29. the discovery of antipsychotic drugs in 1950s that revolutionized treatment for those suffering from schizophrenia Treatment: Antipsychotic Drugs

30. Have a relatively specific effect- reduce psychotic symptoms • Work as dopamine antagonist • Positive symptoms respond better than negative symptoms. • reduce symptoms in at least 65% of patients

31. Motor Side Effects (parkinsonian symptoms) • Extrapyramidal symptoms • Tardivedyskinesia

32. Second-Generation Antipsychotics • Atypical antipsychotics • Work on both serotonin and dopamine • Impact both positive and negative symptoms • Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, and Abilify

33. appear more effective than conventional antipsychotic drugs, especially for negative symptoms cause few extrapyramidal side effects and seem less likely to case tardive dyskinesia Some, however, do produce significant undesirable effects of their own Newer Antipsychotic Drugs

34. Before the discovery of antipsychotic drugs, psychotherapy was not an option for people with schizophrenia Most were too far removed from reality to profit from psychotherapy By helping to relieve their thought and perceptual disturbances, antipsychotic drugs allow people with schizophrenia to learn about their disorder, participate in therapy, think more clearly, and make changes in their behavior Psychotherapy

35. Clinicians employ techniques that seek to change how individuals view and react to their hallucinatory experiences, including: Provide education and evidence of the biological causes of hallucinations Challenge clients’ inaccurate ideas about the power of their hallucinations and delusions Cognitive-behavioral therapy

36. Over 50% of persons recovering from schizophrenia and other severe disorder live with family members This creates significant family stress Those who live with relatives who display high levels of expressed emotion are at greater risk for relapse than those who live with more positive or supportive families Family therapy

37. Family therapy Family therapy attempts to create more realistic expectations and provide psychoeducation about the disorder Family therapy

38. Social Therapy • Treatment should include techniques that address social and personal difficulties • include: practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing