Essentials of Understanding Abnormal Behavior Chapter Eleven

1. Essentials of Understanding Abnormal BehaviorChapter Eleven Schizophrenia: Diagnosis and Etiology Psychology 215 Dr. Piercy Schizophrenia is the most commonly misunderstood psychological disorder, perhaps because the symptoms are not merely an exaggeration of any normal human experience. Schizophrenia is NOT the presence of multiple personalities. When people who are schizophrenic hear voices, they are experiencing them as they would hear other sounds in the environment, not as the voice of their �split� personalities. Remember that the presence of �multiple personalities� (which we know is really just extreme and frequent dissociation) is now diagnosed as Dissociative Identity Disorder which is NOT at all a form of Schizophrenia.Schizophrenia is the most commonly misunderstood psychological disorder, perhaps because the symptoms are not merely an exaggeration of any normal human experience. Schizophrenia is NOT the presence of multiple personalities. When people who are schizophrenic hear voices, they are experiencing them as they would hear other sounds in the environment, not as the voice of their �split� personalities. Remember that the presence of �multiple personalities� (which we know is really just extreme and frequent dissociation) is now diagnosed as Dissociative Identity Disorder which is NOT at all a form of Schizophrenia.

2. Schizophrenia Schizophrenia: A group of disorders characterized by severely impaired cognitive processes, personality disintegration, affective disturbances, and social withdrawal NOT the presence of multiple personalities. Course and duration vary considerably.

3. Schizophrenia (cont�d) Lifetime prevalence: 1% of U.S. population, males and females equally Higher for African Americans (2.1%) Lower SES and higher divorce rate Lower for Hispanic Americans (0.8%) Underreporting of symptomatology Lower level of help seeking Age of onset is earlier for men than for women. Men also tend to have more severe symptoms.Men also tend to have more severe symptoms.

4. History of the Diagnostic Category and DSM-IV-TR Emil Kraepelin: Dementia praecox (insanity at an early age) Eugen Bleuler: Observed that age of onset and course of schizophrenia were more variable than theorized by Kraepelin DSM-I and II: Broader definition allowed more disorders to be incorporated into the category of schizophrenia

5. History of the Diagnostic Category and DSM-IV-TR (cont�d) DSM-III-R: New categories: Brief psychotic disorder: Lasts no longer than one month Schizophreniform disorder: Duration of at least 1 month, but less than 6 months DSM-IV-TR: Uses the more restrictive duration requirements of DSM-III-R

6. The Symptoms of Schizophrenia Three uncorrelated dimensions: Psychoticism A loss of contact with reality involving delusions (false beliefs) and/or hallucinations (false perceptions). Auditory hallucinations are, by far, the most common Disorganization Of thought, speech, emotion, behavior Inferior premorbid social functioning Prior to full psychotic or schizophrenic symptoms, the individual�s social functioning seems to slowly deteriorate. Uncorrelated meaning these symptoms are not correlated with one another and may or may not appear together.Uncorrelated meaning these symptoms are not correlated with one another and may or may not appear together.

7. The Symptoms of Schizophrenia (cont�d) Positive symptoms: Symptoms which are not present in the normal individual but are added to the schizophrenic person. Psychoticism and disordered thought are present during active phase, then disappear with treatment: Psychoticism includes hallucinations and delusions, disorganized speech and behavior, inappropriate affect, and motoric disturbances May indicate a reversible condition Hallucinations are perceptual experiences that do not have a basis in reality. Auditory are the most common. May involve sounds or tactile hallucinations, such as tingling or burning sensations of the skin. Delusions are false beliefs (of persecution, that others are spying on them or are out to get them) or of reference, that objects, events, or other people have some particular significance; of identity (believe you are someone else) or of grandiosity (that you are very special in some way, talented or prestigious). Disturbed thought processes may include �loosening� of associations as well as going off on bizarre, irrelevant tangents. Phrases used are often grammatically incorrect, but do not make sense because the pieces put together do not fit together logically (therefore, called �word salad� each piece is separately logical, but tossed together in such a way that it does not make sense. Disturbed thought processes often cause individuals with schizophrenia to perform at reduced intellectual levels. - this is known as the schizophrenic deficit. However, some individuals with schizophrenia function very well. Cognitive flooding is the inability to screen out irrelevant internal and external stimuli � inability to close the gate on incoming stimuli. As much as 60% of people with schizophrenia also have depression. � may be a drug side effect or simply co-symptoms. Schizophrenic inidividuals also often have inappropriate emotions. DSM does not list physical symptoms, although drugs for schizophrenia have many side effects such as dry mouth and increased sensitivity to sun. There is a broad range of motor symptoms including increased or decreased activity, repetitive hand movements or facial grimacing �though many of these may be due to drugs. PEOPLE WITH SCHIZOPHRENIA ARE GENERALLY NOT AWARE OF THEIR symptoms. Hallucinations are perceptual experiences that do not have a basis in reality. Auditory are the most common. May involve sounds or tactile hallucinations, such as tingling or burning sensations of the skin. Delusions are false beliefs (of persecution, that others are spying on them or are out to get them) or of reference, that objects, events, or other people have some particular significance; of identity (believe you are someone else) or of grandiosity (that you are very special in some way, talented or prestigious). Disturbed thought processes may include �loosening� of associations as well as going off on bizarre, irrelevant tangents. Phrases used are often grammatically incorrect, but do not make sense because the pieces put together do not fit together logically (therefore, called �word salad� each piece is separately logical, but tossed together in such a way that it does not make sense. Disturbed thought processes often cause individuals with schizophrenia to perform at reduced intellectual levels. - this is known as the schizophrenic deficit. However, some individuals with schizophrenia function very well. Cognitive flooding is the inability to screen out irrelevant internal and external stimuli � inability to close the gate on incoming stimuli. As much as 60% of people with schizophrenia also have depression. � may be a drug side effect or simply co-symptoms. Schizophrenic inidividuals also often have inappropriate emotions. DSM does not list physical symptoms, although drugs for schizophrenia have many side effects such as dry mouth and increased sensitivity to sun. There is a broad range of motor symptoms including increased or decreased activity, repetitive hand movements or facial grimacing �though many of these may be due to drugs. PEOPLE WITH SCHIZOPHRENIA ARE GENERALLY NOT AWARE OF THEIR symptoms.

8. The Symptoms of Schizophrenia (cont�d) Negative symptoms: Symptoms involving characteristics, behavior or abilities that are present in a normal person but missing in the schizophrenic individual. Associated with inferior premorbid social functioning Poorer prognosis than positive symptoms Flat affect (little or no emotion in situations in which strong reactions are expected), alogia (poverty of speech), and avolition (inability to take action or to become goal oriented) May indicate irreversible neuronal loss in a structurally abnormal brain The negative symptoms are more difficult to treat and generally indicate a more serious and persistent form of the disorder.The negative symptoms are more difficult to treat and generally indicate a more serious and persistent form of the disorder.

9. Table 13.1: DSM-IV-TR Criteria for Schizophrenia

10. Positive Symptoms Distortions or excesses of normal functioning Delusions: False beliefs firmly and consistently held despite disconfirming evidence or logic Delusions of grandeur Delusions of control Delusions of thought broadcasting Delusions of persecution Delusions of reference Thought withdrawal Capgras�s syndrome Delusions of grandeur Delusions of control � belief that other people, animals, or objects are trying to control you Delusions of thought broadcasting � belief that others can hear your thoughts Delusions of persecution Delusions of reference � Belief that you are the center of attention and that things happening around you are always directed at you; that others are whispering about you or that the words in the paper are meant just for you and have special improtance. Thought withdrawal � belief that your thoughts are being removed from your mind. Capgras�s syndrome - belief that there are �doubles� of you who may replace or coexist with you. Delusions of grandeur Delusions of control � belief that other people, animals, or objects are trying to control you Delusions of thought broadcasting � belief that others can hear your thoughts Delusions of persecution Delusions of reference � Belief that you are the center of attention and that things happening around you are always directed at you; that others are whispering about you or that the words in the paper are meant just for you and have special improtance. Thought withdrawal � belief that your thoughts are being removed from your mind. Capgras�s syndrome - belief that there are �doubles� of you who may replace or coexist with you.

11. Positive Symptoms (cont�d) Perceptual distortion (hallucinations): Sensory perceptions not directly attributable to environmental stimuli (appear real to the schizophrenic): Auditory (hearing) Visual (seeing), Olfactory (smelling) Tactile (feelings) Gustatory (tasting)

12. Positive Symptoms (cont�d) Greatest distress: When voices are dominant and insulting, and patient lacks communication with the voices Coping strategies: Distraction Ignoring Selective listening (to only some of what the voices say) Setting limits (for example, that voices can speak to you after 8pm, but not before). Remember that hallucinations are not pathognomonic � meaning they are not specific to schizophrenia.Remember that hallucinations are not pathognomonic � meaning they are not specific to schizophrenia.

13. Positive Symptoms (cont�d) Disorganized thought and speech: Loosening of associations (cognitive slippage): Continual shifting from topic to topic without any apparent logical or meaningful connection between thoughts Disorganized motoric disturbances: Extreme activity levels, peculiar body movements or postures (catatonia), strange gestures or grimaces, or a combination

14. Negative Symptoms Primary symptoms: Arise from the disease itself Avolition: Inability to take action or become goal-oriented Alogia: Lack of meaningful speech Flat affect: Little or no emotion Secondary symptoms: Response to medication and institutionalization

15. Associated Features and Mental Disorders Anhedonia: Inability to feel pleasure Lack of insight concerning symptoms

16. Cultural Issues Japan: Stigma indicated by term seishin-bunretsu-byou (split in mind or spirit) Western countries: More depressive symptoms, more reports of thought broadcasting and insertion Non-Western countries: More visual and directed auditory hallucinations Content of delusions influenced by culture and society Ethnic differences in symptoms and likelihood of diagnosis

17. Types of Schizophrenia Five types of schizophrenia: Paranoid Disorganized Catatonic Undifferentiated Residual

18. Figure 13.2: Disorders Chart: Schizophrenia

19. Figure 13.2: Disorders Chart: Schizophrenia (cont�d)

20. Paranoid Schizophrenia Characterized by one or more systematized delusions or auditory hallucinations and the absence of such symptoms as disorganized speech and behavior or flat affect People wake up in the same delusions every day, rather than having disorganized delusions/ Includes mostly positive symptoms. Responds more readily to medication than other forms. Most common symptom: Delusions of persecution Similar disorder: Delusional disorder Characterized by persistent, nonbizarre delusions that are not accompanied by other unusual or odd behavior Paranoid type: Tend to show history of increasing suspiciousness and relationship issues Often have bizarre delusions which may change frequently (most often persecutory) -themes of grandeur are also common and there may be hallucinations. The adoption of this delusional identity and understanding of the world seems somehow to aid the individual. Judgment impaired and may �obey� voices. Less likely to be confined because they tend to show less bizarre behavior (but may be dangerous). Because they tend not to show symptoms other than delusions and hallucinations, this may represent a separate diagnosis.Paranoid type: Tend to show history of increasing suspiciousness and relationship issues Often have bizarre delusions which may change frequently (most often persecutory) -themes of grandeur are also common and there may be hallucinations. The adoption of this delusional identity and understanding of the world seems somehow to aid the individual. Judgment impaired and may �obey� voices. Less likely to be confined because they tend to show less bizarre behavior (but may be dangerous). Because they tend not to show symptoms other than delusions and hallucinations, this may represent a separate diagnosis.

21. Disorganized Schizophrenia Formerly hebephrenic schizophrenia: Characterized by grossly disorganized behaviors manifested by disorganized speech and behavior, and flat or grossly inappropriate affect Have delusions and hallucinations that are less organized than those of the paranoid schizophrenic, and have disorganization of thought, behavior and emotion. Tends to occur at an earlier age and be more severe. Fairly uncommon. Starts out as oddness and progresses to emotional indifferentness and infantile behavior. Speech may become incoherent and the person may invent new words (neologisms). Hallucinations are common and are changeable and unsystematic). The person may occasionally become hostile and may exhibit peculiar behavior and mannerisms. Prognosis: poor. May include excessive, purposeless, motor activity, or lack of movement, resistance to instructions or mutism, as well as bizarre movements or postures, echolalia (repeating sounds) or echopraxia (repeating movements). Tends to occur at an earlier age and be more severe. Fairly uncommon. Starts out as oddness and progresses to emotional indifferentness and infantile behavior. Speech may become incoherent and the person may invent new words (neologisms). Hallucinations are common and are changeable and unsystematic). The person may occasionally become hostile and may exhibit peculiar behavior and mannerisms. Prognosis: poor. May include excessive, purposeless, motor activity, or lack of movement, resistance to instructions or mutism, as well as bizarre movements or postures, echolalia (repeating sounds) or echopraxia (repeating movements).

22. Catatonic Schizophrenia Includes significant disturbance of motor activity Motoric immobility or stupor (withdrawn catatonia; little or no motor activity) Excessive purposeless motor activity (excited catatonia) Note that catatonia denotes an abnormality of motor behavior rather than an absence of motor behavior. Extreme negativism or physical resistance Peculiar voluntary movements, including waxy flexibility Echolalia (repeating words of others) or echopraxia (repeating actions of others) Behavior may become dangerous/violent Tends to become a chronic pattern. Some are highly suggestible and may imitate the actions of others (echopraxia) or mimic phrases (echolalia). May resist effort to change position or become mute. May also display waxy flexibility (allowing themselves to be molded into any position. May hold the same bizarre position for days or weeks even as their limbs swell from the pressure of it. May not eat, may lose bladder and bowel control and drool (Note how pervasive schizophrenia can be and that it is a disorder of everything the brain is supposed to do, rather than just �hearing voices.� Tend to have vacant facial expression and waxy appearing skin. May pass suddenly into states of excitement � seeming manic.Tends to become a chronic pattern. Some are highly suggestible and may imitate the actions of others (echopraxia) or mimic phrases (echolalia). May resist effort to change position or become mute. May also display waxy flexibility (allowing themselves to be molded into any position. May hold the same bizarre position for days or weeks even as their limbs swell from the pressure of it. May not eat, may lose bladder and bowel control and drool (Note how pervasive schizophrenia can be and that it is a disorder of everything the brain is supposed to do, rather than just �hearing voices.� Tend to have vacant facial expression and waxy appearing skin. May pass suddenly into states of excitement � seeming manic.

23. Undifferentiated and Residual Schizophrenia Undifferentiated: Behavior shows prominent psychotic symptoms not meeting criteria for paranoid, disorganized, or catatonic schizophrenia (Doesn�t fit into any other category) Residual: At least one previous schizophrenic episode but current absence of prominent psychotic features and continuing evidence of 2 or more symptoms, such as marked social isolation, peculiar behaviors, blunted affect, odd beliefs, or unusual perceptual experiences Showing symptoms of schizophrenia which remain in between episodes or after medication has been used to treat all treatable symptoms.

24. Psychotic Disorders Once Considered Schizophrenia Brief psychotic disorder: Schizophrenic episodes that last at least one day but less than one month Schizophreniform disorder: Schizophrenic episodes that last at least one month but less than six months Does not require impairment in social or occupational functioning

25. Other Psychotic Disorders Delusional disorder: Holding nonbizarre beliefs (situations that could occur) lasting at least one month; except for the delusion the behavior is not odd Common themes: Erotomania, grandiosity, jealousy, persecution, and somatic complaints Shared psychotic disorder: A person with a close relationship to an individual with delusional/psychotic believes comes to accept those beliefs Folie a deux (Madness shared by two)

26. Other Psychotic Disorders (cont�d) Schizoaffective disorder: Mood disorder, plus psychotic symptoms for at least 2 weeks in the absence of prominent mood symptoms Controversial; Some say this is just the co-existence of schizophrenia and a mood disorder in the same person.

27. Table 13.2: Comparison of Brief Psychotic Disorder, Schizophreniform Disorder, and Schizophrenia

28. The Course of Schizophrenia Prodromal phase: Onset and buildup of schizophrenic symptoms Active phase: Full-blown symptoms: severe disturbances in thinking, deterioration in social relationships, and flat or inappropriate affect Residual phase: Symptoms no longer prominent Complete recovery is rare, but schizophrenics can lead productive lives. Recovery rates are higher in developing countries.

29. Long-Term Outcome Studies Kraepelin: Schizophrenia follows a deteriorating course DSM-IV-TR: Chronic condition 15-year follow-up study: More than 26% had complete remission, but half of that group had more than one psychotic episode; 50% had partial remission, accompanied by anxiety and depression or negative symptoms; 11% had no recovery. Relapses for 2/3 of the sample �Full recovery� for 50% of schizophrenics may be in time-limited remissions.

30. Figure 13.3: Some Different Courses Found in Schizophrenia

31. Etiology of Schizophrenia Biological: Genetic, brain-structure, and biochemical explanations SCHIZOPHRENIA IS A BIOLOGICAL DISEASE and CANNOT be CAUSED BY PSYCHOLOGICAL FACTORS. Psychological factors (such as stress) can contribute to the likelihood of becoming schizophrenic in a biologically vulnerable person.

32. Figure 13.4: Morbidity Risk Among Blood Relatives of People with Schizophrenia Note that the morbidity risk (risk of being diagnosed) increases as the blood relationship between individuals increases. (see figure 13.4)Note that the morbidity risk (risk of being diagnosed) increases as the blood relationship between individuals increases. (see figure 13.4)

33. Heredity and Schizophrenia Although heredity is seen as an important cause in developing schizophrenia, there are problems in interpreting genetic studies: Several types of schizophrenia may exist Consider psychological condition of both parents Studies based on patients with severe and chronic cases may inflate estimates of genetic influence Researchers may use different definitions of concordance Interviewer bias In spite of these research flaws, schizophrenia appears to be highly heritable.In spite of these research flaws, schizophrenia appears to be highly heritable.

34. Heredity and Schizophrenia (cont�d) Studies involving blood relatives: Genetic studies: Close blood relatives run greater risk of developing schizophrenia Caveat: Relatives share both similar genes, but also similar environmental factors and stressors

35. Heredity and Schizophrenia (cont�d) Twin studies: Examine concordance rates (likelihood that both members of a twin pair will show the same characteristic) If genetic factors are of prime importance, MZ twins should show higher concordance rate than DZ twins. Concordance rates of MZ twins are 2-4 times higher than for DZ twins. Early studies (achieving rate of 86%) included schizophrenia spectrum, a broader definition

36. Heredity and Schizophrenia (cont�d) Adoption studies: Sort out effects of heredity and environment Schizophrenia more likely among biological relatives than adoptive family members Interesting finding: ~50% of at-risk group showed no impairment, became successful adults, and were more spontaneous and �colorful� than control group

37. Heredity and Schizophrenia (cont�d) Studies of high-risk populations: Developmental studies of high risk populations have greater probability that participants will include some who develop schizophrenia Mednick et al.: Predicted that eventually ~50% of high-risk individuals will exhibit psychopathology Those developing symptoms had greater risk factors.

38. Heredity and Schizophrenia (cont�d) Israeli study: Prospective (long-term) study Most who developed disorders in their 30s no longer had symptoms at 25-year follow-up. Children receiving �adequate� parenting (even from schizophrenic parents) developed normally.

39. Heredity and Schizophrenia (cont�d) Conclusions and methodological problems of high-risk studies: Strong support for heredity Childhood and adolescence are vulnerable periods Interaction of predisposition and environment Most high-risk children do NOT develop schizophrenia; most show good adjustment Methodological problems

40. Table 13.3: Biological Findings in Schizophrenia and Some Problems Associated with Them

41. Physiological Factors in Schizophrenia Biochemistry: Dopamine hypothesis Schizophrenia may result from excess dopamine activity at certain synaptic sites. Phenothiazines block dopamine receptor sites. L-dopa sometimes produces schizophrenic-like symptoms. Amphetamines: symptoms similar to acute paranoid schizophrenia in non-schizophrenics 25% of schizophrenics do not respond to antipsychotic medications which work by blocking dopamine, suggesting that there may either be an undiscovered type of dopamine, or that something other than excess dopamine causes symptoms in 25% of people. The Serotonin Explanation: Low levels of serotonin are linked to both positive and negative symptoms. Biochemical Factors: dopamine theory was popular for a long time all early antischiz. Meds (neuroleptics) were dopamine-antagonists. This hypothesis is too simplistic. (there are several different types of dopamine receptors and antischiz. Drugs take effect too quickly to explain. Serotonin may serve an inhibitory function � keeping dopaminergic neurons from firing excessively. .. Low serotonin probably only produces positive symptoms of schizophrenia in combination with high levels of dopamine. Low levels of serotonin may be related to negative symptoms of schizophrenia such as apathy and poverty of thought. Antipsychotic drugs that block dopamine and increase serotonin appear to reduce negative symptoms. Biochemical Factors: dopamine theory was popular for a long time all early antischiz. Meds (neuroleptics) were dopamine-antagonists. This hypothesis is too simplistic. (there are several different types of dopamine receptors and antischiz. Drugs take effect too quickly to explain. Serotonin may serve an inhibitory function � keeping dopaminergic neurons from firing excessively. .. Low serotonin probably only produces positive symptoms of schizophrenia in combination with high levels of dopamine. Low levels of serotonin may be related to negative symptoms of schizophrenia such as apathy and poverty of thought. Antipsychotic drugs that block dopamine and increase serotonin appear to reduce negative symptoms.

42. Physiological Factors in Schizophrenia (cont.) High Neurological Activity PET scans show higher levels of activity in the prefrontal cortex and temporal cortex of schizophrenic individuals Differences in cerebral glucose metabolism, especially during cognitive tasks The prefrontal cortex is where information from different parts of the brain is integrated and the temporal cortex is where memory for auditory and visual experiences are stored (which may explain hallucinations� particularly since these areas are particularly active when individuals are experiencing hallucinations). The prefrontal cortex is where information from different parts of the brain is integrated and the temporal cortex is where memory for auditory and visual experiences are stored (which may explain hallucinations� particularly since these areas are particularly active when individuals are experiencing hallucinations).

43. Physiological Factors in Schizophrenia (cont�d) Neurophysiological Factors An imbalance in eye movement control and inappropriate autonomic arousal may disrupt normal information processing. Biological traumas �individuals who developed schizophrenia are 2x as likely to have experienced perinatal complications (particularly anoxia) as non-schizophrenic individuals� Schizophrenic individuals are 8% more likely to have been born in the winter and early spring than non-schizophrenic people (season of birth effect) Exposure to polio virus, food deprivation of mother during first trimester, prolonged or difficult labor, preeclampsia and use of forceps are all related to schizophrenia Neurophysiological Factors: Many schiz. Ps have smooth pursuit eye movement deficiency (difficulty tracking an object) as do many of their close relatives. Also may difficulties with attention, information processing and memory & EEG (alpha) Re: biological traumas: the season of birth effect appears to be due to a serious case of the flu during 2nd trimester. Neurodevelopmental Issues: All of the above traumas may cause damage which causes schizophrenic sx to manifest in adol. Or early adulthood when the process of brain deterioration is beginning and extensive cell reorg. Occurs. schiz. May be due to some abnormality of the brain�s basic wiring that may interfere with normal synapse devel. Esp. during adol and adulthoodNeurophysiological Factors: Many schiz. Ps have smooth pursuit eye movement deficiency (difficulty tracking an object) as do many of their close relatives. Also may difficulties with attention, information processing and memory & EEG (alpha) Re: biological traumas: the season of birth effect appears to be due to a serious case of the flu during 2nd trimester. Neurodevelopmental Issues: All of the above traumas may cause damage which causes schizophrenic sx to manifest in adol. Or early adulthood when the process of brain deterioration is beginning and extensive cell reorg. Occurs. schiz. May be due to some abnormality of the brain�s basic wiring that may interfere with normal synapse devel. Esp. during adol and adulthood

44. Physiological Factors in Schizophrenia (cont�d): Problems with brain development and activity Reversed hemispheric dominance Suggesting that the left hemisphere did not develop normally and become dominant Failure of neural migration The movement of neurons to the gray matter of the cortex during prenatal development appears retarded Cortical atrophy Prefrontal cortex � smaller, less active, and decreasing in size at a faster rate than normal (hypofrontality) Temporal cortex- smaller and less active than normal Subcortical atrophy Enlarged ventricles Smaller hippocampus (esp. for people with negative sx) Thalamus is smaller and less active Smaller amygdala This theory of schizophrenia suggests that it develops �when areas of the brain do not develop adequately and/or deteriorate faster than normal� (page 318) Reversed hemispheric dominance -In normal individuals, the right hemisphere is dominant early in life, but then the left becomes dominant around age 3, when spatial and analytical abilities develop. This pattern is more likely in individuals whose sx began early in life and is more associated with (-) sx. Failure of neural migration � particularly in prefrontal and temporal cortexes Prefrontal cortex � deterioration of neurons here is linked to increase in (-) sx. Temporal cortex � surgery on cortex for epileptic people -> schiz. Sx. Enlarged ventricles (may suggest faster deterioration of brain since they hold waste materials) Hippocampus is responsible for processing of information for storage in memory Thalamus is responsible for relaying sensory info. To the rest of the brain Amygdala is responsible for emotional arousal and assertiveness (both lacking in people with (-) sx). This theory of schizophrenia suggests that it develops �when areas of the brain do not develop adequately and/or deteriorate faster than normal� (page 318) Reversed hemispheric dominance -In normal individuals, the right hemisphere is dominant early in life, but then the left becomes dominant around age 3, when spatial and analytical abilities develop. This pattern is more likely in individuals whose sx began early in life and is more associated with (-) sx. Failure of neural migration � particularly in prefrontal and temporal cortexes Prefrontal cortex � deterioration of neurons here is linked to increase in (-) sx. Temporal cortex � surgery on cortex for epileptic people -> schiz. Sx. Enlarged ventricles (may suggest faster deterioration of brain since they hold waste materials) Hippocampus is responsible for processing of information for storage in memory Thalamus is responsible for relaying sensory info. To the rest of the brain Amygdala is responsible for emotional arousal and assertiveness (both lacking in people with (-) sx).

45. Physiological Factors in Schizophrenia (cont�d) Research findings: Differences between schizophrenics and non-schizophrenics are intriguing but subtle: Interpretation is problematic Abnormalities are not limited to schizophrenia Schizophrenia appears to be a heterogeneous illness

46. Environmental Factors in Schizophrenia Family influences: Theories considered in the past (now disregarded as causes of schizophrenia) Schizophrenogenic parents are simultaneously or alternately cold and overprotecting, rejecting, and dominating. Double-bind theory: Repeated experiences that preschizophrenic child has with one or more family members (usually parents) in which the child receives contradictory messages Methodological Flaws � Bad parenting does not cause schizophrenia but any stressful environment can be a contributing factor in a vulnerable person.

47. Environmental Factors in Schizophrenia (cont�d) Family influences (cont�d): Expressed emotion: Negative communication pattern in some families with schizophrenic member; associated with higher relapse rates Stress of high-EE environment may lead to relapse. Severely ill individual may cause high-EE patterns. Bidirectional model (which causes which) Correlational studies may have multiple interpretations. A high EE environment represent one type of stressful environment.

48. Figure 13.5: Possible Relationships Between High Rates of Expressed Emotion and Relapse Rates in Patients with Schizophrenia

49. Environmental Factors in Schizophrenia (cont�d) Sociocultural perspective required for ethnic minorities Effects of social class: Schizophrenia is disproportionately concentrated in poor areas of large cities and low-status occupations Breeder hypothesis Downward drift theory Cross-cultural comparisons: Indigenous belief systems influence etiology, symptoms, type of disorder, and treatment

50. Figure 13.6: Members of Two Cultures Explain the Causes of Auditory Hallucinations

51. The Treatment of Schizophrenia Antipsychotic medication (neuroleptics): Can reduce symptoms, dosage levels must be monitored, and can produce side effects Reduce severity of positive symptoms of schizophrenia (e.g., hallucinations and delusions) Offer little relief for negative symptoms (e.g., social withdrawal, apathy, impaired personal hygiene)

52. The Treatment of Schizophrenia (cont�d) Antipsychotic medication (neuroleptics) (cont�d): Newer drugs have fewer side effects and are effective for some patients even with negative symptoms Dosage levels may depend in part on family support (more support/lower dosage)

53. The Treatment of Schizophrenia (cont�d) The right to refuse medication Psychosocial therapy: Most beneficial: Antipsychotic medication plus therapy Useful aspects of psychotherapy: practical advice, getting in touch with one�s feelings, understanding one�s effect on others, understanding reasons for one�s actions and feelings, and understanding the impact of past on present behavior Most important quality of therapist: Friendship

54. The Treatment of Schizophrenia (cont�d) Institutional approaches: Traditional institutional treatments of custodial care, plus medication, yield poor results Milieu therapy (hospital as community and patients have responsibilities) plus behavioral therapy has been found to be effective. Social learning programs: Appropriate self-care, conversational skills, role skills Undesirable behaviors are decreased through reinforcement and modeling Community homes produce positive results.

55. The Treatment of Schizophrenia (cont�d) Cognitive-behavioral therapy: Work at reducing frequency and severity of positive and negative symptoms Enhance coping skills Weaken beliefs regarding power/omnipotence of auditory hallucinations Challenge false beliefs Social skills training emphasizes communication skills and assertiveness, encourages functional independence, improves family relationships

56. The Treatment of Schizophrenia (cont�d) Family communication and education: Normalize family experience Educate family members about schizophrenia Identify strengths and competencies Develop problem solving and stress management skills Learn to cope with symptoms Recognize early signs of relapse Create supportive family environment Understand/meet needs of all family members