PowerPoint Lecture Notes Presentation

Chapter 11
Schizophrenia
Abnormal Psychology, Eleventh Edition
by
Ann M. Kring, Gerald C. Davison, John M. Neale,
& Sheri L. Johnson

Copyright 2009 John Wiley & Sons, NY 2
Schizophrenia
One of the psychotic disorders
Major disturbances in:
Thought
Emotion
Behavior
Disordered thinking
Faulty perception and attention
Inappropriate or flat emotions
Disturbances in movement or behavior
Disrupted interpersonal relationships
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Schizophrenia
Disorder impacts families & friends
Difficult to live with someone who experiences
delusions, hallucinations, and paranoia.
Social skills deficits common
Isolation, few social contacts
Symptoms impact employability
Often lead to unemployment & homelessness
Substance abuse & suicide rates high

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Schizophrenia
Lifetime prevalence ~1%
Affects men slightly more often than
women
Onset typically late adolescence or early
adulthood
Men diagnosed at a slightly earlier age
Diagnosed more frequently in African
Americans
May reflect diagnostic bias
DSM-IV-TR Criteria
Two or more symptoms lasting for at least 1
month
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Social and occupational functioning have
declined since onset
Signs of disturbance for at least 6 mos
At least 1 mo. for delusions
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Clinical Description of
Schizophrenia
No single essential symptom
Heterogeneity of symptoms across patients
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Positive Symptoms: Behavioral
excesses
Delusions
Firmly held beliefs
Contrary to reality
Resistant to disconfirming
evidence
Persecutory delusions
common
The CIA planted a
listening device in my
head
Other common forms :
Thought insertion
Thought broadcasting
Grandiose delusions
Ideas of reference

Hallucinations
Sensory experiences in
the absence of sensory
stimulation
Types of hallucinations
Audible thoughts
Voices commenting
Voices arguing
Increased levels of
activity in Brocas area
during hallucinations

Negative Symptoms: Behavioral
deficits
Avolition
Lack of interest; apathy
Alogia
Reduction in speech
Anhendonia
Inability to experience
pleasure
Consummatory pleasure
Anticipatory pleasure
Flat affect
Exhibits little or no affect in
face or voice
Asociality
Inability to form close
personal relationships
Negative symptoms
predict poor quality
of life post-
hospitalization (Ho
et al., 1998)
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Disorganized Symptoms
Disorganized speech (Formal thought
disorder)
Incoherence
Inability to organize ideas
Loose associations (derailment)
Rambles, difficulty sticking to one topic
Disorganized behavior
Odd or peculiar behavior
Silliness, agitation, unusual dress
e.g., wearing several heavy coats in hot weather
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Other Symptoms
Catatonia
Motor abnormalities
Repetitive, complex gestures
Usually of the fingers or hands
Excitable, wild flailing of limbs
Catatonic immobility
Maintain unusual posture for long periods of time
e.g., stand on one leg
Waxy flexibility
Limbs can be manipulated and posed by another
person
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Other Symptoms
Inappropriate affect
Emotional responses inconsistent with
situation
e.g., laugh uncontrollably at a funeral
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Schizophrenia in DSM-IV-TR
Two or more of the following symptoms for at
least 1 month:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Declining social and occupational functioning
Signs of disturbance for at least 6 months
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DSM-IV-TR Schizophrenia
Subtypes
Disorganized
Incoherence, disorganized speech and
behavior
Flat or inappropriate affect
Catatonic
Prolonged immobility or purposeless
agitation
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DSM-IV-TR Schizophrenia
Subtypes
Paranoid
Delusions, hallucinations related to persecution or
grandiosity
Ideas of reference
Assigning personal significance to trivial or neutral events
e.g., newscast on TV is about me
Undifferentiated
Meet criteria for schizophrenia but not for a
subtype
Residual
No longer meets criteria for schizophrenia but still
exhibits signs of the disorder
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Evaluation of Subtypes
Diagnosis of subtypes difficult
Reliability low
Poor predictive validity
Overlap of symptoms among subtypes
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Other Psychotic Disorders
Schizophreniform Disorder
Symptom duration greater than 1 month but less
than 6 months
Brief Psychotic Disorder
Symptom duration of 1 day to 1 month
Often triggered by extreme stress
Schizoaffective Disorder
Symptoms of both mood disorder and
schizophrenia
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Other Psychotic Disorders
Delusional Disorder
Delusions may include:
Jealousy, erotomania, & somatic delusions
No other symptoms of schizophrenia

Table 11.3 Family and Twin
Genetic Studies
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Table 11.4 Characteristics of Adopted Offspring
of Mothers with Schizophrenia
Insert Table 11.4 HERE (Table 11.3 in
previous edition)
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Molecular Genetics Research
Not likely that disorder caused by single gene
Linkage studies
A number of chromosomes implicated
Results inconsistent and marked by a failure to replicate
Association studies
Two genes identified
DTNGP1
NGR1
Genome-wide scans
Identification of gene mutations
Several identified but results need to be replicated
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Etiology of Schizophrenia: Evaluation
of Genetic Research
Genetics doesnt completely explain the
disorder
Diathesis-stress model
Genetic factors constitute underlying predisposition
Stress triggers onset
Schizophrenia may be genetically heterogeneous
from person to person
Genetic research doesnt reveal what is inherited
Eye tracking studies
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Etiology of Schizophrenia:
Neurotransmitters
Dopamine Theory
Disorder due to excess levels of dopamine
Drugs that alleviate symptoms reduce dopamine activity
Amphetamines, which increase dopamine levels, can
induce a psychosis
Theory revised
Excess numbers of dopamine receptors or
oversensitive dopamine receptors
Localized mainly in the mesolimbic pathway
Dopamine abnormalities mainly related to
positive symptoms
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Figure 11.1 The Brain and
Schizophrenia
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Figure 11.2 Dopamine Theory of
Schizophrenia
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Etiology of Schizophrenia: Evaluation
of Dopamine Theory
Dopamine theory doesnt completely explain
disorder
Antipsychotics block dopamine rapidly but
symptom relief takes several weeks
To be effective, antipsychotics must reduce
dopamine activity to below normal levels
Other neurotransmitters involved:
Serotonin
GABA
Glutamate
Medication that targets glutamate shows promise
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Etiology of Schizophrenia: Brain
Structure and Function
Enlarged Ventricles
Implies loss of brain cells
Correlate with
Poor performance on cognitive tests
Poor premorbid adjustment
Poor response to treatment
Reduced activity in prefrontal cortex
Involved in speech, executive functions,
goal-directed behavior
May be related to dopamine underactivity
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Etiology of Schizophrenia: Brain
Structure and Function
Prefrontal Cortex
Many behaviors disrupted by schizophrenia
(e.g., speech, decision making) are governed
by prefrontal cortex
Individuals with schizophrenia show
impairments on neuropsychological tests of
prefrontal cortex (e.g., memory)
Individuals with schizophrenia show low
metabolic rates in prefrontal cortex.
Failure to show frontal activated related to negative
symptoms

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Figure 11.3 Micrograph of a
Neuron
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Etiology of Schizophrenia: Brain
Structure and Function
Congenital Factors
Damage during gestation or birth
Obstetrical complications rates high in patients with
schizophrenia
Reduced supply of oxygen during delivery may result in
loss of cortical matter
Viral damage to fetal brain
In Finnish study, schizophrenia rates higher when
mother had flu in second trimester of pregnancy
(Mednick et al., 1988)
Maternal exposure to parasite associated with
higher rates of schizophrenia in their offspring
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Etiology of Schizophrenia: Brain
Structure and Function
Developmental Factors
Prefrontal cortex matures in adolescence or early
adulthood
Dopamine activity also peaks in adolescence
Stress activates HPA system which triggers
cortisol secretion
Cortisol increases dopamine activity
May explain why symptoms appear in late
adolescence but brain damage occurs early in
life
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Etiology of Schizophrenia:
Psychological Stress
Reaction to stress
Individuals with schizophrenia and their first-
degree relatives more reactive to stress
Greater decreases in positive mood and increases in
negative mood
Socioeconomic status
Highest rates of schizophrenia among urban poor.
Sociogenic hypothesis
Stress of poverty causes disorder
Social selection theory
Downward drift in socioeconomic status
Research supports social selection

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Etiology of Schizophrenia: Family
Factors
Schizophrenogenic mother
Cold, domineering, conflict inducing
No support for this theory
Communication deviance (CD)
Hostility and poor communication
Family CD predicted onset in one longitudinal
study (Norton, 1982)
CD not specific to families of schizophrenic
patients
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Etiology of Schizophrenia:
Families and Relapse
Family environment impacts rehospitalization
Expressed Emotion (EE; Brown et al., 1966)
Hostility, critical comments, emotional
overinvolvement
Bi-directional association
Unusual patient thoughts increased critical
comments
Increased critical comments unusual patient
thoughts
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Etiology of Schizophrenia:
Developmental Studies
Developmental histories of children who
later developed schizophrenia
Lower IQ
More often delinquent and withdrawn
Coding of home movies
Poorer motor skills
More expression of negative emotion
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Etiology of Schizophrenia:
Developmental Studies
High risk studies
Danish children with a schizophrenic mother who later
developed disorder (Mednick & Schulsinger, 1968)
Negative symptom patients
More pregnancy birth complications
Failure to show electrodermal responding
Positive symptom patients
Family instability
Australian study (Yung et al., 1995)
Reduced gray matter volume predicted later
development of psychotic disorder
North American Prodrome Longitudinal
Study (NAPLS)
Treatment of Schizophrenia:
Medications
First generation antipsychotic medications
(Neuroleptics; 1950s)
Phenothiazines (Thorazine), butyrophenones
(Haldol), thioxanthenes (Navane)
Reduce agitation, violent behavior
Block dopamine receptors
Little effect on negative symptoms
Extrapyramidal side effects
Tardive Dyskinesia
Maintenance dosages to prevent relapse
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Treatment of Schizophrenia:
Medications
Second generation antipsychotics
Clozapine (Clozaril)
Impacts serotonin receptors
Fewer motor side effects
Less treatment noncompliance
Reduces relapse
Side effects
Can impair immune symptom functioning
Seizures, dizziness, fatigue, drooling, weight gain
Newer medications may improve cognitive function:
Olanzapine (Zyprexa)
Risperidone (Risperdal)
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Table 11.5 Summary of Major
Schizophrenia Drugs
Insert Table 11.5 (previously numbered
11.4)
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Psychological Treatments
Patient Outcomes Research Team
(PORT; Lehman et al., 2004) treatment
recommendation:
Medication PLUS psychosocial intervention
Social skills training
Teach skills for managing interpersonal situations
Completing a job application
Reading bus schedules
Make appointments
Involves role-playing and other practice
exercises, both in group and in vivo

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Psychological Treatments
Family therapy to reduce Expressed Emotion
Educate family about causes, symptoms, and
signs of relapse
Stress importance of medication
Help family to avoid blaming patient
Improve family communication and problem-
solving
Encourage expanded support networks
Instill hope
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Psychological Treatments
Cognitive behavioral therapy
Recognize and challenge delusional beliefs
Recognize and challenge expectations associated
with negative symptoms
e.g., Nothing will make me feel better so why bother?
Cognitive enhancement therapy (CET)
Improve attention, memory, problem solving and
other cognitive based symptoms

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