abnormal PSYCHOLOGY

Fourth Canadian Edition

Chapter 11Chapter 11Schizophrenia

Prepared by: Tracy Vaillancourt, Ph.D.

Modified by: Réjeanne Dupuis, M.A.

Chapter Outline

• Clinical Symptoms of Schizophrenia

• History of the Concept of Schizophrenia

• Etiology of Schizophrenia

• Therapies for Schizophrenia

Schizophrenia

• Psychotic disorder characterized by major disturbances in thought, emotion, and behaviour– Disordered thinking in which ideas are not

logically related– Faulty perception and attention– Flat or inappropriate affect– Bizarre disturbances in motor activity

Prevalence and Comorbidity

• Prevalence in Canada: 1% of general population (0.2% in women; 0.3% in men)– Usually appears in late adolescence or early adulthood– Appears earlier for men than for women – Almost half are treated in the community– Almost 10% commit suicide – 50% suffer from a comorbid disorder

• Comorbid Conditions– Substance abuse (37%); Depression (40%)

Clinical Symptoms

Positive Symptoms

• Excesses or distortions

• Delusions

• Hallucinations

Negative Symptoms

• Behavioural deficits

Positive Symptoms• Excesses or distortions

– Disorganized speech • Problems in organizing ideas and in speaking so that a

listener can understand• Loose associations• Derailment

• Delusions

• Hallucinations

Negative Symptoms• Behavioural deficits

– Avolition• Lack of energy

– Alogia• Poverty of speech, amount of speech, poverty of

content of speech etc. – Anhedonia

• Lack of interest in recreational activities, relationships with others and sex

– Flat affect– Asociality

• Few friends, poor social skills, and little interest in being with others

Other Symptoms

• Catatonia – Catatonic immobility

– Waxy flexibility

• Inappropriate affect

Summary

Early Descriptions of Schizophrenia

• Concept formulated by Emil Kraepelin and Eugen Bleuler

• Kraepelin first presented his notion of dementia praecox– Differentiated two groups of endogenous psychoses

• Manic-depressive illness • Dementia praecox

– Dementia paranoides, catatonia, and hebephrenia

• Bleuler broke with Kraepelin on 2 major points:– Did not believe in early onset– Did not believe in inevitably progress toward dementia

• Proposed own term— schizophrenia

Categories of Schizophrenia

• Disorganized schizophrenia

• Catatonic schizophrenia

• Paranoid schizophrenia – Grandiose delusions– Delusional jealousy– Ideas of reference

• Undifferentiated schizophrenia– Person does not meet the criteria for any of the above types

• Residual schizophrenia – No longer meets full criteria for schizophrenia but still shows

some signs of illness

Etiology: Genetic Data

Etiology: Adoption Study

Etiology: Molecular Genetics

• Not likely transmitted by a single gene• Now using “endophenotypic strategy”

– Endophenotypes – characteristics that reflect actions of genes predisposing individual to a disorder, even in the absence of diagnosable pathology (Turetsky et al., 2007,p. 69)

• Assumed to be determined by fewer genes than the more complex schizophrenia phenotype

– Some examples: • Serotonin type 2A receptor (5—HT2a) gene• Dopamine D3 receptor gene• Chromosomal regions on chromosomes 6, 8, 13, and 22,• Microdeletion on chromosome 22ql1

The Genain Quadruplets

Dopamine Theory • Schizophrenia thought to be related to > activity

of dopamine – Drugs effective in treating schizophrenia dopamine

activity– Also produce side effects similar to Parkinson’s

disease which is caused in part by dopamine

– Other clues provided by amphetamine psychosis• Closely resembles paranoid schizophrenia and can

exacerbate symptoms of schizophrenia • Amphetamines cause release of norepinephrine and

dopamine– Dopamine thought to be the culprit of the symptoms

Brain Structure and Function

• Enlarged Ventricles– Enlarged ventricles which implies a loss of subcortical

brain cells

• Structural problems – In subcortical temporal-limbic areas, such as hippocampus

and basal ganglia, and prefrontal and temporal cortex

• Prefrontal cortex– Known to play a role in behaviours such as speech,

decision-making, and willed action all of which are disrupted in schizophrenia

• Note. MRI studies have shown reductions in grey matter in the prefrontal cortex

Other Etiologies

• Psychological Stress in life stress the likelihood of a relapse

• Social class and Schizophrenia rates of schizophrenia found in central city areas

inhabited by people in the socio-economic class• Sociogenic hypothesis

• Social-selection theory

• Family and Schizophrenia – Schizophrenogenic mother

Developmental / High-Risk Studies

• High-risk children: their mothers have chronic schizophrenia

• Low-risk children: mothers do not have schizophrenia • Comparing high-risk and low-risk participants as adults

– 15 of the 207 high-risk participants developed schizophrenia as compared to 0 out of 104 for the low-risk

• Differences were also found between the participants with positive-symptoms, compared with negative-symptoms schizophrenia

• Attentional dysfunction, low IQ, poor concentration, poor verbal ability, poor motor coordination were also found

Biological Treatments

• Shock and Psychosurgery– Prefrontal lobotomy

• Drug Therapies– Antipsychotic drugs (aka neuroleptics)

• First Generation (Conventional) Antipsychotic Drugs

– Primarily target D2 receptors

• Second Generation (Atypical) Antipsychotics– Primarily target D3 and D4 receptors

Summary of Major Drugs

Psychological Treatments

• Social Skills Training

• Family Therapy and Reducing Expressed Emotions

• Cognitive-Behavioural Therapy

• Personal Therapy

• Treatment Focus on Basic Cognitive Functions– Cognitive enhancement therapy

Classic Behaviour Therapy Project

Comparison of patients in 3 wards:

• Social Learning Ward – Based on token economy; Addressing all aspects of living; Kept

busy for 85% of the time;

• Milieu-Therapy Ward– Based on Therapeutic Community; Acting responsibly and

participate in decision-making; Kept busy for 85% of the time;

• Routine Hospital Management – Regular custodial care; Antipsychotic medication; Kept busy for

5% of the time

• Participants in social learning and milieu-therapy wards improved both positive and negative symptoms; social learning ward showed the greatest improvement

Other Issues

• Homelessness

• Employment and Housing

• Substance Abuse– Note. Lifetime prevalence rate for substance

abuse among people with schizophrenia is 50%

• Stigmatization

Copyright

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