SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia

<< SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms

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Abnormal Psychology PSY404

Lesson 39

SCHIZOPHRENIA

1- What is Schizophrenia?

· Schizophrenia is a disorder that includes changes in the way a person thinks, feels, and

relates to other people and the outside environment.

· It is a disorder in which previously adaptive levels of social, personal, and occupational

functioning deteriorate.

· No single symptom or specific set of symptoms is characteristic of all schizophrenic

patients.

2- Is Schizophrenia a disease like diabetes?

· It is a disease like diabetes.

· Where the whole life pattern is modified.

· Schizophrenia is a devastating disorder for both the patients and their families.

3- Or some overwhelming stress that leads to Schizophrenia?

· Psychological stressors contribute to Schizophrenia.

4- Do Schizophrenic people Perceive and experience reality differently?

Yes Schizophrenic people Perceive and experience reality differently.

5- Can Schizophrenics be cured?

The treatment includes

Medication

· Psychotherapy

· Rehabilitation

6- Why we study Schizophrenia?

· Schizophrenia has an enormous impact on society. Among mental disorders, it is the second

leading cause of disease burden.

The problems of most patients can be divided into three phases of variable and unpredictable duration:

prodromal, active, and residual.

i) The prodromal phase precedes the active phase and is marked by an obvious deterioration in

role functioning as a student, employee, or homemaker.

Prodromal signs and symptoms are similar to those associated with schizotypal personality

disorder. They include peculiar behaviors (such as talking to one's self in public), unusual

perceptual experiences, outbursts of anger, increased tension, and restlessness.

ii) Social withdrawal, indecisiveness, and lack of willpower are often seen during the prodromal

phase. Symptoms such as hallucinations, delusions, and disorganized speech are characteristic of

the active phase of the disorder.

iii) The residual phase follows the active phase of the disorder and is defined by signs and

symptoms that are similar in many respects to those seen during the prodromal phase. The

symptoms of schizophrenia can be divided into three dimensions: positive symptoms, negative

symptoms, and disorganization.

a) Positive Symptoms

· Positive symptoms, also called psychotic symptoms. Positive symptoms are characterized by the

presence of a response (such as hearing a voice that is not really there).

· Hallucinations are sensory experiences that are not caused by actual external stimuli.

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Although hallucinations can occur in any of the senses, those experienced by schizophrenic

patients are most often auditory.

Hallucinations strike the person as being real, in spite of the fact that they have no basis in

reality. They are also persistent over time. Many schizophrenic patients express delusions, or

false beliefs that are rigidly held. Delusions have sometimes been defined as false beliefs based

on incorrect inferences about reality. In the most obvious cases, delusional patients express and

defend their beliefs with utmost conviction, even when presented with contradictory evidence.

b) Negative Symptoms

· In contrast, negative symptoms involve deficits in normal behavior in the areas of speech

emotion and motivation, such as lack of initiative, social withdrawal.

· Blunted affect, or affective flattening, involves a flattening or restriction of the person's

nonverbal display of emotional responses. Another type of emotional deficit is called

anhedonia, which refers to the inability to experience pleasure.

· A person who suffers from avolition becomes apathetic and ceases to work toward personal

goals or to function independently. Another negative symptom involves a form of speech

disturbance called alogia. In one form of alogia, known as poverty of speech, patients show

remarkable reductions in the amount of speech.

· In another form, referred to as thought blocking, the patient's train of speech is interrupted before

a thought or idea has been completed.

c) Disorganization

· Verbal communication problems and bizarre behavior represent this third dimension, which is

sometimes called disorganization. Common features of disorganized speech in schizophrenia

include shifting topics too abruptly, called loose associations or derailment; replying to a

question with an irrelevant response, called tangentiality; or persistently repeating the same

word or phrase over and over again, called perseveration.

DSM-IV-TR lists several specific criteria for schizophrenia. The first requirement (Criterion A) is

that the patient must exhibit two (or more) active symptoms for at least 1 month. The DSM-IV-TR

definition also takes into account social and occupational functioning as well as the duration of the

disorder (Criteria B and C). The DSM-IV-TR definition requires evidence of a decline in the

person's social or occupational functioning as well as the presence of disturbed behavior over a

continuous period of at least 6 months.

The final consideration in arriving at a diagnosis of schizophrenia involves the exclusion of related

conditions, especially mood disorders. DSM-IV-TR recognizes five subtypes of schizophrenia.

i) The catatonic type is characterized by symptoms of motor immobility (including rigidity and

posturing) or excessive and purposeless motor activity.

ii) The disorganized type of schizophrenia is characterized by disorganized speech,

disorganized behavior, and flat or inappropriate affect.

iii) The most prominent symptoms in the paranoid type are systematic delusions with persecutory

or grandiose content.

iv) The undifferentiated type of schizophrenia includes schizophrenic patients who display

prominent psychotic symptoms and either meet the criteria for several subtypes or otherwise do

not meet the criteria for the catatonic, disorganized, or paranoid types.

· The most prominent symptoms in the paranoid type are systematic delusions with persecutory

or grandiose content.

· The undifferentiated type of schizophrenia includes schizophrenic patients who display

prominent psychotic symptoms and either meet the criteria for several subtypes or otherwise

do not meet the criteria for the catatonic, disorganized, or paranoid types.

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v) The residual type includes patients who no longer meet the criteria for active phase

symptoms but nevertheless demonstrate continued signs of negative symptoms or forms of

delusions, hallucinations, or disorganized speech.

· They are in "partial remission."

Related Psychotic Disorders

· Schizoaffective disorder is defined by an episode in which the symptoms of schizophrenia

partially overlap with a major depressive episode or a manic episode. People with delusional

disorder do not meet full symptomatic criteria for schizophrenia, but they are preoccupied for

at least 1 month with delusions that are not bizarre.

· Brief psychotic disorder is a category that includes those people who exhibit psychotic

symptoms--delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic

behavior--for at least 1 day but no more than 1 month. Schizophrenia is a severe, progressive

disorder that most often begins in adolescence and typically has a poor outcome. Follow-up

studies of schizophrenic patients have found that the description of outcome can be a

complicated process. Many factors must be taken into consideration other than whether the

person is still in the hospital.

· One of the most informative ways of examining the frequency of schizophrenia is to consider

the lifetime morbidity risk--that is, the proportion of a specific population that will be affected by

the disorder at some time during their lives.

· Most studies in Europe and the United States have reported lifetime morbid risk figures of

approximately 1 percent.

Gender Differences

Most epidemiological studies have reported that across the life span men and women are equally

likely to be affected by schizophrenia.

Cross-Cultural Comparisons

Schizophrenia has been observed virtually in every culture that has been subjected to careful

scrutiny. Two large-scale epidemiological studies, conducted by teams of scientists working for the

World Health Organization (WHO), indicate that the incidence of schizophrenia is relatively

constant across different cultural settings.

Causes of Schizophrenia

An interaction of sociological, biological, and psychological factors seem to contribute to

schizophrenia.

1- Socio-cultural Factors

The socio-cultural view is based on the principle that society has certain expectations in regard to

the behavior of a person who is labeled as schizophrenic, and that these expectations may promote

the development of symptoms.

2- Biological Factors

· The family history data twin and adoption studies are consistent with the hypothesis that

transmission of schizophrenia is influenced by genetic factors.

· One of the most exciting areas of research on genetics and schizophrenia focuses on the search

for genetic linkage. Studies of this type are designed to identify the location of a specific gene

that is responsible for the disorder (or some important component of the disorder).

· Linkage analysis has not been able to identify a specific gene for schizophrenia, but it has

implicated regions on a small number of chromosomes that may contribute to the etiology of the

disorder.

· For example, reports of positive linkage on regions of chromosomes 6, 8, 13, and 22 have been

verified by more than one laboratory.

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3- Pregnancy and Birth Complications

· People with schizophrenia are more likely than the general population to have been exposed to

various problems during their mother's pregnancy and to have suffered birth injuries. Problems

during pregnancy include the mother's contracting various types of diseases and infections.

· Birth complications include extended labor, breech delivery, forceps delivery, and the umbilical

cord wrapped around the baby's neck.

4- Viral Infections

· Some speculation has focused on the potential role that viral infections may play in the etiology

of schizophrenia.

· One indirect line of support for this hypothesis comes from studies indicating that people who

develop schizophrenia are somewhat more likely than other people to have been born during

the winter months. Exposure to infection presumably interferes with brain development in the

fetus. Research support for the hypothesis remains inconsistent.

5- Neuropathology

· Many investigations of brain structure in people with schizophrenia have employed magnetic

resonance imaging (MRI).

· Schizophrenia seems to affect many different regions of the brain and the ways in which they

connect or communicate with each other.

· Most MRI studies have reported a decrease in total volume of brain tissue among

schizophrenic patients.

· The most consistent findings point toward structural as well as functional irregularities in the

frontal cortex and limbic areas of the temporal lobes, which play an important role in cognitive

and emotional processes.

6- Neurochemistry

Scientists have proposed various neurochemical theories to account for the etiology of

schizophrenia. The most influential theory, known as the dopamine hypothesis, focuses on the function

of specific dopamine pathways in the limbic area of the brain. Several studies have found decreased

serotonin receptor density in cortical areas of schizophrenic patients. Brain imaging studies that

point to problems in the prefrontal cortex have also drawn attention to glutamate and GABA

(gammaaminobutyric acid), the two principal neurotransmitters in the cerebral cortex.

7- Social Factors

The evidence supporting an inverse relationship between social class and schizophrenia is

substantial. Adverse social and economic circumstances may increase the probability that persons

who are genetically predisposed to the disorder will develop its clinical symptoms.

Treatment

1-Antipsychotic Medication

· Antipsychotic drugs reduce the severity and sometimes eliminate psychotic symptoms. Classical

antipsychotics are also known as neuroleptic drugs because they also induce side effects that

resemble the motor symptoms of Parkinson's disease. In the case of antipsychotic drugs, the

most obvious and troublesome side effects are called extrapyramidal symptoms (EPS) which

include neurological disturbances, such as muscular rigidity, tremors, restless agitation, peculiar

involuntary postures, and motor inertia.

· Atypical antipsychotics also produce side effects, such as weight gain and obesity.

· All antipsychotic medications--both traditional and atypical forms--act by blocking dopamine

receptors in the cortical and limbic areas of the brain.

· They also affect a number of other neurotransmitters, including serotonin and acetylcholine.

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2-Psychosocial Treatment

· Family treatment programs attempt to improve the coping skills of family members,

recognizing the burdens that people often endure while caring for a family member with a

chronic mental disorder. There are several different approaches to this type of family

intervention. Most include an educational component that is designed to help family members

understand and accept the nature of the disorder.

i- Social skills training (SST) is a structured, educational approach that involves

modeling, role playing, and the provision of social reinforcement for appropriate behaviors.

ii- Assertive community treatment (ACT) is a psychosocial intervention that is delivered by

an interdisciplinary team of clinicians.

· They provide a combination of psychological treatments--including education, support, skills

training, and rehabilitation--as well as medication.

· Some patients are chronically disturbed and require long-term institutional treatment Social

learning programs, sometimes called token economies, can be useful for these patients. In these

programs specific behavioral contingencies are put into place for all of the patients on a

hospital ward. The goal is to increase the frequency of desired behaviors, such as appropriate

grooming and participation in social activities, and to decrease the frequency of undesirable

behaviors, such as violence or incoherent speech.

· Carefully structured inpatient programs, especially those that follow behavioral principles, can

have important positive effects for chronic schizophrenic patients, Fountain house.

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