Chapter 12 | Schizophrenia

PSY2043 | Abnormal Psychology

What is schizophrenia?

a severe psychotic disorder in which there is deterioration in personal, social and occupational functioning because inside their mind, they are preoccupied with hallucinations, unusual moods, and sometimes motor abnormalities

What happens in psychotic disorders?

you lose contact with reality; you can no longer tell the difference between what is real and what is happening in your mind

What is the most common form of psychosis?

drug-induced

How is schizophrenia a diagnosis of last resort?

you must rule out every other possible thing it could be before you make the diagnosis of schizophrenia

When do positive symptoms occur?

when something is there that shouldn’t be

What are the positive symptoms in schizophrenia?

• delusions

• hallucinations

• disorganized thinking and speech

What are delusions?

false beliefs or thoughts that occur contrary to evidence

What are the types of delusions?

• delusions of persecutions

• delusions of grandeur

• delusions of reference

• delusions of control

What are delusions of persecution?

you believe that other people, forces, etc. are out to harm or interfere with your life

What are delusions of grandeur?

you believe that you have these powers that make you different and that you have great prominence

What are delusions of reference?

you attach special meanings to the actions of other people or to various objects and events; you believe that when an event happens, it’s a message for you

What are delusions of control?

you believe that your thoughts, feelings, and actions are controlled by someone else

What are hallucinations?

sensory experiences without any external stimuli causing them

What are the most common type of hallucinations?

auditory (hearing voices)

What are the types of disorganized thinking and speech?

• formal thought disorder

• loose association (derailment)

• perseveration

• neologism

• clang

• inappropriate affect

• inappropriate shifts in mood

What is formal thought disorder?

you have a disturbance in both the production and organization of your thinking

What is loose association (derailment)?

when you’re talking, you rapidly shift topics and can’t stay focused in conversation; you often get frustrated because you think you’re talking logically but the other person can’t understand you

What is perseveration?

constantly repeating words, sentences or phrases

What is neologism?

creating your own language

What is clang?

speaking in rhyme

What is inappropriate affect?

your emotions don’t match the situation (e.g. laughing at a funeral)

Why do schizophrenics have inappropriate shifts in mood?

because they have faulty memory and can’t refer to it to understand the emotional state that they should have

When do negative symptoms occur?

when something that should be there is missing

What are the negative symptoms in schizophrenia?

• poverty of speech (alogia)

• blunted feelings

• flat affect

• loss of pleasure (anhedonia)

What is poverty of speech (alogia)?

decrease in speech; you may mumble slowly and quietly enough that the other person can’t understand you or your may stop speaking altogether

What are blunted feelings?

you show less emotion than you should

What is flat affect?

you show almost no emotional response

What are behaviors caused by flat affect?

• you maintain little to no eye contact with people

• you speak very slowly and in a monotonous voice

• you lack facial expression

What is loss of pleasure (anhedonia)?

general lack of enjoyment; nothing makes you happy

What are behaviors caused by loss of pleasure (anhedonia)?

• loss of volition

• apathy

• low energy

• low interest

• unable to start projects or follow through with activities

• social withdrawal

When is loss of pleasure (anhedonia) common?

when the individual has been suffering from schizophrenia for a very long time

Which type of symptoms in schizophrenia are harder to treat?

negative

What do negative symptoms keep a person from doing?

living independently

When do psychomotor symptoms?

when there is some type of disturbance in limb movement or facial expression

What is catatonia?

when you have an extreme psychomotor disturbance

What is catatonic stupor?

you completely stop responding to your external environment for an extended period of time

What is catatonic rigidity?

you become completely rigid and statue-like; if someone tries to move you, you become dead weight

What is catatonic posturing?

you take an odd position for a prolonged period of time

What is waxing mobility?

someone poses you, and you stay in that position for a prolonged period of time

What is catatonic excitement?

you move your arms and legs very wildly

True or false: you are born with schizophrenia

true

What is the prime time for someone with schizophrenia to become actively psychotic?

from late teens to mid-thirties

What are the characteristics of the Prodromal phase?

• positive symptoms may not be readily apparent, but the person has already started to deteriorate

• they may miss taking a shower, putting on deodorant, or brushing teeth

• the small things start building up in the mind

What happens in the Active phase?

symptoms become obvious and apparent

What are the characteristics of the Residual phase?

• you have now become some form of treatment for your symptoms

• focuses on positive symptoms; moderating them is considered a success

What is the best you can hope for with schizophrenia?

returning to a prodromal state

What are the diagnostic criteria for schizophrenia?

• symptoms must be persistent for at least 6 months

• you’ve ruled out every other possible condition

What are the different categories of schizophrenia?

• disorganized

• catatonia

• paranoid

• undifferentiated

What are the characteristics of disorganized schizophrenia?

• confusion

• incoherence in thought and speech

• flat, inappropriate affect

• social withdrawal

• odd mannerisms

• med-noncompliant

• often become homeless

What is catatonic schizophrenia?

you engage in catatonia when the stressors appear

What are the characteristics of paranoid schizophrenia?

• delusions and hallucinations must be organized; they have a central theme

• may fly under the radar for a while

What is undifferentiated schizophrenia?

when delusions and hallucinations don’t fall in the other three categories

What is a residual state?

when you have lessened the strength and number of symptoms

What is Type I schizophrenia?

when positive symptoms are dominant

What is Type II schizophrenia?

when negative symptoms are dominant

What is the Biological view of schizophrenia?

that it runs in families

What is the chance of an identical twin having schizophrenia if the other has it?

48%

What is the chance of a fraternal twin having schizophrenia if the other has it?

17%

What increases the more closely related you are to someone with schizophrenia?

your likelihood of having it too

How does the number of chromosomal abnormalities in an individual affect their symptoms?

the more abnormalities there are, the earlier and more severe the symptoms are

What is the dopamine hypothesis?

in schizophrenia, there is an inability to properly balance and use dopamine properly

What does an oversupply of dopamine in receptor sites cause?

the nervous system fires too quickly and too often; it’s trying to communicate too many messages at the same time and the messages are just getting jumbled

When was the dopamine hypothesis discovered?

in the ‘50s and ‘60s when antihistamines were tested on schizophrenic patients, and there was a reduction in positive symptoms

What do antihistamines do?

help reduce dopamine interaction by putting a cover on D2 receptor sites, so only a bit of D2 can enter

What is the drawback of shutting off D2 sites?

it severely incapacitates your ability to function normally

What must you do in order to treat schizophrenia?

you must block D2 but also let enough dopamine in for muscles to move and work

What are the differences in brain structure in schizophrenia?

• ventricles become elongated

• there tends to be less gray matter in temporal and frontal lobes

• there tends to be structural abnormalities in limbic system (amygdala, hippocampus, thalamus)

What is a possible explanation for the higher rate of schizophrenia in those born in February and March?

flu season occurs at a point in pregnancy where the brain is going through intricate development, and if the mother picked up the flu or some other viral infection, it could cause brain abnormalities

What is Freud’s view of schizophrenia?

• that you’re schizophrenic because your parents were cold and unloving

• when someone becomes schizophrenic, they are reverting or regressing back to the pre-ego stage of development and acting out of their id – primary narcissism

What did Neo-Freudian Frieda Fromm-Reichmann say about schizophrenia?

that cold and unloving parents set schizophrenia in motion

What are schizophrenogenic mothers?

mothers that appear to be self-sacrificing but actually do nothing for their kids; everything they do is for themselves, so the kids aren’t getting the attention they need

What does the Cognitive view of schizophrenia?

because of the faulty memory, the individual misinterprets key events, driving the delusions to develop

What does the Cognitive view use psychoeducation to do in the Residual phase to do?

to explain what schizophrenia is and how it can be managed

What does the Sociocultural view look at?

issues with diagnosis rates

How does research explain higher diagnosis rates in the black population than in the white population?

it has less to do with race and more to do with socioeconomic status because those in classes don’t receive treatment services as early

When is the chance of success in the residual phase increased?

when:

• it is Type I schizophrenia

• the country is more developed

• the family is more stable

When is labeling a problem?

when people outside the field do it because there is a lot of negative connotation behind the word “schizophrenic”

Why does a stable family help someone who is schizophrenic?

family can ensure that medications are being taken and help create a less stressful environment

What does milieu therapy do?

it creates a social environment focused on productivity, giving individuals menial jobs that aren’t important but help give them a sense of purpose

What did psychiatrist Maxwell Jones argue about state hospitals?

that they took care of patients’ basic physical needs, but don’t do anything for their mental needs, essentially just warehousing them away from society

Why does token economy work well for schizophrenia?

because people with schizophrenia like smoking

What are early psychotics called?

conventional antipsychotics

When were conventional antipsychotics used?

1954 to mid-1980s

What are conventional antipsychotics good at?

decreasing positive symptoms

What do conventional antipsychotics do for schizophrenia?

block dopamine from getting in D2 receptor sites

What does Thorazine do?

produce a decrease in dopamine

What percentage of patients have reduced positive symptoms 6 months after taking it?

close to 70%

What are the drawbacks of Thorazine?

Thorazine shuffle, tardive dyskinesia (TD) and extra pyramidal effects

What is the Thorazine shuffle?

change in muscle movement (dragging feet while walking)

What is tardive dyskinesia (TD)?

when you’ve been on Thorazine at least a year and one morning wake up with involuntary tics in your body

What are extra pyramidal effects?

when the Thorazine starts bringing on Parkinson’s-like symptoms

What do atypical antipsychotics do?

slow down D1, D2, and D4

What is the improvement rate for individuals that take atypical antipsychotics?

85%

What are the major benefits of atypical antipsychotics?

they rarely cause motor disorders, and they can help regulate negative symptoms

What demographic are atypical antipsychotics popular with?

younger people

What is the side effect of Clozaril?

it stops the production of white blood cells, so while you’re on it, you have to get your blood drawn each week to monitor your blood cells

What does psychotherapy do for schizophrenia?

it educates the person on the disorder

Who is psychotherapy more helpful for?

the family, as it teaches them how to deal with it and how to create a supportive environment

Why was the Community Mental Health Act (1963) created?

to try to get people out of state hospitals and into a community-based setting

What did the Community Mental Health Act (1963) do?

it made it so that if you weren’t court-ordered to be in the state hospital, you could leave as long as you signed a paper saying you were leaving against medical advice (AMA)