Ab Psych Chapter 11: Schizophrenia

DSM Criteria for Schizophrenia→

• Two or more of the following, present significantly during a 1 month period:

  • Delusions (at least 1 of these 3 must)

  • Hallucinations (at least 1 of these 3 must)

  • Disorganized speech (at least 1 of these 3 must)

  • Grossly disorganized or catatonic behavior

  • Negative symptoms (blunted affect, anhedonia, etc)

• Disturbance continuously for 6 months

• Social, occupation, self-care dysfunction

• Schizoaffective, depressive, bipolar rule out

• Substance and medical rule out

Schizophrenia vs Psychosis:

Positive & Negative Symptoms:

Delusions: An erroneous belief that is fixed and firmly held despite clear contradictory evidence

• Common types:

  • Delusions of persecution or paranoia: “The CIA is out to get me”

  • Delusions of reference: “People on TV are making fun of me”

  • Delusions of being controlled: “believing own thoughts, feelings, impulses, actions, are controlled by external forces”

  • Delusions of grandeur: “believing to be Jesus or have grand but illogical plans for saving the world”

  • Thought broadcasting:

  • Thought insertion:

  • Thought withdrawal:

Hallucinations: sensory perceptions experienced in the absence of any external perceptual stimulus.

• Most common: auditory hallucinations (hearing voices)

  • Also common- Tactile (tingling, electrical, burning sensations) or Somatic (e.g., feeling like snakes are crawling inside body)

  • Less common- Visual (seeing things that are not there), Olfactory (smelling odors that are not there), and Gustatory (tasting things that aren’t present)

Disorganized Speech: a breakdown in the organization, processing, and control of thoughts

• Looseness of associations: words combined incoherently; jumping from one topic to another

• Less common-

  • Neologisms: made up words

  • Perseveration: persistent repetition

  • Clanging: stringing together words or sounds based on rhyming

  • Blocking: Involuntary, abrupt, interruption of speech or thought

  • Incoherence: word salad

Disorganized Behavior:

• Avolition - apathy, lack of interest or engagement in goal-directed behavior (can’t convert desires into actions)

• Catatonia - state of unresponsiveness to external stimuli (odd gestures & facial expressions, may become stuck in odd postures)

Negative Symptoms: Loss of motivation, disinterest, social withdrawal, blunted affect

• Blunted/flat affect: absence of emotional expression in the face and voice

• Exaggerated or inappropriate affect: e.g., laughing for no reason or giggling at bad news. Internal experience of emotions doesn’t seem to match external expression of emotions

Three Phases of Schizophrenia:

• Prodromal phase: early, subtle signs of deterioration. e.g., subtle unusable thoughts or abnormal perceptions

• Acute phase: Apparent psychotic symptoms present, Behavior becomes increasingly odd over time

• Residual phase: Return to prodromal-like levels

  • Behavior stabilizes (i.e., obvious psychotic symptoms gone)

  • Cognitive, social, emotional impairment remains that makes it hard to function in social, occupational roles

Prevalence of Schizophrenia→

• 1% world prevalence

• <1% US prevalence

• Mixed evidence for racial/ethnic differences

• Slightly more prevalent in males than females

• Typically diagnosed in late teens to early thirties

  • Males - Single peak age for onset: 21-25

  • Females - Two peak ages for onset: 25-30 & 45+

• Sex differences: females have more functioning before onset, tend to respond more favorably to treatment

Patterns of Schizophrenia:

• Chronic condition - occasional acute psychotic episodes & cognitive, emotional, and motivational impairment

• With continued drug treatment, 60%+ have long periods of remission

• Many improve significantly over time but low likelihood of returning to pre-morbid levels of functioning

Theoretical Perspectives of Schizophrenia→

• Genes, biochemical factors, abnormalities in brain structure, viral infections

• Genes: Offspring of older fathers are at higher risk for schizophrenia and autism (No increased risk of genetic mutations in older mothers)

• Biochemical: Overactivity of dopamine transmission in the brain (dopamine hypothesis). Two sources of evidence:

  • Neuroleptics - block dopamine receptors, reduce hallucinations and delusions

  • Amphetamines - increase concentration of dopamine, in high doses of amphetamines - can cause schizophrenia-like symptoms

• Brain abnormalities: people with schizophrenia have abnormally enlarged ventricles, decreased gray matter

  • Especially in prefrontal cortex

  • Associated deficits: regulating attention, organizing thoughts, formulating goal, planning action

• Viral infections: Higher risk for disability if pregnant women are exposed to flu virus in 1st trimester. Or if born in winter and early spring in northern hemisphere

  • Viral agents could act on the developing brain during prenatal development in ways that increase risk of developing schizophrenia later on.

Treatments for Schizophrenia→

• Schizophrenia requires lifelong treatment

• Drug treatment: Typical antipsychotics (e.g., chlorpromazine, haloperidol)

  • First generation of drugs; block dopamine in the brain

  • Effective for most patients but risk of tardive dyskinesia (involuntary repetitive movements) with long-term use

    • Most common among older people and women

    • Improves over time but can be disabling

  • Atypical antipsychotics (e.g, clozapine, risperidone, olanzapine)

    • Second-generation drugs with lower risk of TD

  • Drug therapy + psychological approaches better than drug therapy alone, according to a large study of 400+ patients with schizophrenia.

• Assertive Community Treatment (ACT): Team-based approach, Support available 24/7, Help person address every aspect of life

  • Medication management, Social support, Vocational training and support, For people who have transferred out of an inpatient hospital but need similar level of care, Shown to reduce hospitalizations by 20%

• Social Skills Training: how they will do daily tasks

• CBT: goal isn’t to cure schizophrenia, but rather to manage symptoms and reduce stress

  • Helping the person become more flexible in thinking patterns - replacing delusional beliefs with alternative explanations

  • Change thinking patterns regarding hallucinations (reattributing voices to own internal voice or self)

  • Help patients identify cognitive errors, such as jumping to conclusions

  • Combat negative symptoms, such as lack of motivation and apathy, that make it difficult for them to adjust to demands of community living

  • A large and growing body of evidence shows therapeutic benefits from using CBT and similar techniques in treating patients with schizophrenia

• Family Intervention Programs: educating family about schizophrenia, demonstrating how to relate it in a less hostile way, aims at reducing family conflict and improving social functioning in schizophrenia

• Related Disorders:

  • Brief Psychotic Disorder: at least one of the symptoms (delusions, hallucinations, disorganized speech, catatonic behavior) and lasts from a day to a month

  • Schizophreniform Disorder: Similar to schizophrenia but symptoms occur for a shorter period of time (1 to 6 months)

  • Delusional Disorder: Bizarre delusions but no other odd behavior

  • Schizoaffective Disorder: “Mixed bag” of symptoms. Mood disorder + schizophrenia