Chapter Fourteen: Schizophrenia and Related Disorders

Schizophrenia: A psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities * Psychosis: A loss of contact with reality * Hallucinations: False sensory perceptions * Delusions: False beliefs * May withdraw into a private world * Symptoms must continue for six months or more in order to receive a diagnosis
1 in every 100 people suffers from schizophrenia during their lifetime
Equal numbers of men and women experience the disorder
Average onset for men is 23 and average onset for women is 28
People with this disorder are much more likely to attempt suicide than the general population
People with this disorder have an increased risk of physical illness
Live 10-20 yrs fewer than other people
Found more frequently in the lower socioeconomic levels * Stress of poverty is a cause of the disorder * Downward Drift Theory: Schizophrenia causes its sufferers to fall from a higher to a lower socioeconomic level or to remain poor because they are unable to function effectively

The Clinical Picture of Schizophrenia

Most of today’s clinicians believe that schizophrenia is actually a group of distinct disorders that happen to have some features in common

What Are the Symptoms of Schizophrenia?

Most tend to have both positive and negative symptoms to some degree
Around half of those with schizophrenia have significant difficulties with memory and other kinds of cognitive functioning
Positive Symptoms: Excesses of thought, emotion, and behavior * Delusions: Ideas that people believe wholeheartedly but that have no basis in fact * May consider the ideas enlightening * May feel confused by them * Delusions of Reference: Attach special and personal meaning to the actions of others or to various objects or events * Delusions of Grandeur: Believe themselves to be specially empowered persons * Delusions of Control: Believe their feelings, thoughts, and actions are controlled by other people * Disorganized Thinking and Speech * May not be able to think logically and speak in peculiar ways * Formal Thought Disorder: A disturbance in the production and organization of thought * Cause the sufferer great confusion and make communication extremely difficult * Positive symptoms * Loose Associations / Derailment: A common thinking disturbance, characterized by rapid shifts from one topic of conversation to another * Neologisms: Made-up words that typically have meaning only to the person using them * Preservation: Repeating their words and statements again and again * Clang / rhyme * Some people may have disorganized speech or thinking long before their full pattern of schizophrenia unfolds * Heightened Perceptions and Hallucinations * Perceptions and attention of some people with schizophrenia seem to intensify * May feel that their senses are being flooded by all the sights and sounds that surround them * Makes it almost impossible for them to attend to anything important * Hallucinations: Perceptions that a person has in the absence of external stimuli * People with auditory hallucinations actually produce the nerve signals of sound in their brains, “hear” them, and then believe that external sources are responsible * Tactile Hallucinations: Tingling, burning, or electric-shock sensations * Somatic Hallucinations: Feel as if something is happening inside the body * Visual Hallucinations: May produce vague perceptions of colors or clouds or distinct visions of people or objects * Gustatory Hallucinations: Regularly find that their food or drink tastes strange * Olfactory Hallucinations: Smell odors that no one else does * Hallucinations and delusional ideas often occur together * Inappropriate Affect: Emotions that are unsuited to the situation * Undergo inappropriate shifts in mood * May be merely a response to other features of the disorder
Negative Symptoms: Deficits of thought emotion, and behavior * Poverty of Speech / Alogia: A reduction in speech or speech content * Think and say very little * Say quite a bit but still manage to convey little meaning * Restricted Affect: Display less anger, sadness, joy, and other feelings than most people * Flat Affect: Showing almost no emotions at all * may reflect an inability to express emotions as others do * Loss of Volition * Avolition / apathy * Feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action * Ambivalence: Conflicting feelings * Social Withdrawal * Withdraw from their social environment * Has the effect of distancing themselves further from reality * Leads to a breakdown of social skills
Psychomotor Symptoms: Unusual movements or gestures * Move relatively slowly * Make awkward movements or repeated grimaces and odd gestures * Catatonia: A pattern of extreme psychomotor symptoms, found in some forms of schizophrenia * Catatonic Stupor: People stop responding to their environment, remaining motionless and silent for long stretches of time * Catatonic Rigidity: People maintain a rigid, upright posture for hours and resist efforts to be moved * Catatonic Posturing: People assume awkward, bizarre positions for long periods of time * Catatonic Excitement: Different form of catatonia in which people move excitedly * Around 10% of people with schizophrenia experience some degree of catatonia

What Is the Course of Schizophrenia?

Usually first appears between the person’s late teens and mid-thirties
Relapses are apparently more likely during times of life stress

Diagnosing Schizophrenia

Schizophrenia Spectrum Disorders: Schizophrenia-like disorders that are distinguished by particular durations and sets of symptoms

How Do Theorists Explain Schizophrenia?

Diathesis-Stress relationship may be at work: People with a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present

Biological Views

Genetic Factors * Some people inherit a biological predisposition to schizophrenia and develop the disorder later when they face extreme stress, usually during late adolescence or early adulthood * Schizophrenia and schizophrenia-like brain abnormalities are more common among relatives of people with the disorder * close family members are exposed to many of the same environmental influences as the person with schizophrenia, and it may be these influences that lead to the disorder * Identical twins have a higher concordance rate for schizophrenia than fraternal twins * A predisposition to schizophrenia could be the result of a prenatal problem * Biological relatives of adoptees with schizophrenia are more likely than their adoptive relatives to develop schizophrenia or another schizophrenia spectrum disorder * Schizophrenia is a polygenic disorder, caused by a combination of gene defects
Biochemical Abnormalities * Dopamine Hypothesis: Certain neurons that use the neurotransmitter dopamine fire too often and transmit too many messages, producing the symptoms of schizophrenia * Antipsychotic Drugs: Drugs that help correct grossly confused or distorted thinking * Phenothiazines: A group of antihistamine drugs that became the first group of effective antipsychotic medications * Second-generation Antipsychotic Drugs: A relatively new group of antipsychotic drugs whose biological action is different from that of the first-generation antipsychotic drugs
Dysfunctional Brain Structures and Circuitry * Schizophrenia-related brain circuit * Prefrontal cortex, hippocampus, amygdala, thalamus, striatum, substantia nigra * The structures function and interconnect in problematic ways that are unique to this disorder * Particular structures in the circuit may be hyperactive or underactive among people with schizophrenia * Interconnectivity between particular structures in the circuit is typically excessive or diminished for people with schizophrenia * May be two distinct subcircuits whose various structures sometimes overlap
Viral Problems * Brain abnormalities may result from exposure to viruses before birth * Unusually large number of people with schizophrenia are born during the late winter * Could be because of an increase in fetal or infant exposure to viruses at that time of year * Mothers of people with schizophrenia were more likely to have been exposed to the flu during pregnancy

Psychological Views

The Psychodynamic Explanation * Schizophrenogenic Mother: A type of mother - supposedly cold, domineering, and uninterested in the needs of her children - who was once thought to cause schizophrenia in her child * Little research support * Rejected by most of today’s psychodynamic theorists * Biological deficiencies cause people with schizophrenia to develop a fragmented, rather than integrated, self
Cognitive Behavioral Explanations * Operant Conditioning: The process by which people learn to perform behaviors for which they have been rewarded frequently * Most people in life become proficient at reading and responding to social cues and respond to these cues in a socially acceptable way * Some people aren’t reinforced for their attention to social cues, so they stop attending to such cues and focus instead on irrelevant cues * As they attend to irrelevant cues more and more, their responses become increasingly bizarre * Bizarre responses are rewarded with attention or other types of reinforcement, making them likely to be repeated * Circumstantial support for this explanation * Only considered a partial explanation * Misinterpreting Unusual Sensations * Brains of people with schizophrenia are actually producing strange and unreal sensations when they have hallucinations and related perceptual experiences * When the individuals attempt to understand their unusual experiences, more features of their disorder emerge * Draw incorrect and bizarre conclusions

Sociocultural Views

Multicultural Factors * 2.1% of African Americans receive a diagnosis of schizophrenia * More prone to developing schizophrenia * Clinicians are unintentionally biased in their diagnoses of African Americans * Clinicians misread cultural differences of symptoms of schizophrenia * 1.4% of non-Hispanic white Americans receive a diagnosis of schizophrenia * African Americans with schizophrenia are overrepresented in state hospitals * Schizophrenic patients who live in developing countries have better recovery rates than schizophrenic patients in developed countries
Social Labeling * Features of schizophrenia are influenced by the diagnosis * Once the label is assigned, it becomes a self-fulfilling prophecy * People who are labeled schizophrenic may be viewed and treated as crazy
Family Dysfunction * Schizophrenia is often linked to family stress * Parents of people with schizophrenia often * display more conflict * have more difficulty communicating with one another * are more critical of and overinvolved with their children than other parents * Expressed Emotion: The general level of criticism, disapproval, and hostility expressed in a family * People recovering from schizophrenia are considered more likely to relapse if their families are rated high in expressed emotion * Could be that people with schizophrenia greatly disrupt family life and help produce the observed family problems

Developmental Psychopathology View

Genetically inherited predisposition to the disorder
May lead to schizophrenia if the individual experiences significant life stressors, difficult family interactions, and / or other negative environmental factors
Overreactive HPA stress pathway and chronic stress reactions lead to the development of a dysfunctional immune system

Psychological and Sociocultural Models Lag Behind

Most clinical theorists now believe that schizophrenia is caused by a combination of factors
Researchers must identify psychological and sociocultural factors with greater precision