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

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