chapter twelve Schizophrenia Psychosis People with schizophrenia experience PSYCHOSIS Defined by a loss of contact with reality Includes symptoms of hallucinations (false sensory perceptions) and/or delusions (false beliefs)
May be substance-induced or caused by brain injury, but most psychoses appear in the form of schizophrenia SCHIZOPHRENIA SPECTRUM DISORDERS (SSD) SSD Include number of schizophrenia-like disorders listed in DSM-5 Each distinguished by particular durations and
sets of symptoms All bear a similarity to schizophrenia Most prevalent of these disorders is SCHIZOPHRENIA Diagnosing Schizophrenia DSM-5 diagnosis of SCHIZOPHRENIA Continuation of symptoms of psychosis for 6 months
or more Deterioration in social relations and ability to care for themselves must be shown Dx Checklist Schizophrenia 1. For 1 month, individual displays two or more of the following symptoms much of
the time: a) b) c) d) e) Delusions Hallucinations Disorganized speech
Very abnormal motor activity, including catatonia Negative symptoms 2. At least one of the individuals symptoms must be delusions, hallucinations, or disorganized speech. 3. Individual functions much more poorly in various life spheres than was the case prior to the symptoms. 4. Beyond this 1 month of intense
symptomology, individual continues to display some degree of impaired functioning for at least 5 additional months. Schizophrenia SCHIZOPHRENIA Affects approximately 1 in 100 people in the world Creates enormous financial and emotional costs
Appears in all socioeconomic groups, but is found more frequently in the lower economic levels Is diagnosed equally in men and women Differs diagnostically by marital status The Clinical Picture of Schizophrenia Schizophrenia produces many clinical pictures Symptoms can be grouped into three categories POSITIVE SYMPTOMS
NEGATIVE SYMPTOMS PSYCHOMOTOR SYMPTOMS What Are the Symptoms of Schizophrenia? Pathological excesses are bizarre additions to a persons behavior Positive symptoms
DELUSIONS DISORDERED THINKING AND SPEECH Loose associations (derailment) Neologisms (made-up words) Perseveration
Clang (rhymes) Heightened perceptions Hallucinations Inappropriate affect What Are the Symptoms of Schizophrenia? Psychomotor symptoms Awkward movements Repeated grimaces
Odd gestures Catatonia What Is the Course of Schizophrenia? Schizophrenia usually first appears between the late teens and mid-30s Many sufferers experience three phases PRODROMAL ACTIVE RESIDUAL
What Is the Course of Schizophrenia? Many researchers believe that a distinction between Type I and Type II schizophrenia helps predict the course of the disorder TYPE I SCHIZOPHRENIA is dominated by positive symptoms TYPE II SCHIZOPHRENIA is dominated by negative symptoms
How Do Theorists Explain Schizophrenia? Biological, psychological, and sociocultural theorists have proposed explanations Biological explanations have received the most research support DIATHESIS-STRESS RELATIONSHIP may be at work People with a biological predisposition will
develop schizophrenia only if certain kinds of stressors or events are also present Biological Views Following principles of the diathesis-stress perspective, genetic and biological studies of schizophrenia have dominated clinical research Key roles of inheritance and brain activity and important changes in treatment have been
reported Biological Views Genetic view and factors supported by research Relatives of people with schizophrenia Twins with this disorder People with schizophrenia who are adopted Genetic linkage and molecular biology
Biological Views Biological abnormalities Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities Biochemical abnormalities DOPAMINE HYPOTHESIS: challenged by atypical antipsychotics Abnormal brain structure
Enlarged VENTRICLES; abnormalities in hosts of brain structures Biological Problems Brain abnormalities may result from exposure to viruses before birth Interrupt brain development Remain quiet until puberty or young adulthood when activated by changes in hormones or another virus
Evidence Animal model investigation Winter birth rate, virus infection rate of mothers, and antibodies to certain viruses of people with schizophrenia MIND TECH Can Computers Develop Schizophrenia? To test the hyperlearning theory, research built a
computer neural network (DISCERN) and simulated effects of dopamine flooding in humans After DISCERN finished reprogramming, it began to display patterns of functioning similar to those found in people with schizophrenia Fantastical, delusional stories Can you think of alternativenonschizophrenic explanations for the patterns of dysfunction displayed by the computer network DISCERN?
Psychological Views Psychodynamic explanation (Freud) Schizophrenia develops from regression to pre-ego stage of primary narcissism and efforts to reestablish ego control Near-total regression leads to self-centered symptoms such as neologisms, loose associations, and delusions of grandeur Attempts to reestablish control and contact reality may
influence development of other psychotic symptoms Psychological Views Psychodynamic explanation (FrommReichmann) SCHIZOPHRENOGENIC MOTHERS Psychodynamic explanation (Contemporary psychodynamic theorists) Views of Freud and Fromm-Reichmann rejected
Psychological Views Cognitive explanation Agree with biological view that brains of people with schizophrenia produce strange and unreal sensations during hallucinations and related perceptual differences Suggest further features emerge when people try to understand these unusual experiences Rational path to madness
Sociocultural Views Sociocultural theorists believe that three main social forces contribute to schizophrenia Multicultural factors Social labeling Family dysfunction Research has not yet clarified what their precise causal relationships might be
Sociocultural Views Multicultural factors Rates of the disorder differ between racial and ethnic groups Although the overall prevalence is stable, the course and outcome of schizophrenia differs between countries Sociocultural Views
Social labeling Many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself Society labels people who fail to conform to certain norms of behavior; well-documented Once assigned, the label becomes a SELFFULFILLING PROPHECY Sociocultural Views Family dysfunctioning
Many studies suggest that schizophrenia is often linked to family stress Family theorists recognize that some families are high in EXPRESSED EMOTION How Are Schizophrenia and Other Severe Mental Disorders Treated? For much of human history People with schizophrenia and other severe mental disorders were considered beyond help
Inaccurate diagnosis often occurred Though schizophrenia is still extremely difficult to treat Discovery of antipsychotic drugs has enabled people with the disorder to think clearly and profit from psychotherapies Institutional Care in the Past Institutionalization
Began in 1793 Practice of MORAL TREATMENT U.S. states required to establish public mental institutions for poor Overcrowded; human warehouses For more than half of the twentieth century People with schizophrenia were institutionalized in public mental hospitals
Primary goal was to restrain and meet basic needs Institutional Care In the 1950s, clinicians developed two institutional approaches for chronic patients MILIEU THERAPY TOKEN ECONOMIES These approaches helped improve personal care and self-image of patients, problem
areas that had been worsened by institutionalization Institutional Care Questions have been raised about such programs Many research studies have been uncontrolled Are such programs truly effective?
Token economy programs are no longer as popular as they once were but they are still used in many mental hospitals, usually along with medication PSYCH WATCH Labotomy: How Could It Happen? From the early 1940s through the middle 1950s, the lobotomy was touted as a miracle cure in
psychosurgical treatment By the 1950s, research findings revealed potential serious problems with the procedure and discovered effective antipsychotic drugs for use as better mental health treatments Todays psychosurgical procedures are greatly refined, used only as a last resort Antipsychotic Drugs Discovery of ANTIPSYCHOTIC DRUGS in the
1950s revolutionized treatment for schizophrenia Conventional antipsychotic drugs (PHENOTHIAZINE Antihistamine used to calm surgery patients CHLORPROMAZINE Tested successfully on patients with psychotic symptoms; approved in United States as Thorazine Second generation antipsychotic drugs
How Effective Are Antipsychotic Drugs? Research has shown that antipsychotic drugs reduce schizophrenia symptoms in at least 65 percent of patients In most cases, the drugs produce the maximum level of improvement within the first 6 months of treatment The Unwanted Effects of
Conventional Antipsychotic Drugs EXTRAPYRAMIDAL EFFECTS Parkinsonian symptoms Tardive dyskinesia Newer antipsychotic drugs (atypicals) Biological operation differs; atypicals received at fewer dopamine D-2 receptors and more D1, D-4, and serotonin receptors Psychotherapy
The most helpful forms of psychotherapy are often combined therapies Cognitive-behavioral therapy Two broader sociocultural therapies Family therapy Social therapy Psychotherapy Cognitive-behavioral therapy Techniques to help patients change how they
view and react to their hallucinatory experiences New-wave cognitive-behavioral therapy Therapy helps clients to accept their streams of problematic thoughts, gain a greater sense of control, become more functional, and move forward in life Psychotherapy
Family therapy Over 50 percent of persons recovering from schizophrenia and other severe disorders live with family members Creates significant family stress Are at greater risk for relapse when they live with relatives who display high levels of expressed emotion Goals Attempts to address such issues, create more realistic
expectations, and provide psychoeducation about the disorder May also involve family support groups and family psychoeducation programs Psychotherapy Social Therapy Addresses social and personal difficulties in the clients lives Includes practical advice, problem solving, decision making, social skills training, medication
management, employment counseling, financial assistance, and housing Reduces rehospitalization The Community Approach Community approach Broadest approach for the treatment of schizophrenia and other severe mental disorders In 1963, Congress passed the Community Mental
Health Act Provided that patients should be able to receive care within their own communities, rather than being transported to institutions far from home Led to massive deinstitutionalization of patients with schizophrenia REVOLVING DOOR SYNDROME What Are the Features of Effective Community Care?
ASSERTIVE COMMUNITY TREATMENT Combination of services that include medication, psychotherapy, help in handling daily pressures and responsibilities, guidance in making decisions, training in social skills, residential supervision, and vocational counseling Other key features
Coordinated services Short-term hospitalization Partial hospitalization Supervised residences Occupational training and support
What Are the Consequences of Inadequate Community Treatment? No treatment at all Short-term help (hospitalization) and premature discharge Inadequate follow-up Homelessness The Promise of Community Treatment
Effective community care can be a major feature of treatment for assisting in recovery from schizophrenia Several national interest groups, including the National Alliance on Mental Illness (NAMI), have formed to push for better community treatment The Promise of Community Treatment Today, community care is a major feature of treatment for people recovering from severe
mental disorders in countries around the world Both in the United States and abroad, varied and well-coordinated community treatment is seen as an important part of the solution to the problem of schizophrenia
