CHAPTER THIRTEEN
Schizophrenic Disorders
OVERVIEW Psychosis - profoundly out of touch with reality Most common symptoms: changes in the way
a person thinks, feels, and relates to other people and the outside environment.
Involves disruptions of mental functions
Schizophrenia
Affects people from all walks of
life
Characterized by an array of diverse
symptoms
Usually begins in late adolescence or early adulthood
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Epidemiology
Risk• Lifetime prevalence• Age of father• Onset age• Gender• Among mental disorders, the second
leading cause of disease burden.
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Figure 13.1: Age Distribution of Onset of Schizophrenia
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Clinical Picture
• Delusions• Hallucinations• Disorganized speech and
behavior• Negative Symptoms
Hallmark symptoms
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Positive and Negative Symptoms
• Excess or distortion in normal repertoire of behavior and experience
Positive symptoms of schizophrenia
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Delusions
• Erroneous belief• Fixed and firmly held despite
clear contradictory evidence• Disturbance in the content of
thought• Grandeur• Persecution• Reference• Nihilistic• Thought Broadcasting
Delusions
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Hallucinations
• False Sensory experiences/Perceptual disturbances
• Seems real but occurs in absence of any external perceptual stimulus
• Can occur in any sensory modality
Hallucinations
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Disorganized Speech
• Failure to make sense • Despite conforming to
semantic and syntactic rules of speech
• Disturbance in form (not content) of thought
Disorganized speech
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Disorganized Behavior
• Impairment of goal-directed activity
• Occurs in areas of daily functioning
• Catatonia • Catatonia stupor
Disorganized and Catatonic Behavior
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Negative Symptoms
• Affective flattening, Blunted affect• Anhedonia – inability to experience
pleasure.• Apathy - Socially withdrawn
• Both a symptom and coping strategy
• Avolition – lack of will, motivation• Alogia – impoverished thinking,
poverty of speech.
Absence or deficit of normally present
behaviors
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Other Psychotic Disorders
• Schizoaffective disorder• Schizophreniform disorder• Delusional disorder• Brief psychotic disorder• Shared psychotic disorder
Other psychotic disorders
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Genetics
TWIN STUDIES ADOPTION STUDIES The average concordance
rate for MZ twins is 48%, whereas the comparable figure for DZ twins is 17%.
Suggests strong genetic factors.
Also compelling evidence for the importance of environment.
Genain quadruplets
• Genetic factors play role in development of the disorder (Heston)
Figure 13.2: Risk of Developing Schizophrenia Based on Shared Genes
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Prenatal Exposures
Prenatal exposures:
Prenatal infection
Rhesus incompatibility
Early nutritional deficiencies and maternal stress
Pregnancy and birth complications
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Genes and Environment in Schizophrenia: A Synthesis
Current thinking emphasizes interplay
Multiple genetic factors
Environmental factors
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A Neurodevelopmental Perspective
Brain lesion lies dormant until
normal developmental changes occur
Changes expose problems resulting
from this brain abnormality
Developmental precursors may
include variety of abnormalities
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Other Biological Factors
Many brain areas are abnormal in schizophrenia
• Decreased brain volume• Enlarged ventricles• Frontal lobe dysfunction• Reduced volume of the thalamus• Abnormalities in temporal lobe
areas
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Disorder seems to affect many different regions of the brain.Enlarged lateral ventriclesDifferences (decreased size) in parts of the limbic system.
Other Biological Factors Implicated in Schizophrenia
Neurotransmitters
• Dopamine• Glutamate• Serotonin
Cytoarchitecture
• Overall organization of cells in brain may be compromised
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Figure 13.8: Cytoarchitecture and Neural Development
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Neurocognition
Neurocognitive deficits found in
people with schizophrenia
Attentional and working memory
deficits
Eye-tracking dysfunctions
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Figure 13.11: A Diathesis-Stress Model of Schizophrenia
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Psychosocial and Cultural Aspects
Families and relapse
Urban living
Immigration
Cannabis abuse
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Treatments and Outcomes
Treatment and outcomes
Prognosis before 1950s
Introduction of antipsychotic drugs in 1950s
15-25 years outcomes
Long-term institutionalization rate
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Pharmacological Approaches
Pharmacologicalapproaches
First-generation antipsychotic drugs
Second-generation antipsychotics
Side effects
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Psychosocial Approaches
Psychosocial
approaches
Family therapy
Case management
Social-skills training
Cognitive remediation
Cognitive-behavioral therapy
Other forms of individual treatment
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