Schizophrenia 1

Psychosis Psychosis is a state defined by a loss of contact with reality The ability to perceive and respond to the environment is significantly disturbed; functioning is impaired Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs) Psychosis may be substance-induced or caused by brain injury, but most psychoses appear in the form of schizophrenia

Schizophrenia Schizophrenia affects approximately 1 in 100 people in the world About 2.5 million Americans currently have the disorder The financial and emotional costs are enormous Sufferers have an increased risk of suicide and physical – often fatal – illness

Schizophrenia Schizophrenia appears in all socioeconomic groups, but is found more frequently in the lower levels Why?

Schizophrenia Equal numbers of men are women are diagnosed The average age of onset for men is 21 years, compared to 27 years for women Rates of diagnosis differ by marital status 3% of divorced or separated people 2% of single people 1% of married people It is unclear whether marital problems are a cause or a result

The Clinical Picture of Schizophrenia Schizophrenia produces many “clinical pictures” The symptoms, triggers, and course of schizophrenia vary greatly Some clinicians have argued that schizophrenia is actually a group of distinct disorders that share common features

What Are the Symptoms of Schizophrenia? Symptoms can be grouped into three categories: Positive symptoms Negative symptoms Psychomotor symptoms

What Are the Symptoms of Schizophrenia? Positive symptoms These “pathological excesses” are bizarre additions to a person's behavior Positive symptoms include: Delusions – faulty interpretations of reality Delusions may have a variety of bizarre content: being controlled by others; persecution; grandeur; Disordered thinking and speech May include loose associations, neologisms, and perseverations,

What Are the Symptoms of Schizophrenia? Positive symptoms Loose associations (derailment): “The problem is insects. My brother used to collect insects. He's now a man 5 foot 10 inches. You know, 10 is my favorite number; I also like to dance, draw, and watch TV.” Neologisms (made-up words): “It is an amorition law” Perseveration Patients repeat their words and statements again and again

What Are the Symptoms of Schizophrenia? Positive symptoms Heightened perceptions People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything important Hallucinations – sensory perceptions that occur in the absence of external stimuli Most common are auditory Seem to be spoken directly to, or overheard by, the hallucinator Inappropriate affect –

What Are the Symptoms of Schizophrenia? Negative symptoms These “pathological deficits” are characteristics that are lacking in an individual Negative symptoms include: Poverty of speech (alogia) Reduction of quantity of speech or speech content May also say quite a bit but convey little meaning

What Are the Symptoms of Schizophrenia? Negative symptoms Blunted and flat affect Show less emotion than most people Avoidance of eye contact Immobile, expressionless face Monotonous voice, low and difficult to hear Anhedonia – general lack of pleasure or enjoyment

What Are the Symptoms of Schizophrenia? Psychomotor symptoms People with schizophrenia sometimes experience psychomotor symptoms Awkward movements, repeated grimaces, odd gestures The movements seem to have a magical quality These symptoms may take extreme forms, collectively called catatonia Includes stupor, rigidity, posturing, and excitement

Diagnosing Schizophrenia

How Do Theorists Explain Schizophrenia? As with many other disorders, biological, psychological, and sociocultural theorists have proposed explanations Biological explanations have received the most research support A 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 Genetic and biological studies of schizophrenia have dominated clinical research in the last several decades These studies have revealed the key roles of inheritance and brain activity and have opened the door to important changes in treatment

Family Links

Biological Views Biochemical abnormalities Over the past four decades, researchers have developed a dopamine hypothesis to explain their findings on schizophrenia: Certain neurons using dopamine fire too often, producing symptoms of schizophrenia This theory is based on the effectiveness of antipsychotic medications

Biological Views Abnormal brain structure During the past decade, researchers have also linked schizophrenia (particularly cases dominated by negative symptoms) to abnormalities in brain structure For example, brain scans have found that many people with schizophrenia have enlarged ventricles – the brain cavities that contain cerebrospinal fluid This enlargement may be a sign of poor development or damage in related brain regions People with schizophrenia have also been found to have smaller temporal and frontal lobes, smaller amounts of grey matter, and abnormal blood flow to certain brain areas

Biological Views While the biochemical, brain structure, and viral findings are beginning to shed much light on the mysteries of schizophrenia, they offer only a partial explanation Some people who have these biological problems never develop schizophrenia Might be because biology sets the stage for the disorder, but psychological and sociocultural factors must be present for it to appear

Sociocultural Views Sociocultural theorists believe that three main social forces contribute to schizophrenia: Multicultural factors Social labeling Family dysfunction Although these forces are considered important in the development of schizophrenia, 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 As many as 2.1% of African Americans are diagnosed, compared with 1.4% of Caucasians One possibility to explain this finding is that African Americans are more prone to develop the disorder Yet another explanation may lie in the economic sphere African Americans are more likely to be poor and, when economic differences are controlled for, rates of schizophrenia become closer Consistent with the economic explanation, Hispanic Americans who also are, on average, economically disadvantaged, appear to have a much higher likelihood of being diagnosed than White Americans

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 Once assigned, the label becomes a self-fulfilling prophecy The dangers of social labeling have been well demonstrated Example: Rosenhan “pseudo-patient” study

Sociocultural Views Family dysfunctioning A number of studies suggest that schizophrenia is often linked to family stress: Parents of people with the disorder often: Display more conflict Have greater difficulty communicating Are more critical of and overinvolved with their children than other parents Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism and hostility and intrude on each other's privacy Individuals who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family

Treatment of Schizophrenia 25

Antipsychotic Drugs  The discovery of antipsychotic medications dates back to the 1940s, when researchers developed antihistamine drugs for allergies  It was discovered that one group of antihistamines, phenothiazines, could be used to calm patients about to undergo surgery  Psychiatrists tested one of the drugs, chlorpromazine, on 6 patients with psychosis and observed a sharp reduction in their symptoms  In 1954, chlorpromazine (under the trade name Thorazine) was approved for sale in the U.S. as an antipsychotic drug

How Effective Are Antipsychotic Drugs? Research has shown that antipsychotic drugs reduce schizophrenia symptoms in at least 65% of patients In direct comparisons, drugs appear to be more effective than any other approach used alone In most cases, the drugs produce the maximum level of improvement within the first six months of treatment Symptoms may return if patients stop taking the drugs too soon

How Effective Are Antipsychotic Drugs? Antipsychotic drugs, particularly the conventional ones, reduce the positive symptoms of schizophrenia more completely, or at least more quickly, than the negative symptoms Correspondingly, people who display largely positive symptoms generally have better rates of recovery than those with primarily negative symptoms Although the use of such drugs is now widely accepted, patients often dislike the powerful effects of the drugs, and some refuse to take them

The Unwanted Effects of Conventional Antipsychotic Drugs The most common of these effects produce Parkinsonian symptoms, reactions that closely resemble features of the neurological disorder Parkinson's disease, including: Muscle tremor and rigidity Bizarre movements of the face, neck, tongue, and back Great restlessness, agitation, and discomfort in the limbs

The Unwanted Effects of Conventional Antipsychotic Drugs  In as many as 1% of patients, particularly elderly ones, conventional antipsychotic drugs produce neuroleptic malignant syndrome – a severe, potentially fatal reaction  Symptoms include muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system  As soon as the syndrome is recognized, drug use is discontinued and each symptom is treated medically  Individuals may also be given dopamine-enhancing drugs

Unwanted Effects of Conventional Antipsychotic Drugs A more difficult side effect of conventional antipsychotic drugs appears up to 1 year after starting the medication This reaction, called tardive dyskinesia, involves writhing or tic- like involuntary movements, usually of the mouth, lips, tongue, legs, or body It affects more than 10% of those taking the drugs Tardive dyskinesia can be difficult, sometimes impossible, to eliminate

Newer Antipsychotic Drugs In recent years, new antipsychotic drugs have been developed Examples: Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, and Abilify

Newer Antipsychotic Drugs These new drugs are called “atypical” because their biological operation differs from that of conventional antipsychotics They appear more effective than conventional antipsychotic drugs, especially for negative symptoms They cause few extrapyramidal side effects and seem less likely to case tardive dyskinesia They do, however, carry a risk of agranulocytosis, a life- threatening drop in white blood cells They also may cause weight gain, dizziness, and significant elevations in blood sugar