1. Chapter 13 Schizophrenia and Other Psychotic Disorders
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 13
Schizophrenia and Other Psychotic Disorders
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2. Psychosis Schizophrenia Significant loss of contact with reality
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3. Perspectives on Schizophrenia
Schizophrenia vs. psychosis
Psychosis – broad term (e.g., hallucinations, delusions)
Schizophrenia – a type of psychosis
Psychosis and schizophrenia are heterogeneous
Disturbed thought, emotion, behavior

4. Schizophrenia
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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5. FIGURE 12.2  The longitudinal course of schizophrenia is depicted starting at birth through old age. The severity of the symptoms is shown on the left axis, and the changes in symptoms across each phase (premorbid, prodromal, onset, and chronic) are labeled. (Adapted from Lieberman, J. A., Perkins, D., Belger, A., Chakos, M., Jarskog, F., Boteva, K., & Gilmore, J., The early stages of schizophrenia: Speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biological Psychiatry, 50, p. 885).

6. Origins of the Schizophrenia Construct
“splitting of the mind”
First clinical description appeared in 1810
Emil Kraepelin used term dementia praecox to refer to mental deterioration at early age
Eugen Bleuler introduced term “schizophrenia” in 1911
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7. Risk Epidemiology Lifetime prevalence Age of father – 45 or higher
Country
Onset age – late adolescence or early adulthood
Gender – worse in men
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8. Figure 13.1: Age Distribution of Onset of Schizophrenia
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9. Disorganized speech and behavior Hallmark symptoms
Clinical Picture
Delusions
Hallucinations
Disorganized speech and behavior
Hallmark symptoms
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10. Delusions Delusions Erroneous belief
Fixed and firmly held despite clear contradictory evidence
Disturbance in the content of thought
Delusions of reference
Delusions of persecution
Delusions of grandeur
Delusions
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11. Hallucinations Hallucinations Sensory experience
Seems real but occurs in absence of any external perceptual stimulus
Can occur in any sensory modality
Hallucinations
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12. SPECT study on auditory hallucination

13. The disorganized symptoms
disorganized speech
Cognitive slippage – illogical and incoherent speech
Tangentiality – “going off on a tangent”
disorganized affect
Inappropriate emotional behavior
disorganized behavior
Catatonia spectrum
Poor personal hygiene, disregard for safety, unusual dress

14. Positive symptoms of schizophrenia
Excess or distortion in normal repertoire of behavior and experience
Examples
Positive symptoms of schizophrenia
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15. Disorganized Symptoms
Speech
Affect
Behavior
Disorganized symptoms of schizophrenia
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16. Negative symptoms of schizophrenia
Absence or deficit of normally present behaviors
Examples
Negative symptoms of schizophrenia
Avolition
Alogia
anhedonia
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17. Other Psychotic Disorders
Schizoaffective disorder
Schizophreniform disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic disorder
Other psychotic disorders
Let’s take a few minutes to define each of these.
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18. Risk and Causal Factors
True or false?
Genetic factors are clearly implicated in schizophrenia.
True.
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19. Risk and Causal Factors
The following slide shows that having a relative with the disorder significantly raises a person’s risk of developing schizophrenia.
Let’s look and see.
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20. Figure 13.2: Risk of Developing Schizophrenia Based on Shared Genes
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21. Genetic Factors
Monozygotic twins (of people with schizophrenia) are much more likely to develop schizophrenia than are dizygotic twins.
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22. Genetic Factors
The influence of genetics
Twin studies
Adoption studies
Studies of molecular genetics
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23. Prenatal Exposures Prenatal exposures: Prenatal infection
Rhesus incompatibility
Early nutritional deficiencies and maternal stress
Pregnancy and birth complications
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24. Genes and Environment in Schizophrenia: A Synthesis
Current thinking emphasizes interplay
Multiple genetic factors
Environmental factors
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25. 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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26. 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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27. Other Biological Factors Implicated in Schizophrenia
Neurotransmitters
Dopamine
Glutamate
Cytoarchitecture
Overall organization of cells in brain may be compromised
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28. Figure 13.8: Cytoarchitecture and Neural Development
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29. Neurocognition
Neurocognitive deficits found in people with schizophrenia
Attentional and working memory deficits
Eye-tracking dysfunctions
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30. Figure 13.11: A Diathesis-Stress Model of Schizophrenia
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31. Psychosocial and cultural factors
The role of stress
May activate underlying vulnerability
May also increase risk of relapse
Family interactions
Families – show ineffective communication patterns
Schizophrenogenic mother
Double blind communication
High expressed emotion (EE)– associated with relapse

32. Psychosocial and Cultural Aspects
Families and relapse
Urban living
Immigration
Cannabis abuse
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33. 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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34. Pharmacological Approaches
First-generation antipsychotic drugs
Second-generation antipsychotics
Side effects
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35. Psychosocial Approaches
Family therapy
Case management
Social-skills training
Cognitive remediation
Cognitive-behavioral therapy
Other forms of individual treatment
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36. Unresolved Issues What is the best way to prevent schizophrenia?
By improving prenatal care for women with schizophrenia in their biological families?
By reducing cannabis abuse in teens?
By identifying and intervening with people at high risk for developing schizophrenia?
By intervening early with people who have developed schizophrenia?
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