1. Fundamentals of Abnormal Psychology Ronald Comer Chapter 12 Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

2. Schizophrenia Psychosis Significant loss of contact with reality © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

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. Diagnostic Features of Schizophrenia Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

5. Schizophrenia Affects people from all walks of life Characterized by an array of diverse symptoms Usually begins in late adolescence or early adulthood © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

7. Origins of the Schizophrenia Construct 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. (1857-1939) “splitting of the mind” (1856-1926)

8. Epidemiology Risk Lifetime prevalence Age of father – 45 or higher Developed Countries Onset age – late adolescence or early adulthood (men – 23 years; women – 28 years) Gender – worse in men © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

9. Figure 13.1: Age Distribution of Onset of Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

10. 10 Comer, Fundamentals of Abnormal Psychology, 7e

11. Positive Symptoms Excess or distortion in normal repertoire of behavior and experience Examples Positive symptoms of schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

12. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

13. Hallucinations Sensory experience Seems real but occurs in absence of any external perceptual stimulus Can occur in any sensory modality Hallucinations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

14. SPECT study on auditory hallucination

15. Positive Symptoms  Loose associations (derailment):  Neologisms (made-up words):  “It is an amorition law”  Perseveration  Patients repeat their words and statements again and again  Clang (rhymes):  How’s the weather? “So hot, you know it runs on a cot” Inappropriate affect © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

16. Negative Symptoms Absence or deficit of normally present behaviors Examples Negative symptoms of schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Avolition Alogia Anhedonia Social Withdrawal

17. Psychomotor symptoms disorganized behavior –Catatonia spectrum awkward movements, grimaces –Poor personal hygiene, disregard for safety, unusual dress

18. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.  Many sufferers experience three phases:  Prodromal – beginning of deterioration; mild symptoms  Active – symptoms become apparent  Residual – a return to prodromal- like levels  One-quarter of patients fully recover; three-quarters continue to have residual problems

19. Other Psychotic Disorders Schizoaffective disorder Schizophreniform disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Other psychotic disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

20. Genetic Factors Monozygotic twins (of people with schizophrenia) are much more likely to develop schizophrenia than are dizygotic twins. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

21. Figure 13.2: Risk of Developing Schizophrenia Based on Shared Genes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

22. Genetic Factors The influence of genetics Twin studies Adoption studies Studies of molecular genetics © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

23. Prenatal Exposures Prenatal exposures: Prenatal infection Rhesus incompatibility Early nutritional deficiencies and maternal stress Pregnancy and birth complications © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

24. Genes and Environment in Schizophrenia: A Synthesis Current thinking emphasizes interplay Multiple genetic factors Environmental factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

26. Figure 13.8: Cytoarchitecture and Neural Development © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

27. Other Biological Factors Many brain areas are abnormal in schizophrenia Decreased brain volume (3%) Enlarged ventricles Frontal lobe dysfunction Reduced volume of the thalamus Abnormalities in temporal lobe areas – hippocampus amygdala © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

28. Neurocognition Neurocognitive deficits found in people with schizophrenia Attentional and working memory deficits Eye-tracking dysfunctions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

29. Other Biological Factors Implicated in Schizophrenia Neurotransmitters Dopamine Glutamate Cytoarchitecture Overall organization of cells in brain may be compromised © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

30. Psychological Views  The psychodynamic explanation  Freud believed that schizophrenia develops from two processes:  Regression to a pre-ego stage  Efforts to re-establish ego control Schizophrenogenic mother 30 Comer, Fundamentals of Abnormal Psychology, 7e

31. Psychological Views  The cognitive view  biological factors produce symptoms  Then, a faulty interpretation and a misunderstanding of symptoms  There is little direct research support for this view 31 Comer, Fundamentals of Abnormal Psychology, 7e

32. 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 –High expressed emotion (EE)– associated with relapse

33. Psychosocial and Cultural Aspects Families and relapse Urban living Immigration Cannabis abuse © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

34. Figure 13.11: A Diathesis-Stress Model of Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

35. Institutional Care  In the 1950s:  Milieu therapy  Based on humanistic principles  Token economies  Based on behavioral principles 35 Comer, Fundamentals of Abnormal Psychology, 7e

36. Treatments and Outcomes Treatment and outcomes Prognosis before 1950s Introduction of antipsychotic drugs in 1950s 15-25 years outcomes Long-term institutionalization rate © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

37. Pharmacological Approaches Pharmacological approaches First-generation antipsychotic drugs (neuroleptics) Second-generation antipsychotics Side effects © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

38. Psychosocial Approaches Psychosocial approaches Family therapy Case management Social-skills training Cognitive-behavioral therapy Other forms of individual treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

39. 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? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.