ABNORMAL PSYCHOLOGY,
SIXTEENTH EDITION
James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 13
Schizophrenia and Other
Psychotic Disorders
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Schizophrenia
Psychosis
• Significant loss of contact with
reality
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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
Schizophrenia
Affects people
from all walks of
life
Schizophrenia
Characterized by
an array of
diverse symptoms
Usually begins in
late adolescence
or early adulthood
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Origins of the
Schizophrenia Construct
“splitting of the mind”
(1857-1939)
Eugen Bleuler
introduced term
“schizophrenia” in
1911
First clinical
description
appeared in 1810
Emil Kraepelin
used term
dementia praecox
to refer to mental
deterioration at
early age
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(1856-1926)
Epidemiology
Risk
•
•
•
•
Lifetime prevalence
Age of father – 45 or higher
Country
Onset age – late adolescence or early
adulthood
• Gender – worse in men
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Figure 13.1: Age Distribution of
Onset of Schizophrenia
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Clinical Picture
Hallmark symptoms
• Delusions
• Hallucinations
• Disorganized speech and
behavior
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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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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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SPECT study on auditory hallucination
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
Positive Symptoms
Positive
symptoms of
schizophrenia
• Excess or
distortion in
normal
repertoire of
behavior and
experience
• Examples
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Disorganized Symptoms
Disorganized
symptoms of
schizophrenia
Speech
Affect
Behavior
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Negative Symptoms
Negative
symptoms of
schizophrenia
• Absence or
deficit of
normally
present
behaviors
• Examples
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Avolition
Alogia
anhedonia
Other Psychotic Disorders
Other psychotic disorders
•
•
•
•
•
Schizoaffective disorder
Schizophreniform disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic disorder
Let’s take a few minutes to define
each of these.
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Risk and Causal Factors
• True or false?
• Genetic factors are clearly implicated in
schizophrenia.
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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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Figure 13.2: Risk of Developing
Schizophrenia Based on Shared Genes
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Genetic Factors
Monozygotic twins (of
people with schizophrenia)
are much more likely to
develop schizophrenia
than are dizygotic twins.
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Genetic Factors
Twin studies
The influence
of genetics
Adoption
studies
Studies of
molecular
genetics
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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
Environmental
factors
Multiple
genetic
factors
Current thinking
emphasizes interplay
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A Neurodevelopmental Perspective
Brain lesion lies
dormant until
normal
developmental
changes occur
Changes expose
problems
resulting from this
brain abnormality
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Developmental
precursors may
include variety of
abnormalities
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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Other Biological Factors
Implicated in Schizophrenia
Neurotransmitters
• Dopamine
• Glutamate
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
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Eye-tracking
dysfunctions
Figure 13.11: A Diathesis-Stress
Model of Schizophrenia
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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
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
Pharmacological Approaches
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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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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