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pleasure.• Apathy - Socially withdrawn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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