Chapter 10: Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

Schizophrenia

Answer 1

A chronic psychotic disorder is characterized by acute episodes involving a break with reality, as manifested by delusions, hallucinations, illogical thinking, incoherent speech, and bizarre behaviour.
Has both hallucinations, paranoia/delusions

Question 2

Schizophrenia Trends

Answer 2

• Most puzzling and disabling clinical syndrome; a psychological disorder that best corresponds to madness or lunacy
• Most people with schizophrenia do not marry (60%-70%).
• High unemployment rate among people with schizophrenia (79%).
• 80% of people w/ schizophrenia abuse substances at some point in their lives.
• 40%-60% attempt suicide, 10% die from suicide; between 15 and 25 times more likely to die from a suicide attempt than the general population
• People w/ schizophrenia greatly overrepresent in prison and homeless populations.
• More often, the victims rather than the perpetrators of violence.
• Most people with schizophrenia are withdrawn and not violent

Question 3

Schizophrenia Prevalence

Answer 3

About 1% of the Canadian population. Similar rates in both developed and developing countries.
- Men have a slightly higher risk than women and also tend to develop it at an earlier age. But remains equal between men and women.
- It’s the fifth leading cause of disability
worldwide; most common diagnoses of people who are involuntarily hospitalized.

Question 4

Schizophrenia Onset & Course

Answer 4

Onset:
- Men: 10-25 years
- Women: 25-35years
- 75% by age 25
Course: Chronic, Exacerbations and remissions

Question 5

Kraepelin: Dementia Praecox (origin word of schizophrenia)

Answer 5

Refers to premature impairment of mental abilities
Kraepelin believed it was a disease process caused by specific (though unknown) bodily pathology.
- It involves the “loss of inner unity of thought, feeling, and act”
- Syndrome begins early in life, and the course of deterioration eventually results in complete “disintegration of the personality.”
- Includes delusions, hallucinations, and of motor behaviours (things that characterize the disorder today

Question 6

Bleuer: Renamed schizophrenia

Answer 6

• The splitting of the brain functions gives rise to cognition, feelings or affective responses, and behaviour.
• Ex: Person w/ schizo. might giggle inappropriately when discussing an upsetting event
• Bleuler believed schizophrenia could be recognized by four primary features/symptoms, now referred as the Four A’s: association, affect, ambivalence, autism
• To Bleuler, hallucinations and delusions represent “secondary symptoms”

Question 7

Four A’s of schizophrenia

Answer 7

• Associations: Associations or relationships among thoughts become disturbed, now called Thought Disorder or Looseness of associations, where ideas are strung together with little or no relationship among them. The speaker does not appear to be aware of the lack of connectedness; their speech appears to become rambling & confused.
• Affect: Affect or emotion response becomes flattened or inappropriate. The individual may show a lack of
  response to upsetting events or burst into laughter upon hearing that a family/friend has died.
• Ambivalence: People w/ schizophrenia hold ambivalent or conflicting feelings toward others, such as loving and hating them simultaneously.
• Autism: Autism is withdrawal into a private fantasy world that is not bound by principles of logic.

Question 8

Schneider schizophrenia

Answer 8

Believed that Bleuler’s ‘Four A’s’ criteria was too vague and failed to distinguish schizophrenia from other disorders. He distinguished between two sets of symptoms
- Fist-rank symptoms
- Second-rank symotms

Question 9

Schneider schizophrenia: First-rank symptoms

Answer 9

Primary features of schizophrenia, such as hallucinations and delusions, distinctly
characterize the disorder. Although, we now know that some symptoms found in First-Rank are found in other disorders, especially BPD

Question 10

Schneider schizophrenia: Second-rank symptoms

Answer 10

Associated with schizophrenia that also occurs in other psychological disorders.
→ Confused thinking and disturbances in the mood to be Second-Rank Symptoms

Question 11

Looseness of Associations

Answer 11

Ideas are strung together with little or no relationship among them.

Question 12

Phases of Schizophrenia

Answer 12

In some cases, the onset of the disorder is acute; occurs suddenly within a few weeks or months.
In most cases, there is a slower and more gradual decline in functioning. Phases of decline include:
- Prodromal phase
- Acute phase
- Residual phase

In the beginning, the odd behaviour may be attributed to a “phase” by family/friends, but as the behaviour becomes more bizarre, the acute phase of the disorder begins, and the psychotic symptoms develop.

Question 13

Prodromal Phase

Answer 13

The period of decline in functioning that precedes the development of the first acute psychotic episode; is characterized by waning interest in social activities and increasing difficulty in meeting the responsibilities of daily living

Question 14

Acute Phase

Answer 14

In schizophrenia, the phase in which psychotic symptoms develop, such as hallucinations, delusions, and disorganized speech and behaviour.

Question 15

Residual Phase

Answer 15

In schizophrenia, the phase of the disorder that follows an acute phase, is characterized by a return to a level of functioning typically of the prodromal phase

Question 16

Newman: Schizophrenia

Answer 16

Newman and colleagues at the University of Alberta followed 128 individuals w/ schizophrenia over 34 years, where patients experience severe symptoms 50% of the time and moderate symptoms 25% of the time; most individuals did not show any improvement in the severity of their symptoms throughout their life.

Question 17

Thought Disorder

Answer 17

Disturbances in thinking are characterized by various features, especially a breakdown in the logical association between thoughts.
- As a result, their speech pattern is disorganized or jumbled, with parts of words combined incoherently.
- Looseness of Association (one of Bleuler’s Four A’s) is a chief sign of thought disorder.
- In severe cases, speech may become completely incoherent or incomprehensible.
- Another common sign is a poverty of speech, where speech is incoherent but is so limited in production or vague that little informational value is conveyed

Question 18

Schizophrenia Symptoms: Delusions

Answer 18

The most prominent disturbance in the thought content involves delusions or false beliefs that remain fixed in their mind despite their illogical bases and lack of supporting evidence. Include:
- Delusions of persecution: The police are out to get me
- Delusions of reference: People on the bus are talking about me
- Delusions of grandeur: Believing oneself to be
Jesus and on a mission

Also include:
- thought broadcasting
- Thought insertion
- thought withdrawal

Question 19

Thought Broadcasting

Answer 19

Believing one’s thoughts are somehow transmitted to the external world so that others can overhear them. Example: A 21-year-old student reported, “As I think, my thoughts leave my head on a type of mental
ticker-tape. Everyone around has only to pass the tape through their mind, and they know my thoughts”.

Question 20

Thought Insertion

Answer 20

Believing one’s thoughts have been planted in one’s mind by external source. Example: A 29-year-old housewife reported that when she looks out of the window, she thinks, “The garden looks nice and the grass looks cool, but the thoughts of [a man’s name] come into my mind. There are no other thoughts there, only his…. He treats my mind like a screen and flashes his thoughts on it like you flash a
picture”.

Question 21

Thought Withdrawl

Answer 21

Believing thoughts have been removed from one’s mind. Example: A 22-year-old woman experienced the following: “I am thinking about my mother, and
suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor, and there is nothing in my mind, it is empty”.

Question 22

Poverty of Speech

Answer 22

It is speech that is coherent but s so limited in production or vague that little informational value is converted. This lack of conversation is called alogia, or “poverty of speech.” Alogia can affect your quality of life. Less commonly occurring signs include:
- Neologisms
- Perseveration
- Clanging
- Blocking

Question 23

Neologisms

Answer 23

Type of disturbed thinking associated with schizophrenia involving the coining of new words. Neologisms can take many forms, and may be entirely new, or formed of existing words. To give you an example, “mansplain” combines the words “man” and “explain”. However, neologisms don’t have to be constructed language. They can also be an existing word that has developed.

Question 24

Perseveration

Answer 24

Persistent repetition of the same thought or train of thought. Perseveration is when someone “gets stuck” on a topic or an idea. You may have heard the term in regard to autism, but it can affect others, too. People who perseverate often say the same thing or behave in the same way over and over again. But they can get stuck on their emotions, actions, and thoughts, too.

Question 25

Clanging

Answer 25

Tendency to string words together because they rhyme or sound alike.

Question 26

Blocking

Answer 26

A condition of suddenly becoming silent w/ loss of memory for what they have just discussed. Thought blocking occurs most often in people with psychiatric illnesses, most commonly schizophrenia. A person’s speech is suddenly interrupted by silences that may last a few seconds to a minute or longer. When the person begins speaking again, after the block, they will often speak about an unrelated subject.

Question 27

Catatonia

Answer 27

Gross disturbances in motor activity and cognitive functioning.

Question 28

Stupor

Answer 28

State of relative or complete unconsciousness in which a person is not generally aware of or responsiveness to the environment, as in a cationic stupor.

Question 29

Waxy Flexibility

Answer 29

Feature of catatonia involving adopting a fixed posture into which people with schizophrenia have been positioned by others.

Question 30

Positive Symptoms

Answer 30

The moe flagrant features of schizophrenia are characterized by the presence of abnormal behaviour, such as hallucinations, delusions, thought disorder, disorganized speech, and disorganized behaviour.

Question 31

Negative Symptoms

Answer 31

Features of schizophrenia characterized by the absence of normal behaviour. Negative symptoms are deficits or behavioural deficiencies, such as social skills deficits, social withdrawal flattened affect, poverty of speech, thought psychomotor retardation, or failure to experience pleasure in pleasant activities.
- People w/ schizophrenia tend to have been introverted and peculiar even before the appearance of psychotic behaviour.
- Disturbances of affect or emotional response are typified by blunted affect or flat affect.
- Research supports the idea that they experience emotions internally but lack the capacity to express them outwardly.

Question 32

Blunted Affect (Negative Symptom)

Answer 32

Significant reduction in emotional expression.

Question 33

Flat Affect (Negative Symptom)

Answer 33

Absence of emotional expression in face and voice.

Question 34

Hallucinations

Answer 34

Perceptions occur in the absence of external stimulus and are the most common form of perceptual disturbance in schizophrenia. May involve any of the senses:
- Auditory hallucinations - most common
- Tactile hallucinations - (tingling, electrical, or burning
sensations) -common
- Somatic hallucinations - (feeling like snakes are crawling inside one’s belly) - common
- Visual hallucinations - common
- Gustatory hallucinations - rare
- Olfactory hallucinations - rare
- Command hallucinations - voices that instruct the to do certain acts

Question 35

Common Hallucinations

Answer 35

• Voice that instructs them to do certain acts. They are often hospitalized for fear they may harm themselves or others.
• Study found that 62% of people reported obeying benign commands, and 30% obeyed commands to harm themselves during the past month.
• Yet, command hallucinations often go undetected by professionals because hallucinators deny them or are unwilling to discuss them.

Question 36

Causes of Hallucinations

Answer 36

Causes remain unknown, but speculations abound, including the following:
* Disturbances in brain chemistry
- The neurotransmitter dopamine: Antipsychotic drugs that block dopamine activity also tend to reduce
hallucinations. Conversely, drugs that increase the production of dopamine tend to induce hallucinations.
* Hallucinations resemble dreams-like states; it’s possible hallucinations are types of daytime dreams connected w/ a failure of brain mechanisms that normally prevent dream images from intruding on waking experiences.
* May also represent a type of subvocal inner speech: In one experiment, individuals w/ schizophrenia reported voices disappeared when engaged in a procedure that prevented them from talking to themselves under their breath.
- activity in Broca’s area (part involved in controlling speech) was greater in people w/ schizophrenia when they heard voices than when they weren’t hallucinating.
- Found evidence of similar activity in the auditory cortex during auditory hallucinations.

Question 37

Loss of Ego Boundaries

Answer 37

Failure to recognize themselves as unique individuals and unclear how much they experience is
part of themselves.

Question 38

Cross-fostering Study

Answer 38

Method of determining the heritability of a trait or disorder by examining differences in prevalence among adoptees reared by either adoptive parents or biological parents who possessed the trait or disorder in question. Evidence that the disorder followed biological rather than adoptive parentage favours the heritability of the trait or disorder.

Question 39

Dopamine Theory

Answer 39

The biochemical theory of schizophrenia proposes schizophrenia involves the action of dopamine.
- People w/ schizophrenia appear to use more dopamine. Why? Research indicates they may have a greater than a normal number of dopamine receptors or have receptors that are overly sensitive to dopamine.

Question 40

Dopamine Theory Evidence/Support

Answer 40

Evidence for the dopamine Model is found in the effects of antipsychotic drugs called major tranquillizers or neuroleptics.
- Neuroleptics block dopamine receptors, thus reducing dopamine activity.
- Most widely used neuroleptic: Phenothiazines, such as Largactil and Mellaril
- Amphetamines(a class of stimulant drugs) increase the concentration of dopamine in the synaptic cleft by blocking its reuptake by presynaptic neurons (When given in large doses to normal people, they can lead to abnormal behaviour states that mimic schizophrenia).

Question 41

Psychodynamic Perspective: Ego & Id

Answer 41

• Schizo. represents a regression to a psychological state corresponding to early infancy in which the prodding of the id produces bizarre, socially deviant behaviour and gives rise to hallucinations and delusions.
• Schizo. represents the overwhelming of the ego by primitive sexual or aggressive drives or impulses arising from the id.
• These impulses threaten the ego and give rise to intense intrapsychic conflict. Under such threat, the person regresses to an early period of the oral stage, referred to as primary narcissism.
• Because the ego mediates the relationship between self and the outer world, this breakdown in ego functioning accounts for the detachment from reality that is typically schizophrenia.
• Input from the id causes fantasies to be mistaken for reality.

Question 42

Freud’s psychoanalytic theory

Answer 42

The id is the primitive and instinctual part of the mind that contains sexual and aggressive drives and hidden memories, the super-ego operates as a moral conscience, and the ego is the realistic part that mediates between the desires of the id and the super-ego.
- The id is driven by the pleasure principle, which strives for immediate gratification of all desires, wants, and needs.1 If these needs are not satisfied immediately, the result is a state of anxiety or tension. For example, an increase in hunger or thirst should produce an immediate attempt to eat or drink.
- The ego operates based on the reality principle, which strives to satisfy the id’s desires in realistic and socially appropriate ways. The reality principle weighs the costs and benefits of an action before deciding to act upon or abandon impulses.
- The superego tries to perfect and civilize our behavior. It suppresses all id’s unacceptable urges and struggles to make the ego act upon idealistic standards rather than on realistic principles. The superego is present in the conscious, preconscious, and unconscious.

Question 43

Psychodynamic Perspective: Sullivan

Answer 43

Placed more emphasis or interpersonal than
interpsychic factors.
Emphasized the importance of impaired mother-child relationships, arguing they can set the stage
for a gradual withdrawal from other people. Hostile relationships between parent and child can lead the child to take refuge in a private fantasy world. Eventually, over the years, as the social relationships with parents and others deteriorate, the person becomes overwhelmed w/ anxiety and withdraws completely into a fantasy world.

Question 44

Learning Perspective: Ullman and Krasner

Answer 44

Propose that some forms of schizo. behaviour may result from a lack of social reinforcement, which leads to gradual detachment from the social environment and increased attention to an inner world of fantasy. Modelling and selective reinforcement of bizarre behaviour may explain some schizo—behaviours in a hospital setting.
- Support for this is found in operant conditioning, where bizarre behaviour is shaped by reinforcement

Question 45

Schizophrenia: Brain Abnormalities

Answer 45

• The most prominent finding is enlargements of brain ventricles.
• Ventricular enlargement is a sign of structural damage involving loss of brain cells (Found in 3 out of 4 patients).
• Structural damages may have occurred long before the initial onset of the disorder. One theory is prenatal complications during the period of 13 to 15 weeks in fetal development when certain brain structures are forming.
• Study found schizophrenia tends to be associated with poor fetal growth, premature birth, and low birth weight.
• Anoxia (oxygen deprivation), early brain traumas, environmental influences, and genetic defects are suspected causes.
• Research points to possible neurotransmitter disturbances; found evidence of reduced brain activity in frontal lobes (specifically in the prefrontal cortex), and area of the frontal lobes in the cerebral cortex (lies in front of the motor cortex). The prefrontal cortex performs cognitive and emotional functions (often impaired in schizophrenia).
• Hippocampus: One of a pair of structures in the limbic system involved in memory processes.
• Amygdala: One of a pair of structures in the limbic system involved in emotion and memory.
• The limbic system plays a key role in regulating emotions and higher mental functions (including memory)

Question 46

How is schizophrenia conceptualized in the diathesis-stress model?

Answer 46

Suggests that schizo. results from an interaction of a genetic predisposition (the diathesis) and environmental stressors (family conflict, child abuse, emotional deprivation, loss of supportive figures, and early brain trauma).

Question 47

Diathesis-stress Model: Cannabis and Schizophrenia

Answer 47

Cannabis can be considered an environmental stimulus.
People who possess particular forms of the COMT gene are liable to develop psychotic symptoms when they use cannabis, and some symptoms persist to the point that they develop schizophrenia.
- COMT gene is involved in the regulation of dopamine.

Question 48

How are family factors related to the development and course of schizophrenia?

Answer 48

Family factors such as communication deviance and expressed emotion (EE) may act as sources of stress and increase the risk of the development or recurrence of schizophrenia among people with a genetic predisposition.
- “Schizo. Mother”
- Double-Blind Communications
- Communication Deviance
- Expressed Emotion

Question 49

Schizophrenic Mother

Answer 49

Type of mother described as cold but overprotective, who was believe to be capable of causing
schizophrenia in children. (This used to be early family theories for causes of schizophrenia). No support for this validity.

Question 50

Double-Bind Communications

Answer 50

• A situation in which an individual receives contradictory messages from another person. For example, a parent may respond negatively when his or her child approaches or attempts to engage in affectionate behaviour but then, when the child turns away or tries to leave, reaches out to encourage the child to return.
• 1950’s, Gregory Bateson and co. presented Double-Bind Communications: Patterns of communication involving the transmission of contradictory or mixed messages without acknowledgment of the inherent conflict; posited by some theorists as a source of family stress that plays a role in the development of schizophrenia.

Question 51

Communication Deviance

Answer 51

Pattern characterized by unclear, vague, disruptive, or fragmented parental communication.
- Parents of people w/ schizophrenia show higher levels of communication deviance.

Question 52

Expressed Emotion (EE)

Answer 52

Form of disturbed family communication in which the family members of the individual w/ schizophrenia tend to be hostile, critical, and unsupportive.
- A family factor linked to an increased risk of relapse in people with schizo.
- Low EE families may protect/buffer the individual with schizophrenia from the adverse impact of outside
stressors and help prevent recurrent episodes.
- High EE families tend to show poorer adjustment and have higher rates of relapse following release from the hospital.

Question 53

Expressed Emotion (EE): Cultural Differences

Answer 53

Cultural differences need to be taken into account: In study of cultural differences, families with higher EE were linked to more negative outcomes in patients with schizophrenia among Anglo American families, but not among Mexican American families

Question 54

Tardive Dyskinesia

Answer 54

Movement disorder is characterized by involuntary movements of the face, mouth, neck, trunk, or extremities caused by long-term use of antipsychotic medications.
- Major Risk of long-term treatment with neuroleptic drugs (possibly excluding clozapine and other new-generation drugs).
- Associated with 1st generation: Tranquilizers or
Neuroleptics

Question 55

Atypical Antipsychotic Drugs & Risks

Answer 55

Clozapine, risperidone, and olanzapine; have largely replaced the earlier generation of antipsychotics. Risks:
Sudden cardiac death
- Substantial weight gain
- Metabolic disorders associated with increased risks of death due to heart disease and stroke.
- The drug ‘Clozapine’ carries the risk of potentially lethal disorder where the body produces inadequate supplies of white blood cells. (Because of this, patients need to have their blood checked regularly)

Question 56

Atypical Antipsychotic Drugs & Risks

Answer 56

Clozapine, risperidone, and olanzapine; have largely replaced the earlier generation of antipsychotics. Risks:
Sudden cardiac death
- Substantial weight gain
- Metabolic disorders associated with increased risks of death due to heart disease and stroke.
- The drug ‘Clozapine’ carries the risk of potentially lethal disorder where the body produces inadequate supplies of white blood cells. (Because of this, patients need to have their blood checked regularly)

Question 57

Schizophrenia Relapse Rates

Answer 57

It’s been noted that the relapse rate may be as high as 90% in the first year after hospital discharge if the patient discontinues medication, but staying on medication can reduce the relapse rate to about 40%.

Question 58

Learning-Based Approaches

Answer 58

• Token Economy Systems
• Social Skills Traning
• CBT with Social Skills Training

Question 59

Schizophrenia Onset & Course

Answer 59

Onset:
- Men: 10-25 years
- Women: 25-35years
- 75% by age 25
Course: Chronic, Exacerbations and remissions