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Chapter 8
Schizophrenia & Related Psychotic Disorders
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 82
Schizophrenia
A form of psychosis—the inability to tell the difference between the real and the unreal
Widespread and costly Up to 3% of national health budgets 0.5–2% of the general population affected
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 83
Schizophrenia & Residence
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Positive Symptoms
Delusions Persecutory Delusions of Reference Grandiose Delusions Delusions of Thought Insertion
Hallucinations Disorganized Thought and Speech Disorganized or Catatonic Behavior
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 85
Negative Symptoms
Affective Flattening (or Blunted Affect)– Severe reduction or complete absence of affective
(emotional) responses to the environment Alogia
– Severe reduction or complete absence of speech Avolition
– Inability to persist at common, goal-oriented tasks
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 86
Cognitive Symptoms
Deficits in basic cognitive processes, including attention and memory
Deficits in working memory
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DSM-IV-TR Criteria for Schizophrenia A. Two or more of the following present significantly
during a 1-month (acute) period1. Delusions2. Hallucinations3. Disorganized speech4. Grossly disorganized or catatonic behavior5. Negative symptoms—affective flattening, alogia, or avolition
B. Social/occupational functioning: significant impairment in work, academic performance, interpersonal relationships, and/or self-care
C. Duration: continuous signs of disturbance for at least 6 months including 1 month with symptoms that meet Criterion A
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 88
DSM-IV-TR Criteria for Schizophrenia, cont.D. Schizoaffective and mood disorder with psychotic
features have been ruled outE. Disturbance not physiological due to a substance
or general medical conditionF. If autism or other pervasive developmental disorder
present, must be prominent delusions or hallucinations as well
Prodromal symptoms—present before the acute stage
Residual symptoms—present after the acute stage
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 89
Schizophrenia subtypes
Paranoid Disorganized Catatonic Undifferentiated Residual
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Prognosis of Schizophrenia
50–80% rehospitalization rate Stabilize within 5–10 years of first episode Gender and Age Factors
Women develop disorder later, milder symptoms, and have a more favorable course than do men
Functioning improves with age Sociocultural Factors
Possibly less severe in developing countries Acceptance of deviant behavior Gender differences Social response and treatment availability
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Other Psychotic Disorders
Schizoaffective Schizophreniform Brief Psychotic Delusional Shared Psychotic
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DSM-IV-TR - Schizoaffective Disorder
A. An uninterrupted period of illness during which there is either a major depressive episode, a manic episode, or a mixed episode concurrent with Criterion A schizophrenia symptoms.
B. During the same period delusions or hallucinations for at least 2 weeks without prominent mood symptoms.
C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
D. Disturbance not physiological due to a substance or general medical condition
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 813
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Biological Theories of Schizophrenia
Genetic Family, twin, and adoption studies indicate a
genetic component to schizophrenia, or at least a vulnerability to schizophrenia
Structural Brain Abnormalities Enlarged ventricles, reduced volume, and
neuron density in frontal cortex, and other brain abnormalities linked to cognitive and emotional deficits
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 818
Biological Theories of Schizophrenia, continued
Birth Complications & Prenatal Viral Exposure Particularly those involving loss of oxygen that
could damage brain
Neurotransmitter Theories Imbalances in levels of or receptors for
dopamine cause symptoms; serotonin, GABA, and glutamate may also play roles
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 819
Integrative Model
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Psychosocial Perspectives on Schizophrenia
Social drift and urban birth Stress and relapse Psychodynamic
expressed emotion Cognitive
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Biological Treatment for Schizophrenia
ECT Antipsychotic drugs
Neuroleptics—Phenothiazines, Butyrophenones, Thioxanthenes
Atypical—Clozapine
Behavioral, Cognitive, and Social Interventions: Recognition of demoralizing attitudes they may have toward their illness, operant conditioning, modeling, family therapy, token economies, self-help groups, assertive community treatment programs
Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 822
Psychological and Social Treatment
Behavioral Cognitive Social Interventions
Family Therapy Assertive Community Treatment Programs
Cross-Cultural Structural Social support Persuasive Clinical
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