Psychotic disorder: Schizophrenia

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ABC America

Schizophrenia Defined

Psychosis: loss of contact with reality

Schizophrenia is type of psychotic disorder characterised by:

- disturbances of thinking (delusions & hallucinations)

- disorganised thoughts & behaviour

- unusual emotions

Biological Contributing Factors

Genetic Predisposition

Drug Induced Onset

Changes in brain activity

Genetic Predisposition

Essentially means that family members of those suffering from schizophrenia have a tendency to develop the

disorder. This does not mean they will!

Research has found that the closer the relation - the higher the tendency is to develop the disorder

Unrelated person in general population - 1%Identical twins - 48%

Drug Induced Onset

The use of certain drugs particularly those that manipulate the brains use of the chemical Dopamine has been shown to lead to mental

health problems.

Such drugs include: Hallucinogens (LSD), Stimulants (amphetamines, cocaine, ecstasy), Phencyclidine (PCP), and Cannabis (marijuana)

Some mimic the effect of positive symptoms and can result in a first psychotic episode

If experience symptoms whilst under influence of drugs - then is referred to as a drug-induced psychosis or in DSM substance induced

psychotic disorder.

Changes in brain activity

Dopamine theory: schizophrenia is caused by too much dopamine in the brain

Enlarged ventricles: Patients of schizophrenia show a loss of brain tissue in the brain (see figure 21.32 of text p 523)

involved in emotions, thinking and information processing.

Prefrontal cortex activity: Hypofrontality - patients of schizophrenia show a reduced level of brain activity in the

prefrontal area of the brain

Biological Management

Dopamine-blocking medication - dopamine antagonists -

block dopamine activity at the synapse

According to the dopamine theory or dopamine hypothesis - schizophrenia is caused by the release of too

much dopamine in the brain.

Anti-psychotic medications (aka anti psychotics and neuroleptics) are designed to reduced the level of

dopamine and thus relieve patients of positive symptoms.

Psychological Contributing Factors

Impaired Reasoning Impaired Memory

Impaired Reasoning

Reasoning involves goal-directed thinking

When we engage in reasoning we use what we already know to understand and interact with the present situation

There are many types of reasoning, however the type that is found to influence schizophrenia sufferers is probabilistic

reasoning

Probabilistic reasoning involves making judgements related to the probability of its occurrence

Linked with the development and persistence of delusions

Impaired Memory

Extensive research has shown individuals suffering from schizophrenia usually have some degree of mental

impairment

This is consistent with the idea of schizophrenia being a brain disorder

Aleman et el (1999) findings revealed memory impairment to be wide-ranging with significant impairments of short-term (working) memory and long-term memory. Severity,

time since diagnosis or age did not alter degree of memory impairment.

Psychological Management

CBT - Cognitive Behavioural TherapyAims to change the thinking of patients, in particular - question there judgements related to their delusions. Linked with probabilistic reasoning. Can also assist with negative symptoms such as anhedonia by shifting ones thinking about the enjoyment of an activity.

CRT - Cognitive Remediation TherapyFocuses on improving cognitive functions - in particular, improve working memory, language, problem-solving and attention by completing cognitive training tasks.

Stress managementInvolves the use of various techniques to alleviate or cope with the effects of stress, usually for the purpose of everyday functioning. Such techniques explored in stress (biofeedback, mediation, physical exercise etc.) are also helpful for those suffering from schizophrenia

Social Contributing Factors

*Social Disadvantages*Trauma

*Psycho-social Stress

Risk Factors Protective Factors

*Psycho-education*Supportive Social

Environments*Removal of Social

Stigma

Social Disadvantages

Involves the range of difficulties that block life opportunities and prevent people from participating within society

Socio-economic status is commonly used to measure ones social stance

Social Causation Hypothesis suggests members of a lower socio-economic class can trigger the development or onset of schizophrenia, one reason being they are exposed to higher levels of stress in

their environment.

Social Drift Hypothesis (aka downward drift hypothesis) suggests low socio-economic status and therefore social disadvantage is a result or consequence of schizophrenia. A person’s onset of

schizophrenia occurs first, resulting in their ‘drifting downward’ to the lowest socio-economic group.

(Research supports both hypotheses)

Low Socio-economic Status(social disadvantage)

schizophrenia

Low Socio-economic Status(social disadvantage)

schizophrenia

Trauma

Trauma refers to an event that a person experiences, witnesses or confronts that is extremely distressing and to which the person’s

response involves intense fear, helplessness or horror.

Many research studies have found a relationship between the experience of trauma and development or onset of schizophrenia

Shevlin et el. (2008) found that participants that reported more than one experience of trauma significantly increased the

likelihood of psychosis

This does not mean trauma causes schizophrenia!

Psycho-social Stress

Schizophrenia is not a stress-related disorder nor can stress cause schizophrenia however research findings suggest the family environment can pose a risk for the

development of schizophrenia.

Research is inconclusive if families with high expressed emotion causes schizophrenia or if it is a response to living

with a person with schizophrenia

Protective Factors: Social Management

Supportive environments Includes friends and family whom offer support, advice and understanding to assist in the presence of stressors

Psycho-education Educate people about the illness. Helpful for both patients and carers with an understanding of what is characteristic of symptoms and how to manage the experience

Removal of Social Stigma Due to a grave misunderstanding of schizophrenia, a negative attitude toward the illness has developed. This can have a negative impact on an individual suffering from schizophrenia, making them feel even more excluded from society. By removing the negative stigma, it encourages understanding and acceptance of schizophrenia.

BioPsychoSocial Approach

Vulnerability theory

Describes how biological, psychological and social factors interact

Four points 1. Susceptibility to the illness is biological2. Different people have different levels of vulnerability3. Susceptibility dependent on genetics and abnormalities4. Psychological and socio-cultural factors can influence a person’s vulnerability

Someone’s vulnerability, mixed with stress, can lead to schizophrenia