Chapter 9 -- Schizophrenia

I. Characteristics of Schizophrenia

A. Diagnostic Symptoms (1% of adults)
1. Disturbance for six months with at least one month of active symptoms including two of the following.
2. Positive symptoms of Delusions (disturbances of thought, false beliefs of importance or ideas of reference)
or Hallucinations (disturbances in perception, hearing voices)
3. Disorganized symptoms of Disorganized Speech (disturbance of communication)
or Disorganized behavior (odd movements)
4. Negative symptoms (flat affect, lack of words, lack of motivation, and lack of pleasure)
5. Social and occupational dysfunction
B. Other Psychotic Disorders
1. Brief Psychotic Disorder (Psychotic symptoms of less than a month)
2. Schizophreniform Disorder (Psychotic symptoms of 1 to 6 months)
3. Schizoaffective Disorder (Psychotic symptoms and mood disorder)
4. Delusional Disorders
a. Erotomanic (A prominent person is in love with him or her)
b. Grandiose (Belief one is an extremely important person)
c. Jealous (Belief that one's partner is unfaithful)
d. Persecutory (Belief that one is a target of attack)
e. Somatic (Belief that one has a terminal illness)
5. Shared Psychotic Disorder (Development of a delusional system through close relationship with a psychotic person)
C. Gender and Age characteristics
1. Men develop the disorder between 18 and 25, women between 25 and 35
2. Women have more of the positive symptoms of delusions, hallucinations, and positive affect while men have the negative symptoms of flat affect and social withdrawal

II. Theoretical Causes and Treatments

A. Biological
1. Multiple genes combine to produce vulnerability (COMT gene affects executive functioning: planning, working memory, and problem solving)
2. Cortical atrophy (deterioration of cerebral cortex tissue, large ventricles, small hippocampus)
3. Dopamine hypothesis (oversensitive dopamine receptors)
4. Difficulty with sustained attention to stimuli
5. Poor smooth pursuit eye movements
6. Excessive event related potentials (unable to screen out stimuli)
7. Treatment with neuroleptics (Thorazine, Stelazine, Haldol, Prolixin have more serious side effects than Clozaril, Zyprexa, and Risperdal)
8. Danger of tardive dyskinesia for first-generation drugs (uncontrollable movements of the mouth, tongue, lips, fingers, arms, and legs)
B. Psychological
1. Disturbed behaviors are reinforced
2. People conform to labels
3. Social skills treatment and token economy
4. Cognitive-Behavioral Therapy focuses on low expectations for success or pleasure
5. Cognitive Enhancement Therapy focuses on attention, memory, and problem-solving
C. Sociocultural
1. Expressed emotion by family members who criticize or have overconcern
2. Environmental stressors such as poverty
3. Improve family communication and support
D. Factors with a more favorable prognosis
1. Prior good adjustment and acute onset at a later age
2. Being female with some mood disturbance
3. Compliance with medication
4. No family history of schizophrenia or mood disorders