PSY360: Abnormal Psychology-3rd week

DR. SUMAIRA KHURSHID TAHIRA

ASSOCIATE PROF

NNU, CHINA

Psychosis

 Psychosis is a state defined by a loss of contact with reality

The ability to perceive and respond to the environment is significantly

disturbed; functioning is impaired

Symptoms may include hallucinations (false sensory perceptions)

and/or delusions (false beliefs)

 Psychosis may be substance-induced or caused by brain injury, but most

psychoses appear in the form of schizophrenia

Schizophrenia

 Schizophrenia affects approximately 1 in 100 people in the world

About 2.5 million Americans currently have the disorder

 The financial and emotional costs are enormous

Sufferers have an increased risk of suicide and physical – often fatal –

illness

Schizophrenia

 Schizophrenia appears in all socioeconomic groups, but is found more

frequently in the lower levels

Leading theorists argue that the stress of poverty causes the disorder

Other theorists argue that the disorder causes victims from higher social

levels to fall to lower social levels and remain at lower levels

This is called the “downward drift” theory

Schizophrenia

 Equal numbers of men are women are diagnosed

The average age of onset for men is 21 years, compared to 27 years for

women

 Rates of diagnosis differ by marital status

3% of divorced or separated people

2% of single people

1% of married people

It is unclear whether marital problems are a cause or a result

The Clinical Picture of Schizophrenia

 Schizophrenia produces many “clinical pictures”

The symptoms, triggers, and course of schizophrenia vary greatly

Some clinicians have argued that schizophrenia is actually a group of

distinct disorders that share common features

What Are the Symptoms of Schizophrenia?

 Symptoms can be grouped into three categories:

Positive symptoms

Negative symptoms

Psychomotor symptoms

What Are the Symptoms of Schizophrenia?

Positive symptoms

• These “pathological excesses” are bizarre additions to a person's behavior

• Positive symptoms include:

• Delusions – faulty interpretations of reality

• Delusions may have a variety of bizarre content: being controlled by others; persecution; reference; grandeur; control

• Disordered thinking and speech

• May include loose associations, neologisms, perseverations, and clang

What Are the Symptoms of Schizophrenia?

Positive symptoms

• Loose associations (derailment):

• “The problem is insects. My brother used to collect insects. He's now a man 5 foot 10 inches. You know, 10 is my favorite number; I also like to dance, draw, and watch TV.”

• Neologisms (the use of nonsense words or making up words/ made-up words):

• “It is an amorition law” (see Comer’s book for detail)

What Are the Symptoms of Schizophrenia?

 Perseveration

Patients repeat their words and statements again and again

 Clang (rhymes):

How are you? “Well, hell, it's well to tell”

How's the weather? “So hot, you know it runs on a cot”

What Are the Symptoms of Schizophrenia?

Positive symptoms

• Heightened perceptions

• People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything important

• Hallucinations – sensory perceptions that occur in the absence of external stimuli (Most common are auditory)

• Seem to be spoken directly to, or overheard by, the hallucinator

• Hallucinations can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory

• Inappropriate affect – emotions that are unsuited to the situation

What Are the Symptoms of Schizophrenia?

Negative symptoms

• These “pathological deficits” are characteristics that are lacking in an individual

• Negative symptoms include:

• Poverty of speech (alogia)

• Reduction of quantity of speech or speech content

• May also say quite a bit but convey little meaning

What Are the Symptoms of Schizophrenia?

Negative symptoms

• Blunted and flat affect

• Show less emotion than most people

• Avoidance of eye contact

• Immobile, expressionless face

• Monotonous voice, low and difficult to hear

• Anhedonia – general lack of pleasure or enjoyment

What Are the Symptoms of Schizophrenia?

Negative symptoms

• Loss of volition (motivation or directedness)

• Feeling drained of energy and interest in normal goals

• Inability to start or follow through on a course of action

• Ambivalence – conflicted feelings about most things

• Social withdrawal

• May withdraw from social environment and attend only to their own ideas and fantasies

• Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people's needs and emotions

What Are the Symptoms of Schizophrenia?

Psychomotor symptoms

• People with schizophrenia sometimes experience psychomotor symptoms

• Awkward movements, repeated grimaces, odd gestures

• The movements seem to have a magical quality

• These symptoms may take extreme forms, collectively called catatonia

• Includes stupor (a state of near-unconsciousness or insensibility.), rigidity, posturing, and excitement

What Is the Course of Schizophrenia?

 Schizophrenia usually first appears between the late teens and mid-30s

 Many sufferers experience three phases:

Prodromal – beginning of deterioration; mild symptoms

Active – symptoms become apparent

Residual – a return to prodromal-like levels

One-quarter of patients fully recover; three-quarters continue to have

residual problems

What Is the Course of Schizophrenia?

 Each phase of the disorder may last for days or years

 A fuller recovery from the disorder is more likely in people:

With good premorbid functioning

Whose disorder was triggered by stress

With abrupt onset

With later onset (during middle age)

Who receive early treatment

Diagnosing Schizophrenia

Diagnosing Schizophrenia

 Many researchers believe that a distinction between Type I and Type II

schizophrenia helps predict the course of the disorder

Type I schizophrenia is dominated by positive symptoms

Seem to have better adjustment prior to the disorder, later onset of

symptoms, and greater likelihood of improvement

May be linked more closely to biochemical abnormalities in the brain

Type II schizophrenia is dominated by negative symptoms

May be tied largely to structural abnormalities in the brain

How Do Theorists Explain Schizophrenia?

 As with many other disorders, biological, psychological, and sociocultural

theorists have proposed explanations

Biological explanations have received the most research support

 A diathesis-stress relationship may be at work

People with a biological predisposition will develop schizophrenia only

if certain kinds of stressors or events are also present

Biological Views

 Genetic and biological studies of schizophrenia have dominated clinical

research in the last several decades

These studies have revealed the key roles of inheritance and brain

activity and have opened the door to important changes in treatment

Biological Views

Genetic factors

• Following the principles of a diathesis-stress approach, genetic researchers believe that some people inherit a biological predisposition to schizophrenia

• This disposition (and disorder) are triggered by later exposure to extreme stress

• This theory has been supported by studies of relatives, twins, and adoptees, and by genetic linkage studies and molecular biology

Biological Views

Genetic factors

• Family pedigree studies have repeatedly found that schizophrenia is more common among relatives of people with the disorder

• The more closely related they are to the person with schizophrenia, the greater their likelihood for developing the disorder

• General population: 1%

• Second-degree relatives: 3%

• First-degree relatives: 10%

• Factors other than genetics may explain these findings

Family Links

Biological Views

Genetic factors

• Twins have received particular research study

• Studies of identical twins have found that if one twin develops the disorder, there is a 48% chance that the other twin will do so as well

• If the twins are fraternal, the second twin has a 17% chance of developing the disorder

• Again, factors other than genetics may explain these findings

Biological Views

Genetic factors • Adoption studies have compared adults with schizophrenia, who

were adopted as infants, with both their biological and adoptive relatives

• Because they were reared apart from their biological relatives, similar symptoms in those relatives would indicate genetic influences; similarities to their adoptive relatives would suggest environmental influences

• Researchers have found that the biological relatives of adoptees with schizophrenia are more likely to display schizophrenic symptoms than are their adoptive relatives

Biological Views

Genetic factors

• Genetic linkage and molecular biology studies indicate that possible gene defects on numerous chromosomes may predispose individuals to develop schizophrenia

• These varied findings may indicate:

• A case of “mistaken identity” – that is, some of these gene sites do not contribute to the disorder;

• Different types of schizophrenia are linked to different genes; or

• Schizophrenia, like many disorders, is a polygenic disorder, caused by a combination of gene defects

Biological Views

Genetic factors

• Genetic factors may lead to the development of schizophrenia through two kinds of (potentially inherited) biological abnormalities:

• Biochemical abnormalities

• Abnormal brain structure

Biological Views

Biochemical abnormalities

• Over the past four decades, researchers have developed a dopamine hypothesis to explain their findings on schizophrenia:

• Certain neurons using dopamine fire too often, producing symptoms of schizophrenia

• This theory is based on the effectiveness of antipsychotic medications

Biological Views

Biochemical abnormalities

• Originally developed for treatment of allergies, antipsychotic drugs were found to cause a Parkinson's disease-like tremor response in patients

• Scientists knew that Parkinson's patients had abnormally low levels of dopamine, which caused their shaking

• This relationship between symptoms suggested that symptoms of schizophrenia were related to excess dopamine

Biological Views

Biochemical abnormalities

• Investigators have also located the dopamine receptors to which antipsychotic drugs bind

• The drugs are apparently dopamine antagonists that bind to the receptors, preventing dopamine binding and neuron firing

• These findings suggest that, in schizophrenia, messages traveling from dopamine-sending neurons to dopamine-receptors (particularly D-2) may be transmitted too easily or too often

• An appealing theory, because certain dopamine receptors are known to play a key role in guiding attention

Biological Views

Biochemical abnormalities

• Dopamine may be overactive in people with schizophrenia because of a larger-than-usual number of dopamine receptors (particularly D-2) or their dopamine receptors may operate abnormally

• Autopsy findings have found an unusually large number of dopamine receptors in people with schizophrenia

• Imaging studies have revealed particularly high occupancy levels of dopamine at D-2 receptors in patients with schizophrenia

Biological Views

Biochemical abnormalities

• Though enlightening, the dopamine hypothesis has certain problems

• It has been challenged by the discovery of a new type of antipsychotic drug (“atypical” antipsychotics), which are more effective than traditional antipsychotics and also bind to D-1 receptors and to serotonin receptors

Biological Views

 It has also been challenged by theorists who claim that excessive

dopamine activity contributes primarily to the positive symptoms of

schizophrenia

 These symptoms respond particularly well to conventional antipsychotic

drugs that bind to D-2 receptors

 Still other studies suggest that negative symptoms may be related to

abnormal brain structure, rather than to dopamine overactivity

Biological Views

Abnormal brain structure

• During the past decade, researchers have also linked schizophrenia (particularly cases dominated by negative symptoms) to abnormalities in brain structure

• For example, brain scans have found that many people with schizophrenia have enlarged ventricles – the brain cavities that contain cerebrospinal fluid

Biological Views

 This enlargement may be a sign of poor development or damage in related

brain regions

 People with schizophrenia have also been found to have smaller temporal

and frontal lobes, smaller amounts of grey matter, and abnormal blood

flow to certain brain areas

Biological Views

Viral problems

• A growing number of researchers suggest that the biochemical and structural brain abnormalities seen in schizophrenia result from exposure to viruses before birth

• Some of the evidence comes from animal model investigations and other is circumstantial

Biological Views

Viral problems

• Circumstantial evidence for this theory comes from the unusually large number of people with schizophrenia who were born in winter months

• More direct evidence comes from studies showing that mothers of children with schizophrenia were more often exposed to the influenza virus during pregnancy than mothers of children without schizophrenia

• Other studies have found a link between schizophrenia and a particular group of viruses found in animals, suggesting that people had at some point been exposed to those particular viruses

Biological Views

 While the biochemical, brain structure, and viral findings are beginning to

shed much light on the mysteries of schizophrenia, they offer only a

partial explanation

Some people who have these biological problems never develop

schizophrenia

Might be because biology sets the stage for the disorder, but

psychological and sociocultural factors must be present for it to

appear

Psychological Views

 When schizophrenia investigators began to identify genetic and biological

factors linked to schizophrenia, clinicians largely abandoned

psychological theories

During the past few decades, however, psychological factors are again

being considered important

Leading psychological explanations come from the psychodynamic,

behavioral, and cognitive perspectives

Psychological Views

 The psychodynamic explanation

 Freud believed that schizophrenia develops from two processes:

Regression to a pre-ego stage

Efforts to re-establish ego control

 He proposed that when their world is extremely harsh, people who develop

schizophrenia regress to the earliest points in their development (primary

narcissism), in which they recognize and meet only their own needs

This regression leads to self-centered symptoms such as neologisms, loose

associations, and delusions of grandeur

Psychological Views

 The psychodynamic explanation

 Freud's theory posits that attempts to reestablish ego control from such a state fail

and lead to further schizophrenic symptoms

 Years later, another psychodynamic theorist elaborated on Freud's idea of harsh

parents

The theory of schizophrenogenic mothers proposed that mothers of people with

schizophrenia were cold, domineering, and uninterested in their children's needs

 Both of these theories have received little research support and have been rejected

by most psychodynamic theorists

Psychological Views

 The behavioral view

 Behaviorists cite operant conditioning and principles of reinforcement as the cause

of schizophrenia

 They propose that some people are not reinforced for their attention to social cues

and, as a result, they stop attending to those cues and focus instead on irrelevant

cues (e.g., room lighting)

Their responses become increasingly bizarre yet are rewarded with attention

and, thus, are likely to be repeated

 Support for this model has been circumstantial and the view is considered (at best)

a partial explanation

Psychological Views

 The cognitive view

 Leading cognitive theorists agree that biological factors produce symptoms

 They argue that further features of the disorder emerge because of faulty

interpretation and a misunderstanding of symptoms

Example: a man experiences auditory hallucinations and approaches his friends

for help; they deny the reality of his sensations; he concludes that they are trying

to hide the truth from him; he begins to reject all feedback and starts feeling

persecuted

 There is little direct research support for this view

Sociocultural Views

 Sociocultural theorists believe that three main social forces contribute to

schizophrenia:

Multicultural factors

Social labeling

Family dysfunction

 Although these forces are considered important in the development of

schizophrenia, research has not yet clarified what their precise causal

relationships might be

Sociocultural Views

Multicultural Factors

Rates of the disorder differ between racial and ethnic groups

◼As many as 2.1% of African Americans are diagnosed, compared

with 1.4% of Caucasians

◼One possibility to explain this finding is that African Americans

are more prone to develop the disorder

Sociocultural Views

◼Yet another explanation may lie in the economic sphere

◼African Americans are more likely to be poor and, when

economic differences are controlled for, rates of schizophrenia

become closer

◼Consistent with the economic explanation, Hispanic

Americans who also are, on average, economically

disadvantaged, appear to have a much higher likelihood of

being diagnosed than White Americans

Sociocultural Factors

Multicultural Factors

Rates also differ between countries, as do the course and outcome of

the disorder

Some theorists believe the differences partly reflect genetic

differences from population to population

Others argue that the psychosocial environments of developing

countries tend to be more supportive than developed countries,

leading to more favorable outcomes for people with schizophrenia

Sociocultural Views

Social labeling

Many sociocultural theorists believe that the features of schizophrenia

are influenced by the diagnosis itself

Society labels people who fail to conform to certain norms of

behavior

Once assigned, the label becomes a self-fulfilling prophecy

The dangers of social labeling have been well demonstrated

Example: Rosenhan “pseudo-patient” study

Sociocultural Views

Family dysfunctioning

One of the best-known family theories of schizophrenia focuses on

double-bind communication:

Some parents repeatedly communicate pairs of mutually contradictory

messages that place the child in so-called double-bind situations; the

child cannot avoid displeasing the parents because nothing the child

does is right

In theory, the symptoms of schizophrenia represent the child's attempt

to deal with the double binds

Sociocultural Views

Family dysfunctioning

 Double-bind messages typically consist of a “primary” verbal communication and an accompanying contradictory nonverbal “metacommunication”

 According to the double-bind theory, a child repeatedly exposed to these

communications will adopt a special strategy for coping with them and may progress

toward paranoid schizophrenia

 This theory is closely related to the psychodynamic notion of a schizophrenogenic

mother

It has been similarly unsupported by research, but is popular in clinical practice

Sociocultural Views

Family dysfunctioning

A number of studies suggest that schizophrenia is often linked to family

stress:

Parents of people with the disorder often:

Display more conflict

Have greater difficulty communicating

Are more critical of and overinvolved with their children than

other parents

Sociocultural Views

Family theorists have long recognized that some families are high in “expressed emotion” – family members frequently express criticism

and hostility and intrude on each other's privacy

Individuals who are trying to recover from schizophrenia are

almost four times more likely to relapse if they live with such a

family

Sociocultural Views

 RD Laing's view

Most controversial explanation of schizophrenia

Argues that the disorder is actually a constructive process in which

people try to cure themselves of the confusion and unhappiness caused

by their social environment

Laing believed that, left alone to complete this process, people with

schizophrenia would indeed achieve a healthy outcome

Most theorists reject this notion; research has largely ignored it

Thanks