Psychology Column | Psychopathology | Chapter 8 | Schizophrenia II: Explanations and Treatments

This is an informative chapter about schizophrenia (explanations and treatments). None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Explanations for Schizophrenia

Psychodynamic explanations:

1. Problems with child-rearing;
Mothers behaving inconsistently overprotective and rejective. Child confused about what is “real”.
Once popular but now discredited.

2. Stress;
Is not a cause but contributes to schizophrenia.

Learning explanations:

1. Rewards and symptoms;
People with schizophrenia use abnormal behaviors to get rewards (attention).
Overly simplistic.

2. Labels, roles, and expectations;
A Label could lead to behave abnormally.
A blurring of the distinction between listening to her thoughts and hearing voices. A label can influence others’ interpretation of the behavior.
The role of being “schizophrenic” permits a wide variety of behaviors than the role of being “normal”.
Sensory deprivation test implicit suggestion and panic button may cause symptoms.

Cognitive explanations:

Turn our thinking of schizophrenia upside down.

1. Unusual sensory experiences;
Hallucinations: Stimulus overload and to make sense of it “fill in the blanks”.
Delusions: Some may have different sensory experiences and these may lead to different beliefs about the world
Example: Loss of hearing = whispering.

2. Distraction;

Intellectual decline and language problems are due to the intrusion of irrelevant thoughts that distract the individuals and disrupt their thought processes.

Associative intrusions;

1. Semantic intrusion:
   An alternative meaning for a particular word introduces a new word (strong association/weak association).
2. Thought content intrusion:
   A word reminds a different topic.
3. Clang associations:
   Associative intrusion based on a sound of a word.
4. Habit strength intrusions:
   Words commonly used together.

Physiological explanations:

1. Problems with neurotransmitters;

The dopamine explanation:

Dopamine lead to high levels of activity in the brain and that high activity then disrupts cognitive functioning and causes symptoms positive symptoms (psychosis, disorganized thought processes)

Evidence for the dopamine explanation;

1. Decreasing dopamine reduces symptoms (antipsychotics)
2. Increasing dopamine increases symptoms (amphetamines, L-Dopa)
3. More dopamine receptors more symptoms.

The serotonin explanation:

Low levels of serotonin and high levels of dopamine lead to positive symptoms.
Low levels of serotonin cause depression and lead to negative symptoms.

High neurological activity and symptom:

The prefrontal cortex: Information from different parts of the brain is integrated and where thought processes occur.
High and low levels of activity cause symptoms.
The temporal cortex: Memories for auditory and visual experiences are stored.
High levels of activity cause symptoms.

2. Problems with brain development and activity;

Neurodevelopmental theory of schizophrenia:

Problems with brain structures: Reversed hemispheric dominance failure of neural migration.
Cortical atrophy (prefrontal/temporal cortex).
Subcortical atrophy (hippocampus, thalamus, amygdala).

Problems with brain under activity:
The prefrontal cortex is underactive: hypofrontality.

3. Genetic factors:

Biologic relatives, twins (MZ - DZ) and adoptive parents.
Probably account for less than 10% of schizophrenia.

4. Biological traumas;

a.) Prenatal complications:
Problems in the fetal brain development.
Season of birth effect (born in late winter) flu in the second trimester of pregnancy.
Probably account for 5-10% of schizophrenia.

b.) Perinatal complications:
Prolonged or difficult labor.
Oxygen deprivation (anoxia).
High blood pressure (preeclampsia).

Summary of explanations:

• Positive symptoms are due to high levels of activity in the prefrontal cortex and temporal cortex. High levels of activity are linked to the dopamine and serotonin.
• Negative symptoms are due to structural problems in the prefrontal cortex and temporal cortex, hippocampus, thalamus, amygdala. These structural problems are due to reversed hemispheric dominance, the failure of neural migration, atrophy.
• Negative symptoms are also related to low brain activity.

Treatments for Schizophrenia

Physiological treatments:

1. Drug treatment;

Neuroleptics: to reduce the high level of neurological activity.
Neuroleptics;

1. Block the receptors on post-synaptic dopamine neurons (wrong key in a lock).
2. Reduce the sensitivity of the post-synaptic receptors (delayed effect).
3. Increase the level of serotonin inhibits the activity of dopamine.

3 Types of Neuroleptics;

Low potency (the 1950’s):
Effective for positive symptoms, ineffective for negative symptoms.
80% dopamine blockage. Chlorpromazine, Thioridazine.

High potency (the 1970’s):
Effective for positive symptoms, ineffective for negative symptoms.
85% dopamine blockage. High muscular side effects. Use antiparkinsonian drugs. Haloperidol.

Atypical:
Effect on both positive and negative symptoms.
65% dopamine blockage. More selective dopamine blockage (D-2). (fewer on D-1 receptors, the tracts of muscle movements). Increase serotonin levels. Clozapine. Side effect on leukocytes (2%). Risperidone, Olanzapine. Fewer side effects.

Neuroleptics side effects:

• Salivation, weight gain, dry mouth etc.
• Muscle activity; tremors, shaking, jerking (dopamine is responsible for motor activity, basal ganglia).
• Tardive dyskinesia.
• Akathisia.
• Malignant neuroleptic syndrome.

2. Psychosurgery;

Prefrontal lobotomy (1935-1955).
Transorbital lobotomy (1948).

High side effects and abused.

Cognitive treatment (psychoeducation):

Social skills training;

• Education of the patient and the family.
• Education to reduce the stress that can lead to symptoms.
• Coping with the symptoms.

Effective in reducing symptoms and cost-effective.

Learning treatment (behavior therapy):

Decreasing rewards for abnormal behavior and increasing rewards for normal behavior.

Token economy approach;

• Effective on overt behaviors.
• Ineffective on cognitive processes and emotional responses.

Psychodynamic treatment (psychotherapy):

Not effective in treatment.

Patient Story

Source: American Psychiatric Association

Myles was a 20-year-old man who was brought to the emergency room by the campus police of the college from which he had been suspended several months ago. A professor had called and reported that Myles had walked into his classroom, accused him of taking his tuition money and refused to leave.

Although Myles had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. His sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from his room and ask his family to be quiet even when they were not making any noise.

Myles began talking about organized crime so often that his father and sister brought him to the emergency room. On exam there, Myles was found to be a poorly groomed young man who seemed inattentive and preoccupied. His family said that they had never known him to use drugs or alcohol, and his drug screening results were negative. He did not want to eat the meal offered by the hospital staff and voiced concern that they might be trying to hide drugs in his food.

His father and sister told the staff that Myles’ great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Myles’ mother left the family when Myles was very young. She has been out of touch with them, and they thought she might have been treated for mental health problems.

Myles agreed to sign himself into the psychiatric unit for treatment. His story reflects a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible. In the case of Myles, he was having persecutory delusions, auditory hallucinations and negative symptoms that had lasted for at least one year. All of these symptoms fit with a diagnosis of schizophrenia. It is key for the treating doctor to quickly rule out other causes of the problem, such as substance use, a head injury or a medical illness. Treatment for these conditions differs from that for schizophrenia and may be lifesaving.

Table of Contents

1.Introduction and Historical Issues
Normality and Abnormality in Clinical Psychopathology
2.Diagnostic Systems and Techniques
Interviews, Observations and Tests
3.Anxiety Disorders I
Symptoms of Anxiety, Phobic Disorders, Generalized Anxiety Disorders, Panic Disorder
4.Anxiety Disorders II
Obsessive-Compulsive Disorders, Post-Traumatic and Acute Stress Disorders.
5.Mood Disorders I
Major Depressive Disorder and Dysthymia.
6.Mood Disorders II
Bipolar Disorder and Cyclothymic Disorder.
7.Schizophrenia I
Symptoms and Issues.
8.Schizophrenia II
Explanations and Treatments.
9.Disruptive Behavior Disorders-I
Attention Deficit/Hyperactivity Disorder.
10.Disruptive Behavior Disorders-II
Conduct Disorder and Oppositional Defiant Disorder.
11.Pervasive Development Disorders
Autistic Disorder, Asberger`s and other Developmental Disorders.
12.Elimination Disorders and Tic Disorder.
13.Mental Retardation.
14.Cognitive Disorders
Amnesia Disorders, Dementia Disorders, Delirium Disorders.
15.Suicide.
16.Substance-related disorders.
17.Sexual Dysfunctions.