Ch. 12 Schizophrenia Spectrum Disorder
Please explain the Diathesis-Stress Model and then explain how it attempts to account for the development of schizophrenia? What evidence supports the model?
Please answer in a minimum of 500 words and use only your textbook and notes/memory from the in-class lecture to complete this assignment. Your word count should be included at the end of your writing.
* Module 12-Page 238 of fundamentals of Psychology
Schizophrenia Spectrum and Other Psychotic Disorders
Chapter 12
But first..
This content is all supplemental and pulled from sources outside of your text
You can refer to your text for further info, but please listen to lecture for real world experiences and explanations of these diagnoses/
Please watch the videos in this presentation
They are shown in the lecture with my commentary on each one
These videos show what it’s actually like to have schizophrenia or love someone who does. Some may be hard to watch, however these videos will play a role in our discussion this week and when we get to the final chapter, regarding Mental Illness and the law
This lecture is a little longer due to the videos, but I think it’s important to add my commentary and discuss what’s happening in the videos.
I will try to keep the rest of the lecture as brief as possible.
A Word on Schizophrenia
Today’s class is not meant to be funny or humorous.
I take this diagnosis very seriously; I will not tolerate disrespect toward individuals with schizophrenia
Please treat this topic with respect and understand that while behaviors may look funny or strange, these are real people with very real illnesses.
When we feel uncomfortable, some of us tend to laugh. Today you will need to control that laughter.
It’s possible there may be emotional moments today
Schizophrenia
Begging for help: https://youtu.be/aMrJUPN_OyM
What do you know about schizophrenia?
What have you seen?
What have your heard?
What have you experienced?
Schizophrenia Spectrum and Other Psychotic d/o
Schizophrenia is perhaps the most puzzling and disabling psychological disorder
It is the condition that best corresponds to popular conceptions of madness or lunacy
Although researchers are probing the psychological and biological foundations of schizophrenia, the disorder remains largely a mystery.
In this lecture, we consider what we know about schizophrenia and what remains to be learned.
It was a hot night in August 1976, the summer of my seventeenth year, when, uninvited and unannounced, the Voices took over my life.
I was going into my senior year in high school, so this was to be my last year at summer camp. College, a job, adulthood, responsibility—they were all just around the corner. But for the moment I wasn’t prepared for anything more than a summer of fun. I certainly wasn’t prepared to have my life change forever….
“You must die!” Other Voices joined in. “You must die! You will die!”
At first, I didn’t realize where I was. Was I at the lake? Was I asleep? Was I awake? Then I snapped back to the present. I was here at camp, alone. My summertime fling was long gone, two years gone. That long-ago scene was being played out in my mind, and in my mind alone. But as soon as I realized that I was in my bunk, and awake—and that my roommate was still sleeping peacefully—I knew I had to run. I had to get away from these terrible, evil Voices….
Since that time, I have never been completely free of those Voices. At the beginning of that summer, I felt well, a happy, healthy girl—I thought—with a normal head and heart. By summer’s end, I was sick, without any clear idea of what was happening to me or why. And as the Voices evolved into a full-scale illness, one that I only later learned was called schizophrenia, it snatched from me my tranquility, sometimes my self-possession, and very nearly my life.
Along the way I have lost many things: the career I might have pursued, the husband I might have married, the children I might have had. During the years when my friends were marrying, having their babies and moving into the houses I once dreamed of living in, I have been behind locked doors, battling the Voices who took over my life without even asking my permission.
Source: From Schiller & Bennett, 1994; “I Hear Something You Can’t Hear”
Simulation: Anderson Cooper tries a Schizophrenia Simulator
Schizophrenia
Schizophrenia is a chronic, debilitating disorder that touches every facet of the affected person’s life.
People with schizophrenia become increasingly disengaged from society.
They fail to function in the expected roles of student, worker, or spouse, and their families and communities grow intolerant of their deviant behavior
17 Self Portraits Of The Schizophrenic Artist Bryan Charnley! (Google it)
The paintings of Bryan Charnley (1949-1991) used visual metaphor and symbolism to vividly illustrate the physical experience of schizophrenia, an illness Charnley lived with from adolescence until his premature death in 1991.
Schizophrenia
Bryan Charnley, 23rd May,1991
"I really tire of having to explain my paintings. It is very much my tragedy that people cannot understand the straightforward poetic use of symbols I am employing. The blue of the portrait is there because I felt depressed through cutting back on the anti-depressants.
At this stage my central worry was thought broadcasting. This would pass as I gained insight and effects of drug withdrawal wore off. I was much worried about radio and television because I seemed to intertwine with their broadcasted waves and expose myself completely which I found humiliating. People laughed at me when this happened or let me know it was for real by acute remarks. I continued my retreat from social contact.“
Schizophrenia Spectrum Disorders
Schizophrenia is not the only type of psychotic disorder in which a person experiences a break with reality:
Brief psychotic disorder
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
These disorders along with schizophrenia and a type of personality disorder called schizotypal personality disorder are classified in the DSM-5 within a spectrum of schizophrenia-related disorders called Schizophrenia Spectrum and Other Psychotic Disorders.
Schizophrenia and Dissociative Disorders: Crash Course by Hank Green: https://youtu.be/uxktavpRdzU
By Clouded-and-Shadowed
Catatonia
A 24-year-old man had been brooding about his life. He professed that he did not feel well but could not explain his bad feelings. While hospitalized, he initially sought contact with people, but a few days later he was found in a statuesque position, his legs contorted awkwardly. He refused to talk to anyone and acted as if he couldn’t see or hear. His face was an expressionless mask.
A few days later, he began to talk, but in an echolalic or mimicking way. For example, he would respond to the question, “What is your name?” by saying, “What is your name?” He could not care for his needs and had to be fed.
Treatment
It was as if it [my brain] were draining out from the inside. My head had been filled with sticky stuff, like melted rubber or motor oil. Now all that sticky stuff was dripping out, leaving only my brain behind. Slowly I was beginning to think more clearly.
And the Voices? The Voices were growing softer. Were the Voices growing softer? They were growing softer! They began moving around, from outside my skull, to inside, to outside again. But their decibel level was definitely falling.
It was happening. I was being set free. I had prayed to find some peace, and my prayers were finally being answered…. I want to live. I want to live.
Mom who struggled to accept her son's schizophrenia talks about crisis services
Course of Development of Schizophrenia
Schizophrenia typically develops during late adolescence or early adulthood.
In some cases, the onset of the disorder is acute (it occurs suddenly, within a few weeks or months)
The individual may have been well adjusted and may have shown few signs of behavioral disturbance then, a rapid transformation in personality and behavior leads to an acute psychotic episode
In most cases, there is a slower, more gradual decline in functioning
Psychotic behaviors may emerge gradually over several years, although early signs of deterioration may be observed. This period of gradual deterioration is called the prodromal phase or prodrome.
Course of Development of Schizophrenia
The prodromal phase is characterized by subtle symptoms involving
Unusual thoughts
Abnormal perceptions (but not outright delusions or hallucinations)
Waning interest in social activities
Difficulty meeting responsibilities of daily living
Impaired cognitive functioning
Involving problems with memory and attention, use of language, and ability to plan and organize one’s activities
One of the first signs of a prodrome is often a lack of attention to one’s appearance.
A person may fail to bathe regularly or wear the same clothes repeatedly.
Over time, the person’s behavior becomes increasingly odd.
There are lapses in job performance or schoolwork
Speech becomes vague and rambling
Course of Development of Schizophrenia
Following acute episodes, some people with schizophrenia enter the residual phase
Behavior returns to the level of the prodromal phase
Flagrant psychotic behaviors are absent, but the person is still impaired by significant cognitive, social, and emotional deficits, such as:
a deep sense of apathy
difficulties in thinking or speaking clearly
harboring unusual ideas, such as beliefs in telepathy or clairvoyance
These cognitive and social deficits can make it difficult for patients with schizophrenia to function effectively in their social and occupational roles
Although schizophrenia is a chronic disorder, as many as one half to two-thirds of patients with schizophrenia improve significantly over time (USDHHS, 1999)
However, a full return to normal behavior is uncommon, although it does occur in some cases
Typically, patients develop a chronic pattern characterized by occasional acute episodes and continued cognitive, emotional, and motivational impairment between psychotic episodes
Key Features of Schizophrenia
Acute episodes of schizophrenia involve a break with reality marked by the appearance of symptoms such as:
Delusions
Hallucinations
Illogical thinking
Incoherent speech
Bizarre behavior
Art By Eric Baumann
Key Features of Schizophrenia
Between acute episodes, people may have lingering deficits, such as
being unable to think clearly
Speaking only in a flat tone
Difficulty perceiving facial expressions of emotion in others
Showing little if any facial expression of emotions
By 9SuperNova6
Key Features of Schizophrenia
Persistent deficits in cognitive and emotional functioning make it difficult for patients to meet responsibilities of daily life, including holding a job.
On a more positive note, 40% or more of schizophrenia patients have long periods of remission (i.e., no disturbing symptoms and ability to work in some capacity) that last a year or longer
We still lack specific predictors to know which patients are likely to do well on their own and which need to take their medication continually to reduce the risk of relapse
Schizophrenia affects about 1% of the world’s population, which in the United States translates to more than 2 million people
Nearly 1 million people are treated each year in the United States, with about a third of those requiring hospitalization.
Key Features of Schizophrenia
Men have a slightly higher risk of developing schizophrenia than women and also tend to develop the disorder at an earlier age
The peak period of life when psychotic symptoms first appear is the early to middle twenties for men and the late twenties for women
Women tend to have a higher level of functioning before the onset of the disorder and to have a less severe course of illness than men.
Men with schizophrenia tend to have more cognitive impairment, greater behavioral deficits, and a poorer response to drug therapy than do women with the disorder.
Gender differences have led researchers to speculate that men and women may tend to develop different forms of schizophrenia.
Perhaps schizophrenia affects different areas of the brain in men and women, which may explain the differences in the form or features of the disorder.
Key Features of Schizophrenia
DSM criteria for schizophrenia require that psychotic behaviors be present at some point during the course of the disorder and that signs of the disorder be present for at least six months and must have been active and prominent for at least one month (if not treated successfully).
People with briefer forms of psychosis receive other diagnoses, such as brief psychotic disorder
Note that the diagnosis of schizophrenia in the DSM-5 requires that at least two features of the disorder be present (not just an isolated delusional belief or hallucination) and that at least one of these features must include the cardinal symptoms of delusions, hallucinations, or disorganized (loosely connected, incoherent, or bizarre) speech.
Criteria for DSM 5
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
Delusions
Hallucinations
Disorganized speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms (i.e., diminished emotional expression or avolition)
Criteria for DSM 5
For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
Criteria for DSM 5
Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
Symptoms of Schizophrenia
Positive symptoms are atypical excesses of behavior involving a break with reality, include hallucinations and delusional thinking.
Negative symptoms are behavioral deficits or absences of typical behaviors and affect a person’s ability to function in daily life.
These include a lack of emotional responses or expression (maintaining a blank expression), loss of motivation, loss of pleasure in normally pleasant activities, lack of social relationships or withdrawal or isolation, and limited verbal expression (“poverty of speech”)
Negative symptoms tend to persist even when positive symptoms lessen and often have a greater effect on the person’s ability to adjusting to daily living than positive symptoms.
Negative symptoms are also less responsive than positive symptoms to antipsychotic drugs
Key Features of Schizophrenia
| Symptom | Description |
| Disturbed thought processes | Delusions (fixed false ideas) and thought disorder (disorganized thinking and incoherent speech) |
| Attentional deficiencies | Difficulty attending to relevant stimuli and screening out irrelevant stimuli |
| Perceptual disturbances | Hallucinations (sensory perceptions in the absence of external stimulation) |
| Emotional disturbances | Flat (blunted) or inappropriate emotion |
| Other types of impairments | Confusion about personal identity, lack of volition, excitable behavior or states of stupor, odd gestures or bizarre facial expressions, impaired ability to relate to others, or possible catatonic behavior or gross disturbance in motor activity and orientation in which a person’s behavior may slow to a stupor but then abruptly shift to a highly agitated state |
Aberrant Content of Thought
Delusions involve disturbed content of thought in the form of false beliefs that remain fixed in a person’s mind despite their illogical bases and lack of evidence to support them.
They tend to remain unshakable even in the face of disconfirming evidence.
Delusions may take many forms. Some of the most common types include the following:
Delusions of persecution or paranoia (e.g., “The CIA is out to get me”)
Delusions of reference (“People on the bus are talking about me,” or “People on TV are making fun of me”)
Delusions of being controlled (believing that one’s thoughts, feelings, impulses, or actions are controlled by external forces, such as agents of the devil)
Delusions of grandeur (believing oneself to be Jesus or believing one is on a special mission, or having grand but illogical plans for saving the world)
Other commonly occurring delusions
Thought broadcasting (believing one’s thoughts are somehow transmitted to the external world so that others can overhear them)
A 21-year-old student reported, “As I think, my thoughts leave my head on a type of mental ticker tape. Everyone around has only to pass the tape through their mind and they know my thoughts.”
Thought insertion (believing one’s thoughts have been planted in one’s mind by an external source)
A 29-year-old housewife reported that when she looks out of the window, she thinks, “The garden looks nice and the grass looks cool, but the thoughts of [a man’s name] come into my mind. There are no other thoughts there, only his…. He treats my mind like a screen and flashes his thoughts on it like you flash a picture.”
Thought withdrawal (believing that thoughts have been removed from one’s mind). Mellor (1970) offers the following examples:
A 22-year-old woman experienced the following: “I am thinking about my mother, and suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor, and there is nothing in my mind, it is empty.”
Perceptual Disturbances
The most common perceptual disturbances in schizophrenia are hallucinations, which are sensory perceptions experienced in the absence of external stimulation.
Hallucinations may involve various senses.
Auditory hallucinations are the most common form of hallucination, affecting about 75% of patients with schizophrenia
Tactile hallucinations (such as tingling, electrical, or burning sensations) and somatic hallucinations (such as feeling like snakes are crawling inside one’s belly) are also common.
Visual hallucinations
Gustatory hallucinations (tasting things that are not present)
Olfactory hallucinations (sensing odors that are not present) are rare
Causes of Hallucinations
The causes of psychotic hallucinations remain unknown, but speculations abound. Disturbances in brain chemistry are suspected.
The neurotransmitter dopamine is implicated, largely because antipsychotic drugs that block dopamine activity also reduce hallucinations.
Conversely, drugs that lead to increased production of dopamine, such as cocaine, can induce hallucinations.
Because hallucinations resemble dreamlike states, they may be connected to a failure of brain mechanisms that normally prevent dream images from intruding on waking experiences.
Investigators find that the auditory cortex becomes active during auditory hallucinations in the absence of real sounds
Auditory hallucinations may be a form of inner speech that for unknown reasons becomes attributed to external sources rather than to one’s own thoughts
Biological Factors
In a study of people who were given up for adoption, adoptees whose biological mothers had schizophrenia and who had been raised in a disturbed family environment were much more likely to develop schizophrenia or another psychotic disorder than were any of the other groups in the study:
Of adoptees whose biological mothers had schizophrenia (high genetic risk) and who were raised in disturbed family environments, 36.8% were likely to develop schizophrenia.
Of adoptees whose biological mothers had schizophrenia (high genetic risk) and who were raised in healthy family environments, 5.8% were likely to develop schizophrenia.
Of adoptees with a low genetic risk and who were raised in disturbed family environments, 5.3% were likely to develop schizophrenia.
Of adoptees with a low genetic risk and who were raised in healthy family environments, 4.8% were likely to develop schizophrenia (Tienari et al., 2004).
Biological Factors
Generally speaking, the more closely one is related to people who have developed schizophrenia, the greater the risk of developing schizophrenia oneself.
Monozygotic (MZ) or identical twins, whose genetic heritages are identical, are much more likely than dizygotic (DZ) or fraternal twins, whose genes overlap by 50%, to be concordant for schizophrenia.
Diathesis-Stress Model
Several lines of evidence support the diathesis-stress model.
One is the fact that schizophrenia tends to develop in late adolescence or early adulthood, around the time that young people typically face the increased stress associated with establishing independence and finding a role in life.
Other evidence shows that psychosocial stress, such as expressed emotion (EE), worsens symptoms in people with schizophrenia and increases risks of relapse.
EE: a pattern of responding to the family member with schizophrenia in hostile, critical, and unsupportive ways
People with schizophrenia who live in a high EE family environment have mor