Hooley 18e PPT CH13

Abnormal Psychology
Eighteenth Edition, Global Edition
Chapter 13
Schizophrenia and Other
Psychotic Disorders
Copyright © 2021 Pearson Education Ltd.

Learning Objectives (1 of 2)
13.1 Describe the prevalence of schizophrenia and who is
most affected.
13.2 Identify the symptoms of schizophrenia as described

in DSM-5.
13.3 List four different types of psychotic disorders and

state one way in which each is different from
schizophrenia.
13.4 Explain the genetic and biological risk and causal

factors associated with schizophrenia.

Learning Objectives (2 of 2)
13.5 Discuss how the brain is affected in schizophrenia.
13.6 Explain the psychosocial and cultural factors

associated with schizophrenia.
13.7 Describe the clinical outcome of schizophrenia and

how is it treated, noting the advantages and disadvantages
associated with the use of antipsychotic medications.

Schizophrenia (1 of 2)
Learning Objective 13.1: Describe the prevalence of schizophrenia and who is most
affected.
• Psychosis significant loss of contact with reality

– Hallmark of schizophrenia
Origins of the Schizophrenia Construct

• First clinical description appeared in 1810
• Emil Kraepelin (1896) used term dementia praecox to
refer to mental deterioration at early age
• Eugen Bleuler introduced term “schizophrenia” in 1911
– From Greek meaning “to split or crack” and “mind”
– Not the same as multiple personalities

Schizophrenia (2 of 2)
Epidemiology
• Lifetime prevalence just under 1%
• Age of father (over 50)
• Parent in dry cleaning business
• First- and second-generation immigrants
– Particularly those from black Caribbean and black African
countries who live in majority white communities
• Onset: ages 18-30

• More common and more severe in men

Figure 13.1 Onset of Schizophrenia
Age distribution of onset of schizophrenia (first sign of mental disorder) for men and women.

Clinical Picture (1 of 5)
Learning Objective 13.2: Identify the symptoms of schizophrenia as described in DSM-5.
Delusions
• Delusions are an erroneous belief that is fixed and firmly
held despite clear contradictory evidence
– Disturbance in the content of thought
• Examples:
– Being controlled by external agents
▪ Private thoughts are being broadcast to others
▪ Thoughts have been inserted by external agency
▪ Thoughts withdrawn by external agency
– Neutral environmental event (T.V., radio) have special meaning
intended for one person
– Delusions of bodily changes or removal of organs
Hallucinations
• A hallucination is a sensory experience that seems real
to the person having it, but occurs in the absence of any
external perceptual stimulus
– Can occur in any sensory modality
– Auditory are most common
• Patients become emotionally involved with hallucinations

– Incorporate them into delusions

Video: Larry: Schizophrenia
Click on the screenshot to view this video.

Disorganized Speech
• Disorder in thought form
– Delusions are a disorder of thought content
• Fail to make sense even though they are using language

in a conventional way
– Words and combinations sound communicative
– Listener is left with a lack of understanding
– May make up new words (neologisms)

Disorganized Behavior
• Impairment of goal-directed activity
• Occurs in areas of daily functioning
– Examples: hygiene, silliness or unusual dress
• Catatonia involves almost no movement at all,

sometimes in an unusual posture
• Catatonic stupor a virtual absence of all movement and
speech

Negative Symptoms
• Positive symptoms excess or distortion in normal
behavior and experience
• Negative symptoms reflect an absence or deficit of
normally present behaviors
– Two domains
– Reduced expressive behavior
▪ Voice, facial expression, speech
▪ Blunted or flat affect, or alogia (little speech)
– Reductions in motivation or experience of pleasure
▪ Avolition: the inability to initiate or persist in goal-directed activity
– Presence of negative symptoms is not a good sign

Other Psychotic Disorders (1 of 2)
Learning Objective 13.3: List four different types of psychotic disorders and state one
way in which each is different from schizophrenia.
Schizoaffective Disorder
• Features of schizophrenia and severe mood disorder
• Diagnostic criteria revised in DSM-5 to improve reliability
Schizophreniform Disorder
• Schizophrenia-like psychoses lasting at least 1 month but
less than 6 months
• Do not warrant a schizophrenia diagnosis

Other Psychotic Disorders (2 of 2)
Delusional Disorder
• Delusional beliefs with otherwise normal behavior
• Erotomania delusion involves great love for a person,
usually of higher status
Brief Psychotic Disorder
• Sudden onset of psychotic symptoms or disorganized
speech or catatonic behavior

Genetic and Biological Factors (1 of 6)
Learning Objective 13.4: Explain the genetic and biological risk and causal factors
associated with schizophrenia.
Genetic Factors
• Disorders of the schizophrenia type are “familial”—tend
to “run in families”
– The prevalence of schizophrenia in the first-degree relatives
(parents, siblings, and offspring) is 10 percent
– Second-degree relatives who share only 25 percent of their
genes is closer to 3 percent
• Familial and genetic are not synonymous

– A disorder can run in families for nongenetic reasons

Figure 13.2 Risk of Developing
Schizophrenia by Genetic Relationship
Lifetime age-adjusted, averaged risks for the development of schizophrenia-related

psychoses in classes of relatives differing in their degree of genetic relatedness.

TWIN STUDIES
• Schizophrenia concordance rates for identical twins (28%) are
higher than those for fraternal twins or ordinary siblings (6%)
– If only genetic, the rate would be 100% between identical twins
– Genes are not the whole story
ADOPTION STUDIES
• Higher rates of schizophrenia among adopted children of
schizophrenic biological parents
THE QUALITY OF THE ADOPTIVE FAMILY
• Children at high genetic risk who were raised in healthy family
environments did not develop problems any more frequently
than did children at low genetic risk
– Evidence of genotype–environment interaction in schizophrenia
MOLECULAR GENETICS
• Schizophrenia probably involves many genes working together
Prenatal Exposures
VIRAL INFECTION
• Elevated rates of schizophrenia in children born to mothers who had
been in their second trimester of pregnancy at the time of the
influenza epidemic
RHESUS INCOMPATIBILITY
• Mechanism involves oxygen deprivation, or hypoxia—risk for
schizophrenia linked to birth complications
• Rh-incompatibility between the mother and fetus may increase the
risk of brain abnormalities
PREGNANCY AND BIRTH COMPLICATIONS
• Many delivery problems (breech delivery, prolonged
labor, or the umbilical cord around the baby’s neck) affect
the newborn’s oxygen supply
EARLY NUTRITIONAL DEFICIENCY
• Schizophrenia might be caused or triggered by
environmental events
MATERNAL STRESS
• Extremely stressful event late in 1st trimester/early in 2nd
trimester of pregnancy increases schizophrenia risk

Genes and Environment in Schizophrenia: A
Synthesis
• The focus on MZ concordance rates causes an
overestimate of the heritability of schizophrenia
– Chorionic arrangements could mean different environments
– Around two-thirds of MZ embryos are monochorionic—share a
placenta and blood supply
• Genetic liability to schizophrenia may predispose an

individual to suffer more from the environment than those
without the genetic predisposition

A Neurodevelopmental Perspective
• The stage is set for schizophrenia early in life
– Problems may not appear until the brain is mature
• Research focuses on those showing prodomal—very

early signs of schizophrenia
• Attenuated psychosis syndrome is not part of DSM-5
as a disorder in need of further study

Structural and Functional Brain
Abnormalities (1 of 6)
Learning Objective 13.5: Discuss how the brain is affected in schizophrenia.
Neurocognition
• Cognitive impairment is a core feature of schizophrenia
– Apparent even before there is a diagnosable illness
• Lower IQ may be a risk factor; higher IQ may be

protective in some way
• Patients with schizophrenia are not able to respond to a
stimulus as quickly and appropriately
• Deficits are apparent in the earliest stages of visual and
auditory processing

Social Cognition
• Social cognition: how we recognize, think about, and
respond to social information, including the emotions and
intentions of others
• People with schizophrenia show significant impairments
in social cognition
– Failure to spot the kinds of subtle (or not so subtle) social hints
– Difficulty recognizing emotion in faces and emotion being
conveyed in speech

Loss of Brain Volume
• Patients with schizophrenia have enlarged brain
ventricles
– Males more affected than females
– Indicator of a reduction in brain tissue
• Decrease in brain volume is present very early in the

illness
• Progressive brain deterioration continues for many years

Affected Brain Areas
• Reductions in the volume of regions in the frontal and
temporal lobes
– More specifically, in the volume of medial temporal areas: the
amygdala, the hippocampus, and the thalamus
• Brain structure is abnormal, but the abnormality is linked

to:
– Stage of illness
– Use of medications
– Other factors

White Matter Problems
• White matter is crucially important for the connectivity of
the brain
– White matter abnormalities have been shown to be correlated
with cognitive impairments
• Patients have reductions in white matter volume as well

as structural abnormalities in the white matter itself
– Abnormalities are found in first-episode patients and in people
at genetic high risk for the disorder
– Dysconnectivity: abnormal integration between distinct brain
regions, particularly those involving the frontal lobes

Figure 13.8 The Brain in Schizophrenia
Many brain regions and systems operate abnormally in schizophrenia, including those
highlighted here.

Brain Development in Adolescence
• Major brain changes take place during adolescence, as
the brain matures
– If problems occur, schizophrenia may be the result
• People who were in the hospital for a head injury have a

65 percent increase risk for schizophrenia
– If a head injury occurs between the ages of 11 and 15, the risk
of schizophrenia is increased by 85 percent

Psychosocial and Cultural Aspects (1 of 6)
Learning Objective 13.6: Explain the psychosocial and cultural factors associated with
schizophrenia.
Do Bad Families Cause Schizophrenia?

• Popular theories in the past blaming the family do not
have empirical support
• If the child is not at genetic risk for schizophrenia,
adverse family environments and communication
deviance have little consequence

Families and Relapse
• Expressed emotion (EE): a measure of the family
environment based on how a family member speaks
about the patient during a private interview with a
researcher
– Three main elements: criticism, hostility, and emotional
overinvolvement (EOI)
• High-EE home environment more than doubles the

chance of a relapse
– Especially strong for chronically ill patients
• Researchers are still trying to understand how EE affects

the brain
Urban Living
• One study showed children who spend the first 15 years
of life in an urban setting were 2.75 times more likely to
develop schizophrenia than those in rural settings
• It is estimated if we all lived in relatively rural settings the
number of schizophrenia cases could decrease by 30%

Immigration
• Recent immigrants have a much higher risk
• There is no evidence that this can be explained by
cultural misunderstandings
• Immigrants with darker skin have a much higher risk of
developing schizophrenia than those with lighter skin
• Healthy people who feel discriminated against are more
likely to develop psychotic symptoms than healthy people
who do not perceive any discrimination

Cannabis Use and Abuse
• People with schizophrenia are twice as likely to smoke
cannabis as people in the general population
– This could be a correlate and not a cause
– The majority of cannabis users never develop schizophrenia
• Cannabis may accelerate the progressive brain changes

that seem to go along with schizophrenia

Figure 13.10 Brain Volume Changes over
5 Years in Patients with Schizophrenia
and Healthy Comparison Subjects
Patients with schizophrenia who also use
cannabis show more loss of gray matter
over the course of a 5-year follow-up than
patients who do not use cannabis or
healthy controls.

A Diathesis-Stress Model of Schizophrenia
• Biological factors play a role
– Genetic predispositions is shaped by environmental factors
such as prenatal exposures, infections, and stressors
• No simple answer to what causes schizophrenia

– Genetics and environment combine in such a way that brain
pathways develop abnormally

Table 13.2 Nongenetic Risk Factors
for Schizophrenia
Nongenetic Risk Factor
Older father
Virus exposure
Obstetric complications
Urban upbringing
Head injury
Cannabis use
Migrant status

Figure 13.11 A Diathesis–Stress
Model of Schizophrenia
Genetic factors and acquired constitutional factors (such as prenatal events and birth
complications) combine to result in brain vulnerability. Normal maturational processes,
combined with stress factors (family stress, cannabis use, urban living, immigration, etc.),
may push the vulnerable person across the threshold and into schizophrenia.

Treatments and Outcomes (1 of 4)
Learning Objective 13.7: Describe the clinical outcome of schizophrenia and how it is
treated, noting the advantages and disadvantages associated with the use of
antipsychotic medications.
Clinical Outcome
• Around 38% of patients have a favorable outcome and
can be thought of as being recovered 15 to 25 years after
development of the disorder
– They do not return to how they were before they became ill
• Around 12 percent of patients need long-term

institutionalization
• Around one-third show signs of continued negative
symptoms

Pharmacological Approaches
FIRST-GENERATION ANTIPSYCHOTICS
• Block the action of dopamine
SECOND-GENERATION ANTIPSYCHOTICS
• Fewer extrapyramidal symptoms
OTHER APPROACHES
• Researching the role of estrogen

Figure 13.12 Estrogen Treatment
and Positive Symptoms
Positive symptoms at baseline (day 0) and on days 7, 14, 21, and 28 for the estrogen
and placebo groups.

THE PATIENT’S PERSPECTIVE
• Not all patients benefit from antipsychotic medications
• May show clinical improvement but still need help
• Side effects may lead patients to discontinue taking the
medication
• Some patients may try to avoid taking medications
because, to them, needing to take medications confirms
that they are mentally ill

CASE MANAGEMENT
FAMILY THERAPY
PSYCHOEDUCATION
SOCIAL-SKILLS TRAINING
COGNITIVE REMEDIATION
COGNITIVE-BEHAVIOR THERAPY
EXERCISE

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Abnormal Psychology

Eighteenth Edition, Global Edition

Copyright © 2021 Pearson Education Ltd.

13.2 Identify the symptoms of schizophrenia as described

13.3 List four different types of psychotic disorders and

13.4 Explain the genetic and biological risk and causal

Copyright © 2021 Pearson Education Ltd.

13.6 Explain the psychosocial and cultural factors

13.7 Describe the clinical outcome of schizophrenia and

Copyright © 2021 Pearson Education Ltd.

• Psychosis significant loss of contact with reality

Origins of the Schizophrenia Construct

Copyright © 2021 Pearson Education Ltd.

• Onset: ages 18-30

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• Patients become emotionally involved with hallucinations

Copyright © 2021 Pearson Education Ltd.

Click on the screenshot to view this video.

• Fail to make sense even though they are using language

Copyright © 2021 Pearson Education Ltd.

• Catatonia involves almost no movement at all,

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• Familial and genetic are not synonymous

Copyright © 2021 Pearson Education Ltd.

Lifetime age-adjusted, averaged risks for the development of schizophrenia-related

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• Genetic liability to schizophrenia may predispose an

Copyright © 2021 Pearson Education Ltd.

• Research focuses on those showing prodomal—very

Copyright © 2021 Pearson Education Ltd.

• Lower IQ may be a risk factor; higher IQ may be

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• Decrease in brain volume is present very early in the

Copyright © 2021 Pearson Education Ltd.

• Brain structure is abnormal, but the abnormality is linked

Copyright © 2021 Pearson Education Ltd.

• Patients have reductions in white matter volume as well

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• People who were in the hospital for a head injury have a

Copyright © 2021 Pearson Education Ltd.

Do Bad Families Cause Schizophrenia?

Copyright © 2021 Pearson Education Ltd.

• High-EE home environment more than doubles the

• Researchers are still trying to understand how EE affects

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• Cannabis may accelerate the progressive brain changes

Copyright © 2021 Pearson Education Ltd.

Copyright © 2021 Pearson Education Ltd.

• No simple answer to what causes schizophrenia

Copyright © 2021 Pearson Education Ltd.