Abnormal Psychology

Schizophrenia and Other Psychotic Disorders 547

to develop schizophrenia than were the children whose biological mothers had schizo-

phrenia but whose adoptive families were not dysfunctional. Thus, better parenting

appeared to protect children who were genetically at risk for developing schizophrenia.

Psychological Factors in Schizophrenia

We have seen that schizophrenia is not entirely a consequence of brain structure,

brain function, or genetics. As the neuropsychosocial approach implies, schizophre-

nia arises from a combination of different sorts of factors. For example, the neu-

rocognitive defi cits that plague individuals with schizophrenia also affect how they

perceive the social world, and their perceptions affect their ability to function in that

world (Sergi et al., 2006). If we understand their experiences, their behaviors do not

appear so bizarre. Let’s examine in detail the psychological underpinnings of schizo-

phrenia so that we can better understand how all four Genain quadruplets developed

the disorder, despite the odds against this outcome. Note that not every person with

schizophrenia experiences each type of diffi culty we discuss (Walker et al., 2004).

Mental Processes and Cognitive Diffi culties:

Attention, Memory, and Executive Functions

We’ve already noted problems with attention, working mem-

ory, and executive function in schizophrenia. Let’s now con-

sider how such problems may contribute to the disorder.

The cognitive diffi culties of people with schizophrenia

arise before the DSM-IV-TR symptoms emerge, and the dif-

fi culties persist even after the DSM-IV-TR symptoms have

diminished (Hughes et al., 2003; Rund et al., 2004). The

diffi culties with attention—in distinguishing relevant from

irrelevant stimuli, for example (Nuechterlein, 1991)—occur

even when the person is taking medication and isn’t psychotic

(Cornblatt et al., 1997; Dawson et al., 1993). This attentional

problem can make it hard for individuals with schizophrenia

to discern which stimuli are important and which aren’t; such

individuals may feel overwhelmed by a barrage of stimuli.

This leads to problems in organizing what they are perceiving

and experiencing, which would contribute to their diffi culties

with perception and memory (Sergi et al., 2006).

Furthermore, as noted earlier, problems with working

memory lead people with schizophrenia often to exhibit

defi cits in problem solving, planning, judgment, and other executive functions. It may

be hard for them to plan and complete the various steps of a multistep task, such as

making mashed potatoes.

Another cognitive problem common to people with schizophrenia is that they

often don’t realize that they are having problems; this inability is referred to as a

lack of insight. They do not recognize that they are behaving abnormally or having

unusual experiences. Thus, they are unaware of their disorder or the specifi c prob-

lems it creates for themselves and others (Amador & Gorman, 1998) and see no

need for treatment (Buckley, Wirshing et al., 2007). In Case 12.2, psychologist Fred

Frese discusses his lack of insight into his own schizophrenia and its effects.

P S

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CASE 12.2 • FROM THE INSIDE: Schizophrenia

Psychologist Fred Frese describes his history with schizophrenia:

I was 25 years old, and I was in the Marine Corps at the time, and served two back to back

tours in the Far East, mostly in Japan. And when I came back I was a security offi cer in charge

of a Marine Corps barracks with 144 men. And we had responsibilities for security for atomic

weapons... and a few other duties. About six months into that assignment, I made

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Performance in a virtual maze classifi ed people

with symptoms of schizophrenia versus healthy

controls. Participants had to remember which

combination of three features—color, shape,

and sound—would open each door in the maze.

Participants who did poorly also reported more

symptoms of schizophrenia—both positive and

negative (Sorkin et al., 2006).

Sorkin, A., Weinshall, D., Modai, I., & Peled, A. (2006). Improving the accuracy of the diagnosis of schizophrenia by means of virtual reality. American Journal of Psychiatry, 163, 512–520. Reprinted with permission from the American Journal of Psychiatry.