Abnormal Psychology

564 CHAPTER 12

step 4: improving the patient’s overall functioning and quality of life. As family

and social interactions become less stressful, cortisol levels should decrease.

However, although medication can improve symptoms, it is not a panacea—

in part because many patients stop taking it—which leaves an important role for

psychosocial treatments. For instance, CBT (which addresses medication com-

pliance and psychotic symptoms) focuses on motivation and beliefs, which are

often not affected by medication. And treatments that target social factors (such

as family therapy to change a high EE interaction pattern) can lower relapse

rates (presumably via psychological and neurological factors associated with de-

creased stress). Therefore, each type of treatment for schizophrenia is a part of

a larger whole.

Summary of What Are

Schizophrenia and Other

Psychotic Disorders?

According to DSM-IV-TR, schizophrenia is

marked by two or more symptoms, at least

one of which must be a positive symp-

tom. These symptoms must be present for

a minimum of 6 months and must signifi-

cantly impair functioning. Research fi ndings

suggest that the disorganized symptoms

form their own distinct cluster and should

be grouped separately from delusions and

hallucinations.

Research studies have indicated that

cognitive defi cits underlie negative and dis-

organized symptoms of schizophrenia. The

DSM-IV-TR criteria have been criticized for

omitting important cognitive and social defi -

cits that lead to positive and negative symp-

toms and that are closely associated with

prognosis.

DSM-IV-TR distinguishes five subtypes of

schizophrenia: paranoid, disorganized, catatonic,

undifferentiated, and residual schizophrenia.

However, because the symptoms of schizophre-

nia often shift over time, an individual’s subtype

can change. Many researchers argue that a more

useful way to distinguish subtypes of schizo-

phrenia would be based on whether the individ-

ual has a defi cit or nondefi cit subtype.

Symptoms of schizophrenia can appear to

overlap with those of other disorders, notably

mood disorders and substance-related disor-

ders. The category of psychotic disorders spe-

cifically requires symptoms of hallucinations

or delusions; disorders in this category are

schizophrenia, schizophreniform disorder, brief

psychotic disorder, schizoaffective disorder,

delusional disorder, and shared psychotic dis-

order. These disorders, along with schizotypal

personality disorder, are part of a spectrum of

schizophrenia-related disorders.

Most people with schizophrenia have at

least one comorbid disorder. Men have an

earlier onset of the disorder than do women.

Symptoms of the disorder typically evolve in

phases: premorbid, prodromal, active, and

then middle-to-late phases. People with this

disorder who behave violently are most likely

to have a comorbid disorder that is associated

with violent behavior, such as a substance-

related disorder. People with schizophrenia

are more likely than other people to be vic-

tims of violence.

Thinking like a clinician

Suppose you are a mental health clinician work-

ing in a hospital emergency room in the sum-

mer; a woman is brought in for you to evaluate.

She’s wearing a winter coat, and in the waiting

room, she talks—or shouts—to herself or an

imaginary person. You think that she may be

suffering from schizophrenia. What information

would you need in order to make that diagno-

sis? What other psychological disorders could,

with only brief observation, appear similar to

schizophrenia?

SUMMING UP

Key Concepts and Facts About Treating Schizophrenia

• Treatments that target neurological factors include traditional
  and atypical antipsychotics; when these medications do not
  significantly decrease positive symptoms, ECT may be used.
  Although antipsychotic medications can decrease positive and,
  in some cases, negative symptoms, many patients discontinue
  such treatment because of side effects or because the medica-
  tion did not help them enough. People who stop taking medica-
  tion are much more likely to relapse.


• Treatments that target psychological factors include CBT to help
  patients better manage their psychotic symptoms, cognitive

rehabilitation to reduce cognitive defi cits, and motivational en-

hancement to decrease comorbid substance abuse.

• Treatments that target social factors include family education,
  family therapy to improve the interaction pattern among family
  members, and group therapy to improve social skills. Depend-
  ing on the severity of an episode of schizophrenia, a patient
  may be treated in an inpatient facility or as an outpatient in the
  community. Community-based interventions include residential
  care and vocational rehabilitation.