Schizophrenia and Other Psychotic Disorders 565
Summary of
Understanding
Schizophrenia
A variety of neurological factors are associ-
ated with schizophrenia: (1) Abnormalities in
brain structure and function have been found
in the frontal and temporal lobes, the thala-
mus, and the hippocampus. Moreover, certain
brain areas do not appear to interact with each
other properly. People with schizophrenia are
more likely to have enlarged ventricles than
are other people. The brain abnormalities give
rise to biological markers in some individuals.
(2) These brain abnormalities appear to be
a result of, at least in some cases, maternal
malnourishment, illness during pregnancy, or
fetal oxygen deprivation. (3) Schizophrenia is
associated with abnormalities in dopamine,
serotonin, and glutamate activity, as well as
a heightened stress response and increased
production of cortisol. (4) Genetics is the
strongest predictor that a given individual
will develop schizophrenia. Genetics alone,
though, cannot explain why a given individual
develops the disorder.
Psychological factors that are associated
with schizophrenia and shape the symptoms
of the disorder include: (1) cognitive defi cits
in attention, memory, and executive function-
ing; (2) dysfunctional beliefs and attributions;
and (3) difficulty recognizing and conveying
emotions.
Various social factors are also associated
with schizophrenia: (1) an impaired theory of
mind, which means that that other people’s
behavior routinely appears to be unpredict-
able; (2) a stressful home environment, such
as being raised in an orphanage or by a par-
ent with schizophrenia; (3) the stresses of
immigration—particularly for people likely
to encounter discrimination—and economic
hardship; and (4) the individualist nature of
the culture, which is associated with lower
recovery rates for people with schizophrenia.Thinking like a clinician
Using the neuropsychosocial approach, ex-
plain in detail how the three types of factors
and their feedback loops may have led all four
Genain sisters to develop schizophrenia.Summary of Treating
Schizophrenia
Treatments that target neurological factors
include traditional and atypical antipsychot-
ics; when these medications do not signifi-
cantly decrease positive symptoms, ECT may
be used. Although antipsychotic medications
can decrease positive and, in some cases,
negative symptoms, many patients discon-
tinue such treatment because of side effects
or because the medication did not help them
enough. People who stop taking medication
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 enhancement to decrease co-
morbid substance abuse.
Treatments that target social factors in-
clude family education, family therapy to
improve the interaction pattern among fam-
ily members, and group therapy to improve
social skills. Depending on the severity of an
episode of schizophrenia, a patient may be
treated in an inpatient facility or as an out-
patient in the community. Community-based
interventions include residential care and
vocational rehabilitation.Thinking like a clinician
Suppose you are designing a comprehensive
treatment program for people with schizo-
phrenia. Although you’d like to provide each
program participant with many types of ser-
vices, budgetary constraints mean that you
have to limit the types of treatments your
program offers. Based on what you have read
about the treatment of schizophrenia, what
would you defi nitely include in your treatment
program, and why? Also list the types of treat-
ment you’d like to include if you had a bigger
budget.Key Terms
Schizophrenia (p. 520)
Positive symptoms (p. 520)
Hallucinations (p. 521)
Delusions (p. 522)Word salad (p. 522)
Catatonia (p. 523)
Negative symptoms (p. 523)
Flat affect (p. 523)
Alogia (p. 524)
Avolition (p. 524)
Executive functions (p. 524)
Paranoid schizophrenia (p. 526)
Disorganized schizophrenia (p. 527)
Catatonic schizophrenia (p. 527)
Undifferentiated schizophrenia (p. 528)
Schizophreniform disorder (p. 530)
Brief psychotic disorder (p. 530)
Schizoaffective disorder (p. 530)
Delusional disorder (p. 530)
Shared psychotic disorder (p. 531)
Prodromal phase (p. 536)
Active phase (p. 536)
Biological marker (p. 543)
Dopamine hypothesis (p. 544)
Theory of mind (p. 549)
High expressed emotion (high EE) (p. 550)
Social selection (p. 552)
Social causation (p. 552)
Tardive dyskinesia (p. 556)
Atypical antipsychotics (p. 557)
Cognitive rehabilitation (p. 559)
Community care (p. 562)More Study Aids
For additional study aids related to this
chapter, go to:
http://www.worthpublishers.com/rosenberg