Chapter 16 Specific Disorders and Treatments

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Chapter 16Specific Disorders and Treatments
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Progress in Abnormal Psychology

• The growth of understanding of mental disorders
  and their treatment has paralleled the progress
  of medical science.
• Although we have much yet to learn, we now can
  make accurate distinctions between a wide range
  of disorders and we can tailor treatments to meet
  the needs of those suffering from specific
  disorders.

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Module 16.1

• Anxiety and Avoidance Disorders

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Disorders Characterized by Excessive Anxiety

• Anxiety refers to a certain amount of fear and
  caution in the face of potential hazards.
• A certain amount of anxiety is normal.
• Anxiety is considered pathological when it
  interferes with daily functioning.

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Disorders Characterized by Excessive Anxiety

• Generalized anxiety disorder
• Generalized anxiety disorder (GAD) is the
  experience of almost constant and exaggerated
  worry.
• There is no basis for the worries but the person
  is tense, irritable and tired.
• About 5 of the general population will
  experience GAD.
• Often it is co-diagnosed with other mood
  disorders such as depression.

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Disorders Characterized by Excessive Anxiety

• Panic disorder
• Panic disorder (PD) is characterized by frequent
  periods of anxiety and occasional attacks of
  panic.
• Panic attacks involve rapid breathing, increased
  heart rate, chest pains, sweating, trembling and
  faintness.
• Panic attacks usually last just a few minutes,
  but can be much longer.

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Disorders Characterized by Excessive Anxiety

• Panic disorder
• Panic disorder is experienced by 1-3 of adults
  and occurs in many cultures.
• More women than men are diagnosed with Panic
  Disorder.
• Hyperventilation, or rapid deep breathing, is a
  key symptom.

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Disorders Characterized by Excessive Anxiety

• Panic disorder
• Hyperventilation causes the body to react as if
  suffocation were occurring.
• The persons subjective interpretation of the
  symptoms of hyperventilation can cause an
  increase in panic or a calming down.
• People with panic disorder tend to interpret
  these episodes as uncontrollable and life
  threatening.
• The constant anxiety they experience increases
  the likelihood of further panic attacks.

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Disorders Characterized by Excessive Anxiety

• Panic disorder
• Treatments for panic disorder include
• Psychotherapy
• Anti-depressant drugs
• Advice Dont worry about panic attacks they
  wont kill you.

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Disorders Characterized by Excessive Anxiety

• Panic disorder
• Common co-existing disorders include
• Social phobia severe avoidance of other people
  and fear of doing anything in public.
• Agoraphobia an intense fear of open or public
  places.

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Disorders Characterized by Excessive Anxiety

• Phobias
• Avoidance behaviors are highly resistant to
  extinction.
• Phobia is the most common type disorder involving
  avoidance behaviors.
• A phobia is strong and persistent fear of a
  specific object or situation so strong it
  interferes with daily living.

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Disorders Characterized by Excessive Anxiety

• Phobias
• The Prevalence of Phobias
• Not all extreme fears qualify as phobias.
• About 11 of U.S. adults suffer from a phobia at
  some point in their lives.
• About 5-6 are experiencing a phobia at any given
  time.
• Phobia usually does not persist across the
  lifetime many young adults lose them by middle
  age.

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• Figure 16.2 Most phobias do not last a lifetime.
  Young people with phobias often lose them by
  middle age.

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Disorders Characterized by Excessive Avoidance

• Phobias
• Acquiring a phobia
• Some fears are innate but many are learned.
• Some phobias can be traced to a specific event.
• The early behaviorists were the first to
  demonstrate how fears might be learned.
• This does not account for the fact that some
  phobias are much more common and easily acquired
  than others.

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Disorders Characterized by Excessive Avoidance

• Phobias
• The most common phobias include
• Open spaces
• Closed spaces
• Heights
• Lightening and thunder
• Certain animals (snakes, spiders, dogs)
• Illnesses/germs

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• Figure 16.4 A lab-reared monkey learns to fear
  snakes from the reactions of a wild-reared
  monkey. But if the snake is not visible, the
  lab-reared monkey fails to learn any fear.

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• Figure 16.4 A lab-reared monkey learns to fear
  snakes from the reactions of a wild-reared
  monkey. But if the snake is not visible, the
  lab-reared monkey fails to learn any fear.

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• Figure 16.4 A lab-reared monkey learns to fear
  snakes from the reactions of a wild-reared
  monkey. But if the snake is not visible, the
  lab-reared monkey fails to learn any fear.

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Disorders Characterized by Excessive Avoidance

• Phobias
• Behavior therapy for phobias
• Systematic desensitization reduces fear by
  gradually exposing people to the object under
  controlled conditions. Virtual reality is now
  being employed for this kind of therapy.
• Flooding or implosion a sudden and large-scale
  exposure to the object under controlled
  conditions.

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Disorders Characterized by Excessive Avoidance

• Phobias
• Drug therapies for phobias and anxieties
• Benzodiazepines, a common type of tranquilizer,
  are often prescribed for anxiety disorders.
• They suppress symptoms only temporarily and can
  be addictive.
• Anti-depressants, which are not likely to be
  taken habitually, are used more effectively.

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Disorders Characterized by Excessive Avoidance

• Obsessive-compulsive disorder
• There are two distressing symptoms that comprise
  obsessive-compulsive disorder.
• Obsessions are repetitive, unwelcome streams of
  thought.
• Compulsions are repetitive, almost irresistible
  actions.
• Obsessive thoughts generally lead to compulsive
  actions.
• Checking and cleaning are two very common
  compulsive behaviors.

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Disorders Characterized by Excessive Avoidance

• Obsessive-compulsive disorder
• Therapies for obsessive-compulsive disorder
• Exposure therapy is very similar to systematic
  desensitization.
• The patient is exposed to the situation that
  brings on the compulsive behavior, but is
  prevented from engaging in it.
• The most common drug treatments for this disorder
  utilize clomipramine and other serotonin reuptake
  inhibiters.

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Anxieties and Avoidance

• Phobias and anxiety disorders involve the
  interaction and influence of cognition and
  emotion upon each other.
• People who suffer from these conditions are aware
  that their reactions are exaggerated, but this
  awareness doesnt cure the problem.
• These disorders are challenging but psychologists
  continue to improve the efficacy of available
  treatments.

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Module 16.2

• Substance-Related Disorders

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Substance Dependence (Addiction)

• Individuals who find it difficult or impossible
  to quit a dangerous habit are said to have an
  addiction to it or a dependence on it.
• People vary widely in how this affects their
  daily lives and functioning.

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Substance Dependence (Addiction)

• Nearly all addictive drugs stimulate the dopamine
  receptors in the nucleus accumbens.
• Activation of these synapses causes increased
  attention.
• This activation is accompanied by feelings of
  great pleasure.

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Substance Dependence (Addiction)

• There are two symptoms involved in the
  development of a drug addiction.
• Tolerance decreased effects of a given dose.
• Withdrawal unpleasant sensations when the drug
  is not used (or too little is used given the
  development of tolerance).
• Activities and substances that are not drugs can
  produce addictions suggesting that addiction is
  a function of the person, not the drug alone.

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Substance Dependence (Addiction)

• Is substance dependence a disease?
• It depends in part on how we define disease.
• Psychologists currently favor the use of
  continuum from no addiction to severe
  addiction.

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Substance Dependence (Addiction)

• Nicotine dependence
• Cigarette smoking is based on nicotine addiction.
• People are generally able to quit smoking more
  easily if they have a replacement source of
  nicotine (i.e. a patch).
• Low-nicotine/low-tar cigarettes do not help
  people to quit.

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• Figure 16.7 Low-nicotine cigarettes have a row
  of small holes in the filter room air is
  supposed to enter through those holes when the
  smoker inhales and therefore dilute the tobacco
  smoke. If people smoke such cigarettes without
  covering the air holes, little tar and nicotine
  pass through the cigarette, as we see from the
  relatively clean filter tip. However, if people
  cover the holes with their fingers or tape, they
  will
• receive about as much tar and nicotine as they
  would from any other filtered cigarette.

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Substance Dependence (Addiction)

• Alcoholism
• Alcoholism is defined as the habitual overuse of
  alcohol.
• Treatment of chronic alcoholism is very
  difficult.
• In order for treatment of alcoholism to be
  effective, we need to detect the problem in its
  early stages.
• We need to identify the factors that put certain
  people at risk.

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Substance Dependence (Addiction)

• Alcoholism
• Type I alcoholism develops gradually over the
  lifespan.
• It is equally prevalent in men and women.
• It is generally less severe in its health
  consequences.
• Type II alcoholism has an early onset.
• It is much more prevalent in men and more severe.

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• Table 16.3 Type I and Type II alcoholism

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Substance Dependence (Addiction)

• Alcoholism Risk factors
• Research studies indicate that tendency to
  addiction is influenced by genetics.
• Type II alcoholism shows a strong genetic basis.
• Some people with no family history of alcoholism
  develop an alcohol problem.

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Substance Dependence (Addiction)

• Alcoholism Risk factors
• Exposure to parental conflict, inadequate
  supervision, and abuse can increase the
  likelihood of alcoholism emerging later in life.
• Culture also has an influence prevalence rates
  vary in different nations and ethnic groups.

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Substance Dependence (Addiction)

• Treatment for alcoholism
• It is very difficult for most people to quit
  alcohol and the other drugs.
• Only 10-20 are successful and relapses are very
  common.
• Many recovering addicts seek help from
  mental-health professionals or self-help groups.
• Such help improves the chances of successful
  recovery, but offers no guarantees.

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Substance Dependence (Addiction)

• Treatments for alcoholism
• Detoxification is a program of supervised
  recovery provided in a hospital setting.
• Outpatient mental-health treatment has about the
  same rate of success as detoxification.

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Substance Dependence (Addiction)

• Treatments for alcoholism
• The most widespread treatment for alcoholism is
  offered by Alcoholic Anonymous (AA).
• AA is a self-help group comprised of people who
  abstain from alcohol use and offer help and
  support to each other.

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Substance Dependence (Addiction)

• Treatments for alcoholism
• Antabuse is the trade name for disulfiram.
• Alcoholics who take Antabuse daily become very
  sick when they drink alcohol.
• This treatment is only moderately effective.

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Substance Dependence (Addiction)

• Treatments for alcoholism
• Controlled drinking refers to reducing
  consumption of alcohol from dependent/abusive to
  moderate levels.
• Some physicians believe that abstinence is
  workable for all alcoholics and believe this is a
  viable alternative.
• Harm reduction is a similar approach applied to
  drug abuse.
• These methods are highly controversial

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Substance Dependence (Addiction)

• Opiate dependence
• A very difficult withdrawal syndrome complicates
  recovery from dependence on opiate drugs (i.e.
  heroin, morphine).
• Some opiate addicts go cold turkey in order to
  stop using.

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Substance Dependence (Addiction)

• Opiate dependence
• Recovery programs commonly offer methadone as a
  less dangerous replacement for opiates.
• This is a harm reduction strategy that allows
  recovering opiate addicts to remain employed and
  avoid criminal behavior.

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• Table 16.4 Comparison of methadone with morphine

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Substances, the Individual, and Society

• How we handle the problem of substance dependence
  and abuse in our society remains an area of
  intense debate.
• Our current strategies have not eliminated
  widespread use.
• As a citizen, you may be called upon to think
  about these issues and help to shape changes in
  our national drug policy. As you have learned,
  there are complex and difficult issues involved.

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Module 16.3

• Mood Disorders

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Mood Disorders

• Depression
• Major depression
• Major depression is an extreme condition.
• It usually persists for months.
• The person experiences little interest in
  anything, little pleasure, and little motivation
  to be productive.

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Mood Disorders

• Depression
• Major depression
• Loss of interest in food and sex are common.
• The person has feelings of worthlessness, guilt
  and powerlessness over their lives.
• Sleep abnormalities are associated with
  depression (there is a characteristic rapid onset
  of REM sleep).
• The person may attempt suicide.

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• Figure 16.9 When most people go to sleep at their
  usual time, they progress slowly to stage 4 and
  then back through stages 3 and 2, reaching REM
  sleep toward the end of their first 90-minute
  cycle. Depressed people, however, reach REM more
  rapidly, generally in less than 45 minutes. They
  also tend to awaken frequently during the night.

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Mood Disorders

• Depression
• Seasonal affective disorder (SAD)
• Consistent depression associated with a
  particular season of winter is called seasonal
  affective disorder.
• It is most common in areas that have little
  sunlight in the winter.
• It can be relieved by light therapy, which
  requires the depressed person to sit in front of
  a bright light for a few hours each day.

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• Figure 16.10 Most people feel slightly better
  during the summer (when the sun is out most of
  the day) than during the winter (when there are
  fewer hours of sunlight). People with seasonal
  affective disorder (SAD) feel good in the summer
  and seriously depressed in the winter (or good in
  the winter and depressed in the summer). Seasonal
  affective disorder is commonest in far northern
  locations such as Scandinavia, where the summer
  days are very long and bright and the winter days
  are very short and dark. The disorder is
  unheard-of in tropical locations such as Hawaii,
  where the amount of sunlight per day varies only
  slightly between summer and winter.

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Mood Disorders

• Depression
• Bipolar disorder
• This condition was once referred to as
  manic-depressive disorder.
• It involves a cycling of mood between periods of
  depression and periods of mania.
• Mania is a state of extreme exuberance and
  agitation.

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Mood Disorders

• Depression
• Genetic predisposition to depression
• Having close biological relatives who were
  diagnosed with depression increases ones
  probability of becoming depressed.
• Having adoptive relatives who were depressed also
  increases that probability, but not as much.

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Mood Disorders

• Depression
• Genetic predisposition to depression
• The probability is especially high if one has
  biological relatives who were diagnosed with
  depression before age 30.
• There is probably no one gene that causes
  depression.
• Genes probably influence temperament and
  therefore also the way people respond to events
  in their lives.

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Mood Disorders

• Depression
• Sex differences in depression
• Before adolescence, depression is about equally
  common in boys and girls.
• From adolescence onward, women are about twice as
  likely to experience depression as men.

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Mood Disorders

• Depression
• Sex differences in depression hormones
• Women experience more rapid hormonal changes than
  men do (menstrual cycles, pregnancy, childbirth
  and menopause).
• Postpartum depression is triggered by the rapid
  hormonal changes that follow childbirth.
• However, the hormone levels of depressed women
  are not significantly different that those of
  non-depressed women.

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Mood Disorders

• Depression
• Sex differences in depression coping
• Men generally try to distract themselves when
  they are feeling depressed. Women tend to dwell
  on their feelings more.
• Ruminating may not be useful for coping and may
  make the person feel worse.
• This explanation does not account for why women
  and men choose different strategies.

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Mood Disorders

• Depression
• Events that precipitate depression
• People generally become depressed after losses or
  other negative events occur.
• There is little relationship between the scale of
  the event and the intensity and duration of the
  subsequent depression.
• Severe losses early in life may make people more
  vulnerable to depression later on in life.

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Mood Disorders

• Depression
• Events that precipitate depression
• Lack of social support also increases
  vulnerability to depression.
• As in the case of stress, it is not just the
  event but also the persons interpretation of the
  events significance that influences the degree
  of depression.
• The way people think about their lives, as well
  as the course of the events, is a factor to
  consider.

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Mood Disorders

• Depression
• Cognitive aspects of depression
• Every person has an explanatory style in
  accounting for successes and failures.
• Internal attributions cite causes within the
  person.
• External attributions identify causes outside the
  person.

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Mood Disorders

• Depression
• Cognitive aspects of depression
• People tend to be more consistent in the type of
  attributions that they use to explain their
  failures.
• People who blame themselves for all failures,
  regardless of the circumstances, develop a
  pessimistic explanatory style.
• They view their failures as global (consistent
  over situations) and stable (consistent over
  time).
• Depressed people believe that every silver
  lining has a cloud.
• -- Kalat

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Mood Disorders

• Depression
• Treatments for depression
• Cognitive therapy helps the individual develop
  more positive beliefs.
• Drug therapies use anti-depressant medications
  including the tricyclics, selective serotonin
  reuptake inhibitors, monoamine oxidase
  inhibitors, and atypical antidepressants.
• St. Johns Wort is a naturally occurring herb
  that has antidepressant effects. It should not be
  used with other medications.

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• Figure 16.13 Antidepressant drugs prolong the
  activity of the neurotransmitters dopamine,
  norepinephrine, and serotonin. (a) Ordinarily,
  after the release of one of the
  neurotransmitters, some of the molecules are
  reabsorbed by the terminal button, and other
  molecules are broken down by the enzyme monoamine
  oxidase (MAO). (b) Selective serotonin reuptake
  inhibitors (SSRIs) prevent reabsorption of
  serotonin. Tricyclic drugs prevent reabsorption
  of dopamine, norepinephrine, and serotonin. (c)
  MAO inhibitors (MAOIs) block the enzyme monoamine
  oxidase and thereby prolong the effects of the
  neurotransmitters.

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Mood Disorders

• Depression
• Treatments for depression
• Electroconvulsive shock therapy (ECT) is a
  well-known but controversial treatment.
• A brief electrical shock is administered to the
  patients head.
• It induces a convulsion similar to an epileptic
  seizure.
• How it works is not fully understood.

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Mood Disorders

• Depression
• Treatments for depression
• It is an effective treatment, although the
  benefits are temporary. Other treatments must be
  offered also.
• ECT fell out of favor because it was widely
  abused (administered without patient consent,
  given too often, used as a threat).
• It is now used only for patients who have
  treatment-resistant depressions or who are
  strongly suicidal.

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Mood Disorders

• Bipolar disorder
• Bipolar disorder symptoms
• People whose moods alternate between extremes of
  mania and depression are said to suffer from
  bipolar disorder.
• When they are experiencing mania, they are
  constantly active and uninhibited, and may be
  very happy or very irritable.

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Mood Disorders

• Bipolar Disorder
• Bipolar Disorder types
• Psychologists diagnose two types of bipolar
  disorder.
• Bipolar I disorder involves the experience of at
  least one episode of mania.
• Bipolar II disorder involves alternation between
  major depression and hypomania, which is a milder
  form of mania.

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Mood Disorders

• Bipolar disorder
• Bipolar disorder prevalence
• About 1 of the adult population of the U.S. has
  been diagnosed with a Bipolar Disorder.
• It can be difficult to distinguish bipolar from
  other disorders (attention deficits, delusions
  and hallucinations are also symptoms of other
  disorders).
• There are hereditary influences on bipolar
  disorder.

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Mood Disorders

• Bipolar disorder
• Drug therapies for bipolar disorder
• Lithium is a naturally occurring chemical that is
  used to treat mania.
• How lithium relieves mania is not well
  understood.
• Lithium is toxic at high doses, so a patient who
  takes it must be carefully monitored.
• Valproate and anticonvulsant drugs are also used
  to treat bipolar disorders.

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Mood Disorders

• Suicide
• Mood disorders and suicide
• People who suffer from depression and bipolar
  disorders consider suicide. Some make attempts.
• It is hard to know the true rate of suicide
  because some suicides are disguised to look like
  accidents.
• Suicide rates vary as a function of gender,
  culture and age

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• Figure 16.15 Suicide rates differ as a function
  of age, gender, and culture. The rates shown here
  are for 1988 the rate has dropped since then for
  Hungary, presumably because of economic and
  social changes within the country. (Based on data
  of Lester, 1996)

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• Figure 16.15 Suicide rates differ as a function
  of age, gender, and culture. The rates shown here
  are for 1988 the rate has dropped since then for
  Hungary, presumably because of economic and
  social changes within the country. (Based on data
  of Lester, 1996)

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• Table 16.5 People most likely to attempt suicide

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Mood Disorders

• Suicide
• Mood disorders and suicide
• Women make more attempts but tend to employ less
  lethal means than do men.
• There is no dependable pattern to suicide, but
  certain warning signs and risk factors are
  associated with it.
• Previous attempts, a history of losses, a recent
  loss, and a family history are all likely to
  raise the risk.

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Mood Disorders

• Suicide
• Mood disorders and suicide
• If someone you know is thinking of suicide, try
  to treat the person as you would any other person
  who is in distress.
• Offer support and friendship, and dont be afraid
  to ask him or her to talk about feelings.
• Encourage the person to seek professional help if
  you sense that they are open to the suggestion.

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Mood and Mood Disorders

• Our capacity to experience emotions is an
  important part of our lives. We have a wide
  range of pleasant and unpleasant feelings to
  color our days.
• Mood disorders go beyond this typical spectrum,
  and victimize the person, distorting their
  perspective. Our ways to manage these disorders
  have improved over the past decades, providing
  many with relief from this distortion.

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Module 16.4

• Schizophrenia

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Schizophrenia

• What is schizophrenia?
• Many people confuse the term schizophrenia with
  dissociative identity disorder or multiple
  personality disorder.
• The split in schizophrenia refers to a
  disconnection of the intellectual and emotional
  aspects of the personality.

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• Figure 16.16 Although the term schizophrenia is
  derived from Greek roots meaning split
  personality, it does not refer to cases where
  people alternate among different personalities.
  Rather, the term originally indicated a split
  between the intellectual and emotional aspects of
  a single personality.

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Schizophrenia

• What is schizophrenia?
• The DSM-IV diagnosis of schizophrenia requires
  that the person exhibit a complete deterioration
  of daily activities along with at least two of
  the following symptoms
• Hallucinations
• Delusions or thought disorders
• Incoherent speech
• Grossly disorganized behavior
• Loss of normal emotional responses and social
  behaviors

80
Schizophrenia

• Symptoms of schizophrenia
• It is possible for two people with schizophrenia
  to have very different symptom patterns
• The symptoms are divided into two broad types.
• Positive symptoms are behaviors that are notable
  because of their presence (hallucinations and
  delusions, for example).
• Negative symptoms are behaviors that are notable
  because of their absence (lack of emotional
  expression).

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Schizophrenia

• Symptoms of schizophrenia
• Positive symptoms
• Hallucinations are false sensory experiences.
• Hearing voices is a common auditory hallucination
  of schizophrenia.
• Visual hallucinations occur but are less common.

82
Schizophrenia

• Symptoms of schizophrenia
• Positive symptoms
• Delusions are unfounded beliefs.
• There are three types of delusions associated
  with schizophrenia persecution, grandeur, and
  ideas of reference.
• As it is sometimes hard to distinguish between
  the unusual opinion and a delusion, one cannot
  diagnose a psychotic disorder on the basis of
  such ideas alone.

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Schizophrenia

• Symptoms of schizophrenia
• Positive symptoms
• Disordered thinking refers to a deficit in
  utilizing executive functions.
• Deficits of attention, difficulty in switching
  rules and routines, loose associations, and
  difficulties with abstraction are all common
  types of disordered thinking in people suffering
  from schizophrenia.

84
Schizophrenia

• Types and prevalence
• Four types of schizophrenia
• Undifferentiated
• Catatonic
• Disorganized
• Paranoid

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Schizophrenia

• Four types of schizophrenia
• The symptoms of undifferentiated schizophrenia
  include
• Deterioration of daily functioning
• Hallucinations
• Delusions or thought disorders
• Inappropriate emotions
• None of the symptoms is unusually pronounced or
  bizarre.

86
Schizophrenia

• Four types of schizophrenia
• Catatonic schizophrenia is distinguished by
  prominent movement disorder, including either
• Rigid inactivity
• Excessive activity
• The person is aware of his or her surroundings,
  but the nature of the individuals posture or
  movement has no relationship to the outside world.

87
Schizophrenia

• Four types of schizophrenia
• The symptoms of disorganized schizophrenia
  include
• Incoherent speech
• Extreme lack of social relationships
• Silly or odd behavior

88
Schizophrenia

• Four types of schizophrenia
• The symptoms of paranoid schizophrenia include
• Elaborate hallucinations and delusions
• The delusions have pronounced themes of
  persecution and grandeur.
• Other thought problems tend to be less
  pronounced, and some people with paranoid
  schizophrenia are relatively intact cognitively.

89
Schizophrenia

• Prevalence
• Prevalence of schizophrenia
• About 1 of Americans are afflicted with
  schizophrenia at some time in the lifespan.
• In general, the rates of this disorder have been
  declining over the past 100 years.
• It occurs in many cultures, but is less common in
  developing nations.

90
Schizophrenia

• Prevalence
• Prevalence of schizophrenia
• Schizophrenia is most frequently diagnosed in
  young adults.
• Men are usually diagnosed earlier than women.
• The onset is typically sudden, although there are
  some markers during childhood.

91
Schizophrenia

• Causes
• Genetic influences
• Studies of twins and adopted children suggest a
  genetic basis for the disease.
• In identical twins, if one member of the pair
  develops schizophrenia, there is a 50 chance
  that the other will also.
• As with most other genetic research, it is
  difficult to control for the effects of the
  prenatal environment.

92

• Figure 16.18 The relatives of a schizophrenic
  person have an increased probability of
  developing schizophrenia themselves. Note that
  children of a schizophrenic mother have a 17
  risk of schizophrenia even if adopted by a family
  with no schizophrenic members. (Based on data
  from Gottesman, 1991)

93
Schizophrenia

• Causes
• Genetic influences
• So far researchers have not located a specific
  gene for schizophrenia.
• It is probably not a single-gene disorder.
• It appears that certain people develop it without
  a genetic basis.

94
Schizophrenia

• Causes
• Brain damage may have some influence on the
  development of schizophrenia. Brain scans
  indicate that
• The hippocampus and parts of the cerebral cortex
  are a little smaller than normal.
• The cerebral ventricles are larger than normal.
• People with schizophrenia have smaller neurons
  and fewer synapses in the prefrontal cortex.

95
Schizophrenia

• Causes
• The neurodevelopmental hypothesis
• The neurodevelopmental hypothesis states that
  schizophrenia is the result of nervous system
  impairments that develop before or at birth.
• These impairments may be due to genetic or other
  reasons.
• Non-genetic risk factors include poor prenatal
  care, difficult pregnancy and labor, and mothers
  exposure to influenza virus.

96
Schizophrenia

• Therapies for schizophrenia
• Drug therapies
• Antipsychotic or neuroleptic drugs help to
  relieve the symptoms of schizophrenia.
• These drugs work gradually and vary in
  effectiveness from patient to patient.

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Schizophrenia

• Therapies for schizophrenia
• Drug therapies
• Antipsychotic drugs work to block the production
  of dopamine at the synapses, which is evidence
  for the dopamine hypothesis of schizophrenia.
• An alternative explanation is the glutamate
  hypothesis of schizophrenia, which is supported
  by the deficient stimulation of glutamate (a
  neurotransmitter that is inhibited by dopamine).

98
Schizophrenia

• Therapies for schizophrenia
• Drug therapies
• Tremors and involuntary movements begin gradually
  in people taking antipsychotics for many years, a
  condition known as tardive dyskinesia.
• Atypical antipsychotic medications have been
  developed to provide relief without this
  troublesome side effect.
• The atypical antipsychotics tend to suppress
  immune functioning in many patients, however.

99
Schizophrenia

• Therapies for schizophrenia
• Family therapy for schizophrenia
• Because caring for a schizophrenic family member
  can be stressful, family therapy can be useful in
  a number of ways.
• It provides direct support for the healthy family
  members.
• It reduces the additional risk to the patient by
  circumventing negative reactions to him or her by
  family members that might promote relapse.

100

• Figure 16.20 This graph indicates that during 2
  1/2 years following apparent recovery from
  schizophrenia, the percentage of schizophrenic
  patients who remained improved is higher in the
  group that received continuing drug treatment
  than in the placebo group. But the graph also
  shows that antipsychotic drugs do not always
  prevent relapse. (Based on Baldessarini, 1984)

101
The Elusiveness of Schizophrenia

• Two people with schizophrenia may present their
  illness in very different ways. The causes of
  their illnesses may turn out to be very
  different.
• Psychologists are still uncertain whether we are
  looking at one disorder or several. We still
  have so much to learn about this complex illness.