12.4 SUMMING UP

What Are Schizophrenia and Other Psychotic Disorders?

• According to DSM-5, schizophrenia is characterized by two or more positive and negative symptoms, at least one of which must be hallucinations, delusions, or disorganized speech; these symptoms must be present for a minimum of 6 months and must significantly impair functioning.
• Positive symptoms are delusions, hallucinations, disorganized speech, and disorganized behavior.
• Negative symptoms include diminished emotional expression, avolition, alogia, anhedonia, and asociality.
• Research studies have indicated that cognitive deficits accompany symptoms of schizophrenia. Such deficits include problems with attention, working memory, and executive functioning.
• Symptoms of schizophrenia can appear to overlap with those of other disorders, notably mood disorders and substance use disorders.
• Schizophrenia, schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, and delusional disorder, along with schizotypal personality disorder, are part of a spectrum of schizophrenia-related disorders.
• Schizophrenia occurs in approximately 1% of the population worldwide. Men have an earlier onset of the disorder than do women.
• Up to 15% of people with schizophrenia commit suicide. 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 use disorder. People with schizophrenia are more likely than other people to be victims of violence.

Understanding Schizophrenia

• Various neurological factors are associated with schizophrenia:
  
  • Abnormalities in brain structure and function have been found in the frontal and temporal lobes, the thalamus, and the hippocampus. Moreover, certain brain areas do not appear to interact with each other properly. People with schizophrenia are likely to have enlarged ventricles.
  • These brain abnormalities appear to be a result of, at least in some cases, maternal malnourishment, illness during pregnancy, and/or fetal oxygen deprivation.
  • Schizophrenia is associated with abnormalities in dopamine, serotonin, and glutamate activity, as well as a heightened stress response and increased cortisol production.
  • Genetics is still the strongest predictor that a given person will develop schizophrenia. Genetics alone, though, cannot explain why a given person develops the disorder.
• Psychological factors that are associated with schizophrenia and shape the symptoms of the disorder include:
  
  • cognitive deficits (in attention, working memory, and executive functioning);
  • dysfunctional beliefs and attributions;
  • difficulty conveying and recognizing emotions.
• Various social factors are also associated with schizophrenia:
  
  • an impaired theory of mind, which makes it difficult to understand other people’s behavior, which in turn means that other people’s behavior appears to be unpredictable;
  • a stressful home environment, such as being raised in an orphanage or by a parent with schizophrenia;
  • the stresses of immigration—particularly for people likely to encounter discrimination—and economic hardship; and
  • the individualist nature of the culture, which is associated with lower recovery rates for people with schizophrenia.

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;
  • Many patients discontinue medication because of side effects. 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 and motivational enhancement 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.