What does it mean to suffer from a psychotic disorder?

Psychotic disorders are psychological disorders whose core symptoms are that people’s thoughts and actions are disorganized and their thinking loses touch with reality; people see and worry about things that do not exist.

How prevalent is schizophrenia?

In a meta-analysis of nearly 200 studies from 46 different nations, schizophrenia was identified in about 1 out of every 200 people. Rates do not vary across countries or between genders.

What are the positive and negative symptoms of schizophrenia?

Positive symptoms consist of the presence of undesirable mental events experienced by people with schizophrenia but not by others. Two examples are delusional beliefs and hallucinations. Negative symptoms consist of the absence of desirable behaviors that most others engage in. Two examples are a lack of interest in social activities and flat affect.

What cognitive impairments do people with schizophrenia experience?

People with schizophrenia have difficulty with concentration and memory (especially memory for visual information and episodic memory) and display inaccurate social cognition.

Why are the thoughts of people with schizophrenia so disorganized?

In schizophrenia, impairments in working memory contribute to disorganized thought. In addition, individuals with schizophrenia do not process information as quickly as others.

Why are people with schizophrenia so poor at making decisions?

People with schizophrenia do not exhibit the emotion-induced changes in decision making that people ordinarily exhibit. They do not adjust their decision making on the basis of poor past results. Therefore, they perform poorly on decision-making tasks.

How can the delusional thinking displayed by people with schizophrenia be explained at the mind and brain levels of analysis?

People with schizophrenia have relatively high levels of dopamine in their brains and an excess of dopamine receptors. In schizophrenia, excess dopamine causes even trivial stimuli to grab people’s attention and to seem important. People with schizophrenia try to make sense of this seemingly important yet disparate array of information by inventing explanations. Because this information is strange, their explanations are often delusional.

How are the brains of people with schizophrenia different from those without the disorder?

Brain volume is reduced among people with schizophrenia, in part, due to an enlargement of the ventricles, which are spaces in the brain that contain no neurons and are instead filled with a fluid that supports the brain’s functioning. Activity in the dorsolateral prefrontal cortex, an area that supports working memory, is lower in people with schizophrenia. Activity in the anterior cingulate, an area known to be active when people detect their own errors, is higher in people with schizophrenia.

Do genes alone determine whether someone will develop schizophrenia?

No. Twin studies indicate that genes are only a diathesis for schizophrenia—that is, a factor that predisposes its development. As you read in Research Toolkit, it will be a long time before genome-wide association studies can pinpoint which genes, in particular, are important. Recent research points to the importance of harmful prenatal factors in the development of schizophrenia, including bodily infections and exposure to lead. Poor nutrition may also play a role.

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When does schizophrenia first develop?

Among people who have the mental illness, schizophrenia usually first develops between the ages of 16 and 30.

What drugs are used to treat schizophrenia? What are the side effects? Do they work?

One commonly prescribed typical (traditional) antipsychotic drug is chlorpromazine (trade name thorazine). A common atypical (newer) antipsychotic drug is clozapine. Both work by blocking dopamine receptor sites, which alleviates positive symptoms. Atypical antipsychotics also affect serotonin signaling, which can alleviate negative symptoms. Both types of antipsychotic drugs can produce a side effect known as tardive dyskinesia, which consists of repetitive, uncontrollable muscular movements, typically in the face (e.g., grimacing).

Antipsychotic drugs can substantially reduce the positive symptoms of schizophrenia. Nonetheless, at least half the patients who take the drugs do not experience substantial long-term reductions in schizophrenic symptoms. Moreover, a great many patients stop taking the drugs to avoid their side effects.

What psychotherapies are used to treat schizophrenia?

Cognitive therapy has been empirically demonstrated to effectively reduce the positive and negative symptoms of schizophrenia. Cognitive therapists try to get patients to question the accuracy of their delusional beliefs—to think of them as ideas they have about the world, rather than as statements of fact. Other therapists draw on the humanistic approach by focusing on the person as a whole, a person who copes with not only symptoms, but also the changes in lifestyle and self-concept that the disorder brings.

Is schizophrenia the only psychotic disorder?

No. One other is brief psychotic disorder, in which people experience some of the same symptoms of schizophrenia, including delusions and hallucinations, but for only a brief period. Another is delusional disorder, in which people experience delusions that may persist indefinitely.

What’s the difference between having a personality disorder and just being quirky?

Personality disorders are consistent styles of thinking, behavior, and emotion that severely lower the quality of people’s personal relationships. These styles go beyond quirkiness by harming mental health. Three qualities are shared by personality disorders: inflexible interactions with a given person, an inability to flexibly adapt to different people and roles, and a resulting inability to mature psychologically.

What characterizes the six main types of personality disorder: antisocial, avoidant, borderline, obsessive-compulsive, narcissistic, and schizotypal personality disorder?

People with antisocial personality disorder are manipulative, callous, hostile, and are risk takers. Some individuals with antisocial personality disorder are high in psychopathy, which means that they are particularly dishonest and manipulative.

In avoidant personality disorder, people feel inadequate, have low self-esteem, and are preoccupied with possible negative evaluation by others. Their behavior is withdrawn, shy, and inhibited.

The main features of borderline personality disorder include instability of self-concept, emotions, and interpersonal relationships, as well as an intense fear of abandonment. Borderline individuals report feeling lonely, worthless, and overwhelmed by the stresses of life. They sometimes take desperate steps to escape their stress, including self-harm, and are at high risk for suicide.

Individuals with narcissistic personality disorder hold extraordinarily positive views of themselves, yet their opinions of themselves seem “fragile.” This uncertainty causes them to crave the attention of other people, to support their grandiose but fragile views of self.

Obsessive-compulsive personality disorder is characterized by perfectionism, a desire for order and control over activities, and a rigid adherence to rules for behavior. People’s devotion to work activities may impair their personal relationships.

In schizotypal personality disorder, odd, eccentric patterns of thinking or behavior are combined with social isolation that results from an inability to form close personal relationships with people outside of the immediate family.

How do nature and nurture contribute to the development of antisocial behavior?

According to Caspi and colleagues, nature and nurture interact in the development of antisocial behavior. In their research, among children who did not experience maltreatment, genes did not contribute to the development of antisocial behavior. However, among children who did experience maltreatment, genes greatly contributed to the development of antisocial behavior.

What does the psychopathic brain look like?

When brain scans of men with antisocial personality disorder who have psychopathic qualities are compared to those with the disorder who do not have psychopathic qualities, it is clear that there is lower volume in the frontal cortex, an area that enables us to evaluate others’ behavior and emotions. Lower volume also exists in the temporal lobe, an area that is active when we consider the rules for a given context and monitor whether we are following them. Without this activity, one cannot experience embarrassment or guilt.

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How are the brains of people with borderline personality disorder different from those without the disorder?

Brain activity in the anterior cingulate cortex of borderline patients is less developed relative to those without the disorder. This region is known to be involved in emotional control.

How do therapists treat personality disorders?

Some use cognitive therapy and try to modify patients’ personal beliefs that contribute to psychological distress. They also try to build a therapeutic relationship strong enough that clients will come to accept their suggestions for significant personal change.

Dialectical behavior therapy is a therapy for borderline personality disorder. The therapist teaches patients to avoid black-and-white thinking by acknowledging that their thoughts, even if potentially harmful, are valid. The therapist also focuses on clients’ acceptance of themselves and their circumstances, just as they are.

Do people with dissociative identity disorder truly have multiple independent personalities?

It can be difficult to ascertain whether people with dissociative identity disorder truly have multiple personalities, or whether they simply observe variations in their own behavior and create stories about different characters to understand themselves.

What causes dissociative identity disorder?

Dissociative identity disorder may develop when individuals who experience trauma try to convince themselves it happened to someone else. It may also develop when people adopt different social roles that call for different types of behavior and gradually come to see those differences as different “personalities.” In This Just In, you learned that the most famous case of dissociative identity disorder, Sybil, was a hoax.

An interesting cultural variation on dissociative disorders, latah, was highlighted in Cultural Opportunities. There, you learned that following a startle response, people in Malaysia can enter a trance state in which they imitate and obey others.

What defines depersonalization/derealization disorder?

In depersonalization/derealization disorder, people experience the events of their day with strange detachment, as if they are merely observing the events rather than taking part in them. They also experience derealization, the feeling that objects and events in their lives are unreal.

Can people completely lose their memory for who they are?

Yes. In dissociative amnesia, people are unable to remember significant personal information that normally would be highly memorable. Individuals with this disorder may experience fugue states in which they completely lose memory of their own personal identity.

Are people with dissociative identity disorder responsible for crimes committed by their alternative personalities?

Legal scholars who have addressed this issue explain that people with no control over their behavior cannot be found guilty. If the alter confesses to a crime, the person has the legal option of pleading not guilty by reason of insanity. This defense is typically not very successful in the case of dissociative identity disorder.

What could cause an individual to experience paralysis in the absence of a medical condition?

In conversion disorder, people experience physical symptoms that cannot be explained by any medical condition. Recent brain-imaging evidence supports an explanation that these physical symptoms have an emotional basis.