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PYSC3230-Calhoun-4.2.10
Chapter 13 Continued

What Causes Schizophrenia?

Prototypical model: complex interplay of genetic and environmental factors
Genetic factors are clearly implicated in schizophrenia
Runs in families - higher than expected rates among biological relatives
As the following slide shows, having a relative with the disorder significantly
raises a person‟s risk of developing schizophrenia
Closer relative, greater risk – first degree (sibling) vs second degree (cousin) )

Causal Factors in Schizophrenia

Monozygotic twins (of schizophrenics) are much more likely to develop
schizophrenia than are dizygotic twins
Concerning role of genetics:
-Genes do play a large role but do not tell whole story - environment does play a
role
-It is likely that genes are triggered by environmental events
-Further, genetic make-up may increase vulnerability to environmental factors
-Thus, genetic – environment interaction
-Also, multiple genes involved so that „dose‟ determines likelihood and severity of
disorder
Other factors that have been implicated in the development of schizophrenia
include
-Prenatal exposure to the influenza virus
 During 4th to 7th month of gestation
 Mother's antibodies disrupt neurological development
-Early nutritional deficiencies (noted during war)
-Prenatal birth complications (e.g. hypoxia)
Current thinking emphasizes the interplay between genetic and environmental
factors
 Multiplicity of genes; predisposing factors; environment

A Neurodevelopmental Disorder
A lesion in the brain is thought to lie dormant until normal developmental
changes occur (possibly only at full neurological maturation)
nd
Due to disruption in neural cell migration during 2 trimester creates problem in
internal connectivity of the brain
These neural changes expose the problems that result from this brain
abnormality
Pre-schizophrenic children show more motor abnormalities, problems in
attention, lower social competence
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Biological Aspects (Structure)
Many brain (CAT, PET, MRI) areas are abnormal in schizophrenia including
-Decreased brain volume (3% less)
-Enlarged ventricles (less brain volume)
-Frontal lobe dysfunction (esp. left side)
-Reduced volume of the thalamus (input)
 Reduced ability to handle sensory input
Abnormalities in temporal lobe areas such as the hippocampus and amygdala
Abnormalities are not found in all patients

The above differences further suggest a neuro-developmental disorder since

lower brain volume is found early in schizophrenics
This reflects problems in the cyto-architecture or organization of the brain
which is compromised if the migration of neurons doesn‟t occur normally in the
fetal brain
Biological Aspects (Process)
Neurotransmitters implicated in schizophrenia include
-Dopamine (excess) (chlorpromazine)
The dopamine hypothesis
-Dopamine determines how much salience is given internal and external stimuli
-Excess of dopamine results in aberrant salience
-Glutamate (excitatory) (deficit) (PCP)
The glutamate hypothesis
-Blocking of glutamate results in cognitive symptoms of schizophrenia (slippage)

Neurocognitive deficits found in people with schizophrenia include

-Attentional deficits (allocation of resources)
-Eye-tracking dysfunctions
-Evidence of problems with active functional allocation of attentional resources
-Unable to attend well on demand
-Attentional dysfunctions may be indication of biological susceptibility to
schizophrenia
Biological and Psychosocial Factors
Connection between biology and environment:
-Stress causes release of cortisol which triggers dopamine activity and
suppresses glutamate release
Following slides consider stresses that could play a role
-Family
-Society
Psychosocial and Cultural Aspects (Family)
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Many theories about bad families causing schizophrenia have not stood the test
of time including
The idea of the “schizophrenic mother”
-Cold, aloof
The double-bind hypothesis
-Parent presents child with feelings and demands that are mutually incompatible
Weak evidence for either theory

Instead, communication problems may be the result of having a schizophrenic

in the family
-Amorphous, fragmented communication
Stress of trying to communicate with someone who is schizophrenic
Patients with schizophrenia are more likely to relapse if their families are high in
expressed emotion (EE)
Hostility, criticism, emotional over-involvement
Reflects stress-sensitive nature of schizophrenia

Psychosocial and Cultural Aspects (Social)

A large body of evidence indicates that the lower the socioeconomic status the
higher the prevalence of schizophrenia
Two theories have been presented to explain this (the sociogenic & the social
drift hypotheses)
Essentially both hypotheses argue that urban living, lower socioeconomic
levels, immigration, social conflict all increase risk for development of
schizophrenia
 These factors increase stress, thus increase risk

Treatment and Clinical Outcome

Recovery from schizophrenia is:
-1/3rd recover
-1/3rd improve
-1/3rd remain the same
The lower the severity of negative symptoms, the higher the likelihood of
recovery
The later the onset, the better the prognosis
The better the premorbid functioning, the better the prognosis
-Percentage of followed-up schizophrenics attaining social recovery over the past
century
Before the 1950‟s, there were few treatment options – ECT, permanent
hospitalization

After the 1950‟s, the availability of antipsychotics and pharmocotherapy allowed

for outpatient treatment
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Antipsychotic drugs work by blocking dopamine receptors
There are two types of antipsychotics
-Conventional antipsychotics (neuroleptics)
-Novel antipsychotics
Conventional antipsychotics (e.g. thorazine, haldol) work after 3-6 weeks
-Do best for patients with positive symptoms
-Function as dopamine antagonists
-Have the problems of side effects: drowsiness, weight gain, parkinsonian
symptoms, tardive dyskenesia (extrapyramidal effects)

Patients taking novel antipsychotics (e.g. clozaril, risperdal, seroquel)

-Have fewer extrapyramidal (motor abnormality) side effects
-Tend to do better overall
-Eleviate both positive and negative symptoms
-Still may cause drowsiness and weight gain
-Even with medication, difficulty functioning

Psychosocial approaches include

-Case management (community living)
 A broker who helps patient function in the community locating
housing, jobs treatment
-Social-skills training (interpersonal skills)
 Help in acquiring interpersonal skills for employment, relationships,
self-care
-Cognitive-behavioral therapy (attention)
 Cognitive training to challenge delusions
-Other forms of individual treatment (support)
 Social support; increased social interaction

Treatments and Outcomes

Family therapy
-Provides families with communication skills
 Less amorphous, fragmented
-Reduces high levels of expressed emotion
 Lower hostility, criticism, emotional over-involvement
-Reduces relapse rates
-Educates family about schizophrenia