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PSYCH205: Clinical Psychology

Unit 7: Schizophrenia   Schizophrenia is among the most debilitating of mental diseases. It can lead to sustained hallucinations and delusions, among other symptoms, and ultimately cause an individual to lose all touch with reality. People with this disorder are typically unable to maintain a normal lifestyle without the assistance of both therapy and medical intervention. The disorder is particularly painful because it often develops during an individual’s late teens or early 20s, seemingly robbing a life in its prime. Sadly, these individuals make up a substantial portion of the nation’s homeless population, making it almost impossible for them to receive appropriate help. Schizophrenics often have a co-morbid problem with substance abuse, as they frequently use drugs to self-medicate. This unit will discuss different types of schizophrenia and their respective symptoms, etiologies, and treatments.

Unit 7 Time Advisory
Completing this unit should take you approximately 8 hours.

☐    Subunit 7.1: 7.75 hours

    ☐    Lectures: 3 hours           

    ☐    Readings: 4 hours

    ☐    Web Media: 0.75 hours

☐    Subunit 7.2: 0.25 hours

Unit7 Learning Outcomes
Upon successful completion of this unit, you will be able to:
- describe the positive and negative symptoms associated with schizophrenia and the types of treatment available;
  - identify and describe major research on the etiology of schizophrenia; and
  - describe the course and etiology of late-onset schizophrenia.

7.1 Schizophrenia in Adults   - Lecture: Link: iTunesU: “Schizophrenia: Part I,” “Schizophrenia: Part II" The Saylor Foundation does not yet have materials for this portion of the course. If you are interested in contributing your content to fill this gap or aware of a resource that could be used here, please submit it here.

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  • Reading: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): "Chapter 4: Adults and Mental Health" Link: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999):** "Chapter 4: Adults and Mental Health"

    Instructions: Read the section titled “Schizophrenia.” Please note that the pages in the PDF bar at the top of the document do not match the pages in the table of contents section on the first page. 

    Reading this text and taking notes should take approximately 1 hour.

    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Reading: International Journal of Psychology and Psychological Therapy: An Open Access Publication: Dr. Alex Kopelowicz, Dr. Robert Paul Liberman, and Dr. Charles J. Wallace’s (2003) “Psychiatric Rehabilitation for Schizophrenia" Link: International Journal of Psychology and Psychological Therapy: An Open Access Publication: Dr. Alex Kopelowicz, Dr. Robert Paul Liberman, and Dr. Charles J. Wallace’s (2003) “Psychiatric Rehabilitation for Schizophrenia” (PDF) 

    Instructions: Please click on the link above, scroll down, and download the PDF version of the full article. Read this article (16 pages). This, along with the previous reading, covers the topics outlined in Subunits 7.1.1–7.1.4.
     
    Reading of and note taking for this text should take approximately 3 hours.
     
    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

  • Web Media: MTV’s True Life: “I Have Schizophrenia” Link: MTV’s True Life: “I Have Schizophrenia” (Adobe Flash)
     
    Instructions: Please click on the above link and press the play button to watch this video. If you would like, you can fast forward and start at 2 minutes and 45 seconds, as the first portion represents an overview of the segment. While viewing this video, please observe the types of positive and negative symptoms of schizophrenia exhibited by these individuals and note how these symptoms affects the individuals’ functioning. Also, please take note of the variations of schizophrenia presented as well as the effects/difficulties/potential challenges regarding specific treatments and treatment compliance in general.

    Watching of this video should take approximately 45 minutes.
     
    Terms of Use: Please respect the copyright and terms of use displayed on the webpage above.

7.1.1 Overview   *Schizophrenia is categorized as a profound disruption in cognition and emotion that affect fundamental human attributes (e.g., language, thought, perception, affect, sense of self). The disorder is characterized by a wide array of symptoms (including positive and negative manifestations), and there are issues with diagnostic complications and cultural variance that influence diagnosis and development. Given these aspects, the prevalence of schizophrenia in the general population can be skewed,

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 269–273 and MTV’s True Life link “I Have Schizophrenia” for additional information.*

7.1.2 Course and Recovery   *Studying the course of and recovery from schizophrenia is difficult due to various complications, such as the changing natures of diagnosis, treatment, and social norms. There is also variability in disorder progression and recovery due to multiple influences (e.g., disease heterogeneity, biological/genetic vulnerability, neurocognitive impairments, personal/social issues). However, even with variability, it is possible to generalize long-term course and recovery of schizophrenia due to longitudinal research outcomes, and even gender and age of onset.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 269–273 for additional information.*

7.1.3 Etiology   *As with other mental illnesses, a definitive cause of schizophrenia has yet to be determined, but there are a number of factors that can contribute to its development. Research indicates there may be an interaction between genetic predisposition (endowment) and environmental upheaval (disturbances during brain development). There is ample support for both genetic (i.e., family, twin, adoption studies, brain anatomical abnormalities, and abnormal levels of dopamine) and environmental (i.e., prenatal stressors, prenatal poverty, poor nutrition, and chronic stresses) factors that influence schizophrenia development.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 276–279 for additional information.*

7.1.4 Interventions/Treatments   *Interventions/treatments for schizophrenia have advanced in recent years, with service being linked to clinical phases of the disorder (i.e., acute, stabilizing, maintenance, and recovery) and optimal treatments including a combination of antipsychotic medications with psychosocial interventions. There is also increased awareness of how ethnicity and culture influence treatment
response so clinicians are utilizing ethnopsychopharmacology in providing the best management of the disorder.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 4: Adults and Mental Health,” pages 279–285 and Drs. Kopelowicz, Liberman, and Wallace’s article “Psychiatric Rehabilitation for Schizophrenia” for additional information.*

7.2 Schizophrenia in Older Adults   - Reading: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999): "Chapter 5: Older Adults and Mental Health" Link: United States Department of Health and Human Services’ MentalHealth: A Report of the Surgeon General (1999):** "Chapter 5: Older Adults and Mental Health" (PDF)
 
Instructions: Read the section titled “Schizophrenia in Late Life” under the section “Other Mental Disorders in Older Adults.” Please note that the pages in the PDF bar at the top of the document do not match the pages in the table of contents section on the first page. 
 
Reading of and note taking for this text should take approximately 15 minutes.
 
Terms of Use: Please respect the copyright and terms of use displayed on the web page above.

7.2.1 Schizophrenia in Late Life   *Schizophrenia can occur later in life although it is more commonly thought of as an illness in young adulthood. The diagnostic criteria are the same across the lifespan and there are noted similarities of the disorder in younger and older adults, such as delusions, hallucinations, disorganized speech, and disorganized behavior.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pg. 365 for additional information.*

7.2.2 Prevalence and Cost   *The prevalence and cost associated with schizophrenia in the aging population focuses on prevention compared to the general population and the high economic burden of the illness as related to other mental disorders.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pages 365–366 for additional information.*

7.2.3 Late-Onset   *Individuals with late-onset schizophrenia exhibit some of the same attributes (e.g., similar risks, clinical presentation, treatment response and course) as those who developed the disorder earlier on in life. However, there are significant gender differences in that women are more likely to develop late-onset schizophrenia than are men.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pg. 366 for additional information.*

7.2.4 Course and Recovery   *While it is difficult to determine actual course and recovery of individuals with schizophrenia, research suggests that early interventions, especially with antipsychotics, result in better long-term outcomes. It is important to consider studies by Kraepelin, Eyler-Zorrilla et al., and Klapow et al. when determining course and recovery of schizophrenia in the aging population.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pg. 366 for additional information.*

7.2.5 Etiology   *Etiological implications of late-onset schizophrenia include neurodevelopmental (i.e., physical developmental defects), childhood maladjustment, genetic contributions, and a possible neurobiological subtype of schizophrenia. Various models (i.e., diathesis-stress and multiple insult) also clarify etiological influences of the disorder.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pages 366–367 for additional information.*

7.2.6 Treatment   *Treatment of late-onset schizophrenia presents some challenges including problems/barriers with pharmacotherapies, and compliance with problem-solving therapy, interpersonal psychotherapy, and psychodynamic therapy.

Refer to the United States Department of Health and Human Services’ Mental Health: A Report of the Surgeon General (1999): “Chapter 5: Older Adults and Mental Health,” pg. 367 for additional information.*

The Saylor Foundation’s “Unit 7 Assessment”   - Assessment: The Saylor Foundation’s “Unit 7 Assessment” Link: The Saylor Foundation’s “Unit 7 Assessment”

 Instructions: Complete this unit assessment. For each question,
pick the best possible answer. The correct answers will be displayed
when you click the "Submit" button.  

 You must be logged into your Saylor Foundation School account in
order to access this quiz.  If you do not yet have an account, you
will be able to create one, free of charge, after clicking the
link.  

 Completing this assessment should take approximately 15 minutes.