This document discusses several approaches to understanding and treating schizophrenia, including: - The biological approach which examines genetic and neurological factors. - The cognitive approach which focuses on faulty thought processes that lead to symptoms. - Psychodynamic, behavioral, cognitive-behavioral, family/marital, humanistic, and sociocultural perspectives on etiology and treatment. Key treatment approaches mentioned are psychodynamic therapy, cognitive-behavioral techniques like systematic desensitization and exposure therapy, and rational emotive therapy.

1. Soheir H. ElGhonemy
Assist. Professor of Psychiatry- ASU
Member of ISAM, APA, EPA,WPA
Trainer Approved by NCFLD
selghonamy@hotmail.com

2.  Characterized by distortions: thoughts,
perception, language, emotions
 Eugen Bleuler – Swiss psychiatrist – coined
“schizophrenia”
 Greek words for “split mind” - separation of
cognitive and emotional functions – mental
confusion, inappropriate or absent emotional
expression.

3.  Familiar things like colors, sounds, or tastes may appear
altered in a strange way.
 At first, symptoms may include mild feelings of tension,
inability to sleep or concentrate, and a loss of interest in
school, work, or friends.
 The symptoms of schizophrenia vary from one person to
another, and they can appear either gradually or suddenly
 The person incorrectly evaluates the accuracy of his or her
perceptions and thoughts and makes incorrect conclusions
about reality.

4. The biological, cognitive, and behaviorist approaches all
have their different theories to resolve a cure for this
disorder. Research is revealing that schizophrenia is
indeed a environmental impact during the development
of the brain during pregnancy and childhood. Another
prediction is that is a result of the interaction of certain
variations of genes. These would be the damaged
portions of genes.

5. The Behaviorist Approach interprets abnormal behavior as simply
maladaptive learning.”
From this, the behaviorist approach would then say that
Schizophrenia is not regarded at all differently to other forms of
abnormal behavior.
In other words, the behaviorist approach would actually see the
term Schizophrenia as having no etiological value.
Although the behaviorist approach does not believe that there
seems to be an etiology for this disorder, it does have a number
of different treatments for it, such as token economy.

6. The biological approach closely looks at the interaction between
the environment and genetics. Some might say that the
biological perspective is too radical, and reductionist, but it
seems that genetics due play a major role in the involvement of
this disorder.
Research nowadays proposes the idea that schizophrenia is
caused by a genetic vulnerability which is coupled with the
environmental and psychological stressors. This is also known as
the diathesis-stress model.
The idea basically says that whether the person develops the
disorder or not, for the most part it is determined by the
vulnerability.

7.  Explains Schizophrenia in terms of genetic and
psychological processes (Genetic Predisposition-
Structural Brain abnormalities “smaller frontal cortex” ,
Neurotransmitter abnormalities “Dopamine hypothesis”
,Prenatal abnormalities neuro-developmental hypothesis
and the vulnerability “Stress Approach” )
 Emphasizes environmental influences
 Try to identify individuals who are defined as being at
risk, and observe whether they in fact develop
schizophrenia

8. Suggests that schizophrenia results from excess activity at
dopamine synapses in certain areas of the brain.
Yet;
 Not all patients respond to chlorpromazine.
 Even though drugs reach brain after ingestion, it takes days
or weeks before improvement. If excess dopamine alone
was the problem, behavior should change as soon as
dopamine levels drop.
 Clozapine – better than chlorpromazine, affects more non-
dopamine than dopamine pathways.
 Glutamate and serotonin may be involved.
 Brain scans have showed less frontal lobe activity in
Schizophrenic patients.
 Diathesis-stress model of abnormal behavior – abnormal
behavior arises as a result of the combination of a
predisposition and a stressful environment.

9.  All typical antipsychotics block D2 with varying
affinities
 Dopamine agonists can precipitate a psychosis

10. Nigro-
striatal
Substantia
Nigra
Caudate
and
putamen
Move-
ment
Extrapyramidal
symptoms, dystonias,
Tardive dyskinesia
Meso-
limbic
Ventral
tegmental
area, subst.
nigra
Accumbens
amygdala
Olfactory
tubercle
Emotions,
affect,
memory
Positive symptoms
Meso-
cortical
Ventral
tegmental
area
Prefrontal
Cortex
Thought,
volition,
memory
Blockade here can
worsen negative
symptoms.
Cell bodies
Projections
Functions
Clinical implications

11.  Focuses on analyzing the various types of symptom and
suggests information based on the faulty cognitive
processing.
 Suggests interesting insights into the nature of
schizophrenic behavior
 There are specifically three aspects it focuses on:
Delusions, language, and thought disturbances.
 Cognitive Symptoms of Schizophrenia
Cognitive symptoms refer to the difficulties with
concentration and memory. These can include:
disorganized thinking, slow thinking , difficulty
understanding, poor concentration, poor memory, difficulty
expressing thoughts, difficulty integrating thoughts,
feelings and behavior

12.  Faulty cognitive processing
 Delusions , beliefs contradictory to reality.
 Thought disturbances
• Faulty references, misinterpretation of significance of
stimulus and events. Person attributes meaning to event
which most people would not.
• Individuals problem of defective attention - difficulty in
selecting and attending to the relevant stimuli in a situation.
• The negative responses to other people would aggravate
the social impact of the initial problem of defective
attention.

14.  The psychodynamic explanation
 Freud believed that schizophrenia develops from two
processes:
 Regression to a pre-ego stage
 Efforts to re-establish ego control
 He proposed that when their world is extremely harsh,
people who develop schizophrenia regress to the earliest
points in their development (primary narcissism), in which
they recognize and meet only their own needs
 This regression leads to self-centered symptoms such as
neologisms, loose associations, and delusions of grandeur

15.  The psychodynamic explanation
 Freud's theory posits that attempts to reestablish
ego control from such a state fail and lead to further
schizophrenic symptoms
 Years later, another psychodynamic theorist
elaborated on Freud's idea of harsh parents
 The theory of schizophrenogenic mothers
proposed that mothers of people with
schizophrenia were cold, domineering, and
uninterested in their children's needs
 Both of these theories have received little research
support and have been rejected by most
psychodynamic theorists

16.  The behavioral view:
 Behaviorists cite operant conditioning and principles
of reinforcement as the cause of schizophrenia
 They propose that some people are not reinforced
for their attention to social cues and, as a result,
they stop attending to those cues and focus instead
on irrelevant cues (e.g., room lighting)
 Their responses become increasingly bizarre yet
are rewarded with attention and, thus, are likely to
be repeated
 Support for this model has been circumstantial and
the view is considered (at best) a partial explanation

17.  The cognitive view
 Leading cognitive theorists agree that biological factors
produce symptoms. They argue that further features of
the disorder emerge because of faulty interpretation
and a misunderstanding of symptoms
 Example: a man experiences auditory
hallucinations and approaches his friends for
help; they deny the reality of his sensations; he
concludes that they are trying to hide the truth
from him; he begins to reject all feedback and
starts feeling persecuted
 There is little direct research support for this view

18.  Sociocultural View:
 Sociocultural theorists believe that three main
social forces contribute to schizophrenia:
Multicultural factors
Social labeling
Family dysfunction
 Although these forces are considered important in the
development of schizophrenia, research has not yet clarified
what their precise causal relationships might be

19.  Rates of the disorder differ between racial and ethnic groups
 Rates also differ between countries, as do the course and
outcome of the disorder
 Some theorists believe the differences partly reflect
genetic differences from population to population
 Others argue that the psychosocial environments of
developing countries tend to be more supportive
than developed countries, leading to more favorable
outcomes for people with schizophrenia

20.  Many sociocultural theorists believe that the features
of schizophrenia are influenced by the diagnosis itself
 Society labels people who fail to conform to certain norms
of behavior
 Once assigned, the label becomes a self-fulfilling prophecy
 The dangers of social labeling have been well
demonstrated

21.  One of the best-known family theories of schizophrenia
focuses on double-bind communication:
 Some parents repeatedly communicate pairs of mutually
contradictory messages that place the child in so-called
double-bind situations; the child cannot avoid
displeasing the parents because nothing the child does is
right
 In theory, the symptoms of schizophrenia represent the
child's attempt to deal with the double binds.
 Double-bind messages typically consist of a “primary” verbal
communication and an accompanying contradictory
nonverbal “metacommunication”

22.  This theory is closely related to the psychodynamic notion of a
schizophrenogenic mother.
 Parents of people with the disorder often:
Display more conflict
Have greater difficulty communicating
Are more critical of and overinvolved with their children
than other parents
 Family theorists have long recognized that some families are
high in “ expressed emotion (EE) ” – family members
frequently express criticism and hostility and intrude on each
other's privacy
 Individuals who are trying to recover from schizophrenia are
almost four times more likely to relapse if they live with such
a family

23.  Psychodynamic
 Cognitive-behavioral
 Humanistic
 Family and marital
 Biological

24.  The psychodynamic approach was created by S. Freud
 Mental symptoms reflect unconscious conflicts that
induce anxiety
 Insight refers to the situation when a person comes
to understand their unconscious conflicts
 Therapeutic change requires an alliance
(relationship) between the patient and therapist

25.  The goal of psychodynamic therapy is to achieve
insight into unconscious conflicts
 Free Association refers to a technique in which the patient
is encouraged to say whatever comes to mind to reveal the
unconscious processes of the patient
 Interpretation: Therapist interprets the thoughts, and
feelings of the patient in order to reveal the hidden
conflicts and motivations
 Analysis of transference: Patients bring into therapy their
past troubled relationships; these are transferred to the
therapist

26.  Cognitive-behavioral therapies focus on the
current behaviors of a person
 Emphasis is on the present rather than the past
 Cognitive-Behavioral therapists are very directive
 Therapy duration is short-term rather than years
long
 Initial focus is on a detailed behavioral analysis:
focus is on the problem behavior and the stimuli
associated with it

27.  Classical conditioning techniques can alter
emotional responses
 Systematic desensitization: Patient is encouraged to
confront a feared stimulus while in a relaxed state
 Therapist trains relaxation
 Patient constructs an image hierarchy
 While relaxing, patient imagines the least fearful of the
images in their hierarchy
 Exposure: Patient is exposed to the stimulus that they fear

28.  Focus of cognitive therapies is on changing
dysfunctional thought patterns
 Rational Emotive Therapy focuses on the
hurtful thought patterns of the patient
 Ellis’s theory suggests that pathology results when
persons adopt illogic in response to life situations
 Therapist notes illogical and self-defeating
thoughts and teaches alternative thinking that
promotes rational thought