Schizophrenia and Psychosis and Lifespan Development
Schizophrenia and Psychosis Matrix
Major DSM-IV-TR Categories
Schizophrenia and Psychosis
Positive (Type I): represent excesses or distortions from normal functioning
Grossly disorganized behavior
Negative (Type II): the absence of functioning
Poverty of speech
Schizophrenia and Psychosis
Delusions and Hallucinations
Grossly disorganized behavior
Active symptoms that do not fit other diagnostic types
No Type I symptoms but some negative symptoms
Symptoms of mood disorder and schizophrenia
Brief psychotic disorder
Type I Symptoms
Last less than one month
Type I Symptoms
Shared delusional disorder
Lifespan Development Matrix
Major DSM-IV-TR Categories
Mild, moderate, severe, and profound
Disorder of written expression
Motor skill disorders
Developmental coordination disorder
Expressive language disorder
Mixed receptive-expressive language disorder
Pervasive developmental disorders
Childhood disintegrative disorder
Attention deficit and disruptive behavior disorder
Attention deficit hyperactivity disorder
Oppositional defiant disorder
Feeding deficit and disruptive behavior disorder
Pica (eating nonfood substances)
Rumination disorder (regurgitation)
Chronic motor or vocal tic disorder
Transient tic disorder
Encopresis (defecating in inappropriate places)
Enuresis (urinating in inappropriate places)
Separation anxiety disorder
Reactive attachment disorder
Stereotypic movement disorder
(Hansell & Damour, 2008, 503-504)
Schizophrenia and Psychosis, and Lifespan Development:
Biological, Emotional, Cognitive and Behavioral Components
Schizophrenia is a sever mental illness associated with a wide spectrum of emotional, cognitive and behavioral symptoms. While commonly defined by its major symptoms of psychosis, the high degree of variance and related disorders have led many researchers to refer to the disorder not by a single definition but rather as the schizophrenic spectrum of disorders (Hansell & Damour, 2008, 468). The estimated lifetime prevalence of the disorder in the general population is approximately 1%. The disorder is also one of the most difficult to treat, with less than half of people diagnosed with schizophrenia showing significant clinical improvements after five years of treatment (Maki et al., 2005). Lifespan development, or developmental psychology, is the study of age-related psychological disorders. In particular, it examines the disorders that develop early in a person's childhood and adolescence and traces their development into adulthood. The disorders associated with childhood and adolescence, including schizophrenia and psychosis, each has unique biological, emotional, cognitive and behavioral components.
Schizophrenia shows a high degree of heritability. Studies have shown that family relatives have a substantially higher risk of developing the disorder than the general population (Tsuang, 2001). The risk of developing schizophrenia in family members increases with the degree of biological relatedness to the patient. "Greater risks are associated with higher levels of shared genes" (Tsuang, 2001, 18). First-degree relatives generally share about 50% of their genes and show a risk of about 9%, compared to the 1% risk of the general population. Most compelling evidence for the genetic linkage are monozygotic twins who show a risk near 50%. While these statistics show a genetic connection, they also demonstrate that there is a significant environmental influence on the disease. In particular, for monozygotic twins, who share 100% of their genes, the risk of developing schizophrenia is only 50%. Schizophrenia is a heterogeneous disorder both clinically and genetically. The disorder has a wide spectrum of related disorders and a varying expression of symptomatology. Genetic studies dismiss the idea that schizophrenia springs from a single gene. Instead, most researchers believe that a multi-factorial polygenic model best describes the genetic composition of the disorder (Tsuang, 2008, 19).
The biological components of lifespan development disorders are highly variable as some are directly associated with a single gene while others show a more indeterminate level of inheritance. Mental retardation, for example, one of the fundamental developmental disorders, is most frequently caused by Down Syndrome, which has the characteristic trisomy 21 (Hansell & Damour, 2008, 506). Meanwhile, learning disorders are less well understood. While there is a clear biological component and familial inheritance of the disorder, the exact genetic composition is unclear (Hansell & Damour, 2001, 509).
The emotional components of schizophrenia and psychosis are largely categorized under negative symptoms, or those that are absent or functionally deficient. Studies have specifically identified emotional expression both facially and vocally as deficient in schizophrenic patients. "Compared with individuals without schizophrenia, individuals with schizophrenia display fewer positive and negative facial expressions in response to emotionally evocative film clips, foods, and social interactions" (Kring & Moran, 2008, 821). This symptom is referred to as affective flattening, a negative Type II symptom that refers to the reduction or absence of normal emotions. This is very common amongst schizophrenic patients, who may appear emotionally blunted, or express emotions inappropriate to the particular situation (Hansell & Damour, 2008, 466). Some patients are further debilitated and experience avolition, or a lack of motivation and anhedonia, a lack of pleasure. Patients often find it difficult to perform any sort of constructive occupation.
Given the wide range of lifespan developmental disorders, the emotional components vary substantially. In adults, "emotional distress" is one of the four major criteria in evaluating psychopathology and is a major component of adult-related disorders such as Parkinson and Alzheimer's (Hansell & Damour, 2008, 500). In children, however, it is more difficult to study the emotional components of disorders because children and adolescents are less expressive or communicative. Children with learning disabilities have been shown to suffer emotional harm due to the exclusion experienced by their disorders. The inability to develop or learn as proficiently as their peers has been shown to have a negative impact on a child's emotional stability (Hansell & Damour, 2008, 511). Further, autism is one lifespan developmental disorder that has a pronounced emotional component. Children generally lack social or emotional exchange with others and have impaired communication. Conversely, children with attention deficit hyperactivity disorder are often unable to control the expression of their emotions and instead are excessively effusive.
Cognitive deficiencies and abnormalities are evident in both positive (Type I) and negative (Type II) symptoms of schizophrenia. One of the most debilitating aspects of the disorder is the persistent delusions and hallucinations experienced by patients. The delusions can be bizarre and nonbizarre and involve a shared experience. Hallucinations directly involve cognitive functions as they have both auditory and visual components. These hallucinations are very realistic and often inhibit the patients' awareness that they are not well and interfere with treatment (Hansell & Damour, 2008, 467). Cognitive abilities such as verbal fluency, learning, memory, attention and psychomotor skills are all reduced in schizophrenia. Patient may often make loose associations in speech, create new words, or ramble nonsensically. Still others display symptoms of echolalia (repeating verbatim the words of others) and echopraxia (repeating the gestures of others) (Hansell & Damour, 2008, 463). These cognitive deficiencies may arise from the common feeling amongst patients with schizophrenia that they are overwhelmed by stimuli.
Lifespan development disorders that display special cognitive impairment are mental retardation, learning disorders, Asperger's disorder, attention deficit hyperactivity disorder, and conduct disorders. Of these disorders, children with learning disorders are specifically cognitive impaired. Children with dyslexia have difficulties reading, those with dysgraphia have difficulties with written expression and in children with dyscalculia, academic achievement in mathematics is substantially below what would be expected of the child's age, intelligence or education. (Hansell & Damour, 2008, 509). Conversely, children with Asperger's disorder have substantially enhanced cognitive function and are able to process significantly more information than the average child. In adults, cognitive functions generally become impaired at old age and are especially pronounced in the elderly with senility and Alzheimer's.
The behavioral components of schizophrenia and psychosis are the most readily observable and thus often used to distinguish between different types of the disorder. Disorganized and catatonic schizophrenia are both designated by severe disorganized behavior. Patients classified as catatonic display symptoms that "range from extreme immobility and unresponsiveness to extreme agitation, such as purposeless flailing, pacing, or spinning" (Hansell & Damour, 2008, 464). Patients in these diagnostic categories also show symptoms of severe verbal disorganization as they find it difficult to organize their speech. Catatonic patients often display muteness, echolalia, and echopraxia along with extreme behavioral agitation. Delusions and hallucinations, which are primarily classified as paranoid schizophrenia, also affect the patients' behaviors, as they are often convinced to perform certain actions based on delusional thoughts or visions. (Hansell & Damour, 2008, 467).
In lifespan development, abnormal behavior ranges from extreme agitation and physical aggressiveness in attention deficit hyperactivity disorder, to noncompliance and unawareness of mental retardation. Conduct disorder and…