CLINICAL HANDBOOK OF SCHIZOPHRENIA

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64 I. CORE SCIENCE AND BACKGROUND INFORMATIONMcGue, M., Gottesman, I. I., & Rao, D. C. (1983). The transmission of schizophrenia under amultifactorial threshold model. American Journal of Human Genetics, 35 1161–1178.McGue, M., Gottesman, I. I., & Rao, D. C. (1985). Resolving genetic models for the transmission ofschizophrenia. Genetic Epidemiology, 2, 99–110.Morton, N. E. (1982). Outline of genetic epidemiology. Basel: Karger.O’Rourke, D. H., Gottesman, I. I., Suarez, B. K., Rice, J., & Reich, T. (1982). Refutation of the generalsingle-locus model for the etiology of schizophrenia. American Journal of Human Genetics, 34,630–649.Rüdin, E. (1916). Zur Vererbung und Neuentstehung der Dementia Praecox [Studies on the inheritanceand origin of mental illness]. Berlin: Springer.Tsuang, M. T., Stone, W. S., & Faraone, S. V. (1999). Schizophrenia: A review of genetic studies. HarvardReview of Psychiatry, 7, 185–207.
CHAPTER 7ENVIRONMENTAL PRE-AND PERINATALINFLUENCES IN ETIOLOGYLAUREN M. ELLMANTYRONE D. CANNONIn the search for the causes of schizophrenia, the preponderance of evidence suggeststhat genes play a substantial role in the etiology of the disorder. Based on the results fromtwin, family, and adoption studies, genetic influences account for approximately 80% ofthe disorder’s etiology. Although schizophrenia appears to be a highly heritable disorder,it is clear that environmental factors also are involved. Many environmental influenceshave been investigated as potential contributors to the disorder, such as family environment,socioeconomic status, and substance abuse; however, a repeatedly demonstratedenvironmental predictor of schizophrenia has been a history of obstetric complications(OCs). OCs constitute a fairly broad class of events, including any deviation from thenormal course of pregnancy, labor–delivery, and the early neonatal period, such as lowbirthweight, prenatal maternal infection, and many others (discussed below). Such complicationsare relatively common, occurring in the histories of approximately 20–30% ofpatients with schizophrenia and approximately 5–10% of the population overall. In thischapter, we provide an overview of the various OCs that have been linked to schizophrenia,discuss different explanatory models of how OCs operate within the etiology of thedisorder, and discuss the potential mechanisms underlying two main classes of OCs associatedwith schizophrenia: prenatal infection and fetal oxygen deprivation.HOW DO OCs OPERATE WITHIN THEETIOLOGY <strong>OF</strong> <strong>SCHIZOPHRENIA</strong>?An array of models has been proposed to explain how OCs contribute to the causes ofschizophrenia. We cover the most prominent models in schizophrenia research and discusswhich model is best supported by empirical research.65
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CLINICAL HANDBOOK OF SCHIZOPHRENIA
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© 2008 The Guilford PressA Divisio
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CONTRIBUTORSDonald Addington, MD, D
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ContributorsixGillian Haddock, PhD,
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ContributorsxiRoger H. Peters, PhD,
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PREFACESchizophrenia is arguably th
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Prefacexvcorporation of environment
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CONTENTSI. CORE SCIENCE AND BACKGRO
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ContentsxixCHAPTER 27 Illness Self-
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ContentsxxiCHAPTER 59 Sexuality 604
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CHAPTER 1HISTORY OF SCHIZOPHRENIAAS
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1. History of Schizophrenia 5ularly
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1. History of Schizophrenia 7PSYCHO
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1. History of Schizophrenia 9The ne
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1. History of Schizophrenia 11Since
Page 35 and 36: 1. History of Schizophrenia 13Belli
Page 37 and 38: 2. Epidemiology 15al., 2006), which
Page 39 and 40: 2. Epidemiology 17not generally fou
Page 41 and 42: 2. Epidemiology 19• Intrauterine
Page 43 and 44: 2. Epidemiology 21function in socia
Page 45 and 46: 2. Epidemiology 23KEY POINTS• Sch
Page 47 and 48: CHAPTER 3BIOLOGICAL THEORIESJONATHA
Page 49 and 50: 3. Biological Theories 27cortex (in
Page 51 and 52: 3. Biological Theories 29unchanged
Page 53 and 54: 3. Biological Theories 31raclopride
Page 55 and 56: 3. Biological Theories 33drives, mo
Page 57 and 58: CHAPTER 4BRAIN IMAGINGLISA T. EYLER
Page 59 and 60: 4. Brain Imaging 37yet to be strong
Page 61 and 62: 4. Brain Imaging 39with neuroleptic
Page 63 and 64: 4. Brain Imaging 41events. However,
Page 65 and 66: 4. Brain Imaging 43KEY POINTS• On
Page 67 and 68: 5. Neuropathology 45TABLE 5.1. Summ
Page 69 and 70: 5. Neuropathology 47schizophrenia i
Page 71 and 72: 5. Neuropathology 49has been report
Page 73 and 74: 5. Neuropathology 51also been demon
Page 75 and 76: 5. Neuropathology 53results, especi
Page 77 and 78: CHAPTER 6GENETICSSTEPHEN J. GLATTTh
Page 79 and 80: 6. Genetics 57Question 2: What Are
Page 81 and 82: 6. Genetics 59nia. Each individual
Page 83 and 84: 6. Genetics 61degree relatives desp
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Page 89 and 90: 7. Environmental Pre- and Perinatal
Page 97 and 98: 8. Psychosocial Factors 75Steinberg
Page 99 and 100: 8. Psychosocial Factors 77in terms
Page 101 and 102: 8. Psychosocial Factors 79This mode
Page 103 and 104: 8. Psychosocial Factors 81KEY POINT
Page 105 and 106: 9. Psychopathology 83ations; change
Page 107 and 108: 9. Psychopathology 85sity School of
Page 109 and 110: 9. Psychopathology 87or “loose as
Page 111 and 112: 9. Psychopathology 89lished WHO. Th
Page 113 and 114: CHAPTER 10COGNITIVE FUNCTIONINGIN S
Page 115 and 116: 10. Cognitive Functioning in Schizo
Page 123 and 124: 11. Course and Outcome 101DIAGNOSIS
Page 125 and 126: 11. Course and Outcome 103TABLE 11.
Page 127 and 128: 11. Course and Outcome 105DOMAINS O
Page 129 and 130: 11. Course and Outcome 107mation gi
Page 131 and 132: 11. Course and Outcome 109quency of
Page 133 and 134: 11. Course and Outcome 111to a smal
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CHAPTER 12DIAGNOSTIC INTERVIEWINGAB
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12. Diagnostic Interviewing 119psyc
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12. Diagnostic Interviewing 121not
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12. Diagnostic Interviewing 123tual
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CHAPTER 13ASSESSMENT OFCO-OCCURRING
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Time-Line Follow-BackThe Time-Line
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Testing and Risk Assessment for Inf
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13. Co-Occurring Disorders 131test
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13. Co-Occurring Disorders 133can i
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CHAPTER 14ASSESSMENT OFPSYCHOSOCIAL
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14. Assessment of Psychosocial Func
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TABLE 14.1. Measures of Psychosocia
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CHAPTER 15TREATMENT PLANNINGALEXAND
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15. Treatment Planning 147WHAT DOES
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15. Treatment Planning 149TABLE 15.
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15. Treatment Planning 151Poor adhe
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Occupational/School Functioning15.
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15. Treatment Planning 155Drake, R.
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CHAPTER 16ANTIPSYCHOTICSERIC C. KUT
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16. Antipsychotics 161for at least
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TABLE 16.3. Dosing of the First-Gen
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16. Antipsychotics 165are not avail
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16. Antipsychotics 167• Therapeut
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17. Side Effects of Antipsychotics
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18. Clozapine 179Plasma concentrati
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TABLE 18.1. Clinical tips for cloza
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18. Clozapine 183linergic effects t
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18. Clozapine 185• Common side ef
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19. Other Medications 187agitation
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19. Other Medications 189Small, ope
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19. Other Medications 191ANTIDEPRES
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19. Other Medications 193sation in
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19. Other Medications 195Citrome, L
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20. Electroconvulsive Therapy 197TA
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20. Electroconvulsive Therapy 199FI
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Missed SeizuresIf no seizure occurs
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20. Electroconvulsive Therapy 203(C
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PART IVPSYCHOSOCIAL TREATMENT
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208 IV. PSYCHOSOCIAL TREATMENTdisin
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210 IV. PSYCHOSOCIAL TREATMENTFIGUR
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212 IV. PSYCHOSOCIAL TREATMENTschiz
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CHAPTER 22FAMILY INTERVENTIONCHRIST
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216 IV. PSYCHOSOCIAL TREATMENTTABLE
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218 IV. PSYCHOSOCIAL TREATMENTcommi
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220 IV. PSYCHOSOCIAL TREATMENTother
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222 IV. PSYCHOSOCIAL TREATMENTtient
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224 IV. PSYCHOSOCIAL TREATMENTButzl
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CHAPTER 23COGNITIVE-BEHAVIORAL THER
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228 IV. PSYCHOSOCIAL TREATMENTThe a
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230 IV. PSYCHOSOCIAL TREATMENTAndre
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234 IV. PSYCHOSOCIAL TREATMENTtion.
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236 IV. PSYCHOSOCIAL TREATMENTnever
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238 IV. PSYCHOSOCIAL TREATMENTwith
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CHAPTER 24SOCIAL SKILLS TRAININGWEN
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242 IV. PSYCHOSOCIAL TREATMENTeach
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244 IV. PSYCHOSOCIAL TREATMENTThe m
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246 IV. PSYCHOSOCIAL TREATMENTCogni
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248 IV. PSYCHOSOCIAL TREATMENT• S
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250 IV. PSYCHOSOCIAL TREATMENTThe d
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252 IV. PSYCHOSOCIAL TREATMENTNone
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254 IV. PSYCHOSOCIAL TREATMENT• I
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256 IV. PSYCHOSOCIAL TREATMENTnance
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260 IV. PSYCHOSOCIAL TREATMENTMcGur
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262 IV. PSYCHOSOCIAL TREATMENTalong
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264 IV. PSYCHOSOCIAL TREATMENTappro
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266 IV. PSYCHOSOCIAL TREATMENTKEY P
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CHAPTER 27ILLNESS SELF-MANAGEMENT T
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270 IV. PSYCHOSOCIAL TREATMENTensur
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272 IV. PSYCHOSOCIAL TREATMENTReduc
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274 IV. PSYCHOSOCIAL TREATMENTgage
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276 IV. PSYCHOSOCIAL TREATMENTTABLE
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278 IV. PSYCHOSOCIAL TREATMENTInnov
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280 IV. PSYCHOSOCIAL TREATMENTpredi
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282 IV. PSYCHOSOCIAL TREATMENTCogni
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284 IV. PSYCHOSOCIAL TREATMENTGoal
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286 IV. PSYCHOSOCIAL TREATMENTthey
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288 IV. PSYCHOSOCIAL TREATMENTas nu
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290 IV. PSYCHOSOCIAL TREATMENTway h
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292 IV. PSYCHOSOCIAL TREATMENTThe r
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294 IV. PSYCHOSOCIAL TREATMENT• T
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296 IV. PSYCHOSOCIAL TREATMENTsetti
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CHAPTER 30SELF-HELP ACTIVITIESFREDE
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300 IV. PSYCHOSOCIAL TREATMENThelp,
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302 IV. PSYCHOSOCIAL TREATMENTbeen
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304 IV. PSYCHOSOCIAL TREATMENTdiagn
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PART VSYSTEMS OF CARE
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310 V. SYSTEMS OF CAREcial to addre
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312 V. SYSTEMS OF CAREneeded servic
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314 V. SYSTEMS OF CAREformed by cas
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316 V. SYSTEMS OF CARE4. Conducting
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318 V. SYSTEMS OF CAREvere mental i
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320 V. SYSTEMS OF CAREents receivin
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322 V. SYSTEMS OF CAREculties in ge
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324 V. SYSTEMS OF CAREIn such a sit
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326 V. SYSTEMS OF CAREFIGURE 32.1.
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328 V. SYSTEMS OF CAREREFERENCES AN
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330 V. SYSTEMS OF CAREDESCRIPTION O
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332 V. SYSTEMS OF CAREfor ACT have
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334 V. SYSTEMS OF CAREvices compare
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336 V. SYSTEMS OF CAREA team leader
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338 V. SYSTEMS OF CAREof leverage t
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340 V. SYSTEMS OF CAREcare of thems
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342 V. SYSTEMS OF CAREframework for
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344 V. SYSTEMS OF CAREaccount the v
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346 V. SYSTEMS OF CAREthat deinstit
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348 V. SYSTEMS OF CARETypes of Resi
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350 V. SYSTEMS OF CARESupportive Ho
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352 V. SYSTEMS OF CAREate assistanc
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CHAPTER 35TREATMENT INJAILS AND PRI
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356 V. SYSTEMS OF CARElikely to rem
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358 V. SYSTEMS OF CAREtitled Effect
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360 V. SYSTEMS OF CAREgering, becau
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362 V. SYSTEMS OF CAREior problems.
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364 V. SYSTEMS OF CAREAmerican Psyc
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CHAPTER 36FIRST-EPISODE PSYCHOSISDO
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36. First-Episode Psychosis 369TABL
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36. First-Episode Psychosis 371have
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36. First-Episode Psychosis 373The
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36. First-Episode Psychosis 375divi
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36. First-Episode Psychosis 377Supp
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36. First-Episode Psychosis 379(200
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37. Treatment of the Schizophrenia
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38. Older Individuals 391TABLE 38.1
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38. Older Individuals 393answer, an
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38. Older Individuals 395rates (69%
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38. Older Individuals 397Patterson,
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39. Aggression, Violence, and Psych
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CHAPTER 40HOUSING INSTABILITYAND HO
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40. Housing Instability and Homeles
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41. Medical Comorbidity 425Medical
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41. Medical Comorbidity 427search s
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41. Medical Comorbidity 429TABLE 41
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41. Medical Comorbidity 431Caring f
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41. Medical Comorbidity 433Counseli
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41. Medical Comorbidity 435REFERENC
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CHAPTER 42INTELLECTUAL DISABILITYAN
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42. Intellectual Disability and Oth
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CHAPTER 43TRAUMA AND POSTTRAUMATICS
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43. Trauma and Posttraumatic Stress
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CHAPTER 44MANAGEMENT OFCO-OCCURRING
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44. Management of Co-Occurring Subs
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CHAPTER 45PARENTINGJOANNE NICHOLSON
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45. Parenting 473THE IMPACT OF PARE
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TABLE 45.1. Antipsychotic Medicatio
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Guidelines for Prescribing Antipsyc
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45. Parenting 479provide safe space
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CHAPTER 46CHILDREN AND ADOLESCENTSJ
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46. Children and Adolescents 483pri
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46. Children and Adolescents 485TRE
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46. Children and Adolescents 487Als
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46. Children and Adolescents 489KEY
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CHAPTER 47SUICIDEMARNIN J. HEISELSu
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TABLE 47.1. Selected Risk Factors f
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Clinical Course and Symptoms of Sch
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47. Suicide 497those with schizoaff
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47. Suicide 499assessment tools can
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47. Suicide 501yet focused on suici
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47. Suicide 503ACKNOWLEDGMENTSI gra
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PART VIIPOLICY, LEGAL,AND SOCIAL IS
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508 VII. POLICY, LEGAL, AND SOCIAL
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CHAPTER 49INVOLUNTARY COMMITMENTJON
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CHAPTER 50JAIL DIVERSIONJOSEPH P. M
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PART VIIISPECIAL TOPICS
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560 VIII. SPECIAL TOPICStion, restr
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562 VIII. SPECIAL TOPICSsion criter
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564 VIII. SPECIAL TOPICSbased on ev
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CHAPTER 55RECOVERYDAVID ROELARRY DA
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568 VIII. SPECIAL TOPICSatric disab
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570 VIII. SPECIAL TOPICSA RECOVERY
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572 VIII. SPECIAL TOPICSassumes fro
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574 VIII. SPECIAL TOPICSDeegan, P.
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576 VIII. SPECIAL TOPICSwhereas ado
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578 VIII. SPECIAL TOPICSalence of d
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580 VIII. SPECIAL TOPICS• Because
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582 VIII. SPECIAL TOPICScovering pa
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584 VIII. SPECIAL TOPICSGoldberg, 1
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586 VIII. SPECIAL TOPICSthe quality
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588 VIII. SPECIAL TOPICSof-life mea
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590 VIII. SPECIAL TOPICSBecker, M.,
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CHAPTER 58SPIRITUALITY AND RELIGION
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594 VIII. SPECIAL TOPICSbe related
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596 VIII. SPECIAL TOPICSmore or les
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598 VIII. SPECIAL TOPICSing with bo
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600 VIII. SPECIAL TOPICSExpressive
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602 VIII. SPECIAL TOPICSconsumer ab
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CHAPTER 59SEXUALITYALEX KOPELOWICZR
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606 VIII. SPECIAL TOPICSmay result
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608 VIII. SPECIAL TOPICSTABLE 59.1.
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610 VIII. SPECIAL TOPICSThis second
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612 VIII. SPECIAL TOPICSFIGURE 59.1
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614 VIII. SPECIAL TOPICSTo overcome
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CHAPTER 60SCHIZOPHRENIA INAFRICAN A
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618 VIII. SPECIAL TOPICSTABLE 60.1.
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620 VIII. SPECIAL TOPICSPHARMACOTHE
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622 VIII. SPECIAL TOPICSered a part
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CHAPTER 61ETHICSABRAHAM RUDNICKCHAR
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626 VIII. SPECIAL TOPICSinterests c
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628 VIII. SPECIAL TOPICSticipant re
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630 VIII. SPECIAL TOPICSvide an eth
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632 IndexAmerican CorrectionalAssoc
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634 IndexChildren/adolescents, 481-
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636 IndexDepressive symptoms, 106,
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638 IndexFirst-episode psychosis, 1
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640 IndexInformation technology, he
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642 IndexMotor symptoms, DSM-IV-TR,
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644 IndexPregnancydosing strategies
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646 IndexRisk factorsfor co-occurri
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648 IndexSTG. See Superior temporal
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650 IndexUrine testingfor nicotine
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