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Neuropsychology
of Schizophrenia
An Introduction for Psychotherapists
Patrizia Thoma
essentials
Springer essentials
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Patrizia Thoma
Neuropsychology of
Schizophrenia
An Introduction for Psychotherapists
Patrizia Thoma
Neuropsychologisches Therapie
Centrum, Klinische Neuropsychologie
Ruhr-Universität Bochum
Bochum, Germany
ISSN 2197-6708 ISSN 2197-6716 (electronic)
essentials
ISSN 2731-3107 ISSN 2731-3115 (electronic)
Springer essentials
ISBN 978-3-658-36399-4 ISBN 978-3-658-36400-7 (eBook)
https://doi.org/10.1007/978-3-658-36400-7
© Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2022
This book is a translation of the original German edition „Neuropsychologie der Schizophrenie“
by Thoma, Patrizia, published by Springer Fachmedien Wiesbaden GmbH in 2019. The transla-
tion was done with the help of artificial intelligence (machine translation by the service DeepL.
com). A subsequent human revision was done primarily in terms of content, so that the book will
read stylistically differently from a conventional translation. Springer Nature works continuously
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The registered company address is: Abraham-Lincoln-Str. 46, 65189 Wiesbaden, Germany
v
• An introduction to the epidemiology and etiology of schizophrenic disorders.
• An overview of the neuronal and cognitive changes in the different stages of
schizophrenia.
• Neuropsychological models of the neurocognitive bases of negative symp-
toms, delusions, hallucinations, and ego disorders.
• A brief overview of treatment programs that address the cognitive disorders
associated with schizophrenia.
What You Can Find in This essential
vii
Contents
1 Introduction ............................................... 1
2 Epidemiology, Etiology, and Pathophysiology ................... 3
3 Neurocognitive Changes ..................................... 7
4 Neurocognitive Models of Negative symptoms ................... 11
5 Neurocognitive Models of Positive Symptoms ................... 15
6 Diagnostics and Therapy of Cognitive Disorders ................. 27
7 Summary ................................................. 35
References ................................................... 39
1
Introduction
Schizophrenia is discussed in terms of a developmental neurobiologically deter-
mined disorder. This Essential primarily addresses current neuropsychologi-
cal findings on cognitive dysfunction in the context of schizophrenia, as well as
common neuropsychological models to explain the complex and heterogeneous
psychopathology. A primary concern of the book is to clarify the extent to which
these findings can play a role in the treatment of schizophreniform psychosis with
regard to their use in psychoeducation as well as the development of (meta)cogni-
tive therapy programs.
Looking back, Ms. L’s family would say that Ms. L's difficulties had
already started after the second semester of her studies. Ms. L., who had
always been a good student, complains at that time about concentration
problems and motivation problems. She fails two important exams and
finally drops out of her studies. She gradually withdraws more and more
from her friends and spends a lot of time alone at home. One day she con-
fides to her parents that she is having an affair with a married man but can-
not talk about the details of this relationship. He is a famous actor who
sends her messages of love on television and radio. Only she can decode
these messages. She is threatened by the female fans of her lover who
climb through her window at night to make her give up the relationship.
In this context, she often hears voices speaking disparagingly about her
or asking her to kill herself. This frightens her very much, as she does not
know where these voices are coming from. Her speech seems increasingly
disjointed and her narratives incoherent. When her family urged her to seek
treatment, Ms. L. reacted by breaking off contact. Apparently, they were all
part of a conspiracy to sabotage their relationship.
1
© Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2022
P. Thoma, Neuropsychology of Schizophrenia, Springer essentials,
https://doi.org/10.1007/978-3-658-36400-7_1
2
1 Introduction
The case study describes a young woman who at the end is apparently in a florid
phase of an episode of schizophrenia. In this stage, those affected often show very
bizarre symptoms that seem to be more difficult to grasp than the feelings of a
depressed patient. Delusions and hallucinations are also known as positive symp-
toms. Formal thought disorders, such as derailment and tangentiality, are consid-
ered by some authors to reflect positive symptoms, and by others to represent a
separate syndrome known under the term “disorganization symptoms”. Catatonic
symptoms, which predominantly affect drive and psychomotor function and can
manifest themselves, for example, in the form of stupor or extreme agitation,
mutism, or persistence in strange body positions, occur relatively rarely nowadays
thanks to early intervention with antipsychotics and are not discussed in detail in
the context of this volume.
The acute psychotic phase of the illness is often preceded by a more or less
pronounced prodromal phase, which is characterized by more unspecific neg-
ative symptoms, such as social withdrawal and apathy. Some of the symptoms
are associated with distinct neurocognitive changes, which will be described in
more detail in the following sections. In general, neuroscience has revealed sev-
eral findings in recent years that help us understand which factors are involved in
the aetiology of symptoms occurring in schizophrenia. In addition, neuroscien-
tific findings contribute to the development of effective treatments for the differ-
ent symptom domains. The focus of this volume is mainly on the diagnosis and
treatment of the neurocognitive disorders associated with the illness, as these also
partly explain the characteristic psychopathology.
3
Epidemiology, Etiology,
and Pathophysiology
Schizophrenia is one of the most common psychotic disorders. It occurs world-
wide with an incidence of 0.7% and is considered the most important cause of
chronic psychiatric disability and associated individual and socioeconomic bur-
den (Wittchen et al., 2011). Females appear to be slightly less likely to develop
the disorder than males. On average, schizophrenia occurs earlier in men, with
a peak onset in the second to the third decade of life, whereas women are more
likely to experience their first episode in middle age. Declining estrogen protec-
tion during menopause in women is discussed in this context, as estrogen inter-
acts with the function of the dopaminergic system (Agius et al., 2009). As will
become apparent later in the book, dopamine plays a central role in the patho-
physiology of schizophrenia. In addition, negative symptoms and cognitive
impairment tend to be more pronounced in males than in females. In contrast,
female patients show more florid symptoms, less cognitive impairment, and a
more benign course of the disease and a lower risk of chronification (Abel et al.,
2010).
Schizophrenia is a developmental neurobiologically determined disease (cf.
Piper et al., 2012, for a detailed description of the aspects discussed below). On
the one hand, genetic factors are discussed as causal factors. The risk of devel-
oping the disease increases with the number of and genetic proximity to the bio-
logical relatives affected. For first-degree relatives (e.g. one parent, siblings) of
a patient with schizophrenia, the risk increases by a factor of ten, and by a fac-
tor of twenty to forty for two affected parents. In the case of identical twins, the
concordance rates, i.e. the rates at which both twins develop the disease, amount
to 50%. Adoption studies highlight that this cannot be solely attributed to stress
factors associated with sharing life with psychotic individuals, but truly reflects
2
© Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2022
P. Thoma, Neuropsychology of Schizophrenia, Springer essentials,
https://doi.org/10.1007/978-3-658-36400-7_2