schizophrenia & other psychotic disorders. schizophrenia: lost touch with reality disruption of:...
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Schizophrenia:
Lost touch with reality Disruption of:
Normal thought processes
Perception Personality Affect
positive symptoms – deviant behaviors delusions, hallucinations, thoughts
negative symptoms –deficit symptoms Lack of normal function
SYMPTOMS OF SCHIZOPHRENIA
thought disorder –disrupted cognitive functioning
most dramatic and obvious symptom loosening of associations word salad – seems as if sense Neologisms – new words clang associations - sounds of words
POSITIVE SYMPTOMS
• delusions – not objectively true
• not be accepted as true within culture
• person holds firmly in spite of contrary evidence
POSITIVE SYMPTOMS
POSITIVE SYMPTOMS
Delusions• Paranoid/persecution• Grandeur• Capgas syndrome – double of other’s• Cotard’s syndrome – part of body
changed• Change vs. fixed
• hallucinations – perceptual experiences that feel real although there is nothing to perceive
• Visual• Auditory• tactile
POSITIVE SYMPTOMS
Attention Problems
Difficulty focusing attention
Esp. during first stages
Bombarded Attention is critical to
functioning
Anhedonia - interestAvolition - movementAlogia - content or quantity of speechflat or blunted affect
NEGATIVE SYMPTOMS
catatonia – a psychomotor disturbance of movement and posture catatonic stupor waxy flexibility
OTHER SYMPTOMS
Schizophrenia is not…
Split personality disorderMultiple personality disorderSchizophrenia = “splitting of the
mind”Ambivalence
clinical course –specific pattern of changes in symptomatology over time prodromal phase active phase residual phase
CLINICAL COURSE
Schizophrenia
1% lifetime prevalence
Equal men & women
Consistent across cultures (differences in dx and recovery)
More in lower class Early life Women later
AGE OF RISK FOR SCHIZOPHRENIA
0
5
10
15
20
Proportion
5 10 15 20 25 30 35 40 45 50
Age (in years)
(A) Age at first diagnosis
MalesFemales
Source : Adapted from I.I. Gottesman, Schizophrenia Genesis: The Origins of Madness (New York: Freeman, 1991.)
AGE OF RISK FOR SCHIZOPHRENIA
0
20
40
60
80
100
Cumulative Proportion
5 10 15 20 25 30 35 40 45 50
Age (in years)
(B) Age of risk
MalesFemales
Source : Adapted from I.I. Gottesman, Schizophrenia Genesis: The Origins of Madness (New York: Freeman,1991.)
TYPICAL COURSES FOR SCHIZOPHRENIA
(A) CHRONICGRADUAL ONSET & VERY POOR PROGNOSISGRADUAL ONSET & VERY POOR PROGNOSIS
TYPICAL COURSES FOR SCHIZOPHRENIA
(B) EPISODICOCCASIONAL EPISODES WITH OCCASIONAL EPISODES WITH
NEARLY NORMAL FUNCTIONING BETWEEN THEMNEARLY NORMAL FUNCTIONING BETWEEN THEM
TYPICAL COURSES FOR SCHIZOPHRENIA
(C) SINGLE EPISODEBRIEF PERIOD OF PSYCHOSIS & NEARLY BRIEF PERIOD OF PSYCHOSIS & NEARLY
COMPLETE RECOVERY WITH NO OTHER EPISODESCOMPLETE RECOVERY WITH NO OTHER EPISODES
22%
SUBTYPES OF SCHIZOPHRENIA
disorganizeddisorganized
catatoniccatatonic
paranoidparanoid
undifferentiatedundifferentiated
residualresidual
SUBTYPES OF SCHIZOPHRENIA
characterized by characterized by disorganized disorganized speech or speech or behavior and flat behavior and flat or inappropriate or inappropriate affectaffect
disorganizeddisorganized
catatoniccatatonic
paranoidparanoid
undifferentiatedundifferentiated
residualresidual
SUBTYPES OF SCHIZOPHRENIA
characterized by characterized by psychomotor psychomotor disturbance of disturbance of movement and movement and postureposture
disorganizeddisorganized
catatoniccatatonic
paranoidparanoid
undifferentiatedundifferentiated
residualresidual
SUBTYPES OF SCHIZOPHRENIA
characterized by characterized by fixed delusions of fixed delusions of persecutionpersecution
disorganizeddisorganized
catatoniccatatonic
paranoidparanoid
undifferentiatedundifferentiated
residualresidual
SUBTYPES OF SCHIZOPHRENIA
diagnosis used for diagnosis used for people who meet people who meet the criteria for the criteria for schizophrenia but schizophrenia but do not clearly fit do not clearly fit into the above into the above subtypessubtypes
disorganizeddisorganized
catatoniccatatonic
paranoidparanoid
undifferentiatedundifferentiated
residualresidual
SUBTYPES OF SCHIZOPHRENIA
symptom patterns symptom patterns found in individuals found in individuals with schizophrenia with schizophrenia during periods of during periods of relative remissionrelative remissionincludingincluding cognitive cognitive slippageslippage
disorganizeddisorganized
catatoniccatatonic
paranoidparanoid
undifferentiatedundifferentiated
residualresidual
Development of Schizophrenia
Abnormal signs childhood Less positive affect More negative affect
Older adults ↓ positive symptoms ↑ negative symptoms
CAUSES OF SCHIZOPHRENIA
THEORIES OF CAUSE Hypothesized causes/predispositions Not mutually exclusive Theories are specific - overlap
CAUSES of Schizophrenia
1. Genetics
2. Neurobiology
3. Psychological and Social
4. Psychodynamic Theories
Diathesis – Stress Models
Genetics & Schizophrenia
Genes are responsible for some people’s vulnerability to schizophrenia
Inherent general predisposition, not type
Twin & Adoption Studies
Genetic studies of families do not allow us to decide: Environment? (Nurture) Genetics? (Nature)
Twin & Adoption studies allow us to separate effects
Neurobiology of Schizophrenia
Dopamine is too active
1. Antipsychotic drugs work. They decrease dopamine (by blocking)
2. They produce side effects similar to Parkinson’s. Parkinson’s = too little dopamine
3. L-dopa, given to Parkinson’s patients, which increases dopamine, can produce schizophrenia-like symptoms
4. Amphetamines, which increase dopamine, can make schizophrenia worse
Brain Structure
Enlarged ventricles Adjacent brain parts underdeveloped?
Frontal lobes = less active neurotransmitters
Viral Infection Risk
Recent introduction of schizophrenia (1800s)
↑ in urban areas Prenatal exposure to flu Prenatal brain damage
Psychological & Social Influences - Stress
Retrospective research shows role of stressful events in onset
Prospective research – relapse preceded by higher rates of stress Might also increase depression, which increases
risk of relapse
Psychological & Social Influences - Family
Expressed Emotion In discharged patients, those with less family
contact had fewer relapses Consists of:
Criticism/disapproval Hostility/animosity Emotional overinvolvement
3.7 times increase in relapse (!)
Expressed Emotion
High: “I’ve tried to jolly him out of it and pestered him
into doing things. Maybe I’ve overdone it. I don’t know.”
Low: “I just tend to let it go because I know that when
she wants to speak, she will speak.”
Biological Interventions
Historical biological interventions include: Lobotomies
Sever frontal lobes from lower portions of brain Insulin coma therapy Electroconvulsive therapy
Antipsychotic Medication
Medical breakthrough 1950s – neuroleptics 60% effective
Mostly effect positive symptoms Effect dopamine, but other neurotransmitters
as well
Antipsychotic Medication
New antipsychotics Clozapine Risperidone Olanzapine
Less side effects than early antipsychotics
Problem: Medication Compliance
7% of patients refuse to take prescribed antipsychotic medication
1. Negative relationships with doctors
2. Cost of medication
3. Lack of social support
4. Negative side effects tardive dyskinesia in 20% of long-term users
5. Beliefs about medication use (25%)
Psychosocial Interventions
Inpatient treatment most treatment, until recently
Decreased due to changes in involuntary hospitalization laws
200,000 with serious disorders are homeless
Psychosocial Interventions
Behavioral Family Therapy Psychoeducation – symptoms, causes,
medication compliance Communication skills Problem-solving skills
Most beneficial if ongoing
Living with Schizophrenia
40-60% of patients live with their family 10-20% of homeless individuals have
schizophrenia 10% of patients will commit suicide 50% will experience comorbid substance
abuse 33% will experience physical/sexual assault
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