Transcript Schizophrenia and Psychotic Disorders

Schizophrenia

Definition
 Psychotic
disorder
 Thought Disorder
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Loose associations
 “Split”
from reality
 NOT split or multiple personality
Symptoms of Schizophrenia
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Positive Symptoms
 Loose
associations
 Word salad
 Delusions
 Hallucinations
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Negative Symptoms
 Poverty
of speech content
 Flat or blunted affect
 Avolition or apathy
 Anhedonia
Subtypes of Schizophrenia
Paranoid
 Disorganized
 Catatonic
 Undifferentiated
 Residual
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Paranoid Subtype
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Intact cognitive skills and affect
Do not show disorganized behavior
Hallucinations and delusions – grandeur or
persecution
The best prognosis of all types of schizophrenia
Disorganized Symptoms
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Disorganized speech
slippage – illogical and incoherent speech
 Tangentiality – “going off on a tangent”
 Loose associations – conversation in unrelated
directions
 Cognitive
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Disorganized affect
 Inappropriate
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emotional behavior
Disorganized behavior
 Includes
a variety of unusual behaviors
 Catatonia – spectrum
Disorganized Subtype
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Marked disruptions in speech and behavior
Flat or inappropriate affect
Hallucinations and delusions – tend to be
fragmented
Develops early, tends to be chronic, lacks
remissions
Catatonic Subtype
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Show unusual motor responses and odd
mannerisms
Examples include echolalia and echopraxia
Tends to be severe and quite rare
Additional Subtypes
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Undifferentiated type
 Catch
all category
 Major symptoms of schizophrenia
 Fail to meet criteria for another type
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Residual type
 One
past episode of schizophrenia
 Continue to display less extreme residual symptoms
Age of Onset
Biological Aspects
Runs in Families
 Increased Risk Based on Genetic
Relatedness
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Genetics and Schizophrenia
Biological Aspects
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Search for Marker Genes
 Still inconclusive
 Likely involves multiple genes
 Smooth Pursuit Eye Tracking
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Tracking deficit in persons with schizophrenia,
including their relatives
Brain Structure and Functioning
 Enlarged
ventricles and reduced tissue
volume
 Hypofrontality
Biological Aspects
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Dopamine Hypothesis
 Drugs
that increase dopamine (agonists),
result in schizophrenic-like behavior (e.g.,
amphetamines)
 Drugs that decrease dopamine (antagonists),
reduce schizophrenic-like behavior
 Considered too simplistic (multiple NTs
involved)
Psychosocial Influences
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The Role of Stress
 Diathesis-Stress
Model
 Also seems related to relapse (not just onset)
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Family Interactions
 Communication
patterns
 High expressed emotion associated with relapse
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Psychological factors seem relatively small
Treatment of Schizophrenia
Seldom Results in Complete Recovery
 Early Methods
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 Insulin
Coma Therapy
 Psychosurgery
 ECT
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Biological Treatments (Current)
 Neuroleptics
(Major Tranquilizers)
Haldol, Thorozine, others
 Clozaril, Risperdal, Zyprexa, others
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Treatment of Schizophrenia
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Biological Treatment Issues
 Major
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(Social) Reform in Treatment
Revolving Door Process
 Trial
and Error
 Extrapyramidal Side Effects
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Tardive Dyskinesia
 Address
Positive Symptoms Only
 Medication Compliance Problems
Antipsychotic Drugs and
Inpatient Treatment
Psychosocial Treatment
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Psychosocial Approaches
 Behavioral
(i.e., token economies) on
inpatient units
 Community care programs
 Social and living skills training
 Behavioral family therapy
 Vocational rehabilitation
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Facilitate Medication Compliance
Psychosocial Treatment
Myths About Schizophrenia
People with schizophrenia have “split
personalities.”
 People with schizophrenia are
intellectually disabled
 People with schizophrenia are dangerous
 People with schizophrenia are addicted to
their drugs
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Other Psychotic Disorders
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Brief Psychotic Disorder
 Psychotic
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symptoms for a few weeks
Schizophreniform Disorder
 Schizophrenic
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symptoms for a few months
Schizoaffective Disorder
 Symptoms
of schizophrenia and a mood
disorder independent of each other
Other Psychotic Disorders
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Delusional disorder
 Delusions
without hallucinations or most other
schizophrenic symptoms
 Types of delusions
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Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Other Psychotic Disorders
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Folie a Deux
 Shared
Psychotic Disorder