Transcript Schizophrenia & Other Psychotic Disorders
Schizophrenia & Other Psychotic Disorders
Schizophrenia:
Lost touch with reality Disruption of: Normal thought processes Perception Personality Affect
SYMPTOMS OF SCHIZOPHRENIA
positive symptoms
deviant behaviors – delusions, hallucinations, thoughts
negative symptoms
deficit symptoms – Lack of normal function
POSITIVE SYMPTOMS
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
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delusions
– not objectively true • not be accepted as true within culture • person holds firmly in spite of contrary evidence
POSITIVE SYMPTOMS
Delusions • Paranoid/persecution • • • • Grandeur Capgas syndrome – double of other’s Cotard’s syndrome – part of body changed Change vs. fixed
POSITIVE SYMPTOMS
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hallucinations
– perceptual experiences that feel real although there is nothing to perceive • Visual • Auditory • tactile
Attention Problems
Difficulty focusing attention Esp. during first stages Bombarded Attention is critical to functioning
Negative Symptoms
Negative = absent 25% patients
NEGATIVE SYMPTOMS
Anhedonia
- interest
Avolition
- movement
Alogia
- content or quantity of speech
flat or blunted affect
OTHER SYMPTOMS
catatonia
– a psychomotor disturbance of movement and posture
catatonic stupor
waxy flexibility
OTHER SYMPTOMS
inappropriate affect
– unusual and sometimes bizarre emotional responses
OTHER SYMPTOMS
lack of insight
– lack of awareness that one’s experiences are unusual or abnormal
Schizophrenia is not…
Split personality disorder Multiple personality disorder Schizophrenia = “splitting of the mind” Ambivalence
CLINICAL COURSE
clinical course
– specific pattern of changes in symptomatology over time
prodromal phase
active phase
residual phase
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 (A) Age at first diagnosis 20 15 Proportion 10 5 Males Females 0 5 10 15 20 25 30 35 40 45 50 Age (in years)
Source : Adapted from I.I. Gottesman, Schizophrenia Genesis: The Origins of Madness (New York: Freeman, 1991.)
AGE OF RISK FOR SCHIZOPHRENIA (B) Age of risk 100 80 Cumulative Proportion 60 40 20 0 5 10 15 20 25 30 35 40 45 50 Age (in years)
Source : Adapted from I.I. Gottesman, Schizophrenia Genesis: The Origins of Madness (New York: Freeman,1991.)
Males Females
TYPICAL COURSES FOR SCHIZOPHRENIA (A) CHRONIC GRADUAL ONSET & VERY POOR PROGNOSIS
TYPICAL COURSES FOR SCHIZOPHRENIA (B) EPISODIC OCCASIONAL EPISODES WITH NEARLY NORMAL FUNCTIONING BETWEEN THEM
TYPICAL COURSES FOR SCHIZOPHRENIA 22% (C) SINGLE EPISODE BRIEF PERIOD OF PSYCHOSIS & NEARLY COMPLETE RECOVERY WITH NO OTHER EPISODES
SUBTYPES OF SCHIZOPHRENIA
disorganized catatonic paranoid undifferentiated residual
SUBTYPES OF SCHIZOPHRENIA
disorganized catatonic paranoid characterized by disorganized speech or behavior and flat or inappropriate affect undifferentiated residual
SUBTYPES OF SCHIZOPHRENIA
disorganized catatonic paranoid undifferentiated characterized by psychomotor disturbance of movement and posture residual
SUBTYPES OF SCHIZOPHRENIA
disorganized catatonic paranoid characterized by fixed delusions of persecution undifferentiated residual
SUBTYPES OF SCHIZOPHRENIA
disorganized catatonic paranoid undifferentiated residual diagnosis used for people who meet the criteria for schizophrenia but do not clearly fit into the above subtypes
SUBTYPES OF SCHIZOPHRENIA
disorganized catatonic paranoid undifferentiated residual symptom patterns found in individuals with schizophrenia during periods of relative remission including
cognitive slippage
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
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Genetics Neurobiology Psychological and Social 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
Genetic Markers
Smooth-pursuit eye movement
Neurobiology of Schizophrenia
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Dopamine is too active Antipsychotic drugs work. They decrease dopamine (by blocking) They produce side effects similar to Parkinson’s. Parkinson’s = too little dopamine L dopa, given to Parkinson’s patients, which increases dopamine, can produce schizophrenia like symptoms 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
Schizophrenogenic mothers Double bind communication
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.”
Diathesis Stress Models X
Treatment of Schizophrenia
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Biological 2.
Psychosocial
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
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7% of patients refuse to take prescribed antipsychotic medication Negative relationships with doctors Cost of medication 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
Token economies Contribute to increased self-care More discharge
Psychosocial Interventions
Social skills building Model pieces Role-play Practice in vivo
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
Prognosis of Schizophrenia
Predicting outcome is virtually impossible Recent research has indicated prognosis is better than originally expected 20-40 year longitudinal studies Some research suggests 20 50% “fully recover” later in life