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Chapter 13 Schizophrenia and Other Psychotic Disorders

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1 Chapter 13 Schizophrenia and Other Psychotic Disorders

2 Nature of Schizophrenia and Psychosis: An Overview
Schizophrenia vs. Psychosis Psychosis – Broad term (e.g., hallucinations, delusions) Schizophrenia – A type of psychosis Psychosis and Schizophrenia are heterogeneous Disturbed thought, emotion, behavior

3 Nature of Schizophrenia and Psychosis: History and Current Thinking
Historical Background Benedict Morel – Introduced dementia praecox Demence (loss of mind) precoce (early, premature) Emil Kraepelin – Used the term dementia praecox Focused on subtypes of schizophrenia Eugen Bleuler – Introduced the term “schizophrenia” “Splitting of the mind” Impact of Early Ideas on Current Thinking Many of Kraeplin and Bleuler’s ideas are still with us Understanding onset and course considered important

4 Table 13.1 Table Early Figures in the History of Schizophrenia

5 Schizophrenia: The “Positive” Symptom Cluster
The Positive Symptoms Active manifestations of abnormal behavior Distortions of normal behavior Delusions: The Basic Feature of Madness Gross misrepresentations of reality Include delusions of grandeur or persecution Hallucinations: Auditory and/or Visual Experience of sensory events without environmental input Can involve all senses Findings from SPECT studies

6 Etta

7 Schizophrenia: The “Positive” Symptom Cluster (cont.)
Figure Major areas of functioning of the cerebral cortex. In most people, only the left hemisphere is specialized for language.

8 Schizophrenia: The “Negative” Symptom Cluster
The Negative Symptoms Absence or insufficiency of normal behavior Spectrum of Negative Symptoms Avolition (or apathy) – Lack of initiation and persistence Alogia – Relative absence of speech Anhedonia – Lack of pleasure, or indifference Affective flattening – Little expressed emotion

9 Schizophrenia: The “Disorganized” Symptom Cluster
The Disorganized Symptoms Include severe and excess disruptions Speech, behavior, and emotion Nature of Disorganized Speech Cognitive slippage – Illogical and incoherent speech Tangentiality – “Going off on a tangent” Loose associations – Conversation in unrelated directions Nature of Disorganized Affect Inappropriate emotional behavior Nature of Disorganized Behavior Includes a variety of unusual behaviors Catatonia – Spectrum Wild agitation, waxy flexibility, immobility

10 Subtypes of Schizophrenia
Paranoid Type 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 Type 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

11 Subtypes of Schizophrenia (cont.)
Catatonic Type Show unusual motor responses and odd mannerisms Examples include echolalia and echopraxia Tends to be severe and quite rare Undifferentiated Type Wastebasket category Major symptoms of schizophrenia Fail to meet criteria for another type Residual Type One past episode of schizophrenia Continue to display less extreme residual symptoms

12 Other Disorders with Psychotic Features
Schizophreniform Disorder Schizophrenic symptoms for a few months Associated with good premorbid functioning Most resume normal lives Schizoaffective Disorder Symptoms of schizophrenia and a mood disorder Both disorders are independent of one another Prognosis is similar for people with schizophrenia Such persons do not tend to get better on their own

13 Other Disorders with Psychotic Features (cont.)
Delusional Disorder Delusions that are contrary to reality Lack other positive and negative symptoms Types of delusions include Erotomanic Grandiose Jealous Persecutory Somatic Extremely rare Better prognosis than schizophrenia

14 Additional Disorders with Psychotic Features
Brief Psychotic Disorder One or more positive symptoms of schizophrenia Usually precipitated by extreme stress or trauma Tends to remit on its owns Shared Psychotic Disorder Delusions from one person manifest in another person Little is known about this condition Schizotypal Personality Disorder May reflect a less severe form of schizophrenia

15 Classification Systems and Their Relation to Schizophrenia
Process vs. Reactive Distinction Process – Insidious onset, biologically based, negative symptoms, poor prognosis Reactive – Acute onset (extreme stress), notable behavioral activity, best prognosis Good vs. Poor Premorbid Functioning in Schizophrenia Focus on functioning prior to developing schizophrenia No longer widely used Type I vs. Type II Distinction Type I – Positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment Type II – Negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments

16 Schizophrenia: Some Facts and Statistics
Onset and Prevalence of Schizophrenia worldwide About 0.2% to 1.5% (or about 1% population) Often develops in early adulthood Can emerge at any time Schizophrenia Is Generally Chronic Most suffer with moderate-to-severe lifetime impairment Life expectancy is slightly less than average Schizophrenia Affects Males and Females About Equally Females tend to have a better long-term prognosis Onset differs between males and females Schizophrenia has a Strong Genetic Component

17 Schizophrenia: Some Facts and Statistics (cont.)
Figure The natural history of schizophrenia: a 5-year follow-up. Copyright 1989 by Cambridge University Press. Reprinted with the permission of Cambridge University Press.

18 Causes of Schizophrenia: Findings From Genetic Research
Family Studies Inherit a tendency for schizophrenia Do not inherit specific forms of schizophrenia Risk increases with genetic relatedness Twin Studies Monozygotic twins – Risk for schizophrenia is 48% Fraternal (dizygotic) twins – Risk drops to 17% Adoption Studies -- Risk for schizophrenia remains high Cases where a biological parent has schizophrenia Summary of Genetic Research Risk for schizophrenia increases with genetic relatedness Risk is transmitted independently of diagnosis Strong genetic component does not explain everything

19 Causes of Schizophrenia: Findings From Genetic Research (cont).
Figure Risk for schizophrenia among children of twins.

20 Search for Genetic and Behavioral Markers of Schizophrenia
Genetic Markers: Linkage and Association Studies Search for genetic markers is still inconclusive Schizophrenia is likely to involve multiple genes Behavioral Markers: Smooth-Pursuit Eye Movement The procedure – Eye-tracking a moving object Tracking deficits – Schizophrenics and their relatives

21 Causes of Schizophrenia: Neurotransmitter Influences
The Dopamine Hypothesis Drugs that increase dopamine (agonists) Result in schizophrenic-like behavior Drugs that decrease dopamine (antagonists) Reduce schizophrenic-like behavior Examples – Neuroleptics, L-Dopa for Parkinson’s disease Dopamine hypothesis is problematic and overly simplistic Current theories – Emphasize many neurotransmitters

22 Causes of Schizophrenia: Neurotransmitter Influences (cont.)
Figure Some ways drugs affect neurotransmission.

23 Causes of Schizophrenia: Other Neurobiological Influences
Structural and Functional Abnormalities in the Brain Enlarged ventricles and reduced tissue volume Hypofrontality – Less active frontal lobes A major dopamine pathway Viral Infections During Early Prenatal Development Findings are inconclusive Conclusions About Neurobiology and Schizophrenia Schizophrenia – Diffuse neurobiological dysregulation Structural and functional brain abnormalities Not unique to schizophrenia

24 Causes of Schizophrenia: Other Neurobiological Influences (cont.)
Figure Location of the cerebrospinal fluid in the human brain. This extracellular fluid surrounds and cushions the brain and spinal cord. It also fills the four interconnected cavities (cerebral ventricles) within the brain and the central canal of the spinal cord.

25 Causes of Schizophrenia: Psychological and Social Influences
The Role of Stress May activate underlying vulnerability May also increase risk of relapse Family Interactions Families – Show ineffective communication patterns High expressed emotion – Associated with relapse The Role of Psychological Factors Exert only a minimal effect in producing schizophrenia

26 Cultural Differences Figure 13.8 Cultural differences in expressed emotion (EE).

27 Medical Treatment of Schizophrenia
Historical Precursors Development of Antipsychotic (Neuroleptic) Medications Often the first line treatment for schizophrenia Began in the 1950s Most reduce or eliminate positive symptoms Acute and permanent side effects are common Extrapyramidal and Parkinson-like side effects Tardive dyskinesia Compliance with medication is often a problem Transcranial Magnetic Stimulation Relatively untested procedure for hallucinations

28 Schizophrenia Drug

29 Table 13.2 Table Commonly Used Antipsychotic

30 Psychosocial Treatment of Schizophrenia
Historical Precursors Psychosocial Approaches: Overview and Goals Behavioral (i.e., token economies) on inpatient units Community care programs Social and living skills training Behavioral family therapy Vocational rehabilitation Psychosocial Approaches A necessary part of medication therapy

31 Studies on Treatment Figure Studies on treatment of schizophrenia from 1980 to 1992 (from Falloon, Brooker, & Graham-Hole, 1992).

32 Summary of Schizophrenia and Psychotic Disorders
Schizophrenia – Spectrum of Dysfunctions Affecting cognitive, emotional, and behavioral domains Positive, negative, and disorganized symptom clusters DSM-IV and DSM-IV-TR Five subtypes of schizophrenia Includes other disorders with psychotic features Several Bio-Psycho-Social Variables are Involved Successful Treatment Rarely Includes Complete Recovery

33 Exploring Schizophrenia

34 Exploring Schizophrenia (cont.)

35 Exploring Schizophrenia (cont.)

36 Exploring Schizophrenia (cont.)

37 Exploring Schizophrenia (cont.)

38 Exploring Schizophrenia (cont.)

39 Exploring Schizophrenia (cont.)

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