Presentation on theme: "Chapter 13 Schizophrenia and Other Psychotic Disorders"— Presentation transcript:
1 Chapter 13 Schizophrenia and Other Psychotic Disorders
2 Nature of Schizophrenia and Psychosis: An Overview Schizophrenia vs. PsychosisPsychosis – Broad term (e.g., hallucinations, delusions)Schizophrenia – A type of psychosisPsychosis and Schizophrenia are heterogeneousDisturbed thought, emotion, behavior
3 Nature of Schizophrenia and Psychosis: History and Current Thinking Historical BackgroundBenedict Morel – Introduced dementia praecoxDemence (loss of mind) precoce (early, premature)Emil Kraepelin – Used the term dementia praecoxFocused on subtypes of schizophreniaEugen Bleuler – Introduced the term “schizophrenia”“Splitting of the mind”Impact of Early Ideas on Current ThinkingMany of Kraeplin and Bleuler’s ideas are still with usUnderstanding onset and course considered important
4 Table 13.1Table Early Figures in the History of Schizophrenia
5 Schizophrenia: The “Positive” Symptom Cluster The Positive SymptomsActive manifestations of abnormal behaviorDistortions of normal behaviorDelusions: The Basic Feature of MadnessGross misrepresentations of realityInclude delusions of grandeur or persecutionHallucinations: Auditory and/or VisualExperience of sensory events without environmental inputCan involve all sensesFindings from SPECT studies
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 SymptomsAbsence or insufficiency of normal behaviorSpectrum of Negative SymptomsAvolition (or apathy) – Lack of initiation and persistenceAlogia – Relative absence of speechAnhedonia – Lack of pleasure, or indifferenceAffective flattening – Little expressed emotion
9 Schizophrenia: The “Disorganized” Symptom Cluster The Disorganized SymptomsInclude severe and excess disruptionsSpeech, behavior, and emotionNature of Disorganized SpeechCognitive slippage – Illogical and incoherent speechTangentiality – “Going off on a tangent”Loose associations – Conversation in unrelated directionsNature of Disorganized AffectInappropriate emotional behaviorNature of Disorganized BehaviorIncludes a variety of unusual behaviorsCatatonia – SpectrumWild agitation, waxy flexibility, immobility
10 Subtypes of Schizophrenia Paranoid TypeIntact cognitive skills and affectDo not show disorganized behaviorHallucinations and delusions – Grandeur or persecutionThe best prognosis of all types of schizophreniaDisorganized TypeMarked disruptions in speech and behaviorFlat or inappropriate affectHallucinations and delusions – Tend to be fragmentedDevelops early, tends to be chronic, lacks remissions
11 Subtypes of Schizophrenia (cont.) Catatonic TypeShow unusual motor responses and odd mannerismsExamples include echolalia and echopraxiaTends to be severe and quite rareUndifferentiated TypeWastebasket categoryMajor symptoms of schizophreniaFail to meet criteria for another typeResidual TypeOne past episode of schizophreniaContinue to display less extreme residual symptoms
12 Other Disorders with Psychotic Features Schizophreniform DisorderSchizophrenic symptoms for a few monthsAssociated with good premorbid functioningMost resume normal livesSchizoaffective DisorderSymptoms of schizophrenia and a mood disorderBoth disorders are independent of one anotherPrognosis is similar for people with schizophreniaSuch persons do not tend to get better on their own
13 Other Disorders with Psychotic Features (cont.) Delusional DisorderDelusions that are contrary to realityLack other positive and negative symptomsTypes of delusions includeErotomanicGrandioseJealousPersecutorySomaticExtremely rareBetter prognosis than schizophrenia
14 Additional Disorders with Psychotic Features Brief Psychotic DisorderOne or more positive symptoms of schizophreniaUsually precipitated by extreme stress or traumaTends to remit on its ownsShared Psychotic DisorderDelusions from one person manifest in another personLittle is known about this conditionSchizotypal Personality DisorderMay reflect a less severe form of schizophrenia
15 Classification Systems and Their Relation to Schizophrenia Process vs. Reactive DistinctionProcess – Insidious onset, biologically based, negative symptoms, poor prognosisReactive – Acute onset (extreme stress), notable behavioral activity, best prognosisGood vs. Poor Premorbid Functioning in SchizophreniaFocus on functioning prior to developing schizophreniaNo longer widely usedType I vs. Type II DistinctionType I – Positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairmentType II – Negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments
16 Schizophrenia: Some Facts and Statistics Onset and Prevalence of Schizophrenia worldwideAbout 0.2% to 1.5% (or about 1% population)Often develops in early adulthoodCan emerge at any timeSchizophrenia Is Generally ChronicMost suffer with moderate-to-severe lifetime impairmentLife expectancy is slightly less than averageSchizophrenia Affects Males and Females About EquallyFemales tend to have a better long-term prognosisOnset differs between males and femalesSchizophrenia 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 StudiesInherit a tendency for schizophreniaDo not inherit specific forms of schizophreniaRisk increases with genetic relatednessTwin StudiesMonozygotic twins – Risk for schizophrenia is 48%Fraternal (dizygotic) twins – Risk drops to 17%Adoption Studies -- Risk for schizophrenia remains highCases where a biological parent has schizophreniaSummary of Genetic ResearchRisk for schizophrenia increases with genetic relatednessRisk is transmitted independently of diagnosisStrong 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 StudiesSearch for genetic markers is still inconclusiveSchizophrenia is likely to involve multiple genesBehavioral Markers: Smooth-Pursuit Eye MovementThe procedure – Eye-tracking a moving objectTracking deficits – Schizophrenics and their relatives
21 Causes of Schizophrenia: Neurotransmitter Influences The Dopamine HypothesisDrugs that increase dopamine (agonists)Result in schizophrenic-like behaviorDrugs that decrease dopamine (antagonists)Reduce schizophrenic-like behaviorExamples – Neuroleptics, L-Dopa for Parkinson’s diseaseDopamine hypothesis is problematic and overly simplisticCurrent 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 BrainEnlarged ventricles and reduced tissue volumeHypofrontality – Less active frontal lobesA major dopamine pathwayViral Infections During Early Prenatal DevelopmentFindings are inconclusiveConclusions About Neurobiology and SchizophreniaSchizophrenia – Diffuse neurobiological dysregulationStructural and functional brain abnormalitiesNot 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 StressMay activate underlying vulnerabilityMay also increase risk of relapseFamily InteractionsFamilies – Show ineffective communication patternsHigh expressed emotion – Associated with relapseThe Role of Psychological FactorsExert only a minimal effect in producing schizophrenia
26 Cultural DifferencesFigure 13.8 Cultural differences in expressed emotion (EE).
27 Medical Treatment of Schizophrenia Historical PrecursorsDevelopment of Antipsychotic (Neuroleptic) MedicationsOften the first line treatment for schizophreniaBegan in the 1950sMost reduce or eliminate positive symptomsAcute and permanent side effects are commonExtrapyramidal and Parkinson-like side effectsTardive dyskinesiaCompliance with medication is often a problemTranscranial Magnetic StimulationRelatively untested procedure for hallucinations
30 Psychosocial Treatment of Schizophrenia Historical PrecursorsPsychosocial Approaches: Overview and GoalsBehavioral (i.e., token economies) on inpatient unitsCommunity care programsSocial and living skills trainingBehavioral family therapyVocational rehabilitationPsychosocial ApproachesA necessary part of medication therapy
31 Studies on TreatmentFigure 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 DysfunctionsAffecting cognitive, emotional, and behavioral domainsPositive, negative, and disorganized symptom clustersDSM-IV and DSM-IV-TRFive subtypes of schizophreniaIncludes other disorders with psychotic featuresSeveral Bio-Psycho-Social Variables are InvolvedSuccessful Treatment Rarely Includes Complete Recovery