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SCHIZOPHRENIAS SCHIZOPHRENIA AS PSYCHOSIS DIAGNOSTIC FEATURES AETIOLOGY AND DEVELOPMENT TREATMENT Cato Grønnerød PSY2600.

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Presentation on theme: "SCHIZOPHRENIAS SCHIZOPHRENIA AS PSYCHOSIS DIAGNOSTIC FEATURES AETIOLOGY AND DEVELOPMENT TREATMENT Cato Grønnerød PSY2600."— Presentation transcript:

1 SCHIZOPHRENIAS SCHIZOPHRENIA AS PSYCHOSIS DIAGNOSTIC FEATURES AETIOLOGY AND DEVELOPMENT TREATMENT Cato Grønnerød PSY2600

2 SCHIZOPHRENIA AS PSYCHOSIS  Schizophrenia is the most common and best known of the psychoses  Psychoses Originally: disease of the brain Later: lack of insight into own condition Other psychoses: Schizophreniform disorder Schizo-affective disorder Delusional disorders

3 SCHIZOPHRENIA AS PSYCHOSIS  To be diagnosed, schizophrenia must impact upon more than one psychological process Thought Emotion Perception Communication Psychomotor behaviour  Frequently several of these are affected simultaneously or at different periods

4 HISTORY  Schizophrenia was separated from ”insanity” in 1809  Emil Kraepelin Separated manic depression from ”dementia praecox”  Eugen Bleuler Coined the term ”schizophrenia” Defined symptoms  Adolf Meyer Psychological explanations

5 WHAT SCHIZOPHRENIA IS NOT  Schizophrenia is NOT split-personality Split between though and emotion  Schizophrenia is NOT leading to raving maniacs, lunacy, or unhinged, demented behaviour Patients are mostly shy and withdrawn  Schizophrenia is NOT necessarily a lifetime disorder Many suffer from episodes, then recover

6 DIAGNOSIS AND DIAGNOSTIC ISSUES  Careful diagnosis is important: Affects 1% of population Can be a lifelong diagnosis Can be severe and the impact on social and work functioning, real and prospective may be very significant Management, especially with medication, can have long term and irreversible consequences Risk of suicide is high

7 DIAGNOSTIC ISSUES  Diagnosis is based largely on exclusion of other, possible diagnoses Schizo-affective and mood disorders, drug use, somatic/neuropsychological condition, developmental disorders  Three major criteria Characteristic symptoms ‘Positive’ and ‘negative’ Duration Dysfunction

8 SYMPTOMS: DELUSIONS  “False beliefs that resist all argument and are sustained in the face of evidence that normally would be sufficient to destroy them”  Common to other psychoses, but are mood incongruent in schizophrenia  Bizarre to outsiders

9 SYMPTOMS: DELUSIONS  Five main kinds of delusion Delusions of grandeur Delusions of control Delusions of persecution Delusions of reference Somatic delusions  Other kinds of delusions Delusional jealousy, erotomanic delusion, thought broadcasting

10 SYMPTOMS: HALLUCINATIONS  “False sensory perceptions that have a compelling sense of reality, even in the absence of external stimuli that ordinarily provoke such perceptions”  Auditory hallucinations most common  Distinguished from ordinary experience by Their pervasiveness Their lack of controllability The person’s lack of awareness regarding the division between self and perceptual experience

11 SYMPTOMS: DISORGANIZED SPEECH  ‘Word Salad’ Words and concepts are so disconnected that there is no logical thread (incoherent)  Loose association Associations are made but are irrelevant or out of context  Clang association Words are connected by the way they sound  Neologisms Words ‘made up’ by the person that have no literal meaning

12 SYMPTOMS: DISORGANIZED OR CATATONIC BEHAVIOR  Inappropriate emotional and behavioural responses  Severe lack of concentration or coherence  Inability to ‘repair’ situations  Characterised by extreme slowing of motor behaviour for longer-than-natural periods  Often appearing ‘frozen’, often in rigid and strange postures and positions, immovable, mute and unresponsive

13 NEGATIVE SYMPTOMS  Reduction in normal behaviour and a withdrawal from normal life  Less dramatic or well known, but usually appear first and are more pervasive Flattening of affect Severe social withdrawal Severe reduction in energy and interest levels Poor attention to hygiene and personal grooming Severe reduction in responsiveness

14 TYPES OF SCHIZOPHRENIA  Paranoid Schizophrenia Delusions and auditory hallucinations of persecution and/ or grandeur Complex and intense but not disoriented Irrational to observers  Catatonic Schizophrenia Extreme motor behaviour states – either frozen or overly excited/agitated Some report delusions or hallucinations in these states “Negativism” – will do the opposite of what is instructed

15 TYPES OF SCHIZOPHRENIA  Disorganised Schizophrenia Incoherent, emotionally and contextually inappropriate behaviour Spontaneous affect, unsolicited conversation that continues despite cues to stop Sometimes delusions but less organised than in paranoid schizophrenia Poor hygiene and self care  Undifferentiated Schizophrenia Psychotic symptoms and poor interpersonal functioning but does not meet criteria for the other types

16 TYPES OF SCHIZOPHRENIA  Residual Schizophrenia Often in the aftermath of other schizophrenic episodes Absence of prominent symptoms but continued and marked presence of two of the following Social isolation or withdrawal Impairment in role functioning “Peculiar” behaviour Impairment in personal grooming and hygiene Blunt, flat or inappropriate emotional expression Odd, magical or bizarre thinking Unusual perceptual experiences Apathy

17 TYPES OF SCHIZOPHRENIA  Acute Sudden onset of flurid symptoms Often precipitating incident ”Good premorbid” Better prognosis  Chronic Prolonged and gradual decline No stressor ”Poor premorbid” Poorer prognosis

18 PERCEPTUAL DEFICITS  Patients often report perceptual abnormalities Difficulty understanding speech Spatial distortions  Longer time to identify targets in backward masking tests  Problems when estimating sizes  Difficulties discriminating tones  Abnormal eyetracking movements Jerky saccadic eye movements

19 COGNITIVE DEFICITS  Overinclusiveness Tendency to form concepts from both relevant and irrelevant information Impared ability to resist distracting information  Defective attentional filter Prepulse is less effective in reducing the startle response in patients Connected to maternal deprivation in animal studies  Lacking a theory of mind

20 OTHER DEFICITS  Motoric function Unusual posturing (catatonic stupor) Below average on motor proficiency and coordination Slower reaction times  Emotional Difficulties recognizing facial expressions Some difficulties understanding interpersonal situations More difficult when trying to implement solutions to interpersonal problems

21 SOURCES OF VULNERABILITY  Genetic factors Strong heritability for schizophrenia Severity in proband increases risk for co-twin Closeness of relationship determines risk Adopted children of mothers with schizophrenia have higher risk of mental illness Increased risk in unstable adoption families

22 SOURCES OF VULNERABILITY  Pre- and Perinatal Factors Prenatal viral infections Birth complications/trauma Exposure to stress during pregnancy  Childhood markers Attention deficits Delayed motoric development Emotional instability Increases at the onset of puberty Schizotypal PD often precedes schizophrenia

23 SOURCES OF VULNERABILITY  Neurochemical factors Dopamine hypothesis Antipsychotic drugs inhibit dopamine Increased dopamine levels lead to psychosis Motor symptoms a side effect of drugs Increased density of dopamine receptors High levels of serotonine  Brain structure Enlarged ventricles Reduced frontal and temporal lobes

24 SOURCES OF VULNERABILITY  Social vulnerability Expressed emotion Cynical and hostile comments and marked overinvolvement by care takers Social class Social environment and culture  Diathesis-stress theory More vulnerable Stress caused by dysfunction?

25 TREATMENT OF SCHIZOPHRENIA  Drug therapy Until the development of effective medications, prognosis was very poor Chlorpromazine and haloperidol Sedate but also seem to selectively reduce disordered thought and hallucinations Best with the positive rather than negative symptoms Strong and distressing side effects, most notably tardive dyskinesia

26 TREATMENT OF SCHIZOPHRENIA  Drug therapy New drug treatments (different neurochemical effects) Clozapine, Olanzapine, Risperidone More effective, fewer side effects Block fewer dopamine receptors, plus a majority of serotonin receptors May cause depression  Early medication will restrict later severity

27 TREATMENT OF SCHIZOPHRENIA  Psychological Treatments Address the cognitive, emotional and behavioral symptoms and outcomes Cognitive rehabilitation Focus on attention, memory and executive functions Interpersonal training Integrated Psychological Therapy Program of Assertive Community Treatment


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