1. CHAPTER THIRTEEN Schizophrenic Disorders

2. OVERVIEW  Psychosis - profoundly out of touch with reality  Most common symptoms: changes in the way a person thinks, feels, and relates to other people and the outside environment.  Involves disruptions of mental functions

3. Schizophrenia Affects people from all walks of life Characterized by an array of diverse symptoms Usually begins in late adolescence or early adulthood © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

4. Epidemiology Risk Lifetime prevalence Age of father Onset age Gender Among mental disorders, the second leading cause of disease burden. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

5. Figure 13.1: Age Distribution of Onset of Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

6. Clinical Picture Delusions Hallucinations Disorganized speech and behavior Negative Symptoms Hallmark symptoms © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

7. Positive and Negative Symptoms Excess or distortion in normal repertoire of behavior and experience Positive symptoms of schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

8. Delusions Erroneous belief Fixed and firmly held despite clear contradictory evidence Disturbance in the content of thought Grandeur Persecution Reference Nihilistic Thought Broadcasting Delusions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

9. Hallucinations False Sensory experiences/Perceptual disturbances Seems real but occurs in absence of any external perceptual stimulus Can occur in any sensory modality Hallucinations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

10. Disorganized Speech Failure to make sense Despite conforming to semantic and syntactic rules of speech Disturbance in form (not content) of thought Disorganized speech © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

11. Disorganized Behavior Impairment of goal- directed activity Occurs in areas of daily functioning Catatonia Catatonia stupor Disorganized and Catatonic Behavior © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

12. Negative Symptoms Affective flattening, Blunted affect Anhedonia – inability to experience pleasure. Apathy - Socially withdrawn Both a symptom and coping strategy Avolition – lack of will, motivation Alogia – impoverished thinking, poverty of speech. Absence or deficit of normally present behaviors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

13. Other Psychotic Disorders Schizoaffective disorder Schizophreniform disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Other psychotic disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

14. Genetics TWIN STUDIES ADOPTION STUDIES  The average concordance rate for MZ twins is 48%, whereas the comparable figure for DZ twins is 17%.  Suggests strong genetic factors.  Also compelling evidence for the importance of environment.  Genain quadruplets Genetic factors play role in development of the disorder (Heston)

15. Figure 13.2: Risk of Developing Schizophrenia Based on Shared Genes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

16. Prenatal Exposures Prenatal exposures: Prenatal infection Rhesus incompatibility Early nutritional deficiencies and maternal stress Pregnancy and birth complications © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

17. Genes and Environment in Schizophrenia: A Synthesis Current thinking emphasizes interplay Multiple genetic factors Environmental factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

18. A Neurodevelopmental Perspective Brain lesion lies dormant until normal developmental changes occur Changes expose problems resulting from this brain abnormality Developmental precursors may include variety of abnormalities © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

19. Other Biological Factors Many brain areas are abnormal in schizophrenia Decreased brain volume Enlarged ventricles Frontal lobe dysfunction Reduced volume of the thalamus Abnormalities in temporal lobe areas © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

20. Disorder seems to affect many different regions of the brain. Enlarged lateral ventricles Differences (decreased size) in parts of the limbic system.

21. Other Biological Factors Implicated in Schizophrenia Neurotransmitters Dopamine Glutamate Serotonin Cytoarchitecture Overall organization of cells in brain may be compromised © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

22. Figure 13.8: Cytoarchitecture and Neural Development © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

23. Neurocognition Neurocognitive deficits found in people with schizophrenia Attentional and working memory deficits Eye-tracking dysfunctions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

24. Figure 13.11: A Diathesis-Stress Model of Schizophrenia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

25. Psychosocial and Cultural Aspects Families and relapse Urban living Immigration Cannabis abuse © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

26. Treatments and Outcomes Treatment and outcomes Prognosis before 1950s Introduction of antipsychotic drugs in 1950s 15-25 years outcomes Long-term institutionalization rate © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

27. Pharmacological Approaches Pharmacological approaches First-generation antipsychotic drugs Second-generation antipsychotics Side effects © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

28. Psychosocial Approaches Psychosocial approaches Family therapy Case management Social-skills training Cognitive remediation Cognitive-behavioral therapy Other forms of individual treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.