CHAPTER 11 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

Symptoms Alternations in perceptions, thoughts, or consciousness (delusions and hallucination) DSM-IV categories Schizophrenia Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Psychotic disorder due to general medical condition Substance-induced psychotic disorder

SCHIZOPHRENIA Symptoms Disturbance lasts at least 6 months, including One month of active phase that includes 2 positive or one positive and one negative symptom, and Decline in social or occupational functioning. DSM-IV subtypes Paranoid Catatonic Disorganized Undifferentiated Residual

POSITIVE AND NEGATIVE SYMPTOMS Positive Delusions – Faulty interpretations of reality Hallucinations – Faulty sensory perceptions Disordered speech Disorganized and bizarre behavior Negative Flat affect Poverty of speech Lack of motivation or directedness Loss of energy Loss of feelings of pleasure

EXAMPLES OF NEGATIVE SYMPTOMS Flat affect Avoid eye contact Immobile, expressionless face Lack of emotion when discussing emotional material Apathetic and uninterested Monotonous voice, low and difficult to hear Poverty of speech Long lapses before responding to questions or failure to answer Restriction on quantity of speech Slow speech Loss of directedness Slow movements Reduction of voluntary movements Inability to initiate activities Little interest in social participation

CAUSES OF SCHIZOPHRENIA No known cause, but research has focused on Genetic factors Schizophrenic spectrum disorders Neurodevelopmental model Family studies Twin studies Adoption studies Diathesis-stress theory and family and community vulnerability High-risk studies focusing on family and birth history and markers of attention and cognition deficits

MRI SCANS OF IDENTICAL TWINS

AUDITORY HALLUCINATIONS

BRAIN SCANS OF GENAIN SISTERS

CET SCANS OF GENAIN SISTERS

PRENATAL EXPOSURE TO INFLUENZA AND ADULT SCHIZOPHRENIA

THE FAMILY FACTOR IN SCHIZOPHRENIA

TREATMENT OF SCHIZOPHRENIA Antipsychotic drugs – Some have adverse side effect (tardive dyskinesia) Skills training Family programs Community support Combined treatment approaches Long-term outcome studies- Prognosis poor though deteriorative effects plateau after 5 to 10 years

SKILLS TRAINING Social skills Self-awareness Affect regulation Social cue recognition Cognitive skills Training in elementary cognitive functions Strategies for dealing with cognitive deficits Cognitive restructuring about source of hallucinations Self-care and symptom-identification Improved grooming and self-care Self-monitoring for symptoms of relapse Skills for dealing with stress Identify indicators of stress Apply cognitive and behavioral techniques

FAMILY PROGRAMS Education about probable causes, symptoms. and course Information about treatment Instruction in problem-solving and crisis management skills Decease negative expressed emotion (EE) Relapse recognition

BRAIN METABOLISM OF SCHIZOHPRENIC AND NON-SCHIZOPHRENIC

OTHER PSYCHOTIC DISORDERS Schizoaffective disorder – Delusions or hallucinations combined with symptoms of depression or manic mood Delusional disorder – Less bizarre than schizophrenia delusions; usually related to a particular topic and have some foundation in real life. Shared psychotic disorder – Two or more people who share shame delusional belief; one originates, the other follows. Occurrence is rare.

DELUSIONAL CONTENT IN PSYCHOSES Schizophrenia Variety of bizarre content Being controlled or persecuted by others Finding reference to oneself in other’s behavior or in printed materials Depression Unjustified guilty Perceived bodily changes Mania Great self-importance Grandiosity Delusional disorder Loved by celebrity/high-status person Suspect spouse or lover of being unfaithful Possession of special and unrecognized talent