Schizophrenia Definition Definition  Psychotic disorder  Thought Disorder Loose associations Loose associations  “Split” from reality  NOT split or multiple personality

Symptoms of Schizophrenia Positive Symptoms Positive Symptoms  Loose associations  Word salad  Delusions  Hallucinations Negative Symptoms Negative Symptoms  Poverty of speech content  Flat or blunted affect  Avolition or apathy  Anhedonia

Subtypes of Schizophrenia Paranoid Paranoid Disorganized Disorganized Catatonic Catatonic Undifferentiated Undifferentiated Residual Residual

Paranoid Subtype 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 Symptoms Disorganized speech  Cognitive slippage – illogical and incoherent speech  Tangentiality – “going off on a tangent”  Loose associations – conversation in unrelated directions Disorganized affect  Inappropriate emotional behavior Disorganized behavior  Includes a variety of unusual behaviors  Catatonia – spectrum

Disorganized Subtype 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

Catatonic Subtype Show unusual motor responses and odd mannerisms Examples include echolalia and echopraxia Tends to be severe and quite rare

Additional Subtypes Undifferentiated type  Catch all 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

Age of Onset

Biological Aspects Runs in Families Runs in Families Increased Risk Based on Genetic Relatedness Increased Risk Based on Genetic Relatedness

Genetics and Schizophrenia

Biological Aspects Search for Marker Genes Search for Marker Genes  Still inconclusive  Likely involves multiple genes  Smooth Pursuit Eye Tracking Tracking deficit in persons with schizophrenia, including their relatives Tracking deficit in persons with schizophrenia, including their relatives Brain Structure and Functioning Brain Structure and Functioning  Enlarged ventricles and reduced tissue volume  Hypofrontality

Biological Aspects Dopamine Hypothesis Dopamine Hypothesis  Drugs that increase dopamine (agonists), result in schizophrenic-like behavior (e.g., amphetamines)  Drugs that decrease dopamine (antagonists), reduce schizophrenic-like behavior  Considered too simplistic (multiple NTs involved)

Psychosocial Influences The Role of Stress The Role of Stress  Diathesis-Stress Model  Also seems related to relapse (not just onset) Family Interactions Family Interactions  Communication patterns  High expressed emotion associated with relapse Psychological factors seem relatively small Psychological factors seem relatively small

Treatment of Schizophrenia Seldom Results in Complete Recovery Seldom Results in Complete Recovery Early Methods Early Methods  Insulin Coma Therapy  Psychosurgery  ECT Biological Treatments (Current) Biological Treatments (Current)  Neuroleptics (Major Tranquilizers) Haldol, Thorozine, others Haldol, Thorozine, others Clozaril, Risperdal, Zyprexa, others Clozaril, Risperdal, Zyprexa, others

Treatment of Schizophrenia Biological Treatment Issues Biological Treatment Issues  Major (Social) Reform in Treatment Revolving Door Process Revolving Door Process  Trial and Error  Extrapyramidal Side Effects Tardive Dyskinesia Tardive Dyskinesia  Address Positive Symptoms Only  Medication Compliance Problems

Antipsychotic Drugs and Inpatient Treatment

Psychosocial Treatment Psychosocial Approaches Psychosocial Approaches  Behavioral (i.e., token economies) on inpatient units  Community care programs  Social and living skills training  Behavioral family therapy  Vocational rehabilitation Facilitate Medication Compliance Facilitate Medication Compliance

Psychosocial Treatment

Myths About Schizophrenia People with schizophrenia have “split personalities.” People with schizophrenia have “split personalities.” People with schizophrenia are intellectually disabled People with schizophrenia are intellectually disabled People with schizophrenia are dangerous People with schizophrenia are dangerous People with schizophrenia are addicted to their drugs People with schizophrenia are addicted to their drugs

Other Psychotic Disorders Brief Psychotic Disorder Brief Psychotic Disorder  Psychotic symptoms for a few weeks Schizophreniform Disorder Schizophreniform Disorder  Schizophrenic symptoms for a few months Schizoaffective Disorder Schizoaffective Disorder  Symptoms of schizophrenia and a mood disorder independent of each other

Other Psychotic Disorders Delusional disorder  Delusions without hallucinations or most other schizophrenic symptoms  Types of delusions Erotomanic Grandiose Jealous Persecutory Somatic

Other Psychotic Disorders Folie a Deux Folie a Deux  Shared Psychotic Disorder