1. Chapter 13 Schizophrenia Spectrum and Other Psychotic Disorders
Amber Gilewski
Tompkins Cortland Community College

2. The “Positive” Symptom Cluster
The Positive Symptoms
Active manifestations of abnormal behavior
Distortions of normal behavior
Delusions: The Basic Feature of Madness
Gross misrepresentations of reality
Include delusions of grandeur or persecution
Hallucinations
Experience of sensory events without environmental input
Can involve all senses (auditory most common)

3. The “Negative” Symptom Cluster
The Negative Symptoms
Absence or insufficiency of normal behavior
Spectrum of Negative Symptoms
Avolition (or apathy) – Lack of initiation and persistence
Alogia – Relative absence of speech
Anhedonia – Lack of pleasure, or indifference
Affective flattening – Little expressed emotion

4. The “Disorganized” Symptom Cluster
The Disorganized Symptoms
Severe and excess speech, behavior, and emotion
Nature of Disorganized Speech
Cognitive slippage – Illogical and incoherent speech
Tangentiality – “Going off on a tangent”
Loose associations – Conversation in unrelated directions
• Inappropriate affect -
Odd emotional behavior
Disorganized Behavior
Includes a variety of unusual behaviors

5. Other Disorders with Psychotic Features: Schizophreniform Disorder
Schizophrenic symptoms for a few months
Associated with good premorbid functioning
Most resume normal lives
Lifetime prevalence of 0.2%

6. Other Disorders with Psychotic Features: Schizoaffective Disorder
Symptoms of schizophrenia and a mood disorder
Both disorders are independent of one another
Prognosis is similar for people with schizophrenia
Such persons do not tend to get better on their own

7. Other Disorders with Psychotic Features: Delusional Disorder
Delusions that are contrary to reality
Lack other positive and negative symptoms
Types of delusions include:
Erotomanic: higher status figure love
Grandiose: inflated importance
Jealous: unwarranted beliefs of infidelity
Persecutory: most common; conspired against
Somatic: physical defects, disease, disorder
Extremely rare
Better prognosis than schizophrenia

8. Additional Disorders with Psychotic Features: Brief Psychotic Disorder
One or more positive symptoms of schizophrenia
Usually precipitated by extreme stress or trauma
Tends to remit on its owns

9. Schizophrenia: Some Facts and Statistics
Onset and Prevalence of Schizophrenia worldwide
About 0.2% to 1.5% (1% population in US)
Often develops in early adulthood
Can emerge at any time
Women have better prognosis
Schizophrenia Is Generally Chronic
Life expectancy is slightly less than average

10. Developmental Research
Brain damage – during prenatal or infancy periods may be a cause of schizophrenia
Early brain abnormality – may have better prognosis due to brain’s plasticity (ability to compensate)
Older adult’s symptoms – demonstrate that the illness may improve over time
Levels of impairment – fluctuates between moderate and severe; relapse is common

11. Causes of Schizophrenia: Findings From Genetic Research
Family Studies
Inherit a tendency for schizophrenia, not forms of schizophrenia
Risk increases with genetic relatedness
Twin Studies
- Monozygotic twins – Risk for schizophrenia is 48%
- Fraternal (dizygotic) twins – Risk drops to 17%
Adoption Studies -- Risk for schizophrenia remains high

12. Causes of Schizophrenia: Neurotransmitter Influences
The Dopamine Hypothesis
Drugs that increase dopamine (agonists)
Result in schizophrenic-like behavior
Drugs that decrease dopamine (antagonists)
Reduce schizophrenic-like behavior
Neurological damage?
-Structural and Functional Abnormalities in the Brain
Enlarged ventricles and reduced tissue volume

13. Location of the cerebrospinal fluid in the human brain
Fig. 13.7, p. 486

14. Causes of Schizophrenia: Psychological and Social Influences
The Role of Stress
May activate underlying vulnerability
May also increase risk of relapse
Family Interactions
Families – Show ineffective communication patterns
High expressed emotion – associated with relapse

15. Medical Treatment of Schizophrenia
Historical Treatment
primitive brain surgeries in 1500s
prefrontal lobotomies used in 1950’s
modern treatment using neuroleptic drugs

16. Biological Interventions
The 1930’s
Insulin coma therapy: insulin induced hypoglycemia resulting in convulsions & coma
Psychosurgery: disconnecting frontal lobes
ECT: aka “shock therapy”; not beneficial
The 1950’s: development of antipsychotic (neuroleptic) medications
Often the first line treatment for schizophrenia
Newer medications have fewer serious side effects

17. Medical Treatment of Schizophrenia (continued)
Compliance with medication is often a problem (medical relationship, cost, poor supports, side effects)
Acute and permanent side effects are common
Akinesia: absence, loss, or impairment of the power of voluntary movement
Tardive dyskinesia: twitching of the face, trunk, or limbs

18. Psychosocial Treatment of Schizophrenia
Behavioral (i.e., token economies) on inpatient units
Community care programs: outpatient; reducing institutionalization
Social and living skills training: teaching appropriate behaviors
Independent living skills: encouraged in community care programs
Behavioral family therapy: helping families to be more supportive
Vocational rehabilitation: aiding in job skills and employment

19. NAME THAT SYMPTOM! Disorder of thought content or delusion
Delusion of grandeur
Delusion of persecution
Auditory hallucination
Visual hallucination
Olfactory hallucination
Tactile hallucination
Tangentiality
Loose association
Waxy flexibility & catatonic immobility
Echopraxia
Echolalia
Alogia
Disorganized behavior