1. Chapter 8 Schizophrenia & Related Psychotic Disorders

2. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 2 Schizophrenia A form of psychosis—the inability to tell the difference between the real and the unreal Widespread and costly  Up to 3% of national health budgets  0.5–2% of the general population affected

3. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 3 Schizophrenia & Residence

4. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 4 Positive Symptoms Delusions  Persecutory  Delusions of Reference  Grandiose Delusions  Delusions of Thought Insertion Hallucinations Disorganized Thought and Speech Disorganized or Catatonic Behavior

5. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 5 Negative Symptoms Affective Flattening (or Blunted Affect) –Severe reduction or complete absence of affective (emotional) responses to the environment Alogia –Severe reduction or complete absence of speech Avolition –Inability to persist at common, goal-oriented tasks

6. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 6 Cognitive Symptoms Deficits in basic cognitive processes, including attention and memory Deficits in working memory

7. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 7 DSM-IV-TR Criteria for Schizophrenia A. Two or more of the following present significantly during a 1-month (acute) period 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms—affective flattening, alogia, or avolition B. Social/occupational functioning: significant impairment in work, academic performance, interpersonal relationships, and/or self-care C. Duration: continuous signs of disturbance for at least 6 months including 1 month with symptoms that meet Criterion A

8. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 8 DSM-IV-TR Criteria for Schizophrenia, cont. D. Schizoaffective and mood disorder with psychotic features have been ruled out E. Disturbance not physiological due to a substance or general medical condition F. If autism or other pervasive developmental disorder present, must be prominent delusions or hallucinations as well Prodromal symptoms — present before the acute stage Residual symptoms — present after the acute stage

9. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 9 Schizophrenia subtypes Paranoid Disorganized Catatonic Undifferentiated Residual

10. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 10 Prognosis of Schizophrenia 50–80% rehospitalization rate Stabilize within 5–10 years of first episode Gender and Age Factors  Women develop disorder later, milder symptoms, and have a more favorable course than do men  Functioning improves with age Sociocultural Factors  Possibly less severe in developing countries  Acceptance of deviant behavior  Gender differences  Social response and treatment availability

11. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 11 Other Psychotic Disorders Schizoaffective Schizophreniform Brief Psychotic Delusional Shared Psychotic

12. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 12 DSM-IV-TR - Schizoaffective Disorder A.An uninterrupted period of illness during which there is either a major depressive episode, a manic episode, or a mixed episode concurrent with Criterion A schizophrenia symptoms. B.During the same period delusions or hallucinations for at least 2 weeks without prominent mood symptoms. C.Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness. D.Disturbance not physiological due to a substance or general medical condition

13. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 13

14. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 14

15. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 15

16. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 16

17. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 17 Biological Theories of Schizophrenia Genetic  Family, twin, and adoption studies indicate a genetic component to schizophrenia, or at least a vulnerability to schizophrenia Structural Brain Abnormalities  Enlarged ventricles, reduced volume, and neuron density in frontal cortex, and other brain abnormalities linked to cognitive and emotional deficits

18. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 18 Biological Theories of Schizophrenia, continued Birth Complications & Prenatal Viral Exposure  Particularly those involving loss of oxygen that could damage brain Neurotransmitter Theories  Imbalances in levels of or receptors for dopamine cause symptoms; serotonin, GABA, and glutamate may also play roles

19. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 19 Integrative Model

20. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 20 Psychosocial Perspectives on Schizophrenia Social drift and urban birth Stress and relapse Psychodynamic  expressed emotion Cognitive

21. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 21 Biological Treatment for Schizophrenia ECT Antipsychotic drugs  Neuroleptics — Phenothiazines, Butyrophenones, Thioxanthenes  Atypical — Clozapine Behavioral, Cognitive, and Social Interventions: Recognition of demoralizing attitudes they may have toward their illness, operant conditioning, modeling, family therapy, token economies, self-help groups, assertive community treatment programs

22. Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 8 22 Psychological and Social Treatment Behavioral Cognitive Social Interventions  Family Therapy  Assertive Community Treatment Programs Cross-Cultural  Structural  Social support  Persuasive  Clinical