Schizophrenia

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Schizophrenia Other Psychotic Disorders
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Schizophrenia

• Two or more of the following, each present for a
  significant portion of the time during a 1-month
  period
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms
• Exception to the 2 symptom requirement only
  1 psychotic symptom required if
• Delusion is bizarre
• Hallucination consists of

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Delusions (Positive Symptom)

• Fixed, false beliefs
• Types
• Bizarre
• Thought insertion
• Thought withdrawal
• Thought broadcast
• Reference

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Delusions (positive symptom)

• Types, continued
• Control
• Somatic
• Nihilistic
• Grandiose
• Religious
• Persecutory

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Hallucinations (Positive Symptom)

• False sense perception
• Types
• Auditory
• Tactile
• Visual
• Olfactory/Gustatory
• Somatic

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Disorganized Speech (Positive Symptom)

• Speech that is hard to understand or follow,
  impairs communication
• Types
• Loose associations
• Incoherence
• Frequent derailment

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Disorganized Speech (Positive Symptom)

• Types
• Circumlocution
• Tangential
• Clang
• Neologisms

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Disorganized SpeechGeometric Analogy
Tangential
Normal goal directed and linear
Q
A
A
Q
Incoherence
A
Q
Circumlocution
Loosening of Associations
A
Q
A
Q
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Grossly Disorganized or Catatonic Behavior
(Positive Symptom)

• Grossly Disorganized Behavior

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Grossly Disorganized or Catatonic Behavior
(Positive Symptom)

• Catatonic Behavior

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Negative Affect (Negative Symptom)

• Flat affect
• No emotional expression in speech
• Restricted fluency of thought and speech

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Schizophrenia

• Exception to the 2 symptom requirement only 1
  psychotic symptom required if
• 1. Delusion is bizarre
• OR
• 2. Hallucination consists of either
• a. voice keeps up a running commentary on the
  persons thoughts or behavior
• OR
• b. two or more voices conversing with each
  other

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Schizophrenia

• Impairment in functioning
• Signs of the disturbance for at least 6 months,
  that includes at least 1 month of symptoms
  described by Criterion A
• Symptoms are not better accounted for
  Schizoaffective Disorder or Mood Disorder with
  Psychotic Features
• Not due to a GMC or substance
• If there is a developmental disorder present,
  there are prominent delusions or hallucinations
  present for at least one month

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Facts about Schizophrenia

• Prevalence
• Gender
• Age of Onset
• Course

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Facts about Schizophrenia

• Course
• Onset may be acute or gradual
• Many sufferers experience three phases
• Prodromal beginning of deterioration
• Active meet criteria for Schizophrenia
• Residual return to prodromal levels

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Facts about Schizophrenia

• Course, continued

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Schizophrenia Course
Group 1 15 have only a single episode of illness
with no subsequent impairment
Group 2 25 have repeated episodes of illness
with no impairment between episodes
Group 3 30 have repeated episodes of illness
with some impairment between episodes
Group 4 30 have repeated episodes of illness
with gradually declining impairment between
episodes
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Facts about Schizophrenia

• Outcome
• Approximately 15
• Approximately 85
• Approximately 50
• 90 or more
• 75 or more
• Approximately 10

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Facts about Schizophrenia

• Culture
• Prevalence seems to be higher in lower SES
  communities
• Downward drift direction of causality?

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Facts about Schizophrenia

• Culture, continued
• Prevalence doesnt vary
• Prevalence doesnt vary
• Cross cultural variation

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Factors associated with better prognosis

• Good premorbid functioning
• Acute onset
• Later age at onset
• Being female
• Mood disturbance
• Family history of Mood Disturbance

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Factors associated with better prognosis

• Treatment with antipsychotic medication
• Compliance with medication
• Brief duration of symptoms
• Good interepisode functioning
• No family history of Schizophrenia
• Insight

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Subtypes of Schizophrenia

• Paranoid
• Disorganized
• Catatonic
• Undifferentiated
• Residual

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Paranoid Schizophrenia

• Preoccupation with one or more delusions or
  auditory hallucinations (usually persecutory,
  grandiose, or both)
• None of the following is prominent
• Disorganized speech,
• Disorganized behavior
• Catatonic behavior
• Flat/inappropriate affect

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Disorganized Schizophrenia

• All of the following are prominent
• Disorganized speech
• Disorganized behavior
• Flat/Inappropriate affect
• There is no catatonic behavior

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Catatonic Schizophrenia

• A type of Schizophrenia in which the clinical
  picture is dominated by at least 2 or more
  catatonic behaviors
• Motoric immobility as evidenced by stupor,
  catalepsy, or waxy flexibility
• Excessive motor activity that is apparently
  purposeless and not influenced by external
  stimuli
• Extreme negativism or mutism
• Peculiarities of movement (posturing, stereotyped
  movements, prominent mannerisms, or prominent
  grimacing
• Repeating whatever is said or done

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Undifferentiated Schizophrenia

• Characterized by symptoms which fit do not fit
  the paranoid, disorganized, or catatonic subtypes
• Vague, catch-all category

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Residual Schizophrenia

• Characterized by symptoms that have lessoned in
  strength and number
• Person may continue to display blunted or
  inappropriate emotions

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Schizophrenia Risk Factors

• Being born in winter or early spring
• Family history of Schizophrenia
• Risk of developing Schizophrenia
• 6 chance
• 10 chance
• 13 chance
• 42 chance
• 50 chance
• If one MZ twin has Schizophrenia and the other
  one doesnt, the one who doesnt have it often
  isnt completely asymptomatic (e.g. may have a
  personality disorder)

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Schizophrenia Biology

• Dopamine Hypothesis
• Schizophrenia has been linked to excessive
  dopamine activity
• Effective antipsychotics are dopamine antagonists
• Bind to dopamine receptors
• Decreasing dopamine too far can result in Tardive
  Dyskinesia
• Problem with the Dopamine hypothesis

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Other Psychotic Disorders

• Schizophreniform Disorder
• Brief Psychotic Disorder
• Schizoaffective Disorder
• Delusional Disorder
• Shared Psychotic Disorder

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What is a Psychotic Disorder

• Psychosis
• A break from reality
• Often involves difficulties interacting with and
  perceiving the real world
• Split between thoughts and emotions

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Schizophreniform Disorder

• Criteria A, D, and E of Schizophrenia are met
• An episode of the disorder (including the
  prodromal, active, and residual phases) lasts at
  least 1 month but less than 6 months

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Schizophreniform Disorder

• Essentially, exactly like Schizophrenia, but the
  duration is shorter
• Schizophrenia
• Schizophreniform
• Often used as a provisional diagnosis during the
  first months of a psychotic illness
• Thus, this diagnosis can change to Schizophrenia
  after 6 months have passed without complete
  recovery

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Facts about Schizophreniform Disorder

• Prevalence Varies substantially
• Industrialized areas
• Non-industrialized areas

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Facts about Schizophreniform Disorder

• Gender
• Age of Onset
• Course 1/3 -
• 2/3 -

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Brief Psychotic Disorder

• A. Presence of one or more of the following
  symptoms
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• B. Duration of an episode of the disturbance is
  at least 1 day but less than 1 month, with
  eventual full return to premorbid levels of
  functioning
• C. Disturbance is not better accounted for by
  another mental disorder and is not due to a GMC
  or substance

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Brief Psychotic Disorder vs. Schizophrenia/Schizop
hreniform

• Criteria
• Schizophrenia/Schizophreniform Disorder
• Brief Psychotic Disorder
• Duration
• Schizophrenia
• Schizophreniform Disorder
• Brief Psychotic Disorder

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Facts about Brief Psychotic Disorder

• Prevalence
• Gender
• Age of Onset
• Course

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Schizoaffective Disorder

• An uninterrupted period of illness during which,
  at some time, there is either a Major Depressive
  Episode, a Manic Episode, or a Mixed Episode
  concurrent with symptoms that meet Criterion A
  for Schizophrenia
• During the same period of illness, there have
  been delusions or hallucinations for at least 2
  weeks in the absence of prominent mood symptoms

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Schizoaffective Disorder

• D. Symptoms that meet criteria for a mood episode
  are present for a substantial portion of the
  total duration of the illness
• E. Not due to a GMC or substance

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Subtypes of Schizoaffective Disorder

• Bipolar Type
• Depressive Type

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Facts about Schizoaffective Disorder

• Prevalence
• Gender

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Facts about Schizoaffective Disorder

• Age of Onset
• Bipolar Subtype
• Depressive Subtype
• Course Better prognosis than Worse
  prognosis than
• Better prognosis

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Delusional Disorder

• Nonbizarre delusions lasting for at least 1 month
• Criterion A for Schizophrenia have never been met
  (However, tactile and olfactory may be present if
  they are related to the delusional theme)
• Behavioral functioning is not markedly imparied
  and behavior is not obviously odd or bizarre

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Delusional Disorder

• D. If mood episodes have occurred concurrently
  with delusions, their total duration has been
  brief relative to the duration of the delusional
  periods
• E. Not due to the direct effects of a GMC or
  substance

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Types of Delusional Disorder

• Erotomanic
• Grandiose
• Jealous

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Types of Delusional Disorder

• Persecutory
• Somatic
• Mixed
• Unspecified

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Facts about Delusional Disorder

• Prevalence 0.03 -
• 1-2 -
• Gender
• Age of Onset
• Course

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Shared Psychotic Disorder (Folie á Deux)

• A delusion develops in an individual in the
  context of a close relationship with another
  person(s), who has an already-established
  delusion
• The delusion is similar in content to that of the
  person who already has the established delusion
• The disturbance is not better accounted for by
  another psychotic disorder or is due to a GMC or
  substance

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Shared Psychotic Disorder

• The delusions are shared between two people are
  in a close relationship (husband and wife, parent
  and child, siblings, etc.)
• Typically, the person with the original delusion
  is the more dominant personality in the
  relationship
• Generally the delusions are only shared by two
  people, but can be shared among large groups of
  people as well

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Facts about Shared Psychotic Disorder

• Prevalence
• Gender
• Age of Onset
• Course