Major Psychotic Disorders

1
Major Psychotic Disorders

• schizophrenia
• chronic but episodic
• schizophreniform
• brief psychotic disorder lt6 months
• schizoaffective
• both schizophrenia and major affective disorder
• major depression with psychotic features
• mood congruent delusions and hallucinations
• psychosis only during depressive episodes
• bipolar disorder (manic depression)
• delusional disorder

2
Schizophrenia

• prevalence
• 1 (2.5 million), 100,000 inpatient beds on any
  day (1/3 of psych beds). 71 rehospitalization
  rates over 5 years.
• heterogeneous disorder (mixed bag)
• subtypes paranoid, disorganized, catatonic,
  undifferentiated, residual
• symptom dimensions positive, negative,
  disorganization.
• causes? there are many neuro-developmental
  disorder, dopamine hypothesis, infection,
  multiple causes with a final common pathway (ends
  up looking the same)

3
Conceptualization, Emotion, Treatment

• core problem versus clusters of symptoms
• Bleuler failure of integration (thought,
  emotion, behavior)
• syndrome of signs and symptoms that co-occur
• emotional deficits?
• 30 of pts. experience major depression w/in 1
  yr. of onset
• less facially expressive (less smiles/frowns) but
  their emotional response is like normals
• expressed emotion and outcome (critical comments,
  hostility, over-involvement)
• treatments
• drugs reduce symptoms (not cure), family and
  individual treatment, psychosocial rehabilitation
  (skills training).
• early detection and preventive (low dose)
  medication treatment. the kindling hypothesis.

4
emotion and schizophrenia

• Diathesis-Stress model.pp.372-378.
• individuals have vulnerability to schizophrenia
  but many require environmental stress to develop
  the disorder.
• Expressed Emotion literature. pp. 384-387.
• harsh, critical, emotionally overinvolved
  environments predict rehospitalization.
• varies by culturee.g., hispanic cultures tend to
  have a broad, tolerant notion of bad nerves and
  reduced rates of rehospitalization (compared to
  US)

5
time course of schizophrenia
acute/gradual onset
emotional atmosphere
influenza, season of birth
gross and fine motor deficits
depression suicide
parents psychopathology
level of impairment
inherited risk
shifting symptom profile
levels of positive, negative, disorganization
symptoms
attentional deficits
onset of symptoms
frontal lobe disorder, enlarged ventricals