Schizophrenia and Other Psychotic Disorders

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Schizophrenia and Other Psychotic Disorders

• Barlow and Durand
• Chapter 13

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Schizophrenia
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Schizophrenia

• Disrupts

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Schizophrenia

• Used to be called dementia praecox
• Schizophrenia is a combination of Greek words
  that mean split mind
• There are a number of identifying Sx and
  behaviors that are not necessarily shared by all
  people with the Dx.

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Clinical Description of Schizophrenia

• Age of onset is
• Psychosis

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Symptoms of Schizophrenia

• Active phase Sx
• Positive Sx
• Negative Sx

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Symptoms of Schizophrenia

• Disorganized Sx
• Must have 2 or more positive, negative, or
  disorganized Sx present for at least 1 month to
  be Dx

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DSM-IV-TR Criteria

• A. Characteristic Sx 2 or more of the following
  each present for a significant portion of time
  during a 1 month period

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DSM-IV-TR Criteria

• Note Only 1 of criterion A is necessary if
  delusions are bizarre or hallucinations consist
  of a voice keeping a running commentary of the
  persons behavior and thoughts or of 2 or more
  voices conversing with each other

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DSM-IV-TR Criteria

• B. Social/Occupational dysfunction Since the
  onset 1 or more areas of functioning is markedly
  below the level achieved prior to onset
• C. Duration

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DSM-IV-TR Criteria

• D. Shizoaffective and Mood Disorder Exclusion
• E. Substance/General Medical Condition Exclusion
• F. Relationship to a pervasive developmental
  disorder If there is a Hx of autistic disorder
  or other PDD this Dx is only given if prominent
  delusions or hallucinations are also present for
  at least 1 month

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Positive Sx of Schizophrenia

• Delusions
• Can be delusions of grandeur or of persecution
• Capgras Syndrome

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Positive Sx of Schizophrenia

• Cotards Syndrome
• A good example of delusions are personal TV
  messages
• Hallucinations

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Positive Sx of Schizophrenia

• Auditory Hallucinations
• People appear unusually occupied and sometimes
  respond to the non-existent voices when they are
  hearing them
• Brain Imaging shows us Brocas area is very
  active when

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Positive Sx of Schizophrenia

• This suggests that people with auditory
  hallucinations are not actually hearing the
  voices of others,

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Negative Sx of Schizophrenia

• Absence or insufficiency of normal behaviors
• Emotional withdrawal
• Social withdrawal
• Apathy
• Poverty of thought or speech

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Negative Sx of Schizophrenia

• Avolition
• Alogia
• Anhedonia
• Affective Flattening 2/3 experience this

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Negative Sx of Schizophrenia

• This appears to be a difficulty in EXPRESSING not
  in EXPERIENCING emotion

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Disorganized Sx of Schizophrenia

• Disorganized speech
• Tangentiality
• Loose Association or Derailment

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Disorganized Sx of Schizophrenia

• Inappropriate Affect
• Catatonia Motor dysregulation that ranges from
  wild agitation to immobility

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Schizophrenia Subtypes

• Catatonic
• Disorganized
• Paranoid
• Undifferentiated

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Schizophrenia Subtypes

• Residual people who have had at least 1 episode
  of schizophrenia but are no longer manifesting
  major Sx of (may have some leftover Sx)
• Leftover Sx may include

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Schizophreniform Disorder

• The experience of schizophrenia for a few months
  only then return to normal life
• Can disappear because of successful treatment or
  for unknown reasons
• Lifetime Prevalence 0.2

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Schizophreniform Disorder

• Characteristics include
• Onset of psychotic Sx within 4 weeks of first
  noticed changes in behavior
• Confusion at the height of psychotic episode
• Good premorbid social and occupational
  functioning
• Absence of flat affect

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Schizoaffective Disorder

• Persons who exhibit both Sx of Schizophrenia and
  the characteristics of Mood Disorders
• Criteria
• Presence of mood disorder
• Delusions or hallucinations for at least 2 weeks
  in the absence of prominent mood Sx

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Delusional Disorder

• Persistent beliefs that are contrary to reality
  in the absence of other Sx of Schizophrenia
• Delusion is not the result of an organic factor
  (brain seizure)
• No flat affect, anhedonia, or other negative Sx
• However, they do become socially isolated because
  they are suspicious of others
• Often persists over several years

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Subtypes of Delusions

• Erotomanic
• Grandiose
• Jealous

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Subtypes of Delusions

• Persecutory
• Somatic
• Delusions in this sense are different from
  schizophrenic delusions because they could be
  happening, but they arent (Not quite so bizarre)
• Age of onset is much later
• More female than male

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Brief Psychotic Disorder

• One or more positive Sx occur within a month
• Then the person regains full ability to function
  as well as before the episode
• Often precipitated by extreme stress

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Shared Psychotic Disorder

• An individual develops delusions simply because
  of their close relationship with a delusions
  individual
• (Mass Hysteria?)

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Statistics on Schizophrenia

• Generally chronic
• Significant relationships are hard so many of
  them do not marry
• Tx can help improve
• Roughly equal rates for males and females
• 0.2-1.5 in the general population

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Statistics on Schizophrenia

• Onset is early adulthood (16-25)
• Appear to show some improvement into late
  adulthood less Positive Sx and more Negative Sx
• Relapse rates

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Cultural Factors

• Universal affects every racial and cultural
  group studied so far
• Course and outcome are what vary from culture to
  culture

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Possible Genetic Causes

• Genes are responsible for making some individuals
  vulnerable to developing schizophrenia
• Family studies
• Twin studies

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Possible Genetic Causes

• Adoption studies show 10.3 of adoptees with
  schizophrenia had mothers with schizophrenia as
  opposed to a control group where 1.1 of adoptees
  had schizophrenia if mothers did not have
  schizophrenia

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Possible Genetic Causes

• Offspring of Twins studies show if your parent
  is an identical twin with schizophrenia you have
  a 17 change of having schizophrenia
• You have the same percent change if you are the
  child of an unaffected twin whose identical twin
  has schizophrenia (17)

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Possible Genetic Causes

• Same percent change if your parent is a fraternal
  twin with schizophrenia (17)
• However, if your parent is a fraternal unaffected
  twin whose twin has schizophrenia you only have a
  2 chance of developing schizophrenia
• In other words

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Possible Neurobiological Causes

• Dopamine system TOO active in persons with
  schizophrenia

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Possible Neurobiological Causes

• There are contradictions to this theory
• 1. A significant number of persons with
  schizophrenia are not helped by dopamine
  antagonists

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Possible Neurobiological Causes

• 2. Although the meds block the reception of
  dopamine right away reduction of Sx of
  schizophrenia takes several weeks
• 3. Clozapine
• Problem may be more complex

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Possible Causes in Brain Structure

• Abnormally large lateral ventricles means near
  parts of brain are too small either
  underdeveloped or atrophied
• This seems to rely on sex, age, and duration of
  disorder
• Frontal lobes less active in persons with
  schizophrenia

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Possible Causes Related to Viral Infection

• You do not hear of accounts of schizophrenic
  behavior prior to 1800
• Could this be a virus?
• Prenatal influenza (2nd trimester)

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Psychological and Social Influences

• These may initiate schizophrenia in a person with
  a predisposition to the disorder
• Stress
• Expressed Emotion in families
• If High Expressed Emotion more likely to relapse

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Myths about Causes of Schizophrenia

• Schizophrenogenic Mothers cold and rejecting
• Double-Bind Messages

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Treatment of Schizophrenia

• Neuroleptic Drugs
• Psychosocial Tx in combination
• Reduces relapse
• Compensates for skills deficits
• Improves med compliance

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Biological Tx Interventions

• Past Traditions to Present
• Insulin shock therapy
• Prefrontal lobotomies
• Psychosurgery
• ECT
• Neuroleptics (1950)

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Biological Tx Interventions

• Neuroleptic Drugs work on the positive Sx of
  schizophrenia
• They are dopamine antagonists
• Now they have fewer side effects than ever before
• Problem

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Why Dont People Take Meds?

• Bad patient doctor relationship
• Cost
• Poor social support
• Think they are better because reduction of Sx
• Negative side effects
• Akinesia
• Tardive Dyskinesia

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Why Dont People Take Meds?

• Side effects such as the previous can be
  irreversible
• Up to 20 of people who take meds for long
  periods of time develop them

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Psychosocial Tx Interventions