Download Schizophrenia (psychotic disorder)

A Psychotic Disorder
Terminology
•Psychosis: a loss of contact with reality
•Kraepelin’s “Dementia Praecox” = “early dementia”
•Blueler’s
“Schizophrenia” = “split mind”
1. fragmented thought process
2. emotions separated from thought
3. a withdrawal from reality
Overview of Symptom Categories for Schizophrenia
•Positive Symptoms: bizarre additions to thought, emotions, &/or behavior
•Negative Symptoms: deficits of thought, emotions, &/or behavior
•Psychomotor symptoms: awkward movements, repeated grimaces, &/or odd gestures
Symptoms of Schizophrenia
Positive Symptoms
1) Delusions
a. delusions of persecution
b. delusions of reference
c. delusions of grandeur
d. delusions of control
2) Disorganized thinking & Speech (Formal Thought Disorder)
a. loose associations
b. neologisms
c. perseveration
d. clang
3) Heightened perceptions & Hallucinations
a. auditory
b. tactile
c. somatic
d. visual
e. gustatory
4) Inappropriate affect
Symptoms of Schizophrenia (con)
Negative Symptoms
1) Poverty of Speech (alogia)
2) Blunted & Flat Affect
–may have a problem with anhedonia
3) Loss of Volition
–may have a problem with ambivalence
4) Social withdrawal
Symptoms of Schizophrenia (con)
Psychomotor Symptoms
1) Catatonia
a. catatonic stupor
b. catatonic rigidity
c. catatonic posturing
•may display “waxy flexibility”
d. catatonic excitement
Phases of Schizophrenia
•Prodromal Phase
•Active Phase
•Residual Phase
DSM-IV criteria for diagnosing Schizophrenia
•Major Symptoms:
1) Two or more of the following characteristic symptoms for a ONE MONTH period
(active phase):
a. Delusions
b. Hallucinations
c. Disorganized Speech
d. Grossly Disorganized or Catatonic Behavior (silliness, poor hygiene, or catatonia)
e. Negative Symptoms
(con)
2) Deterioration from prior functional level (e.g. social, occupational, self-care)
3) Not due to mood disorder
4) Not due to drugs or a medical condition
5) Duration of 6 months altogether (includes prodromal, active, and residual phases)
(con)
•Lifetime prevalence: .5-1%
•Onset: men: early to mid 20s; women: late 20s
•Sex-ratio: even (more men in hospital samples)
•Other facts:
–60-70% do not marry
–Have shorter life expectancy
–10% commit suicide
Schizophrenia Characterization
•Type I Schizophrenia: positive symptoms
–Delusions & hallucinations
–Formal Thought Disorders
–Grossly disorganized behavior or catatonic excitement
•Type II Schizophrenia: negative symptoms
–Affective flattening
–Alogia
–Avolition
–Catatonic behavior (deficits in movement)
•This Characterization helps to predict the course of the disorder:
–Type I  linked to biochemical abnormalities of brain & has better prognosis
–Type II  linked to structural abnormalities of brain & typically has poor prognosis
compared to Type I
Schizophrenia Subtypes:
Diagnosing Schizophrenia
1) Paranoid
2) Disorganized (hebephrenic)
3) Catatonic
4) Undifferentiated
5) Residual
•(See Handout for criteria)
Misperceptions
•violence
•multiple personality disorder
•homelessness as an effect
Theories
•Biological
•Psychological
–Psychodynamic
–Behavioral
–Cognitive
•Sociocultural
Biological Theory: Biochemical Abnormalities
•DA hypothesis
•Support:
•phenothiazines & L-dopa
•D-2 receptor sites & dopamine antagonists
•Challenges: atypical antipsychotics & D-1/other receptors
•Type I vs. Type II
Biological Theory: Biochemical Abnormalities (con)
•Glutamate
Biological Theory: Abnormal Brain Structures
•Enlarged ventricles
Biological Theory: Abnormal Brain Structures (con)
•Smaller amounts of cortical gray matter
Biological Theory: Abnormal Brain Structures (con)
•Cellular abnormalities of the hippocampus, amygdala, and thalamus
How do these occur?: genetics
How do these occur?: molecular genetics
•Abnormalities discovered on chromosomes: 1, 5, 6, 8, 9, 10, 11, 13, 18, 19, & 22
How do these occur?: viral infections?
•The seasonality correlation
•The fingerprint ridges
•Flu exposure for mothers with fetus
•Pestivirus antibody presence
Psychological Views
•Psychodynamic
–Regression to ego state --> efforts to reestablish ego control
–Schiophrenogenic mothers (Fromm-Reichmann)
•Behavioral
•Cognitive
•Sociocultural
–Social labeling
–Family dysfunction
•Double bind hypothesis
Treatments
•Humanistic: Milieu Therapy
•Behavioral: Token Economy
•Biological:
–Antipsychotics
•Problems: neuroleptic malignant syndrome
•Tardive dyskinesia
–New antipsychotics
•Insight Therapy
•Family therapy
•Community approach
Community Approach
•Coordinated Services
–Community mental health center
•Short-term hospitalization
•Partial Hospitalization
–Day centers or day hospitals
•Supervised Residences
–Halfway houses
•Occupational Training
–Sheltered workshops