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SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS CHAPTER 6 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SCHIZOPHRENIA • The broad category of schizophrenia includes a set of disorders in which individuals experience distorted perception of reality and impairment in thinking, behavior, affect, and motivation. • A disorder with a range of symptoms involving disturbances In: • • • • • • • • Content of thought Form of thought Perception Affect Sense of self Motivation Behavior Interpersonal functioning Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SYMPTOMS OF SCHIZOPHRENIA POSITIVE + Positive symptoms: NEGATIVE - Negative symptoms: Exaggerations or distortions of Symptoms that involve normal thoughts, emotions, and functioning below the level of behavior normal behavior Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SYMPTOMS OF SCHIZOPHRENIA POSITIVE + Delusions Hallucinations Disorganized speech Disturbed behavior NEGATIVE - Restricted affect Avolition A-sociality Researchers proposed that positive symptoms reflected activated dopamine levels in the nervous system and negative symptoms reflected abnormalities in brain structure. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. DIAGNOSTIC FEATURES OF SCHIZOPHRENIA Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. CHARACTERISTICS OF SCHIZOPHRENIA • Bleuler coined the term schizophrenia • The four fundamental features are still referred to as Bleuler’s Four A’s: • Association (thought disorder) • Affect (emotional disturbance) • Ambivalence (inability to make or follow through on decisions) • Autism (withdrawal from reality) Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. FEATURES OF SCHIZOPHRENIA • Inappropriate affect is the extent to which a person’s emotional expressiveness fails to correspond to the content of what is being discussed. • Paranoia is the irrational belief or perception that others wish to cause you harm, may be associated with delusions or auditory hallucinations related to a theme that somebody is persecuting or harassing them. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SCHIZOPHRENIA SPECTRUM • Schizophrenia is now classified as a spectrum disorder rather than a single disease entity, leading to new diagnostic categories that included, for example, personality and affective disorders. • Section 3 of the DSM-5 includes a set of symptom severity ratings. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY IN SECTION 3 OF DSM-5 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. STATISTICS • Schizophrenia affects slightly more males than females • For every three men who develop schizophrenia over the course of their lives, two women are affected with the disorder. • Researchers estimate the lifetime prevalence as about 5% and the prevalence at any one time of about 3%. • People with schizophrenia are two to three times more likely to die compared to others within their age group. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. COURSES OF SCHIZOPHRENIA • • • • Continuous Remission Recurrent Extended Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. OTHER PSYCHOTIC DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. OTHER PSYCHOTIC DISORDERS • Schizophrenia-like disorders that involve abnormalities in one or more of the five domains: Delusions Hallucinations Disorganized thinking (speech) Grossly disorganized or abnormal motor behavior (including catatonia) • Negative symptoms • • • • Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BRIEF PSYCHOTIC DISORDER • A diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time. • Symptoms must be present for more than a day, but recover in less than a month. • Symptoms • • • • Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SCHIZOPHRENIFORM DISORDER • A disorder with essentially the same symptoms as schizophrenia, but that lasts from 1 to 6 months Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SCHIZOAFFECTIVE DISORDER • Schizophrenia with co-occurring mood disorder Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. DELUSIONAL DISORDERS • • • • • Erotomanic Grandios Jealous Persecutory Somatic Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BIOLOGICAL THEORIES • Brain structure and genetics • Ventricular enlargement and cortical atrophy • Diffusion tensor imaging (DTI) • Dopamine hypothesis Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BIOLOGICAL THEORIES • Genetic abnormalities affects: • • • • Brain development Synaptic transmission Immune functioning Manufacturing of important proteins involved in neurotransmission • Neurodevelopmental hypothesis Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BIOLOGICAL TREATMENT • Neuroleptics • “Typical” or “first generation” • “Atypical” or “second generation” • Consequences • Extrapyramidal symptoms (EPS) • Tardive dyskinesia Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. FIGURE 6.2 - NEUROPSYCHOLOGICAL PERFORMANCE PROFILE OF SCHIZOPHRENIA Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. PSYCHOLOGICAL PERSPECTIVE • Deficit in social cognition • Brains become less activated when given a social cognition task • Difficulty in working on people-oriented jobs • Substance abuse Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. PSYCHOLOGICAL TREATMENT • Token economy • Cognitive-behavioral therapy • Cognitive training Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. FIGURE 6.4 - DEVELOPMENTAL CASCADE TOWARD SCHIZOPHRENIA Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SOCIOCULTURAL PERSPECTIVE • Focus on the family system • Faulty modes of behavior and communication • Cognitive distortions • High degree of expressed emotion • Social class and income • Associated with environmental stressors of poverty • Contracting the disease leads to social and economic “downward drift” Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SOCIOCULTURAL TREATMENT • Assertive Community Treatment (ACT): A team of professionals from psychiatry, psychology, nursing, and social work reach out to clients Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BIOPSYCHOSOCIAL PERSPECTIVE • Theories focus on underlying brain mechanisms as expressed in cognitive deficits • Individuals with these disorders receive integrated care: • Maximizing their chances of recovery Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. • For more information on material covered in this chapter, visit our Web site: • http://www.mhhe.com/whitbourne7eupdate Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.