Download Inappropriate affect

SCHIZOPHRENIA SPECTRUM
AND OTHER PSYCHOTIC
DISORDERS
CHAPTER 6
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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:
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Content of thought
Form of thought
Perception
Affect
Sense of self
Motivation
Behavior
Interpersonal functioning
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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
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SYMPTOMS OF SCHIZOPHRENIA
POSITIVE +

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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.
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DIAGNOSTIC FEATURES OF SCHIZOPHRENIA
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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)
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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.
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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.
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DIMENSIONS OF PSYCHOSIS SYMPTOM
SEVERITY IN SECTION 3 OF DSM-5
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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.
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COURSES OF SCHIZOPHRENIA
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Continuous
Remission
Recurrent
Extended
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OTHER PSYCHOTIC DISORDERS
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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
•
•
•
•
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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
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Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
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SCHIZOPHRENIFORM DISORDER
• A disorder with essentially the same symptoms as
schizophrenia, but that lasts from 1 to 6 months
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SCHIZOAFFECTIVE DISORDER
• Schizophrenia with co-occurring mood disorder
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DELUSIONAL DISORDERS
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Erotomanic
Grandios
Jealous
Persecutory
Somatic
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BIOLOGICAL THEORIES
• Brain structure and genetics
• Ventricular enlargement and cortical atrophy
• Diffusion tensor imaging (DTI)
• Dopamine hypothesis
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BIOLOGICAL THEORIES
• Genetic abnormalities affects:
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•
•
•
Brain development
Synaptic transmission
Immune functioning
Manufacturing of important proteins involved in
neurotransmission
• Neurodevelopmental hypothesis
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BIOLOGICAL TREATMENT
• Neuroleptics
• “Typical” or “first generation”
• “Atypical” or “second generation”
• Consequences
• Extrapyramidal symptoms (EPS)
• Tardive dyskinesia
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FIGURE 6.2 - NEUROPSYCHOLOGICAL
PERFORMANCE PROFILE OF
SCHIZOPHRENIA
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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
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PSYCHOLOGICAL TREATMENT
• Token economy
• Cognitive-behavioral therapy
• Cognitive training
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FIGURE 6.4 - DEVELOPMENTAL
CASCADE TOWARD SCHIZOPHRENIA
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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”
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SOCIOCULTURAL TREATMENT
• Assertive Community Treatment (ACT): A team of
professionals from psychiatry, psychology, nursing,
and social work reach out to clients
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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
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