Download Durand and Barlow Chapter 12: Schizophrenia and Other Psychotic

yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Mania wikipedia , lookup

Parkinson's disease wikipedia , lookup

Narcissistic personality disorder wikipedia , lookup

Depersonalization disorder wikipedia , lookup

Olanzapine wikipedia , lookup

Emergency psychiatry wikipedia , lookup

Mental disorder wikipedia , lookup

Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup

Child psychopathology wikipedia , lookup

Classification of mental disorders wikipedia , lookup

Asperger syndrome wikipedia , lookup

Conversion disorder wikipedia , lookup

Abnormal psychology wikipedia , lookup

Critical Psychiatry Network wikipedia , lookup

History of mental disorders wikipedia , lookup

Pyotr Gannushkin wikipedia , lookup

History of psychiatry wikipedia , lookup

Dissociative identity disorder wikipedia , lookup

Psychosis wikipedia , lookup

Antipsychotic wikipedia , lookup

Causes of mental disorders wikipedia , lookup

Schizoaffective disorder wikipedia , lookup

Dementia praecox wikipedia , lookup

Spectrum disorder wikipedia , lookup

Controversy surrounding psychiatry wikipedia , lookup

Mental status examination wikipedia , lookup

Glossary of psychiatry wikipedia , lookup

E. Fuller Torrey wikipedia , lookup

Schizotypy wikipedia , lookup

Causes of schizophrenia wikipedia , lookup

Schizophrenia wikipedia , lookup

Sluggish schizophrenia wikipedia , lookup

Social construction of schizophrenia wikipedia , lookup

Chapter 12
Schizophrenia and Other Psychotic Disorders
Nature of Schizophrenia and Psychosis: An Overview
Schizophrenia vs. Psychosis
– Psychotic behavior – Cluster of disorders characterized by
hallucinations and/or loss of contact with reality
– Schizophrenia – A type of psychosis with disturbed thought,
perception, language, emotion, and behavior
Historical Background
– Emil Kraeplin – Used the term dementia praecox, focused on onset
and outcomes
– Eugen Bleuler – Introduced the term “schizophrenia” or “splitting of
the mind”
Impact of Early Ideas on Current Thinking About Schizophrenia
– Many of Kraeplin and Bleuler’s ideas are still with us
– Understanding onset and course are still considered important
Early figures in the history of schizophrenia
Table 12.1
Schizophrenia: The “Positive” Symptom Cluster
The Positive Symptoms
– Active manifestations of abnormal behavior, distortions of normal behavior
– Examples include delusions, hallucinations, and disorganized speech
Delusions: “The Basic Characteristics of Madness”
– Gross misrepresentations of reality
– Examples include delusions of grandeur or persecution
– Experience of sensory events without environmental input
– Can involve all senses, but auditory hallucinations are the most common
– Findings from SPECT studies
Some major language areas of the cerebral cortex
Figure 12.1
Schizophrenia: The “Negative” Symptom Cluster
The Negative Symptoms
– Absence or insufficiency of normal behavior
– Examples are emotional/social withdrawal, apathy, and poverty of
Spectrum of Negative Symptoms
– Avolition (or apathy) – Inability to initiate and persist in activities
– Alogia – A relative absence of speech
– Anhedonia – Inability to experience pleasure or engage in
pleasurable activities
– Flat affect – Show little expressed emotion, but may still feel
Schizophrenia: The “Disorganized” Symptoms
The Disorganized Symptoms
– Include severe and excess disruptions in speech, behavior, and emotion
Nature of Disorganized Speech
– Cognitive slippage – Illogical and incoherent speech
– Tangentiality – “Going off on a tangent” and not answering a question
– Loose associations or derailment – Taking conversation in unrelated
Nature of Disorganized Affect
– Inappropriate emotional behavior (e.g., crying when one should be
Nature of Disorganized Behavior
– Includes a variety of unusual behaviors
– Catatonia – Spectrum from wild agitation, waxy flexibility, to complete
Subtypes of Schizophrenia
Paranoid Type – 295.30
– Intact cognitive skills and affect, and do not show disorganized
– Hallucinations and delusions center around a theme (grandeur or
Disorganized Type – 295.10
– Marked disruptions in speech and behavior, flat or inappropriate
– Hallucinations and delusions have a theme, but tend to be
– This type develops early, tends to be chronic, lacks periods of
Subtypes of Schizophrenia (cont.)
Catatonic Type – 295.20
– Show unusual motor responses and odd mannerisms (e.g.,
echolalia, echopraxia)
– This subtype tends to be severe and quite rare
Undifferentiated Type – 295.90
– Major symptoms of schizophrenia, but fail to meet criteria for
another type
Residual Type – 295.60
– One past episode of schizophrenia
– Continue to display less extreme residual symptoms (e.g., odd
Other Psychotic Disorders
Schizophreniform Disorder – 295.40
– Schizophrenic symptoms for less than 6 months
– Associated with good premorbid functioning; most resume normal lives
Schizoaffective Disorder – 295.70
– Symptoms of schizophrenia and a mood disorder (e.g., bipolar disorder)
– Prognosis is similar for people with schizophrenia
– Such persons do not tend to get better on their own
Delusional Disorder – 297.1
– Delusions that are contrary to reality without other major schizophrenia
– Many show other negative symptoms of schizophrenia
– Type of delusions include erotomanic, grandiose, jealous, persecutory, and
– This condition is extremely rare
Additional Disorders with Psychotic Features
Brief Psychotic Disorder – 298.8
– Experience one or more positive symptoms of schizophrenia
– Usually precipitated by extreme stress or trauma
– Lasts less than one month
Shared Psychotic Disorder – 297.3
– Delusions from one person manifest in another person
– Little is known about this condition
Schizotypal Personality Disorder – May reflect a less severe form of schizophrenia
Classification Systems and Their Relation to Schizophrenia
Process vs. Reactive Distinction
– Process – Insidious onset, biologically based, negative symptoms,
poor prognosis
– Reactive – Acute onset (extreme stress), notable behavioral
activity, best prognosis
Good vs. Poor Premorbid Functioning in Schizophrenia
– Focus on person’s level of function prior to developing
– No longer widely used
Type I vs. Type II Distinction and Schizophrenia
– Type I – Positive symptoms, good response to medication,
optimistic prognosis, and absence of intellectual impairment
– Type II – Negative symptoms, poor response to medication,
pessimistic prognosis, and intellectual impairments
Schizophrenia: Some Facts and Statistics
Onset and Prevalence of Schizophrenia worldwide
– About 0.2% to 1.5% (or about 1% population)
– Usually develops in early adulthood, but can emerge at any time
Schizophrenia Is Generally Chronic
– Most suffer with moderate-to-severe impairment throughout their
– Life expectancy in persons with schizophrenia is slightly less than
Schizophrenia Affects Males and Females About Equally
– Females tend to have a better long-term prognosis
– Onset of schizophrenia differs between males and females
Schizophrenia Appears to Have a Strong Genetic Component
Gender differences in onset of schizophrenia in a sample of 470 patients
Figure 12.2
Schizophrenia: Genetic Influences
Family Studies
– Inherit a tendency for schizophrenia, not a specific form of
– Schizophrenia in the family increases risk for schizophrenia in other
family members
Twin Studies
– Risk of schizophrenia in monozygotic twins is 48%
– Risk of schizophrenia drops to 17% for fraternal (dizygotic) twins
Adoption Studies
– Risk of schizophrenia remains high in adopted children with a
biological parent suffering from schizophrenia
Schizophrenia: Genetic Influences (cont.)
Summary of Genetic Research
– Risk of schizophrenia increases as a function of genetic
– One need not show symptoms of schizophrenia to pass on relevant
– Schizophrenia has a strong genetic component, but genes alone
are not enough
Risk of developing schizophrenia
Figure 12.4
Risk for schizophrenia among children of twins
Figure 12.5
Search for Behavioral and Genetic Markers of Schizophrenia
The Search for Behavioral Markers: Smooth-Pursuit Eye Movement
– Tracking a moving object visually with the head kept still
– Tracking is deficit in persons with schizophrenia, including their
The Search for Genetic Markers: Linkage and Association Studies
– Search for genetic markers is still inconclusive
– Schizophrenia is likely involves multiple genes
Schizophrenia: Neurobiological Influences
Neurobiology and Neurochemistry: The Dopamine Hypothesis
– Drugs that increase dopamine (agonists), result in schizophreniclike behavior
– Drugs that decrease dopamine (antagonists), reduce
schizophrenic-like behavior
– Examples include neuroleptics and L-Dopa for Parkinson’s disease
– The dopamine hypothesis proved problematic and overly simplistic
– Current theories emphasize several neurotransmitters and their
Some ways drugs affect neurotransmission
Figure 12.6
Schizophrenia: Other Neurobiological Influences
Structural and Functional Abnormalities in the Brain
– Enlarged ventricles and reduced tissue volume
– Hypofrontality – Less active frontal lobes (a major dopamine
Viral Infections During Early Prenatal Development
– The relation between early viral exposure and schizophrenia is
Conclusions About Neurobiology and Schizophrenia
– Schizophrenia is associated with diffuse neurobiological
– Structural and functional abnormalities in the brain are not unique
to schizophrenia
Location of the cerebrospinal fluid in the human brain
Figure 12.7
Schizophrenia: Psychological and Social Influences
The Role of Stress
– May activate underlying vulnerability and/or increase risk of relapse
Family Interactions
– Families of people with schizophrenia show ineffective
communication patterns
– High expressed emotion in the family is associated with relapse
The Role of Psychological Factors
– Psychological factors likely exert only a minimal effect in producing
Cultural differences in expressed emotion (EE)
Figure 12.8
Medical Treatment of Schizophrenia
Historical Precursors
Antipsychotic (Neuroleptic) Medications
– Medication is often the first line of treatment for schizophrenia
– Began in the 1950s
– Most medications reduce or eliminate the positive symptoms of
– Acute and permanent extrapyramidal and Parkinson-like side
effects are common
– Poor compliance with medication is common
Transcranial Magnetic Stimulation
– Relatively untested procedure for treatment of hallucinations
Psychosocial Treatment of Schizophrenia
Historical Precursors
Psychosocial Approaches: Overview and Goals
– Behavioral (i.e., token economies) on inpatient units
– Community care programs
– Social and living skills training
– Behavioral family therapy
– Vocational rehabilitation
Psychosocial Approaches Are Usually a Necessary Part of Treatment
Summary of Schizophrenia and Psychotic Disorders
Schizophrenia Includes a Spectrum on Cognitive, Emotional, and
Behavioral Dysfunctions
– Positive, negative, and disorganized symptom clusters
DSM-IV and DSM-IV-TR Divides Schizophrenia Into Five Subtypes
Other DSM-IV and DSM-IV-TR Disorders Include Psychotic Features
Several Causative Factors Have Been Implicated for Schizophrenia
Successful Treatment Rarely Includes Complete Recovery
Summary of Schizophrenia and Psychotic Disorders (cont.)
Figure 13.x1
Exploring schizophrenia and its treatment
Summary of Schizophrenia and Psychotic Disorders (cont.)
Figure 13.x1 (cont.)
Exploring schizophrenia and its treatment
Summary of Schizophrenia and Psychotic Disorders (cont.)
Figure 13.x2
Exploring symptoms and types of schizophrenia
Summary of Schizophrenia and Psychotic Disorders (cont.)
Figure 13.x2 (cont.)
Exploring symptoms and types of schizophrenia