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Chapter 13
Schizophrenia Spectrum and
Other Psychotic Disorders
Amber Gilewski
Tompkins Cortland Community College
The “Positive” Symptom Cluster
 The Positive Symptoms
– Active manifestations of abnormal behavior
– Distortions of normal behavior
 Delusions: The Basic Feature of Madness
– Gross misrepresentations of reality
– Include delusions of grandeur or persecution
 Hallucinations
– Experience of sensory events without
environmental input
– Can involve all senses (auditory most common)
The “Negative” Symptom Cluster
 The Negative Symptoms
– Absence or insufficiency of normal behavior
 Spectrum of Negative Symptoms
– Avolition (or apathy) – Lack of initiation and
persistence
– Alogia – Relative absence of speech
– Anhedonia – Lack of pleasure, or
indifference
– Affective flattening – Little expressed
emotion
The “Disorganized” Symptom Cluster
 The Disorganized Symptoms
– Severe and excess speech, behavior, and emotion
 Nature of Disorganized Speech
– Cognitive slippage – Illogical and incoherent speech
– Tangentiality – “Going off on a tangent”
– Loose associations – Conversation in unrelated
directions
• Inappropriate affect -
– Odd emotional behavior
 Disorganized Behavior
– Includes a variety of unusual behaviors
Other Disorders with Psychotic Features:
Schizophreniform Disorder
 Schizophreniform Disorder
– Schizophrenic symptoms for a few months
– Associated with good premorbid
functioning
– Most resume normal lives
– Lifetime prevalence of 0.2%
Other Disorders with Psychotic Features:
Schizoaffective Disorder
 Schizoaffective Disorder
– Symptoms of schizophrenia and a mood
disorder
– Both disorders are independent of one
another
– Prognosis is similar for people with
schizophrenia
– Such persons do not tend to get better on
their own
Other Disorders with Psychotic Features:
Delusional Disorder
– Delusions that are contrary to reality
– Lack other positive and negative symptoms
– Types of delusions include:

Erotomanic: higher status figure love

Grandiose: inflated importance

Jealous: unwarranted beliefs of infidelity

Persecutory: most common; conspired against

Somatic: physical defects, disease, disorder
– Extremely rare
– Better prognosis than schizophrenia
Additional Disorders with Psychotic
Features: Brief Psychotic Disorder
 Brief Psychotic Disorder
– One or more positive symptoms of
schizophrenia
– Usually precipitated by extreme stress or
trauma
– Tends to remit on its owns
Schizophrenia: Some Facts and Statistics
 Onset and Prevalence of Schizophrenia worldwide
– About 0.2% to 1.5% (1% population in US)
– Often develops in early adulthood
– Can emerge at any time
– Women have better prognosis
 Schizophrenia Is Generally Chronic
– Life expectancy is slightly less than average
Developmental Research
 Brain damage – during prenatal or infancy
periods may be a cause of schizophrenia
 Early brain abnormality – may have better
prognosis due to brain’s plasticity (ability to
compensate)
 Older adult’s symptoms – demonstrate that
the illness may improve over time
 Levels of impairment – fluctuates between
moderate and severe; relapse is common
Causes of Schizophrenia:
Findings From Genetic Research
 Family Studies
– Inherit a tendency for schizophrenia, not forms of
schizophrenia
– Risk increases with genetic relatedness
 Twin Studies
- Monozygotic twins – Risk for schizophrenia is 48%
- Fraternal (dizygotic) twins – Risk drops to 17%
 Adoption Studies -- Risk for schizophrenia remains
high
Causes of Schizophrenia:
Neurotransmitter Influences
 The Dopamine Hypothesis
– Drugs that increase dopamine (agonists)

Result in schizophrenic-like behavior
– Drugs that decrease dopamine (antagonists)

Reduce schizophrenic-like behavior
 Neurological damage?
-Structural and Functional Abnormalities in the Brain
– Enlarged ventricles and reduced tissue volume
Location of the cerebrospinal fluid in the
human brain
Fig. 13.7, p. 486
Causes of Schizophrenia:
Psychological and Social Influences
 The Role of Stress
– May activate underlying vulnerability
– May also increase risk of relapse
 Family Interactions
– Families – Show ineffective communication
patterns
– High expressed emotion –
associated with relapse
Medical Treatment of Schizophrenia
 Historical
Treatment
 primitive brain
surgeries in 1500s
 prefrontal lobotomies
used in 1950’s
 modern treatment
using neuroleptic
drugs
www.cerebromente.org.br/n02/historia/psico08.jpg
Biological Interventions
 The 1930’s
www.minddisorders.com/images/gemd_02_img0087.jpg
 Insulin coma therapy: insulin induced
hypoglycemia resulting in convulsions & coma
 Psychosurgery: disconnecting frontal lobes
 ECT: aka “shock therapy”; not beneficial
 The 1950’s: development of antipsychotic
(neuroleptic) medications
– Often the first line treatment for schizophrenia
– Newer medications have fewer serious side
effects
Medical Treatment of Schizophrenia
(continued)
– Compliance with medication is often a problem
(medical relationship, cost, poor supports, side
effects)
– Acute and permanent side effects are
common

Akinesia: absence, loss, or impairment of
the power of voluntary movement

Tardive dyskinesia:
twitching of the face, trunk, or limbs
Psychosocial Treatment of Schizophrenia
– Behavioral (i.e., token economies) on inpatient
units
– Community care programs: outpatient;
reducing institutionalization
– Social and living skills training: teaching
appropriate behaviors
– Independent living skills: encouraged in
community care programs
– Behavioral family therapy: helping families to
be more supportive
– Vocational rehabilitation: aiding in job skills
and employment
NAME THAT SYMPTOM!
 Disorder of thought
content or delusion
 Delusion of grandeur
 Delusion of
persecution
 Auditory hallucination
 Visual hallucination
 Olfactory hallucination
 Tactile hallucination
 Tangentiality
 Loose association
 Waxy flexibility &
catatonic immobility
 Echopraxia
 Echolalia
 Alogia
 Disorganized
behavior