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Chapter 12 Schizophrenia and Other Psychotic Disorders

Chapter 12

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Chapter 12. Schizophrenia and Other Psychotic Disorders. Perspectives on Schizophrenia. Schizophrenia vs. psychosis Psychosis – broad term (e.g., hallucinations, delusions) Schizophrenia – a type of psychosis Psychosis and schizophrenia are heterogeneous - PowerPoint PPT Presentation

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Page 1: Chapter 12

Chapter 12

Schizophrenia and Other Psychotic Disorders

Page 2: Chapter 12

Perspectives on Schizophrenia

• Schizophrenia vs. psychosis– Psychosis – broad term (e.g.,

hallucinations, delusions) – Schizophrenia – a type of psychosis

• Psychosis and schizophrenia are heterogeneous– Disturbed thought, emotion, behavior

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History of schizophrenia

• Historical background– Emil Kraepelin – used the term

dementia praecox• Subtypes of schizophrenia – Catatonia,

hebephrenia and paranoia

– Eugen Bleuler – introduced the term “schizophrenia”• “Splitting of the mind”

(1856-1926)

(1857-1939

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Schizophrenia: The “Positive” Symptom Cluster

• The positive symptoms– Excess or distortion of normal behavior

• Delusions: The basic feature of madness– Gross misrepresentation of reality – Include delusions of grandeur (mistaken

belief that one is famous or powerful)– or delusions of persecution (others out

to get me)

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Schizophrenia: The “Positive” Symptom Cluster

• Hallucinations– Experience of sensory events without

environmental input– Can involve all senses

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SPECT study on auditory hallucination

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Schizophrenia: 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

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Schizophrenia: The “Disorganized” Symptom Cluster

• The disorganized symptoms– Severe and excess speech, behavior, and emotion

• disorganized speech – Cognitive slippage – illogical and incoherent speech– Tangentiality – “going off on a tangent”

• disorganized affect– Inappropriate emotional behavior

• disorganized behavior – Catatonia spectrum

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Subtypes of Schizophrenia:

• Paranoid type– Intact cognitive skills and affect– Do not show disorganized

behavior– Hallucinations and delusions –

grandeur or persecution– The best prognosis

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Subtypes of Schizophrenia: Paranoid and Disorganized

• Disorganized type– Marked disruptions in speech and behavior– Flat or inappropriate affect– Hallucinations and delusions – tend to be

fragmented– Develops early, tends to be chronic, lacks

remissions

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Subtypes of Schizophrenia: Catatonic, Undifferentiated, and Residual

• Catatonic type– Show unusual motor responses, grimacing– Examples include echolalia and echopraxia – Tends to be severe and quite rare

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Subtypes of Schizophrenia: Catatonic, Undifferentiated, and Residual

• Undifferentiated type– Wastebasket category– Major symptoms of schizophrenia– Fail to meet criteria for another type

• Residual type– One past episode of schizophrenia– Continue to display less extreme residual

symptoms

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Other Disorders with Psychotic Features: Schizophreniform and Schizoaffective Disorder

• Schizophreniform disorder– Schizophrenic symptoms for a few months– Associated with good premorbid functioning– Most resume normal lives

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Other Disorders with Psychotic Features: Schizophreniform and Schizoaffective Disorder

• Schizoaffective disorder– Symptoms of schizophrenia and a mood disorder– Both disorders are independent of one another– Prognosis - persons do not tend to get better on

their own such as in schizophrenia

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Other Disorders with Psychotic Features: Delusional Disorder

• Delusional disorder– Delusions that are contrary to reality– Lack other positive and negative symptoms– Types of delusions include• Erotomanic• Grandiose• Jealous• Persecutory• Somatic

– Extremely rare (24-30/100,000)– Better prognosis than schizophrenia

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Additional Disorders with Psychotic Features

• Brief psychotic disorder– One or more positive symptoms of schizophrenia

that lasts less than 1 month– Usually precipitated by extreme stress or trauma– Tends to remit on its own

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Additional Disorders with Psychotic Features

• Shared psychotic disorder– Delusions from one person manifest also in

another person– Little is known about this condition

• Schizotypal personality disorder– May reflect a less severe form of schizophrenia

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Schizophrenia: Statistics– about 1% population)– Often develops in early adulthood but can emerge at

any time– Most have moderate-to-severe lifetime impairment – Life expectancy is slightly less than average

• Schizophrenia affects males and females about equally– Females tend to have a better long-term prognosis– Onset differs between males and females

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Causes of Schizophrenia:Findings From Genetic Research

• Genetic factors• Family studies– Inherit a tendency for schizophrenia, not forms of

schizophrenia– Risk increases with genetic relatedness

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Causes of Schizophrenia:Findings From Genetic Research

• Twin studies– Monozygotic twins (48%) – Fraternal (dizygotic) twins (17%)– Adoption studies – risk for schizophrenia remains

high but less if adopted in good functioning home

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Search for Genetic andBehavioral Markers of Schizophrenia

• Genetic markers: Linkage and association studies– Endophenotypes– Schizophrenia is likely to involve multiple genes

• Behavioral markers: Smooth-pursuit eye movement– Eye movement tracking deficiency– Emotion identification

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Causes of Schizophrenia: Neurobiological Influences

• The dopamine hypothesis– Drugs that increase dopamine (agonists)• Result in schizophrenic-like behavior such as L-Dopa for

Parkinson’s disease, amphetamines– Drugs that decrease dopamine (antagonists)• Reduce schizophrenic-like behavior – neuroleptics

– Dopamine hypothesis is problematic and overly simplistic

– Current theories emphasize many neurotransmitters

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Causes of 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 pathway

• Viral infections during early prenatal development

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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– Schizophrenogenic mother– Double blind communication– High expressed emotion (EE)–

associated with relapse

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Medical Treatment of Schizophrenia

• Historical precursors• Development of antipsychotic (neuroleptic)

medications– Often the first line treatment for schizophrenia– Began in the 1950s– Most reduce or eliminate positive symptoms

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–Acute and permanent side effects are common• Extrapyramidal and Parkinson’s-like side

effects (Tardive dyskinesia)• Compliance with medication is often a

problem

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Psychosocial Treatment of Schizophrenia

• Psychosocial approaches:– Behavioral (i.e., token economies) on inpatient

units– Community care programs– Social and living skills training– Behavioral family therapy – Vocational rehabilitation– Cultural considerations

• Prevention