Schizophrenia

And Other Thought Disorders

Origins of the DiagnosisKraepelin – 19th century: dementia

praecox

Eugene Bleuler (1908) - coined the term schizophreniaskhizein - splitphren - mind

Positive Symptoms

Delusions: false beliefs

◦delusion of grandeur: belief that one has extraordinary powers

◦delusion of persecution: belief that others are out to get you

Other Delusionsideas of reference:

thought broadcasting:

Capgras: belief that someone you know has been replaced by a “double”

Cotard: belief that you are dead

Positive SymptomsHallucinations: experience of a

sensory event without the presence of sensory stimuliauditoryvisualtactileolfactorygustatory

Auditory Hallucinations

Broca’s area: involved in speech production

Wernicke’s area: involved in speech comprehension

brain imaging studies reveal that Broca’s area of the brain was most active during auditory hallucinations.

Negative Symptomsavolition: inability to initiate and

follow through with activities

alogia: the relative absence of speech

anhedonia: lack of pleasure in life

affective flattening: limited range of emotions visible to others

Disorganized Symptoms

disorganized speech

inappropriate affect and disorganized behavior

Historic (i.e., until 2013) Schizophrenia Subtypes

paranoid: delusions of grandeur or persecution

disorganized: marked disruption in speech and behavior

catatonic: unusual motor activity (e.g., fixed positions, excessive activity, odd mannerisms)

undifferentiated: do not meet the criteria for other subtypes

DSM-V criteria for Schizophrenia2 or more of the following symptoms

for a significant portion of a month:◦ Delusions◦ Hallucinations◦ Disorganized speech◦ Grossly disorganized or catatonic behavior◦ Negative symptoms

Possible Biological Causesgenetic influence

Identical twin has it (48% chance)Fraternal twin (17%)

abnormal brain structure

viral infection

dopamine

Dopamine Hypothesis

Evidence For: Evidence Against:

many effective antipsychotics block dopamine

antipsychotics produce Parkinson’s-like side effects

L-dopa can produce schizophrenia-like symptoms

amphetamines make psychotic symptoms worse

some aren’t helped with dopamine antagonists

symptoms take a while to subside but dopamine quickly blocked

antipsychotics alleviate positive but not negative symptoms

Clozopine works – weak effect on dopamine

Psychological Influences

Causesschizphenogenic mother?double-binds?

Relapseexpressed emotion

Psychosocial Interventions: inpatient care

token economydeinstitutionalization

social skills training

family interventions

virtual reality

Intensive Case Mangement (ICM)Typically, but not always, a social

worker.

Links clients to needed services and gives instruction in basic living skills.

Has been found to reduce rates of hospitalization.

Assertive Community Treatment (ACT)

◦Mobile case management.

◦Developed by Stein and Test in 1985 in Madison, Wisconsin.

◦Other aspects of ACT is that takes a wholistic approach, attempts to capitalize on the client’s strengths, and attempts to work within the ecology of the client.

Treatment for Schizophrenia

Antipsychotic medicationsconventional:

Thorazine, Mellaril, Haldolnewer antipsychotics:

Clozaril, risperidal, Zyprexa

Extrapyramidal symptoms:tardive dyskinesia – involuntary

movements of the tongue, face, mouth, or jaw

schizophreniform disorder: symptoms of schizophrenia that last between 1 and 6 months

schizoaffective disorder: presence of a mood disorder and the presence of delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

brief psychotic disorder: presence of one or more positive symptoms within a month

shared psychotic disorder (Folie a deux): individual develops delusions as a result of a close relationship with a delusional individual

Delusional Disorderpersistent belief that is contrary to

reality absence of other characteristics of

schizophrenia

erotomanic: irrational belief that one is loved by another person◦ http://www.youtube.com/watch?v=fAHyA3jA

50o◦ Start at 5:50

grandiose: inflated sense of self-worth, power, knowledge, identity, or special relationship to a deity or famous person

Delusional Disorder

jealous: beliefs that sexual partner is unfaithful – no evidence for it.

persecutory: believe that you or loved one is being treated malevolently

somatic: afflicted by a physical defect or general medical condition.