SchizophreniaSchizophrenia

DefinitionDefinitionPsychotic disorderPsychotic disorderThought DisorderThought Disorder

Loose associationsLoose associations

““Split” from realitySplit” from realityNOT split or multiple personalityNOT split or multiple personality

Symptoms of SchizophreniaSymptoms of Schizophrenia

Positive SymptomsPositive Symptoms Loose associationsLoose associations Word saladWord salad DelusionsDelusions HallucinationsHallucinations

Negative SymptomsNegative Symptoms Poverty of speech contentPoverty of speech content Flat or blunted affectFlat or blunted affect Avolition or apathyAvolition or apathy AnhedoniaAnhedonia

Subtypes of SchizophreniaSubtypes of Schizophrenia

ParanoidParanoid DisorganizedDisorganized CatatonicCatatonic UndifferentiatedUndifferentiated ResidualResidual

Paranoid Subtype

Intact cognitive skills and affect Do not show disorganized behavior Hallucinations and delusions – grandeur or

persecution The best prognosis of all types of schizophrenia

Disorganized Symptoms Disorganized speech

Cognitive slippage – illogical and incoherent speech Tangentiality – “going off on a tangent” Loose associations – conversation in unrelated directions

Disorganized affect Inappropriate emotional behavior

Disorganized behavior Includes a variety of unusual behaviors Catatonia – spectrum

Disorganized Subtype

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

Catatonic Subtype

Show unusual motor responses and odd mannerisms

Examples include echolalia and echopraxia Tends to be severe and quite rare

Additional Subtypes

Undifferentiated type Catch all 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

Age of OnsetAge of Onset

Biological AspectsBiological Aspects

Runs in FamiliesRuns in Families Increased Risk Based on Genetic Increased Risk Based on Genetic

RelatednessRelatedness

Genetics and SchizophreniaGenetics and Schizophrenia

Biological Aspects Biological Aspects

Search for Marker GenesSearch for Marker Genes Still inconclusiveStill inconclusive Likely involves multiple genesLikely involves multiple genes Smooth Pursuit Eye TrackingSmooth Pursuit Eye Tracking

Tracking deficit in persons with schizophrenia, Tracking deficit in persons with schizophrenia, including their relativesincluding their relatives

Brain Structure and FunctioningBrain Structure and Functioning Enlarged ventricles and reduced tissue volumeEnlarged ventricles and reduced tissue volume HypofrontalityHypofrontality

Biological AspectsBiological Aspects

Dopamine HypothesisDopamine HypothesisDrugs that increase dopamine (agonists), Drugs that increase dopamine (agonists),

result in schizophrenic-like behavior (e.g., result in schizophrenic-like behavior (e.g., amphetamines)amphetamines)

Drugs that decrease dopamine (antagonists), Drugs that decrease dopamine (antagonists), reduce schizophrenic-like behaviorreduce schizophrenic-like behavior

Considered too simplistic (multiple NTs Considered too simplistic (multiple NTs involved)involved)

Psychosocial InfluencesPsychosocial Influences

The Role of StressThe Role of Stress Diathesis-Stress ModelDiathesis-Stress Model Also seems related to relapse (not just onset)Also seems related to relapse (not just onset)

Family InteractionsFamily Interactions Communication patternsCommunication patterns High expressed emotion associated with relapse High expressed emotion associated with relapse

Psychological factors seem Psychological factors seem relativelyrelatively small small

Treatment of SchizophreniaTreatment of Schizophrenia

Seldom Results in Complete RecoverySeldom Results in Complete Recovery Early MethodsEarly Methods

Insulin Coma TherapyInsulin Coma Therapy PsychosurgeryPsychosurgery ECTECT

Biological Treatments (Current)Biological Treatments (Current) Neuroleptics (Major Tranquilizers)Neuroleptics (Major Tranquilizers)

Haldol, Thorozine, othersHaldol, Thorozine, others Clozaril, Risperdal, Zyprexa, othersClozaril, Risperdal, Zyprexa, others

Treatment of SchizophreniaTreatment of Schizophrenia

Biological Treatment IssuesBiological Treatment IssuesMajor (Social) Reform in TreatmentMajor (Social) Reform in Treatment

Revolving Door ProcessRevolving Door Process

Trial and ErrorTrial and ErrorExtrapyramidal Side EffectsExtrapyramidal Side Effects

Tardive DyskinesiaTardive Dyskinesia

Address Positive Symptoms OnlyAddress Positive Symptoms OnlyMedication Compliance ProblemsMedication Compliance Problems

Antipsychotic Drugs and Antipsychotic Drugs and Inpatient TreatmentInpatient Treatment

Psychosocial TreatmentPsychosocial Treatment

Psychosocial ApproachesPsychosocial ApproachesBehavioral (i.e., token economies) on inpatient Behavioral (i.e., token economies) on inpatient

unitsunitsCommunity care programsCommunity care programsSocial and living skills trainingSocial and living skills trainingBehavioral family therapy Behavioral family therapy Vocational rehabilitation Vocational rehabilitation

Facilitate Medication ComplianceFacilitate Medication Compliance

Psychosocial TreatmentPsychosocial Treatment

Myths About SchizophreniaMyths About Schizophrenia

People with schizophrenia have “split People with schizophrenia have “split personalities.”personalities.”

People with schizophrenia are People with schizophrenia are intellectually disabledintellectually disabled

People with schizophrenia are dangerousPeople with schizophrenia are dangerous People with schizophrenia are addicted to People with schizophrenia are addicted to

their drugstheir drugs

Other Psychotic DisordersOther Psychotic Disorders

Brief Psychotic DisorderBrief Psychotic DisorderPsychotic symptoms for a few weeksPsychotic symptoms for a few weeks

Schizophreniform DisorderSchizophreniform DisorderSchizophrenic symptoms for a few months

Schizoaffective DisorderSchizoaffective DisorderSymptoms of schizophrenia and a mood

disorder independent of each other

Other Psychotic DisordersOther Psychotic Disorders

Delusional disorder Delusions without hallucinations or most other

schizophrenic symptoms Types of delusions

Erotomanic Grandiose Jealous Persecutory Somatic

Other Psychotic DisordersOther Psychotic Disorders

Folie a DeuxFolie a DeuxShared Psychotic DisorderShared Psychotic Disorder