Schizophrenia

Lori Ridgeway

PSYC 3560

What is Schizophrenia?

Deterioration in fx Extreme disturbances in thoughts, perceptions,

emotions, motor fx Affects social, occupational, personal fx

Psychosis Hallucinations ________________ Withdrawal

Positive & negative sxs

Positive Sxs

Bizarre ________________ to behavior ________________

Ideas that have no basis in fact Persecution most common Other types

Grandeur Control Reference

Positive Sxs, Cont’d…

Hallucinations Sensory perceptions in absence of stimuli Premorbid perception & attention problems ______________ most common Other types

Visual Olfactory Tactile Somatic

Positive Sxs, Cont’d…

Disorganized thinking & speech Formal thought disorders

Can’t think &/or speak logically Loose associations (______________) most common Other types

Neologisms Perseveration Clang

Inappropriate affect Emotions don’t match situation

Negative Sxs

Pathological ________________ in behavior Poverty of speech

Alogia Reduction in speech or speech content May say little or may convey little meaning

Flat affect Show almost ________________ Anhedonia vs. inability to express emotion

Negative Sxs, Cont’d…

Loss of volition Avolition Apathy, ________________ Trouble with goal-directed behavior

Social withdrawal Withdraw into own ideas & fantasies Separate further from reality Loss of social skills

Psychomotor Sxs

Motoric disturbances Gestures not related to environment Catatonia

______________ Posturing Rigidity Waxy flexibility Excitement

Dx Criteria

_______ or more characteristic sxs present for 1 mo Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Negative sxs

Social/occupational dysfunction Signs of disturbance for 6 mos Exclusions

Subtypes: ________________

Prominent delusions or auditory hallucinations Usually related & has theme Persecutory or grandiose most common

Better cognitive/affective functioning Disorganized speech, catatonic behavior,

flat/inappropriate affect not prominent Later onset Less impairment Better outcomes

Subtypes: Disorganized

Disorganized speech &/or behavior Flat or inappropriate affect ________________ Any delusions/hallucinations are fragmented

& no theme Early onset Greater impairment Worse prognosis

Subtypes: Catatonic

Psychomotor disturbance Immobility

catalepsy = ________________

Excessive activity purposeless

Peculiar voluntary movements posturing

Negativism rigid posture, can’t move

Gender Differences

Overall prevalence approx. 1% Age of onset

Men 18 to 25 years of age Women ________________ years of age Late onset much less common in men

Women better premorbid functioning Women more positive sxs Men more negative sxs Women better outcomes

Cultural & Social Factors

Hallucinations with religious content Beliefs that seem delusional Language differences (i.e., disorganized speech) Higher rates in ________________

Overdiagnosis Poverty & divorce

More common in lower SES groups Approx. 0.5% in high SES, but 2% in low SES Stress/poverty “Downward drift”

Course

________________ phase Active phase Early onset

More negative sxs More brain abnormalities & cognitive impairment Worse premorbid fx & prognosis

Contributors to better outcomes Acute onset / late onset Mood disturbance Early treatment Being female

Comorbidity

________________ disorders Anxiety disorders Personality disorders

May be prodromal Suicide

10% commit suicide 30%-40% make at least one attempt

Biological Explanations

Genetics ______% among first-degree relatives Twin studies Adoption studies

Biochemical differences Type I (positive sxs) Dopamine hypothesis

Bio , Cont’d…

Structural differences Type II (negative sxs) ___________________________ in brain Abnormal blood flow Decreased size of temporal lobe

Psychological Explanations

Psychodynamic Schizophrenogenic _____________

Behavioral Operant conditioning

Cognitive perceptual disturbances Problems when try to underst&

Sociocultural Explanations

________________ Label applied to nonconformists Self-fulfilling prophecy Rosenhan (1973)

Family dysfunction Double-bind hypothesis Expressed emotion

Sociocultural-existential Constructive process Self-cure

Diathesis-Stress

________________ view of cause Combination of factors Predisposition combined with environment Biological factors better identified

Childhood Onset

Difficult to dx Insidious onset Differences

Delusions & hallucinations less elaborate Visual hallucinations more common

Some sxs common in other disorders Odd movements/postures PDD/Autism

Sx or normal child behavior?