By: John Boyd and Timothy Chmielewski

SCHIZOPHRENIA

Observations on Madness and Melancholy by John Haslam (1809)

Emil Kraepelin (1899) catatonia, hebephrenia, paranoia

Eugen Bleuler (1908)

WHAT IS IT?

DSM-IV TRDelusions Hallucinations Disorganized speech Disorganized and catatonic behavior Negative symptoms: avolition, a=“without” volition=“an act of choosing,

willing or deciding” alogia, logos=“words” anhedonia, hedonic=“pertaining to pleasure” flat aff ect

IT’S A PSYCHOTIC DISORDER!

Interferes with occupations, interpersonal relationships and self-care

Signs of symptoms have to persist for a 6 month period and 1 month of active symptoms

Schizoaff ective and mood disorders have been ruled out

Eff ects of substances ruled out If some sort of developmental disorder is present

they must have 1 month of prominent delusions of hallucinations

CRITERIA

Paranoid Type: delusions, hallucinations, paranoia Disorganized Type: disruption in speech and behavior Catatonic Type: catatonia, echolalia, echopraxia Undiff erentiated Type: do not fi t into other types Residual Type: display leftover symptoms

SUBTYPES

An accumulation of cognitive and functional impairments leading to Schizophrenia

THE PRODROMAL PERIOD

Three Stages of The Prodrome First, individuals will experience non-specific

symptoms such as depression, anxiety, or social isolation

Next, people will experience basic symptoms and attenuated positive symptoms.

Finally, individuals enter the high risk period, with includes pre-delusionary thoughts, pre-hallucinatory perceptions, and disordered thoughts.

Stages of Prodromal

Risk factors AgeFamily history of psychosis Symptom Scores

Ultra-High-RiskAges 14-29Experienced positive symptoms in the last year

Schizotypal Personality DisorderFamily history of psychosis

ASSESSMENT OF PATIENTS

The Prodromal Period has been shown to have a high rate of conversion to Schizophrenia Study of 291 prodromal patients, 82 converted to

schizophrenia after 2.5 years.

WHY IS THE PRODROME IMPORTANT?

Patients that are classified UHR have a much higher rate of conversion to Schizophrenia A study of 104 UHR people, about 81% of them converted to Schizophrenia after one year

Many variables affect UHR individuals converting to psychosisPoor functioningHigh levels of depressionSubstance AbuseGenetic risk

ULTRA-HIGH-RISK INDIVIDUALS

People that are at risk for substance abuse and psychosis are more likely to convert to Schizophrenia

Study linking cannabis use to schizophrenia Included 54 UHR individuals 6 used cannabis during study, 3 converted 16 reported lifetime abuse, 5 converted 32 reported no lifetime use, only 1 converted

SUBSTANCE ABUSE LINKED TO SCHIZOPHRENIA

Antipsychotic medication is the standard Antagonist to Dopamine receptors

Prolonged exposure is associated with side eff ects such as EPS, and Tardive Dyskinesia Extrapyramidal Symptoms- tremors, muscle spasms, muscle

stiffness, and pseudo-parkinsonism

PHARMACEUTICAL THERAPY

Also called second generation antipsychotic medication

Developed in the 1990 ’sAssociated with much less EPS, but

may have other negative side-effects Weight gainMetabolic Disturbances

Olanzapine, Quetiapine, Risperidone, Ziprasidone, Clozapine, Aripiprazole, etc.

ATYPICAL ANTIPSYCHOTIC DRUGS

Clinical Antipsychotic Trials of Intervention Eff ectiveness

Double-blind, randomized study of 1460 participants over 18 months

Compared eff ectiveness of typical vs. atypical antipsychotic medications

THE CATIE STUDY

Participants were randomly placed on either one of four atypical (2nd generation) medications, or one typical (1st generation) medication.Olanzapine, Quetiapine, Risperidone, Ziprasidone

Perphenazine The study measured how long patients

benefited from the drugs, any side effects they created, and how well they controlled symptoms

THE CATIE STUDY

Olanzapine was slightly better at controlling symptoms Associated with significant weight gain

Perphenazine performed just as well as the other drugs

EPS were not seen more frequentlyComparing the good with the bad, the

newer medications did not have a distinct advantage over the older medications

RESULTS OF THE CATIE STUDY

Study comparing Olanzapine and Haloperidol Found that Olanzapine treated psychosis better and

brain scans showed no changes in grey matter Patients on Haloperidol showed significant decreases in

grey matterWhich type is better??

OTHER STUDIES

Double-blind, randomized, parallel-group, placebo-controlled study

This study examined the eff ects of Olanzapine on symptom severity over an eight week period

Results showed that Olanzapine worked well for acute treatment of symptoms Long term use may be problematic

MORE STUDIES!

A continuation of the previous study looked at conversion rates after two years.

After one year, only 5 of the 31 patients treated with Olanzapine converted to psychosis In the control group, 11 of the 29 patients

converted to psychosisDuring the 2nd year, no treatment was given

Only 17 patients participated in this part Conversion rates between the two groups did not

differ

STUDIES CONTINUED

Group 1: Low doses of Risperidone combined with enriched psychosocial treatment

Group 2: Standard psychosocial treatment

Results: Of the 31 patients in group 1, only 3 converted to psychosis. Of the 28 patients in group 2, 10 converted.

These results were significant and they suggest combination therapy helps delay the onset of psychosis

STUDIES INVOLVING COGNITIVE BEHAVIORAL THERAPY

Randomized, parallel-group study comparing Amisulpride combined with needs based treatment, to needs based treatment alone.Needs based treatment included CBT, counseling, and educational assistance

Results showed that the group with combined therapies had a greater reduction in symptoms, and improvement in functional deficits compared to the other group.

STUDIES INVOLVING COGNITIVE BEHAVIORAL THERAPY

Naturalistic study involving 48 prodromal patients over 2 years

20 prescribed antidepressants No patients converted to psychosis

28 prescribed antipsychotics 12 patients converted to psychosis

However, 11 of these 12 were non-adherent to their medication

RECENT STUDIES INVOLVING ANTIDEPRESSANTS

Another group retrospectively looked at naturalistic data

Results: Of 35 patients prescribed antipsychotics, 10 developed psychosis. Of 13 patients prescribed antidepressants, only one of them developed psychosis

RECENT STUDIES INVOLVING ANTIDEPRESSANTS

Another naturalistic study involving 191 patients, compared the eff ects of antipsychotics and antidepressants on symptom severity

Results showed that patients on antipsychotic medication had a greater decline in symptom severity compared to those on antidepressants.

RECENT STUDIES INVOLVING ANTIDEPRESSANTS

Antipsychotic medications have their ups and downs.Combining antipsychotic medication with Cognitive

Behavioral Therapy can be helpful for many people.Prescribing Antidepressant medication to prodromal

patients can be very beneficial. Early detection and therapy is the key!

WHAT DOES ALL THIS MEAN?

“moral treatment” focus around social improvements, self controls and understanding the importance of work and religion

Gordon Paul and Robert Lentz (1970s) and token economy

Re-teaching social skills

TREATMENT

Independent Living Skills Program at UCLAFocuses on patient taking charge of their own life and

knowing the warning sign of symptoms and how to deal with them

Understanding medications Social support

COMMUNITY BASED TREATMENT

Identify triggersExposure to triggers and exposure therapy Experience still is not real lifeSide eff ects such as “simulator sickness”

VIRTUAL REALITY

Barlow, David H., and Vincent Mark. Durand. Abnormal Psychology: An Integrative Approach . Belmont, CA: Wadsworth, Cengage Learning, 2012. Print.

Freeman, D. "Studying and Treating Schizophrenia Using Virtual Reality: A New Paradigm." Schizophrenia Bulletin 34.4 (2007): 605-10. Print.

http://www.youtube.com/watch?v=_vYQ6pbJt2k

REFERENCES