SchizophreniaSchizophreniaand Substance Use and Substance Use

DisordersDisordersHow do Thought Disorders and

Substance Use Disorders Interact?

Topic AreasTopic Areas

I. Description of Thought Disorders

II. Influential Factors on the Illness

III. Effect of Substance Use

IV. Implications for Recovery

I. Description of Thought Disorders

How is it decided if someone has a

“thought disorder?”

Diagnostic Criteria for Schizophrenia*Diagnostic Criteria for Schizophrenia*A. Characteristic symptoms: Two (or more) of the following, each

present for a significant portion of time during a 1-month period: (1) delusions(2) hallucinations(3) disorganized speech(4) grossly disorganized or catatonic behavior(5) negative symptoms, i.e., affective flattening, alogia, or avolition

B. Social/occupational dysfunction: One or more areas of functioning such as work, interpersonal relations, or self care are markedly below the level achieved prior to the onset.

C. Duration: Continuous signs of the disturbance persist for at least 6 months.

E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 312

Diagnostic Criteria for Diagnostic Criteria for Schizoaffective Disorder*Schizoaffective Disorder*

A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.

B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

C. The disturbance is not due to the direct physiological effects of a substance, or a general medical condition

* Diagnostic and Statistical Manual, 4 th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 323

Diagnostic Criteria for Diagnostic Criteria for Substance-Induced Psychotic Disorder*Substance-Induced Psychotic Disorder*A. Prominent hallucinations or delusions. B. There is evidence from the history, physical examination, or

laboratory findings of either (1) or (2):(1) the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal(2) medication use is etiologically related to the disturbance

D. The disturbance is not better accounted for by a Psychotic Disorder that is not substance-induced.

* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 342

Terms and DefinitionsTerms and Definitions

“Positive” symptoms (“in addition to” what was experienced before the illness) include; – Delusions– Hallucinations (Auditory, Visual, etc.)– Disorganized Speech– Bizarre Behavior

Terms and DefinitionsTerms and Definitions“Negative” symptoms (“taken away

from” what was experienced before the illness) include; – Alogia– Affective Blunting or Flattening– Avolition– Anhedonia– Attentional Impairment

DelusionsDelusions

False beliefsAffects the “Inference” system of the

brain(ex.) “Conspiracy theories” are common

HallucinationsHallucinations

False perceptionAffect the “Perception” system of the

brainAuditory hallucinations are most

commonAny of the 5 senses may be involved

Disorganized SpeechDisorganized SpeechAffects the “Language” system of the

brain (ex.) Word salad is a jumble of

words/phrases that lacks comprehensible meaning;

(ex.) Tangentiality is a style of speech in which a person replies to questions in an irrelevant, “off the topic” manner).

Bizarre BehaviorBizarre Behavior

Affects the “Behavior-inducing” systems of the brain

(ex.) Ritualistic behaviors – may represent “normal” responses to the “abnormal” stimuli of active delusions or hallucinations

AlogiaAlogia

the inability to organize one’s thoughts and express them fluently

Affective Blunting or Affective Blunting or FlatteningFlattening

“Flat affect”

A deficiency in the ability to express a full range of emotion

May be expressed in a monotonal voice, a “poker face,” or a “schizophrenic stare”

AvolitionAvolition

The inability to initiate a behavior, or carry it out

(exs.) Withdrawal, apathy, decreased energy, decreased motivation

AnhedoniaAnhedonia

The inability to experience pleasure or enjoyment

May result in the discontinuation of hobbies or recreational activities

Attentional ImpairmentAttentional Impairment

Difficulty in focusing attention

Can lead to inability to complete tasks or activities that require focused attention

II. Influential Factors

Family History (Genetic) FactorsFamily History (Genetic) Factors

Individuals with schizophrenia are more likely to have relatives with psychiatric illness (or substance use disorders)

Indicates a genetic vulnerability to psychiatric illness (and substance use disorders)

Supersensitivity ModelSupersensitivity Model

Biological vulnerability + environmental stress = precipitate the onset of the disorder or trigger relapses

Medications decrease vulnerabilitySubstance use increases vulnerability

III. Effect of Substance Use

Alcohol UseAlcohol Use

Combining Alcohol and antipsychotic medication can cause life-threatening oversedation

Cocaine UseCocaine Use

Cocaine abuse can damage the brain and cause psychotic episodes to occur

Marijuana UseMarijuana Use

Marijuana use can contribute to the frequency and intensity of psychotic episodes – More severe positive symptoms– Quicker psychiatric relapses & re-

hospitalizations– Earlier age of onset

IV. Implications for Recovery

Special ConsiderationsSpecial Considerations

More likely to develop addiction with recreational use.

Many clients report using substances to facilitate social interactions with peers.

Principles of Integrated Treatment*Principles of Integrated Treatment*IntegrationComprehensivenessAssertivenessReduction of Negative ConsequencesLong-Term PerspectiveMotivation-Based TreatmentMultiple psychotherapeutic modalities

* Mueser, K.T. et al. (2003). Integrated Treatment for Dual Disorders. Guilford Press: Canada. p. 16-33