Schizophrenia and Psychotic Disorders

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Schizophrenia and Psychotic Disorders
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The Nature of Schizophrenia

• Broad Impairments
• Delusions Hallucinations
• Disorganized Speech Behavior
• Inappropriate Emotions

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Schizophrenia Facts and Statistics

• Cause in Unknown
• Affects 1 out of 100 People
• Often Begins (Ages 16 - 30)
• More Hospital Beds Than Any Other Medical Illness
• 2.5 of Total U.S. Healthcare Budget

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Schizophrenia Facts and Statistics

• Often Chronic
• Occurs in .2 to 1.5 Population
• Affects Men and Women Equally
• Age of Onset Varies Across Time
• Lower Life Expectancy
• Increased Risk of Suicide

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Myths of Madness

• People with schizophrenia have split
  personalities.
• People with schizophrenia are intellectually
  disabled?
• People with schizophrenia are dangerous?
• People with schizophrenia are addicted to their
  drugs?

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Myths of Madness

• Schizophrenia is NOT caused by bad parenting or
  an unhappy childhood.
• Schizophrenia is NOT due to a weakness in
  character.
• Schizophrenia is NOT a hopeless situation.

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Perspectives The Concept of
Schizophrenia

• Dementia (Loss of Mind)
• Praecox (Early, Premature)
• Kraepelin
• Categorization Early Onset
• Eugen Bleuler
• Termed Schizophrenia
• Associative Splitting

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The Nature of Schizophrenia Active Phase
Symptoms

• Positive Symptoms
• Displays of Abnormal Behavior
• Disorganized Symptoms
• Speech and Behavior
• Negative Symptoms
• Deficits in Affect, Speech, Motivation

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The Nature of Schizophrenia Active Phase
Symptoms

• Positive Symptoms

• Delusions
• Misrepresentation of Reality
• Basic Feature of Madness
• Examples
• Grandeur -- Importance
• Persecution -- Out to Get Me

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The Nature of Schizophrenia Active Phase
Symptoms

• Positive Symptoms

• Hallucinations
• Absence of Sensory Stimulation
• Involve Any of the Senses
• Examples
• Auditory -- Voices (70)
• Visual -- Seeing Things (25)
• Tactile -- Crawling Sensation

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Brocas Area (Speech)
Wernickes Area (Hearing)
What Area Do You Think is More Active With
Auditory Hallucinations?
Hallucinations A Window on the Brain
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The Nature of Schizophrenia Active Phase
Symptoms

• Positive
• Symptoms

• Disorganized Symptoms

• Disorganized Speech
• Difficulty in Communication
• Examples
• Tangentiality
• Loose Association or Derailment

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The Nature of Schizophrenia Active Phase
Symptoms

• Positive
• Symptoms

• Disorganized Symptoms

• Disorganized Behaviors
• Catatonia
• Spectrum
• Wild Agitation to Immobility
• Examples
• Waxy Flexibility
• Innapropriate Affect

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The Nature of Schizophrenia Active Phase
Symptoms

• Positive
• Disorganized
• Symptoms

• Negative Symptoms

• Flat Affect -- The Mask
• Avolition -- No Initiative
• Alogia -- Speech is Vacant
• Anhedonia -- No Pleasure

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Schizophrenia Subtypes

• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type

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Schizophrenia Subtypes Paranoid

• Delusions Hallucinations
• Intact Cognition and Affect
• No Disorganized Speech
• Best Prognosis

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Schizophrenia Subtypes

• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type

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Schizophrenia Subtypes Disorganized

• Disorganized Speech
• Disorganized Behavior
• Flat or Inappropriate Affect
• Hallucinations and Delusions
• Fragmented or Lacking a Theme
• Often Chronic

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Schizophrenia Subtypes

• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type

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Schizophrenia Subtypes Catatonic

• Disorganized Speech
• Disorganized Behavior
• Flat or Inappropriate Affect
• Hallucinations and Delusions
• Fragmented or Lacking a Theme
• Often Chronic

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Schizophrenia Subtypes

• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type

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Schizophrenia Subtypes Undifferentiated

• Beginnings of Breakdown
• Major Sx of Schizophrenia
• DO NOT Meet Other Criteria
• Wastebasket Category

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Schizophrenia Subtypes

• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type

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Schizophrenia Subtypes Residual

• Have Had One Episode
• Now Mostly Symptom Free

Once a Schizophrenic, Always a Schizophrenic?
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Schizophrenia Onset and Duration

• Process vs. Reactive
• Incidious vs. Acute
• Poor vs. Good Premorbid
• Type I and Type II
• Type I Positive Symptoms
• Type II Negative Symptoms

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• Early Brain Damage
• Children
• Attentional and Reflex Problems
• Runs In Families
• High Expressed Emotion Relapse
• What is the Genetic Risk?

Schizophrenia Developmental Course
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The Causes of Schizophrenia

• Genetic Influences

• Runs in Families
• Increased Risk Based on Genetic Relatedness
• Search for Marker Genes
• Smooth Pursuit Eye Tracking

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The Causes of Schizophrenia

• Neurobiological Influences

• Excess Dopamine (D2 Receptors)

• Antagonists
• Neuroleptics
• Drugs That Reduce Dopamine
• Negative Side Effects
• L-Dopa (Agonist)
• Amphetamines

• Genetic Influences

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The Causes of Schizophrenia

• Brain Structure

• Ventricle Enlargement

• Genetic
• Neurobiological
• Influences

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The Causes of Schizophrenia

• Brain Structure

• Ventricle Enlargement

• Hypofrontality

• Genetic
• Neurobiological
• Influences

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The Treatment of Schizophrenia

• Early Forms of Treatment

• Insulin Coma Therapy
• Psychosurgery
• Electroconvulsive Therapy (ECT)
• Smooth Pursuit Eye Tracking

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The Treatment of Schizophrenia

• Biological Interventions
• Neuroleptics

• Haldol Clozapine
• Trial and Error
• Extrapyramidal Side Effects
• Tardive Dyskineasia
• Akineasia

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Other Psychotic Disorders

• Schizophreniform Disorder
• Schizoaffective Disorder
• Delusional Disorder
• Brief Psychotic Disorder
• Shared Psychotic Disorder
• Folie a Deux