Chapter 13 Schizophrenia Spectrum and Other Psychotic Disorders

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Chapter 13Schizophrenia Spectrum and Other
Psychotic Disorders

• Amber Gilewski
• Tompkins Cortland Community College

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The Positive Symptom Cluster

• The Positive Symptoms
• Active manifestations of abnormal behavior
• Distortions of normal behavior
• Delusions The Basic Feature of Madness
• Gross misrepresentations of reality
• Include delusions of grandeur or persecution
• Hallucinations
• Experience of sensory events without
  environmental input
• Can involve all senses (auditory most common)

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The Negative Symptom Cluster

• The Negative Symptoms
• Absence or insufficiency of normal behavior
• Spectrum of Negative Symptoms
• Avolition (or apathy) Lack of initiation and
  persistence
• Alogia Relative absence of speech
• Anhedonia Lack of pleasure, or indifference
• Affective flattening Little expressed emotion

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The Disorganized Symptom Cluster

• The Disorganized Symptoms
• Severe and excess speech, behavior, and emotion
• Nature of Disorganized Speech
• Cognitive slippage Illogical and incoherent
  speech
• Tangentiality Going off on a tangent
• Loose associations Conversation in unrelated
  directions
• Inappropriate affect -
• Odd emotional behavior
• Disorganized Behavior
• Includes a variety of unusual behaviors

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Other Disorders with Psychotic Features
Schizophreniform Disorder

• Schizophreniform Disorder
• Schizophrenic symptoms for a few months
• Associated with good premorbid functioning
• Most resume normal lives
• Lifetime prevalence of 0.2

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Other Disorders with Psychotic Features
Schizoaffective Disorder

• Schizoaffective Disorder
• Symptoms of schizophrenia and a mood disorder
• Both disorders are independent of one another
• Prognosis is similar for people with
  schizophrenia
• Such persons do not tend to get better on their
  own

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Other Disorders with Psychotic Features
Delusional Disorder

• Delusions that are contrary to reality
• Lack other positive and negative symptoms
• Types of delusions include
• Erotomanic higher status figure love
• Grandiose inflated importance
• Jealous unwarranted beliefs of infidelity
• Persecutory most common conspired against
• Somatic physical defects, disease, disorder
• Extremely rare
• Better prognosis than schizophrenia

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Additional Disorders with Psychotic Features
Brief Psychotic Disorder

• Brief Psychotic Disorder
• One or more positive symptoms of schizophrenia
• Usually precipitated by extreme stress or trauma
• Tends to remit on its owns

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Schizophrenia Some Facts and Statistics

• Onset and Prevalence of Schizophrenia worldwide
• About 0.2 to 1.5 (1 population in US)
• Often develops in early adulthood
• Can emerge at any time
• Women have better prognosis
• Schizophrenia Is Generally Chronic
• Life expectancy is slightly less than average

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Developmental Research

• Brain damage during prenatal or infancy periods
  may be a cause of schizophrenia
• Early brain abnormality may have better
  prognosis due to brains plasticity (ability to
  compensate)
• Older adults symptoms demonstrate that the
  illness may improve over time
• Levels of impairment fluctuates between
  moderate and severe relapse is common

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Causes of SchizophreniaFindings From Genetic
Research

• Family Studies
• Inherit a tendency for schizophrenia, not forms
  of schizophrenia
• Risk increases with genetic relatedness
• Twin Studies
• - Monozygotic twins Risk for
  schizophrenia is 48
• - Fraternal (dizygotic) twins Risk drops to 17
• Adoption Studies -- Risk for schizophrenia
  remains high

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Causes of Schizophrenia Neurotransmitter
Influences

• The Dopamine Hypothesis
• Drugs that increase dopamine (agonists)
• Result in schizophrenic-like behavior
• Drugs that decrease dopamine (antagonists)
• Reduce schizophrenic-like behavior
• Neurological damage?
• -Structural and Functional Abnormalities in
  the Brain
• Enlarged ventricles and reduced tissue volume

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Location of the cerebrospinal fluid in the human
brain
Fig. 13.7, p. 486
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Causes of SchizophreniaPsychological and Social
Influences

• The Role of Stress
• May activate underlying vulnerability
• May also increase risk of relapse
• Family Interactions
• Families Show ineffective communication
  patterns
• High expressed emotion associated
  with relapse

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Medical Treatment of Schizophrenia

• Historical Treatment
• primitive brain surgeries in 1500s
• prefrontal lobotomies used in 1950s
• modern treatment using neuroleptic drugs

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Biological Interventions

• The 1930s
• Insulin coma therapy insulin induced
  hypoglycemia resulting in convulsions coma
• Psychosurgery disconnecting frontal lobes
• ECT aka shock therapy not beneficial
• The 1950s development of antipsychotic
  (neuroleptic) medications
• Often the first line treatment for schizophrenia
• Newer medications have fewer serious side effects

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Medical Treatment of Schizophrenia (continued)

• Compliance with medication is often a problem
  (medical relationship, cost, poor supports, side
  effects)
• Acute and permanent side effects are common
• Akinesia absence, loss, or impairment of the
  power of voluntary movement
• Tardive dyskinesia
  twitching of the face, trunk, or limbs

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Psychosocial Treatment of Schizophrenia

• Behavioral (i.e., token economies) on inpatient
  units
• Community care programs outpatient reducing
  institutionalization
• Social and living skills training teaching
  appropriate behaviors
• Independent living skills encouraged in
  community care programs
• Behavioral family therapy helping families to be
  more supportive
• Vocational rehabilitation aiding in job skills
  and employment

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NAME THAT SYMPTOM!

• Disorder of thought content or delusion
• Delusion of grandeur
• Delusion of persecution
• Auditory hallucination
• Visual hallucination
• Olfactory hallucination
• Tactile hallucination

• Tangentiality
• Loose association
• Waxy flexibility catatonic immobility
• Echopraxia
• Echolalia
• Alogia
• Disorganized behavior