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Chapter 12

Chapter 12. Schizophrenia and Other Psychotic Disorders. Perspectives on Schizophrenia. Schizophrenia vs. psychosis Psychosis – broad term (e.g., hallucinations, delusions) Schizophrenia – a type of psychosis Psychosis and schizophrenia are heterogeneous

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Chapter 12

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  1. Chapter 12 Schizophrenia and Other Psychotic Disorders

  2. Perspectives on Schizophrenia • Schizophrenia vs. psychosis • Psychosis – broad term (e.g., hallucinations, delusions) • Schizophrenia – a type of psychosis • Psychosis and schizophrenia are heterogeneous • Disturbed thought, emotion, behavior

  3. History of schizophrenia • Historical background • Emil Kraepelin – used the term dementia praecox • Subtypes of schizophrenia – Catatonia, hebephrenia and paranoia • Eugen Bleuler – introduced the term “schizophrenia” • “Splitting of the mind” (1856-1926) (1857-1939

  4. Schizophrenia: The “Positive” Symptom Cluster • The positive symptoms • Excess or distortion of normal behavior • Delusions: The basic feature of madness • Gross misrepresentation of reality • Include delusions of grandeur (mistaken belief that one is famous or powerful) • or delusions of persecution (others out to get me)

  5. Schizophrenia: The “Positive” Symptom Cluster • Hallucinations • Experience of sensory events without environmental input • Can involve all senses

  6. SPECT study on auditory hallucination

  7. Schizophrenia: 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

  8. Schizophrenia: The “Disorganized” Symptom Cluster • The disorganized symptoms • Severe and excess speech, behavior, and emotion • disorganized speech • Cognitive slippage – illogical and incoherent speech • Tangentiality – “going off on a tangent” • disorganized affect • Inappropriate emotional behavior • disorganized behavior • Catatonia spectrum

  9. Subtypes of Schizophrenia: • Paranoid type • Intact cognitive skills and affect • Do not show disorganized behavior • Hallucinations and delusions – grandeur or persecution • The best prognosis

  10. Subtypes of Schizophrenia: Paranoid and Disorganized • Disorganized type • Marked disruptions in speech and behavior • Flat or inappropriate affect • Hallucinations and delusions – tend to be fragmented • Develops early, tends to be chronic, lacks remissions

  11. Subtypes of Schizophrenia: Catatonic, Undifferentiated, and Residual • Catatonic type • Show unusual motor responses, grimacing • Examples include echolalia and echopraxia • Tends to be severe and quite rare

  12. Subtypes of Schizophrenia: Catatonic, Undifferentiated, and Residual • Undifferentiated type • Wastebasket category • Major symptoms of schizophrenia • Fail to meet criteria for another type • Residual type • One past episode of schizophrenia • Continue to display less extreme residual symptoms

  13. Other Disorders with Psychotic Features: Schizophreniform and Schizoaffective Disorder • Schizophreniform disorder • Schizophrenic symptoms for a few months • Associated with good premorbid functioning • Most resume normal lives

  14. Other Disorders with Psychotic Features: Schizophreniform and Schizoaffective Disorder • Schizoaffective disorder • Symptoms of schizophrenia and a mood disorder • Both disorders are independent of one another • Prognosis - persons do not tend to get better on their own such as in schizophrenia

  15. Other Disorders with Psychotic Features: Delusional Disorder • Delusional disorder • Delusions that are contrary to reality • Lack other positive and negative symptoms • Types of delusions include • Erotomanic • Grandiose • Jealous • Persecutory • Somatic • Extremely rare (24-30/100,000) • Better prognosis than schizophrenia

  16. Additional Disorders with Psychotic Features • Brief psychotic disorder • One or more positive symptoms of schizophrenia that lasts less than 1 month • Usually precipitated by extreme stress or trauma • Tends to remit on its own

  17. Additional Disorders with Psychotic Features • Shared psychotic disorder • Delusions from one person manifest also in another person • Little is known about this condition • Schizotypal personality disorder • May reflect a less severe form of schizophrenia

  18. Schizophrenia: Statistics • about 1% population) • Often develops in early adulthood but can emerge at any time • Most have moderate-to-severe lifetime impairment • Life expectancy is slightly less than average • Schizophrenia affects males and females about equally • Females tend to have a better long-term prognosis • Onset differs between males and females

  19. Causes of Schizophrenia:Findings From Genetic Research • Genetic factors • Family studies • Inherit a tendency for schizophrenia, not forms of schizophrenia • Risk increases with genetic relatedness

  20. Causes of Schizophrenia:Findings From Genetic Research • Twin studies • Monozygotic twins (48%) • Fraternal (dizygotic) twins (17%) • Adoption studies – risk for schizophrenia remains high but less if adopted in good functioning home

  21. Search for Genetic andBehavioral Markers of Schizophrenia • Genetic markers: Linkage and association studies • Endophenotypes • Schizophrenia is likely to involve multiple genes • Behavioral markers: Smooth-pursuit eye movement • Eye movement tracking deficiency • Emotion identification

  22. Causes of Schizophrenia: Neurobiological Influences • The dopamine hypothesis • Drugs that increase dopamine (agonists) • Result in schizophrenic-like behavior such as L-Dopa for Parkinson’s disease, amphetamines • Drugs that decrease dopamine (antagonists) • Reduce schizophrenic-like behavior – neuroleptics • Dopamine hypothesis is problematic and overly simplistic • Current theories emphasize many neurotransmitters

  23. Causes of Schizophrenia:Other Neurobiological Influences • Structural and functional abnormalities in the brain • Enlarged ventricles and reduced tissue volume • Hypofrontality – less active frontal lobes • A major dopamine pathway • Viral infections during early prenatal development

  24. Causes of Schizophrenia:Psychological and Social Influences • The role of stress • May activate underlying vulnerability • May also increase risk of relapse • Family interactions • Families – show ineffective communication patterns • Schizophrenogenic mother • Double blind communication • High expressed emotion (EE)– associated with relapse

  25. Medical Treatment of Schizophrenia • Historical precursors • Development of antipsychotic (neuroleptic) medications • Often the first line treatment for schizophrenia • Began in the 1950s • Most reduce or eliminate positive symptoms

  26. Acute and permanent side effects are common • Extrapyramidal and Parkinson’s-like side effects (Tardive dyskinesia) • Compliance with medication is often a problem

  27. Psychosocial Treatment of Schizophrenia • Psychosocial approaches: • Behavioral (i.e., token economies) on inpatient units • Community care programs • Social and living skills training • Behavioral family therapy • Vocational rehabilitation • Cultural considerations • Prevention

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