Schizophrenia and other Psychotic Disorders Instructor: Emily Bullock Yowell, Ph.D.

Psychotic Disorders Psychotic a gross impairment in reality testing presence of hallucinations and delusions without insight

Important Terms and Symptoms-Thought Content Thought Content is a description of what the person is thinking about Delusion: False belief; bizarre or non-bizarre Delusions of persecution Delusions of reference Delusions of being controlled Delusions of Grandeur Thought Broadcasting Thought Insertion Thought Withdrawal

Important Terms and Symptoms-Thought Processes Tangential Thought Circumstantial Thought Loosening of Associations Word Salad or incoherent Flight of ideas Thought Blocking Illogical thought Neologism Clang Associations Punning Derailment Poverty of Speech Agnosia Aphasia Apraxia

Important Terms and Symptoms- Perceptual Disturbances Hallucinations: sensory perception experience in the absence of an external stimulus. Modalities: visual, auditory, olfaction, gustatory, tactile, or mixed Illusions: a misperception in external stimuli Derealization: experience of feeling a loss of sense of reality; world may feel dreamlike or lacking significance Depersonalization: marked by feelings of detachment or estrangement from one’s self; may feel as if an outside observer to one’s own body

Important Terms and Symptoms-- Mood and Affect Descriptors Apathetic Flat Blunt Hostile Euthymic Expansive Labile Euphoric Depressed Anxious Angry Irritable Tearful Constricted Affect Flat Blunted Constricted Labile Tearful Angry Irritable Euthymic Anxious Euphoric

DSM-IV-TR Psychotic Disorders Schizophrenia Schizophreniform Disorder Schizoaffective Disorder Delusional Disorder Brief Psychotic Disorder Shared Psychotic Disorder Psychotic Disorder due to a general medical condition Substance-Induced Psychotic Disorder Psychotic Disorder NOS

Schizophrenia Characteristic symptoms: Two or more of the following; present for a significant portion of 1 month Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms Social/occupational dysfunction Duration of some sign of disturbance for at least 6 months Rule out other similar disorders of medical conditions

Schizophrenia Subtypes Catatonic Type Disorganized Type Paranoid Type Undifferentiated Type Residual Type

Schizophrenia Type I and Type II Type I- characterized by positive symptoms and typically respond better to drugs Positive symptoms: hallucinations, delusions, disorganized thought and speech, agitation Type II-characterized by negative symptoms Negative symptoms: lack of drive or initiative, social withdrawal, apathy, emotional unresponsiveness At least 85% of people with schizophrenia will experience problems with cognition

Schizophrenia— Development and Course Typically develops in early to mid 20’s for men; late 20’s for women Can occur acutely but typically begins with a prodromal phase Residual phase-follows an acute phase characterized by a return to prodromal-like functioning Prevalence-1% of the adult population worldwide affected by schizophrenia ; 2.1 million Americans currently affected (according to National Schizophrenia Foundation)

Factors Associated with a Better Prognosis Good premorbid adjustment Acute onset Later age at onset Absence of poor insight Being Female Precipitating events Family history of mood disorder No family history of Schizophrenia Associated mood disturbance Treatment with Antipsychotic Medications soon after onset Consistent Medication compliance Brief duration of active symptoms Good interepisode functioning Minimal residual symptoms Absence of structural brain abnormalities Normal neurological functioning

Schizophrenia- What Causes it? Biological Perspective Genetic Factors Biochemical factors The Dopamine Hypothesis; Most commonly implicated neurotransmitter is dopamine Brain Abnormalities

The Familial Risk of Schizophrenia

Loss of Brain Tissue in Adolescents with Early-Onset Schizophrenia

PET Scans of People with Schizophrenia Versus Normals

Schizophrenia- What Causes it? Family Theories Schizophrenogenic Mother Double-bind communication

Diathesis-Stress Model of Schizophrenia

Treatment of Schizophrenia-Biological CATIE Trial (Liberman, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia, New England Journal of Medicine, 353 (12), 1209-1223) Drugs studied in the CATIE Trial that are used to treat Schizophrenia Trilaphon Zyprexa Seroquel Risperdol Geodon

Common Medication Side Effects 1st generation side effects Dizziness Blurred vision Restlessness Sexual dysfunction Extrapyramidal side effects Tardive Dyskinesia Atypical or 2nd generation drugs Diabetes Weight gain pancreatitis

Treatment of Schizophrenia Learning Based Selective reinforcement of behavior Token economies Social Skills Training Psychosocial Rehabilitation Family Intervention Programs Schizophrenia Digest http://www.schizophreniadigest.com/ -

Psychotic Disorders--Schizoaffective Disorder An uninterrupted period of illness during which there is a mood episode concurrent with symptoms that meet criteria A for Schizophrenia During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness Specifiers Bipolar Type Depressive Type

Psychotic Disorders-- Brief Psychotic Disorder Presence of one or more of the following symptoms Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Duration of at least 1 day and no more than 1 month, with eventual return to previous level of functioning Specifers With marked stressor Without marked stressor With Postpartum onset

Psychotic Disorders Schizophreniform Disorder-same symptomotology as schizophrenia but has not shown symptoms for a full 6 months Delusional Disorder-Nonbizarre delusions of at least 1 month’s duration Shared Psychotic Disorder (Folie a Deux)-Delusion develops in an individual in the context of a close relationship with another person, who has an already established delusion