Schizophrenia and Other Psychotic Disorders Part I Chapter 14 Schizophrenia and Other Psychotic Disorders Part I

Introduction The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind)

Introduction (cont.) Schizophrenia is probably caused by a combination of factors, including Genetic predisposition Biochemical dysfunction Physiological factors Psychosocial stress

Nature of the Disorder Schizophrenia disturbs Thought processes Perception Affect

Nature of the Disorder (cont.) With schizophrenia, there is a severe deterioration of social and occupational functioning In the United States, the lifetime prevalence of schizophrenia is about 1%

Phase I. The Premorbid Phase Characterized by Social maladjustment Social withdrawal Irritability Antagonistic thoughts and behavior

Phase II. The Prodromal Phase Characterized by Functional impairment Deterioration in role functioning Social withdrawal Physical symptoms: sleep disturbance, anxiety irritability, depression, fatigue, and poor concentration

Phase III. Schizophrenia In the active phase of the disorder, psychotic symptoms are prominent Delusions Hallucinations Impairment in work, social relations, and self-care

Phase IV. Residual Phase Symptoms similar to those of the prodromal phase Flat affect and impairment in role functioning are prominent

Etiological Implications (cont.) Physiological influences Factors that have been implicated Viral infection Brain abnormalities Histological changes in the brain

Etiological Implications (cont.) Physiological influences (cont.) Various physical conditions Epilepsy Huntington’s disease Birth trauma Head injury Alcohol abuse Cerebral tumor Cerebrovascular accidents Systemic lupus erythematosus Myxedema Parkinson’s disease Wilson’s disease

Etiological Implications (cont.) Psychological influences Purely psychological factors no longer hold any credibility Researchers in the last decade have focused their studies more in terms of schizophrenia as a brain disorder

Etiological Implications (cont.) Environmental influences Sociocultural factors: poverty has been linked with development of schizophrenia Downward drift hypothesis: poor social conditions are seen as a consequence of, rather than a cause of, schizophrenia

Etiological Implications (cont.) Environmental influences (cont.) Stressful life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse

Etiological Implications (cont.) Theoretical integration Schizophrenia is most likely a biologically based disease, the onset of which is influenced by factors in the internal or external environment

Types of Schizophrenia and Other Psychotic Disorders (cont.) Paranoid schizophrenia Characterized by delusions of persecution or grandeur Auditory hallucinations Client may be argumentative, hostile, and aggressive

Types of Schizophrenia and Other Psychotic Disorders Disorganized schizophrenia Chronic variety with flat or inappropriate affect Silliness and incongruous giggling common Behavior bizarre; social interaction impaired

Types of Schizophrenia and Other Psychotic Disorders (cont.) Catatonic schizophrenia Catatonic stupor: characterized by extreme psychomotor retardation; patient usually mute; posturing common

Types of Schizophrenia and Other Psychotic Disorders (cont.) Catatonic schizophrenia (cont.) Catatonic excitement: extreme psychomotor agitation; purposeless movements that must be curtailed to prevent injury to client or others

Types of Schizophrenia and Other Psychotic Disorders (cont.) Undifferentiated schizophrenia Bizarre behavior that does not meet the criteria outlined for the other types of schizophrenia; delusions and hallucinations prominent

Types of Schizophrenia and Other Psychotic Disorders (cont.) Residual schizophrenia Used to diagnose a person who has a history of at least one episode of schizophrenia with prominent psychotic symptoms

Types of Schizophrenia and Other Psychotic Disorders (cont.) Schizoaffective disorder Schizophrenic symptoms accompanied by a strong element of symptomatology associated with mood disorders, either manic or depressive

Types of Schizophrenia and Other Psychotic Disorders (cont.) Brief psychotic disorder Sudden onset of psychotic symptoms following a severe psychosocial stressor Symptoms persist less than 1 month; client returns to the full premorbid level of functioning

Types of Schizophrenia and Other Psychotic Disorders (cont.) Schizophreniform disorder Same symptoms as schizophrenia, with exception that the duration of the disorder has been at least 1 month but fewer than 6 months

Types of Schizophrenia and Other Psychotic Disorders (cont.) Delusional disorder The existence of prominent, non-bizarre delusions Erotomanic type: the individual believes that someone, usually of a higher status, is in love with him or her

Types of Schizophrenia and Other Psychotic Disorders (cont.) Delusional disorder (cont.) Grandiose type: person has irrational ideas regarding own worth, talent, knowledge, or power Jealous type: person has the irrational idea that the sexual partner is unfaithful

Types of Schizophrenia and Other Psychotic Disorders (cont.) Delusional disorder (cont.) Persecutory type: person believes he or she is being treated malevolently in some way Somatic type: person has an irrational belief that he or she has some physical defect, disorder, or disease

Types of Schizophrenia and Other Psychotic Disorders (cont.) Shared psychotic disorder Delusional system develops in a second person as a result of a close relationship with a person who already has a psychotic disorder with prominent delusions (also called folie á deux)

Types of Schizophrenia and Other Psychotic Disorders (cont.) Psychotic disorder due to general medical condition Symptoms of this disorder include prominent hallucinations and delusions that can be directly attributed to a general medical condition

Types of Schizophrenia and Other Psychotic Disorders (cont.) Substance-induced psychotic disorder The presence of prominent hallucinations and delusions that are judged to be directly attributable to the physiological effects of a substance