Schizophrenia and Other Psychotic Disorders Chapter 12

Outline Perspectives on Schizophrenia Clinical Description, Symptoms and Subtypes Prevalence and Causes of Schizophrenia Treatment of Schizophrenia

Perspectives on Schizophrenia Schizophrenia is characterized by a broad spectrum of disturbances in thinking (delusions), perception (hallucinations), speech, emotions, and behavior Diagnosis of schizophrenia requires that two or more positive, negative and/or disorganized symptoms be present for at least 1 month Affects 1% of population Complete recovery from schizophrenia is rare

Perspectives on Schizophrenia Emil Kraepelin Dementia praecox (premature loss of mind) shares following symptoms Catatonia (disorder of movement involving immobility or excited agitation) Hebephrenia (silly and immature emotionality) Paranoia (delusions of grandeur or persecution) Eugen Bleuler Introduced the term schizophrenia (split of mind) Associative splitting of basic functions of personality (cognition, emotions, perception etc.) Does not mean split of personality or multiple personality

Clinical Description, Symptoms and Subtypes Psychotic behavior Unusual behavior characterized by hallucinations, delusions and loss of contact with reality Positive symptoms More active manifestations of abnormal behavior (delusions and hallucinations) Negative symptoms Deficit in normal behavior (avolition, alogia, anhedonia, affective flattening) Disorganized symptoms Rambling speech, erratic behavior, inappropriate affect

Clinical Description, Symptoms and Subtypes Positive symptoms Delusions Disorder of thought content, strong beliefs that misrepresent reality Delusion of grandeur, delusions of persecution, Capgras syndrome, Cotard’s syndrome Hallucinations Perceptual disturbance in which things are seen or heard or otherwise sensed although they are not real or actually present Auditory hallucinations are most frequent (Broca’s area)

Clinical Description, Symptoms and Subtypes Negative symptoms Avolition Apathy, inability to initiate and persist in activities Alogia Absence of speech (poor communication skills) Anhedonia Lack of pleasure Affective flattening Don’t show emotions when a reaction would be expected  Pos vs. neg symptoms

Clinical Description, Symptoms and Subtypes Disorganized symptoms Disorganized speech Lack of insight Jump from topic to topic, talk illogically, lack of coherence Inappropriate affect and disorganized behavior Laugh or cry at improper times Motor dysfunctions (agitation or immobility)

Clinical Description, Symptoms and Subtypes Schizophrenia subtypes  Etta Paranoid type Delusions, hallucinations but cognitive skills and affect are relatively intact, better prognosis Disorganized type Disrupted speech and behavior, delusions, hallucinations, flat or silly affect, self-absorbed Catatonic type Motor disturbance predominate (echolalia, echopraxia) Undifferentiated type Major symptoms of schizophrenia (no particular type) Residual type People who experienced at least one episode of schizophrenia but no longer manifest major symptoms

Clinical Description, Symptoms and Subtypes Other psychotic disorders Schizophreniform disorder Experience symptoms of schizophrenia for a few months only (up to 6 months) Schizoaffective disorder Symptoms of schizophrenia and also major mood disorder Delusional disorder Persistent belief contrary to reality (delusion) without other symptoms of schizophrenia (onset between 40 and 49) Brief psychotic disorder involves delusions, hallucinations, disorganized speech or behavior that lasts less than 1 month (often reaction to stressor) Shared psychotic disorder A person develops a delusion similar to that of a person with whom he or she shares a close relationship

Prevalence and Causes of Schizophrenia 0.2% to 1.5% of population (equivalent for men and women) Onset in early adulthood (16-25) Children who later develop schizophrenia have abnormal emotional reactions very early (less positive and more negative affect) Genes are responsible for making some individuals vulnerable to schizophrenia (the risk varies according to how many genes an individual shares with someone who has the disorder) Family studies, twin studies, adoption studies, genetic markers

Prevalence and Causes of Schizophrenia

Prevalence and Causes of Schizophrenia Dopamine system is too active in people with schizophrenia (neuroleptics – dopamine antagonists) Enlargement of ventricles Hypofrontality (DLPFC) Viral infections (second-trimester) Stress If the level of criticism, hostility and emotional overinvolvement expressed by families is high, patients tend to relapse

Treatment of Schizophrenia Neuroleptic drugs  treatment Problem with compliance of patients Psychological treatment Self-care training Social skills training Self-help groups Prevention (family environment)