 Kraepelin Credited with - Categorization of various symptoms & putting emphasis on early onset of disorder - Dementia (Loss of Mind) Praecox (Early, Premature)  Eugen Bleuler - Coined Termed “Schizophrenia” - Focused on Associative Splitting (thought process disconnected, not consistent)  Kraepelin Credited with - Categorization of various symptoms & putting emphasis on early onset of disorder - Dementia (Loss of Mind) Praecox (Early, Premature)  Eugen Bleuler - Coined Termed “Schizophrenia” - Focused on Associative Splitting (thought process disconnected, not consistent)

 Positive Symptoms –Hallucinations, Delusions  Disorganized Symptoms –Speech and Behavior  Negative Symptoms –Deficits in Affect, Speech, Motivation  Positive Symptoms –Hallucinations, Delusions  Disorganized Symptoms –Speech and Behavior  Negative Symptoms –Deficits in Affect, Speech, Motivation

 Positive (present) Symptoms  Delusions and paranoia (abnormal thought content) –Misrepresentation of Reality –“Basic Feature of Madness”  Examples –Grandeur -- Importance –Persecution -- Out to Get Me  Delusions and paranoia (abnormal thought content) –Misrepresentation of Reality –“Basic Feature of Madness”  Examples –Grandeur -- Importance –Persecution -- Out to Get Me

 Positive Symptoms  Hallucinations –Absence of Sensory Stimulation –Involve Any of the Senses  Examples –Auditory -- Voices (70%) –Visual -- Seeing Things (25%) –Tactile -- Crawling Sensation  Hallucinations –Absence of Sensory Stimulation –Involve Any of the Senses  Examples –Auditory -- Voices (70%) –Visual -- Seeing Things (25%) –Tactile -- Crawling Sensation

 Disorganized Symptoms  Disorganized Speech –Difficulty in Communication  Examples –Tangentiality –Loose Association or Derailment –Circumstantiality  Disorganized Speech –Difficulty in Communication  Examples –Tangentiality –Loose Association or Derailment –Circumstantiality  Positive Symptoms  Positive Symptoms

 Disorganized Behaviors  Catatonia –Spectrum of sx –Wild Agitation to Immobility  Examples –Waxy Flexibility –Innapropriate Affect  Disorganized Behaviors  Catatonia –Spectrum of sx –Wild Agitation to Immobility  Examples –Waxy Flexibility –Innapropriate Affect  Disorganized Symptoms  Positive Symptoms  Positive Symptoms

 Negative Symptoms  Flat Affect -- “The Mask”  Avolition -- “No Initiative”  Alogia -- “Speech is Vacant”  Anhedonia -- “No Pleasure”  Flat Affect -- “The Mask”  Avolition -- “No Initiative”  Alogia -- “Speech is Vacant”  Anhedonia -- “No Pleasure”

 Paranoid Type  Disorganized Type  Catatonic Type  Undifferentiated Type  Residual Type  *Exam prep: Why did DSM-5 drop these subtypes?  Paranoid Type  Disorganized Type  Catatonic Type  Undifferentiated Type  Residual Type  *Exam prep: Why did DSM-5 drop these subtypes?

 Motor rigidity or excessive movement  Display odd mannerisms ex. Grimacing, echolalia, echopraxia **Infrequently occurring subtype - should it remain as separate classification?  Motor rigidity or excessive movement  Display odd mannerisms ex. Grimacing, echolalia, echopraxia **Infrequently occurring subtype - should it remain as separate classification?

 Schizophreniform Disorder  Schizoaffective Disorder  Delusional Disorder: subtypes of persecutory, jealous, grandiose, erotomanic, and somatic  Brief Psychotic Disorder  Shared Psychotic Disorder  Folie a Deux  Schizophreniform Disorder  Schizoaffective Disorder  Delusional Disorder: subtypes of persecutory, jealous, grandiose, erotomanic, and somatic  Brief Psychotic Disorder  Shared Psychotic Disorder  Folie a Deux

 People with schizophrenia have “split personalities.”  People with schizophrenia are intellectually disabled?  People with schizophrenia are dangerous?  People with schizophrenia are addicted to their drugs?  People with schizophrenia have “split personalities.”  People with schizophrenia are intellectually disabled?  People with schizophrenia are dangerous?  People with schizophrenia are addicted to their drugs?

 Schizophrenia is NOT caused by bad parenting or an unhappy childhood.  Schizophrenia is NOT due to a weakness in character.  Schizophrenia is NOT a hopeless situation.  Schizophrenia is NOT caused by bad parenting or an unhappy childhood.  Schizophrenia is NOT due to a weakness in character.  Schizophrenia is NOT a hopeless situation.

 Affects 1 out of 100 People  Often Begins Between Ages  Cost of caring for these patients in the billions each year  Affects 1 out of 100 People  Often Begins Between Ages  Cost of caring for these patients in the billions each year

 Chronic  Occurs in.2% to 1.5% Population  Affects Men and Women Equally  Lower Life Expectancy –Increased Risk of Suicide  Chronic  Occurs in.2% to 1.5% Population  Affects Men and Women Equally  Lower Life Expectancy –Increased Risk of Suicide

 Process vs. Reactive –Insidious vs. Acute  Poor vs. Good Premorbid Functioning  Type I and Type II –Type I: Positive Symptoms –Type II: Negative Symptoms  Process vs. Reactive –Insidious vs. Acute  Poor vs. Good Premorbid Functioning  Type I and Type II –Type I: Positive Symptoms –Type II: Negative Symptoms

 Early Brain Damage?  Children –Attentional and Reflex Problems  Runs In Families –High Expressed Emotion & Relapse –What is the Genetic Risk?  Early Brain Damage?  Children –Attentional and Reflex Problems  Runs In Families –High Expressed Emotion & Relapse –What is the Genetic Risk?

 Runs in Families  Increased Risk Based on Genetic Relatedness  Search for Marker Genes Smooth Pursuit Eye Tracking  Runs in Families  Increased Risk Based on Genetic Relatedness  Search for Marker Genes Smooth Pursuit Eye Tracking  Genetic Influences

 Antagonists –Neuroleptics –Drugs That Reduce Dopamine –Negative Side Effects –L-Dopa, Amphetamines (Agonists)  Antagonists –Neuroleptics –Drugs That Reduce Dopamine –Negative Side Effects –L-Dopa, Amphetamines (Agonists) Neurobiological Influences Excess Dopamine (D2 Receptors)

 Ventricle Enlargement  Genetic  Neurobiological Influences  Genetic  Neurobiological Influences  Brain Structure

 Ventricle Enlargement  Genetic  Neurobiological Influences  Genetic  Neurobiological Influences  Brain Structure  Hypofrontality: D1 receptors

 Early Forms of Treatment  Insulin Coma Therapy  Psychosurgery  Electroconvulsive Therapy (ECT)  Early Forms of Treatment  Insulin Coma Therapy  Psychosurgery  Electroconvulsive Therapy (ECT)

 Chlorpromazine  Haldol  Trial and Error; Mechanism of antipsychotic action – DA, D2  “dirty”  Side Effects: Tics, pseudoparkinsonism; Tardive Dyskinesia less common – involuntary movements tongue, face, jaw, mouth…  Chlorpromazine  Haldol  Trial and Error; Mechanism of antipsychotic action – DA, D2  “dirty”  Side Effects: Tics, pseudoparkinsonism; Tardive Dyskinesia less common – involuntary movements tongue, face, jaw, mouth…  Biological Interventions  Neuroleptics  Biological Interventions  Neuroleptics

 Biological Interventions  Atypical antipsychotics  Biological Interventions  Atypical antipsychotics –Zyprexa, Abilify Clozaril –Side effects –Mechanisms of action: serotonin-dopamine antagonists increased risk of hyperglycemia, diabetes weight gain Decreased white blood cell counts (clozaril)

 Psychosocial Interventions - case management & advocacy - structured living residences - psychosocial rehab centers (social & work life) - family education and therapy  Psychosocial Interventions - case management & advocacy - structured living residences - psychosocial rehab centers (social & work life) - family education and therapy