Schizophrenia and other Psychotic Disorders

Psychotic Disorders  Symptoms  Alternations in perceptions, thoughts, or consciousness (delusions and hallucination)  DSM-IV categories  Schizophrenia  Schizophreniform disorder  Schizoaffective disorder  Delusional disorder  Brief psychotic disorder  Shared psychotic disorder  Psychotic disorder due to general medical condition  Substance-induced psychotic disorder Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Schizophrenia  Symptoms  Disturbance lasts at least 6 months, including  One month of active phase that includes 2 positive or one positive and one negative symptom, and  Decline in social or occupational functioning.  DSM-IV subtypes  Paranoid  Catatonic  Disorganized  Undifferentiated  Residual Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Positive and Negative Symptoms  Positive  Delusions – Faulty interpretations of reality  Hallucinations – Faulty sensory perceptions  Disordered speech  Disorganized and bizarre behavior  Negative  Flat affect  Poverty of speech  Lack of motivation or directedness  Loss of energy  Loss of feelings of pleasure Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Positive Symptoms: Delusions  Schizophrenia  Variety of bizarre content  Being controlled or persecuted by others  Finding reference to oneself in other’s behavior or in printed materials  Depression  Unjustified guilty  Perceived bodily changes  Mania  Great self-importance  Grandiosity  Delusional disorder  Loved by celebrity/high-status person  Suspect spouse or lover of being unfaithful  Possession of special and unrecognized talent Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Negative Symptoms  Flat affect  Avoid eye contact  Immobile, expressionless face  Lack of emotion when discussing emotional material  Apathetic and uninterested  Monotonous voice, low and difficult to hear  Poverty of speech  Long lapses before responding to questions or failure to answer  Restriction on quantity of speech  Slow speech  Loss of directedness  Slow movements  Reduction of voluntary movements  Inability to initiate activities  Little interest in social participation Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Models of Schizophrenia  No known cause, but research has focused on  Genetic factors  Schizophrenic spectrum disorders  Neuro-developmental model  Family studies  Twin studies  Adoption studies  Diathesis-stress theory and family and community vulnerability  High-risk studies focusing on family and birth history and markers of attention and cognition deficits Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Brain pathology in schizophrenia Abnormal Psychology, 11/e by Sarason & Sarason © 2005

PET scans of the Genain Sisters (Normal) Abnormal Psychology, 11/e by Sarason & Sarason © 2005

CET (Computer EEG Tomographic) scans of the Genain Sisters (Normal) Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Prenatal Exposure to Influenza and Risk of Adult Schizophrenia Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Family Dynamics in Schizophrenia Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Treatment of Schizophrenia  Antipsychotic drugs – Some have side effects (e.g. tardive dyskinesia)  Skills training programs  Family therapy programs  Community support  Combined treatment approaches  Long-term outcome studies- Prognosis poor though deteriorative effects plateau after 5 to 10 years Abnormal Psychology, 11/e by Sarason & Sarason © 2005

The role of therapy in preventing relapse Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Skills Training in Schizophrenia  Social skills  Self-awareness  Affect regulation  Social cue recognition  Cognitive skills  Training in elementary cognitive functions  Strategies for dealing with cognitive deficits  Cognitive restructuring about source of hallucinations  Self-care and symptom-identification  Improved grooming and self-care  Self-monitoring for symptoms of relapse  Skills for dealing with stress  Identify indicators of stress  Apply cognitive and behavioral techniques Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Family Interventions in Schizophrenia  Education about probable causes, symptoms. and course  Information about treatment  Instruction in problem-solving and crisis management skills  Decease negative expressed emotion (EE)  Relapse recognition Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Other Psychotic Disorders  Schizoaffective disorder – Delusions or hallucinations combined with symptoms of depression or manic mood  Delusional disorder – Less bizarre than schizophrenia delusions; usually related to a particular topic and have some foundation in real life.  Shared psychotic disorder – Two or more people who share shame delusional belief; one originates, the other follows. Occurrence is rare. Abnormal Psychology, 11/e by Sarason & Sarason © 2005