Theory to Treatment Schizophrenia Psychopathology Julianne Carroll

The Schizophrenic Picture Between a half and two thirds of sufferers: can’t work live alone don’t develop adequate social relations die younger are at a higher risk of HIV more likely to be victims of crime are often painfully aware of their situation

DSM IV Diagnostic Assumptions There are no biological indicators. Negative symptoms play a predominant role there must be a prodromal period of at least 6 months schizophrenia (Sz) is a discrete disease entity there is the possibility that Sz may lie at the end of a continuum of psychopathology or neurophysiological dysfunction

Any Way Out? Kaepelin suggests a deteriorating course Harding et al (1987) reported that after 32 years 1/2 to 2/3 of chronic patients discharged were symptom free and had reasonable adjustments to community life

Heterogeneity Crow’s 2 Syndrome Model Buchanan & Carpenter’s 3 Factor Model Deficit Syndrome Core Deficit Hypothesis

Positive and Negative Symptoms Neurotransmitter  positive symptoms disturbance (responsive to neuroleptics) neuroanatomical  negative symptoms disturbance(s) (unresponsive to neuroleptics)

3 Factor Model hallucinations and delusions negative symptoms cognitive impairment

Deficit Syndrome Fundamental question: which negative symptoms are primary and enduring? Criteria for diagnosis: 1) DSM IV Sz 2) 2 symptoms present for 12 months - affective flattening - alogia - avolition - *not accounted for by: - depression/anxiety - drug effects - environmental deprivation

Core Deficit Bleuler (1911, 1950) proposed thought disorder as the hallmark symptom of Sz and made the first attempt to specify a primary cognitive deficit theorized to underly an array of symptoms. It’s the disconnection of ‘associative threads’ that leads to confused & bizarre thinking.

Social Competence Pre-morbid social competence is among the best predictors of long term outcome  which comes first? The chicken or the egg? Social dysfunction is now considered quite fundamental in the diagnosis of Sz and has been linked to cognitive functioning, specifically an inability to learn specific social cues.

Stress - Vulnerability Model Predisposing Factors: Dopaminergic anomalies Cognitive (info. Processing) deficits Autonomic hyperactivity to aversive stimuli Schizotypal personality traits

Precipitating Factors: An unsupportive/critical family environment overstimulated social environment stressful life events

Perpetuating Factors: Processing capacity overload Tonic autonomic hyperarousal impaired processing of social stimuli further impairment to processing of social cues disruption of coping abilities Dysfunctional behaviors create environmental stressors

Protective Factors Coping abilities (cognitive and behavioral) A supportive family Psychosocial interventions

Psychotic episode Protective factors Precipitating factors Predisposing factors PerpetuatIngPerpetuatIng -ve +ve Stress-Vulnerability Model

Where Do We Fit In? Psychosocial Treatments: Individual Psychotherapy CBT Behaviour Therapy Cognitive Family Therapy Family Education ”psychoeducation”