Chapter 13 Schizophrenia Spectrum and Other Psychotic Disorders Amber Gilewski Tompkins Cortland Community College

The “Positive” Symptom Cluster The Positive Symptoms Active manifestations of abnormal behavior Distortions of normal behavior Delusions: The Basic Feature of Madness Gross misrepresentations of reality Include delusions of grandeur or persecution Hallucinations Experience of sensory events without environmental input Can involve all senses (auditory most common)

The “Negative” Symptom Cluster The Negative Symptoms Absence or insufficiency of normal behavior Spectrum of Negative Symptoms Avolition (or apathy) – Lack of initiation and persistence Alogia – Relative absence of speech Anhedonia – Lack of pleasure, or indifference Affective flattening – Little expressed emotion

The “Disorganized” Symptom Cluster The Disorganized Symptoms Severe and excess speech, behavior, and emotion Nature of Disorganized Speech Cognitive slippage – Illogical and incoherent speech Tangentiality – “Going off on a tangent” Loose associations – Conversation in unrelated directions • Inappropriate affect - Odd emotional behavior Disorganized Behavior Includes a variety of unusual behaviors

Other Disorders with Psychotic Features: Schizophreniform Disorder Schizophrenic symptoms for a few months Associated with good premorbid functioning Most resume normal lives Lifetime prevalence of 0.2%

Other Disorders with Psychotic Features: Schizoaffective Disorder Symptoms of schizophrenia and a mood disorder Both disorders are independent of one another Prognosis is similar for people with schizophrenia Such persons do not tend to get better on their own

Other Disorders with Psychotic Features: Delusional Disorder Delusions that are contrary to reality Lack other positive and negative symptoms Types of delusions include: Erotomanic: higher status figure love Grandiose: inflated importance Jealous: unwarranted beliefs of infidelity Persecutory: most common; conspired against Somatic: physical defects, disease, disorder Extremely rare Better prognosis than schizophrenia

Additional Disorders with Psychotic Features: Brief Psychotic Disorder One or more positive symptoms of schizophrenia Usually precipitated by extreme stress or trauma Tends to remit on its owns

Schizophrenia: Some Facts and Statistics Onset and Prevalence of Schizophrenia worldwide About 0.2% to 1.5% (1% population in US) Often develops in early adulthood Can emerge at any time Women have better prognosis Schizophrenia Is Generally Chronic Life expectancy is slightly less than average

Developmental Research Brain damage – during prenatal or infancy periods may be a cause of schizophrenia Early brain abnormality – may have better prognosis due to brain’s plasticity (ability to compensate) Older adult’s symptoms – demonstrate that the illness may improve over time Levels of impairment – fluctuates between moderate and severe; relapse is common

Causes of Schizophrenia: Findings From Genetic Research Family Studies Inherit a tendency for schizophrenia, not forms of schizophrenia Risk increases with genetic relatedness Twin Studies - Monozygotic twins – Risk for schizophrenia is 48% - Fraternal (dizygotic) twins – Risk drops to 17% Adoption Studies -- Risk for schizophrenia remains high

Causes of Schizophrenia: Neurotransmitter Influences The Dopamine Hypothesis Drugs that increase dopamine (agonists) Result in schizophrenic-like behavior Drugs that decrease dopamine (antagonists) Reduce schizophrenic-like behavior Neurological damage? -Structural and Functional Abnormalities in the Brain Enlarged ventricles and reduced tissue volume

Location of the cerebrospinal fluid in the human brain Fig. 13.7, p. 486

Causes of Schizophrenia: Psychological and Social Influences The Role of Stress May activate underlying vulnerability May also increase risk of relapse Family Interactions Families – Show ineffective communication patterns High expressed emotion – associated with relapse

Medical Treatment of Schizophrenia Historical Treatment primitive brain surgeries in 1500s prefrontal lobotomies used in 1950’s modern treatment using neuroleptic drugs www.cerebromente.org.br/n02/historia/psico08.jpg

Biological Interventions The 1930’s Insulin coma therapy: insulin induced hypoglycemia resulting in convulsions & coma Psychosurgery: disconnecting frontal lobes ECT: aka “shock therapy”; not beneficial The 1950’s: development of antipsychotic (neuroleptic) medications Often the first line treatment for schizophrenia Newer medications have fewer serious side effects www.minddisorders.com/images/gemd_02_img0087.jpg

Medical Treatment of Schizophrenia (continued) Compliance with medication is often a problem (medical relationship, cost, poor supports, side effects) Acute and permanent side effects are common Akinesia: absence, loss, or impairment of the power of voluntary movement Tardive dyskinesia: twitching of the face, trunk, or limbs

Psychosocial Treatment of Schizophrenia Behavioral (i.e., token economies) on inpatient units Community care programs: outpatient; reducing institutionalization Social and living skills training: teaching appropriate behaviors Independent living skills: encouraged in community care programs Behavioral family therapy: helping families to be more supportive Vocational rehabilitation: aiding in job skills and employment

NAME THAT SYMPTOM! Disorder of thought content or delusion Delusion of grandeur Delusion of persecution Auditory hallucination Visual hallucination Olfactory hallucination Tactile hallucination Tangentiality Loose association Waxy flexibility & catatonic immobility Echopraxia Echolalia Alogia Disorganized behavior