Schizophrenia and Other Psychotic Disorders Chapter 10 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Psychotic Disorders Characterized by unusual thinking, distorted perceptions, and odd behaviors Psychosis – a severe mental condition characterized by a loss of contact with reality Delusion – a false belief Hallucination – a false sensory perception Copyright © 2012 by Pearson Education, Inc. All rights reserved.

What Is Schizophrenia? A severe psychological disorder characterized by disorganization in thought, perception, and behavior -First defined over 100 years ago by German psychiatrist Emil Kraepelin -Dementia praecox -Dementia (pervasive disturbances of perceptual and cognitive faculties) -Praecox (early life onset) -Schizophrenia vs. DID Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Schizophrenia in Depth: Positive Symptoms Group of symptoms including unusual thoughts, feelings, and behaviors Persecutory delusions Delusions of influence Loose associations Thought blocking Clang associations Catatonia and waxy flexibility Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Schizophrenia in Depth: Negative Symptoms Behaviors, emotions, or thought processes that are absent in people with schizophrenia Blunted affect Anhedonia Avolition Alogia Psychomotor retardation Cognitive impairments Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Functional Impairment of Schizophrenia Symptom severity equals the level of impairment Significant human toll on the individual and the family (quality of life) One of the top ten most debilitating conditions in the world (DALY) Cultural factors Violence Copyright © 2012 by Pearson Education, Inc. All rights reserved. In 2002 schizophrenia cost $62.7 billion dollars.

Epidemiology of Schizophrenia Prevalence rates averages 1% to 0.3 to 1.6% of U.S. general population 16 to 40 of every 100,000 people develop schizophrenia Gradual onset (some deterioration of functioning) Prodromal phase (social withdrawal or deterioration in hygiene) Acute phase (starts to exhibit positive symptoms) Residual phase (psychotic symptoms are no longer present but negative symptoms remain) The onset for schizophrenia could be acute or gradual, meaning the individual could have the disorder for years before actively showing psychotic symptoms. How do you explain that? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Sex, Race, Ethnicity, and Development Women (develop schizophrenia at a later age and tend to have milder forms) Developmental factors Hormonal and sociocultural implications Symptoms common across racial and ethnic groups African Americans (more likely to be diagnosed than white and Latino patients) EOS (schizophrenia that develops before the age of 18) Copyright © 2012 by Pearson Education, Inc. All rights reserved. Paranoid Schizophrenia is the most common subtype at 39.8% and Catatonic subtype is more rare at 6.7%.

Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Etiology Biological -Dopamine hypothesis (the presence of too much dopamine in the neural synapse) -Neurotransmitters -Genetics -Neuroanatomy (structural and functional abnormalities in the brain) -Viral theories and prenatal stressors -Synaptic pruning (process in which weaker synaptic contacts in the brain are eliminated and stronger connections strengthened) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Genetics and Environment: Schizophrenia Let’s examine the evidence 1. A research study found that 36.8% of the biological children of schizophrenic mothers who were raised in “disordered” family environment developed a “schizophrenic spectrum disorder.” Fact : Both genetic and environmental factors increase the risk of psychotic disorders, but even without the genetic risk and “healthy family environment,” 4.8% of individuals still develop the disorder. Evidence : The research shows both factors play a role. How might you explain these differences? How would you explain this study to a female patient who wants to have a child? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Figure 10.1 Ventricles of the Brain Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Figure 10.2 Neurodevelopmental Model of Schizophrenia Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Etiology Family Influences -The cause of the disorder is not the same as what people believe is responsible for their suffering -Expressed emotion (describes the level of emotional involvement and attitudes that exist within a family of a patient with schizophrenia) -A variety of cultural explanations for the disorder (biological, social, supernatural, and family environment) -Gene-environment correlation (the same person who provides one’s genetic make-up also provides the environment in which one lives) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Treatment of Schizophrenia Pharmacological -Antipsychotics (a class of medications that block dopamine receptors) -Typical antipsychotics (medications that reduce the positive symptoms) -Atypical antipsychotics (medications that treat positive symptoms, less likely to produce side effects, and affect negative symptoms and cognitive impairments) -Side effects -Tardive dyskinesia (abnormal and involuntary motor movements of the face, mouth, limbs, and trunk) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Treatment of Schizophrenia Psychosocial -Psychoeducation (both patient and family members are educated about disorder) -CBT (used to reduce or eliminate psychotic symptoms) -Social skills training (teaches the basics of social interaction and both verbal and nonverbal skills) -Supported employment (a psychosocial intervention that provides job skills) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Research Hot Topic: Transcranial Magnetic Stimulation (TMS) Goal (provide stimulation to a targeted area of the cerebral cortex to change brain activity) Use of small coil placed over the scalp to induce electrical current Based on neuroimaging studies Decreases (temporarily) the frequency of hallucinations Reduction in positive symptoms (reduced frequency of voices and reduced distraction) Does not reduce delusions Time-limited results and need for further studies Copyright © 2012 by Pearson Education, Inc. All rights reserved.