Schizophrenia And Other Thought Disorders

Origins of the Diagnosis Kraepelin – 19th century: dementia praecox Eugene Bleuler (1908) - coined the term schizophrenia skhizein - split phren - mind

Positive Symptoms Delusions: false beliefs ◦ delusion of grandeur: belief that one has extraordinary powers ◦ delusion of persecution: belief that others are out to get you

Other Delusions ideas of reference: thought broadcasting: Capgras: belief that someone you know has been replaced by a “double” Cotard: belief that you are dead

Positive Symptoms Hallucinations: experience of a sensory event without the presence of sensory stimuli auditory visual tactile olfactory gustatory

Auditory Hallucinations Broca’s area: involved in speech production Wernicke’s area: involved in speech comprehension brain imaging studies reveal that Broca’s area of the brain was most active during auditory hallucinations.

Negative Symptoms avolition: inability to initiate and follow through with activities alogia: the relative absence of speech anhedonia: lack of pleasure in life affective flattening: limited range of emotions visible to others

Disorganized Symptoms disorganized speech inappropriate affect and disorganized behavior

Historic (i.e., until 2013) Schizophrenia Subtypes paranoid: delusions of grandeur or persecution disorganized: marked disruption in speech and behavior catatonic: unusual motor activity (e.g., fixed positions, excessive activity, odd mannerisms) undifferentiated: do not meet the criteria for other subtypes

DSM-V criteria for Schizophrenia 2 or more of the following symptoms for a significant portion of a month: ◦ Delusions ◦ Hallucinations ◦ Disorganized speech ◦ Grossly disorganized or catatonic behavior ◦ Negative symptoms

Possible Biological Causes genetic influence Identical twin has it (48% chance) Fraternal twin (17%) abnormal brain structure viral infection dopamine

Dopamine Hypothesis Evidence For:Evidence Against: many effective antipsychotics block dopamine antipsychotics produce Parkinson’s-like side effects L-dopa can produce schizophrenia-like symptoms amphetamines make psychotic symptoms worse some aren’t helped with dopamine antagonists symptoms take a while to subside but dopamine quickly blocked antipsychotics alleviate positive but not negative symptoms Clozopine works – weak effect on dopamine

Psychological Influences Causes schizphenogenic mother? double-binds? Relapse expressed emotion

Psychosocial Interventions: inpatient care token economy deinstitutionalization social skills training family interventions virtual reality

Intensive Case Mangement (ICM) Typically, but not always, a social worker. Links clients to needed services and gives instruction in basic living skills. Has been found to reduce rates of hospitalization.

Assertive Community Treatment (ACT) ◦ Mobile case management. ◦ Developed by Stein and Test in 1985 in Madison, Wisconsin. ◦ Other aspects of ACT is that takes a wholistic approach, attempts to capitalize on the client’s strengths, and attempts to work within the ecology of the client.

Treatment for Schizophrenia Antipsychotic medications conventional: Thorazine, Mellaril, Haldol newer antipsychotics: Clozaril, risperidal, Zyprexa Extrapyramidal symptoms: tardive dyskinesia – involuntary movements of the tongue, face, mouth, or jaw

schizophreniform disorder: symptoms of schizophrenia that last between 1 and 6 months schizoaffective disorder: presence of a mood disorder and the presence of delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

brief psychotic disorder: presence of one or more positive symptoms within a month shared psychotic disorder (Folie a deux): individual develops delusions as a result of a close relationship with a delusional individual

Delusional Disorder persistent belief that is contrary to reality absence of other characteristics of schizophrenia erotomanic: irrational belief that one is loved by another person ◦ ◦ Start at 5:50 grandiose: inflated sense of self-worth, power, knowledge, identity, or special relationship to a deity or famous person

Delusional Disorder jealous: beliefs that sexual partner is unfaithful – no evidence for it. persecutory: believe that you or loved one is being treated malevolently somatic: afflicted by a physical defect or general medical condition.