1. Schizophrenia and other Psychotic Disorders
Instructor: Emily Bullock Yowell, Ph.D.

2. Psychotic Disorders Psychotic a gross impairment in reality testing
presence of hallucinations and delusions without insight

3. Important Terms and Symptoms-Thought Content
Thought Content is a description of what the person is thinking about
Delusion: False belief; bizarre or non-bizarre
Delusions of persecution
Delusions of reference
Delusions of being controlled
Delusions of Grandeur
Thought Broadcasting
Thought Insertion
Thought Withdrawal

4. Important Terms and Symptoms-Thought Processes
Tangential Thought
Circumstantial Thought
Loosening of Associations
Word Salad or incoherent
Flight of ideas
Thought Blocking
Illogical thought
Neologism
Clang Associations
Punning
Derailment
Poverty of Speech
Agnosia
Aphasia
Apraxia

5. Important Terms and Symptoms- Perceptual Disturbances
Hallucinations: sensory perception experience in the absence of an external stimulus.
Modalities: visual, auditory, olfaction, gustatory, tactile, or mixed
Illusions: a misperception in external stimuli
Derealization: experience of feeling a loss of sense of reality; world may feel dreamlike or lacking significance
Depersonalization: marked by feelings of detachment or estrangement from one’s self; may feel as if an outside observer to one’s own body

6. Important Terms and Symptoms-- Mood and Affect Descriptors
Apathetic
Flat
Blunt
Hostile
Euthymic
Expansive
Labile
Euphoric
Depressed
Anxious
Angry
Irritable
Tearful
Constricted
Affect
Flat
Blunted
Constricted
Labile
Tearful
Angry
Irritable
Euthymic
Anxious
Euphoric

7. DSM-IV-TR Psychotic Disorders
Schizophrenia
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Shared Psychotic Disorder
Psychotic Disorder due to a general medical condition
Substance-Induced Psychotic Disorder
Psychotic Disorder NOS

8. Schizophrenia
Characteristic symptoms: Two or more of the following; present for a significant portion of 1 month
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
Social/occupational dysfunction
Duration of some sign of disturbance for at least 6 months
Rule out other similar disorders of medical conditions

9. Schizophrenia Subtypes
Catatonic Type
Disorganized Type
Paranoid Type
Undifferentiated Type
Residual Type

10. Schizophrenia Type I and Type II
Type I- characterized by positive symptoms and typically respond better to drugs
Positive symptoms: hallucinations, delusions, disorganized thought and speech, agitation
Type II-characterized by negative symptoms
Negative symptoms: lack of drive or initiative, social withdrawal, apathy, emotional unresponsiveness
At least 85% of people with schizophrenia will experience problems with cognition

11. Schizophrenia— Development and Course
Typically develops in early to mid 20’s for men; late 20’s for women
Can occur acutely but typically begins with a prodromal phase
Residual phase-follows an acute phase characterized by a return to prodromal-like functioning
Prevalence-1% of the adult population worldwide affected by schizophrenia ; 2.1 million Americans currently affected (according to National Schizophrenia Foundation)

12. Factors Associated with a Better Prognosis
Good premorbid adjustment
Acute onset
Later age at onset
Absence of poor insight
Being Female
Precipitating events
Family history of mood disorder
No family history of Schizophrenia
Associated mood disturbance
Treatment with Antipsychotic Medications soon after onset
Consistent Medication compliance
Brief duration of active symptoms
Good interepisode functioning
Minimal residual symptoms
Absence of structural brain abnormalities
Normal neurological functioning

13. Schizophrenia- What Causes it?
Biological Perspective
Genetic Factors
Biochemical factors
The Dopamine Hypothesis; Most commonly implicated neurotransmitter is dopamine
Brain Abnormalities

14. The Familial Risk of Schizophrenia

15. Loss of Brain Tissue in Adolescents with Early-Onset Schizophrenia

16. PET Scans of People with Schizophrenia Versus Normals

17. Schizophrenia- What Causes it?
Family Theories
Schizophrenogenic Mother
Double-bind communication

18. Diathesis-Stress Model of Schizophrenia

19. Treatment of Schizophrenia-Biological
CATIE Trial
(Liberman, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia, New England Journal of Medicine, 353 (12), )
Drugs studied in the CATIE Trial that are used to treat Schizophrenia
Trilaphon
Zyprexa
Seroquel
Risperdol
Geodon

20. Common Medication Side Effects
1st generation side effects
Dizziness
Blurred vision
Restlessness
Sexual dysfunction
Extrapyramidal side effects
Tardive Dyskinesia
Atypical or 2nd generation drugs
Diabetes
Weight gain
pancreatitis

21. Treatment of Schizophrenia
Learning Based
Selective reinforcement of behavior
Token economies
Social Skills Training
Psychosocial Rehabilitation
Family Intervention Programs
Schizophrenia Digest -

22. Psychotic Disorders--Schizoaffective Disorder
An uninterrupted period of illness during which there is a mood episode concurrent with symptoms that meet criteria A for Schizophrenia
During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms
Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness
Specifiers
Bipolar Type
Depressive Type

23. Psychotic Disorders-- Brief Psychotic Disorder
Presence of one or more of the following symptoms
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Duration of at least 1 day and no more than 1 month, with eventual return to previous level of functioning
Specifers
With marked stressor
Without marked stressor
With Postpartum onset

24. Psychotic Disorders
Schizophreniform Disorder-same symptomotology as schizophrenia but has not shown symptoms for a full 6 months
Delusional Disorder-Nonbizarre delusions of at least 1 month’s duration
Shared Psychotic Disorder (Folie a Deux)-Delusion develops in an individual in the context of a close relationship with another person, who has an already established delusion