1. Schizophrenia Spectrum and Other Psychotic Disorders
Chapter 6
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2. Schizophrenia
The broad category of schizophrenia includes a set of disorders in which individuals experience distorted perception of reality and impairment in thinking, behavior, affect, and motivation.
A disorder with a range of symptoms involving disturbances In:
Content of thought
Form of thought
Perception
Affect
Sense of self
Motivation
Behavior
Interpersonal functioning
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3. Symptoms of schizophrenia
POSITIVE +
NEGATIVE -
Positive symptoms:
Exaggerations or distortions of normal thoughts, emotions, and behavior
Negative symptoms:
Symptoms that involve functioning below the level of normal behavior
The symptoms the individual experiences during the active phase fall into two categories: positive symptoms and negative symptoms.
Active phase: A period in the course of schizophrenia in which psychotic symptoms are present.
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4. Symptoms of schizophrenia
POSITIVE +
NEGATIVE -
Delusions
Hallucinations
Disorganized speech
Disturbed behavior
Restricted affect
Avolition
A-sociality
Delusions: Deeply entrenched false belief not consistent with the client’s intelligence or cultural background.
Hallucinations: A false perception not corresponding to the objective stimuli present in the environment.
Incoherent speech: Language that is incomprehensible.
Loosening of associations: Flow of thoughts that is vague, unfocused, and illogical.
Restricted affect: Narrowing of the range of outward expressions of emotions.
Avolition: A lack of initiative, either not wanting to take any action or lacking the energy and will to take action.
Asociality: Lack of interest in social relationships.
Researchers proposed that positive symptoms reflected activated dopamine levels in the nervous system and negative symptoms reflected abnormalities in brain structure.
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5. Diagnostic Features of Schizophrenia
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6. Characteristics of Schizophrenia
Bleuler coined the term schizophrenia
The four fundamental features are still referred to as Bleuler’s Four A’s:
Association (thought disorder)
Affect (emotional disturbance)
Ambivalence (inability to make or follow through on decisions)
Autism (withdrawal from reality)
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7. Features of schizophrenia
Inappropriate affect is the extent to which a person’s emotional expressiveness fails to correspond to the content of what is being discussed.
Paranoia is the irrational belief or perception that others wish to cause you harm, may be associated with delusions or auditory hallucinations related to a theme that somebody is persecuting or harassing them.
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8. schizophrenia spectrum
Schizophrenia is now classified as a spectrum disorder rather than a single disease entity, leading to new diagnostic categories that included, for example, personality and affective disorders.
Section 3 of the DSM-5 includes a set of symptom severity ratings.
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9. Dimensions of Psychosis Symptom Severity in Section 3 of DSM-5
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10. Statistics Schizophrenia affects slightly more males than females
For every three men who develop schizophrenia over the course of their lives, two women are affected with the disorder.
Researchers estimate the lifetime prevalence as about 5% and the prevalence at any one time of about 3%.
People with schizophrenia are two to three times more likely to die compared to others within their age group.
Although the prevalence of schizophrenia is relatively low compared to other psychological disorders, a surprisingly high percentage of adults report experiencing minor psychotic symptoms.
People with schizophrenia are two to three times more likely to die compared to others within their age group. The disparities in mortality risk between people with and without schizophrenia are significant. This is in part because the medications that clinicians use to treat people with schizophrenia may contribute to weight gain, which in turn increases the risk of lifethreatening diseases.
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11. Courses of Schizophrenia
Continuous
Remission
Recurrent
Extended
In the most serious cases, the individual experiences continuous positive symptoms with no remission.
Remission: Situation when the individual’s symptoms no longer interfere with his or her behavior and are below those required for a DSM diagnosis.
Schizophrenia have more recurrent episodes and their chances of completely recovering are worse than those of people with other disorders.
People with schizophrenia for extended periods of time propose a model in which 25 to 35 percent show chronic psychotic symptoms.
Factors that contribute to poorer prognosis:
Poorer cognitive skills, a longer period of time without treatment, substance abuse, a poorer course of early development, higher vulnerability to anxiety, and negative life events.
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12. Other Psychotic Disorders
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13. Other Psychotic Disorders
Schizophrenia-like disorders that involve abnormalities in one or more of the five domains:
Delusions
Hallucinations
Disorganized thinking (speech)
Grossly disorganized or abnormal motor behavior (including catatonia)
Negative symptoms
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14. Brief Psychotic Disorder
A diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time.
Symptoms must be present for more than a day, but recover in less than a month.
Symptoms
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
The diagnosis requires that the individual experience symptoms for more than a day, but recover in less than a month.
Clinician must take the following factors into account:
Client’s cultural background.
Whether the client has experienced a recent stressor.
If a woman develops this disorder within four weeks
brief psychotic disorder is a diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time. To receive this diagnosis, an individual must experience one of four symptoms, which include delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Th e diagnosis requires that the individual experience symptoms for more than a day, but recover
in less than a month.
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15. Schizophreniform Disorder
A disorder with essentially the same symptoms as schizophrenia, but that lasts from 1 to 6 months
People with this disorder have larger ventricles in the brain, a phenomenon also observed with schizophrenia.
People have good chances of recovering:
When they show a rapid development of symptoms (within a span of four weeks)
Confusion or perplexity while in the peak of the episode
Good social and personal functioning prior to the episode.
Likely to have a good prognosis if they do not show the negative symptoms of:
Apathy, withdrawal, and asociality.
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16. Schizoaffective Disorder
Schizophrenia with co-occurring mood disorder
Schizoaffective disorder: Experience of a major depressive episode, a manic episode, or a mixed episode while also meeting the diagnostic criteria for schizophrenia.
The individual must have both a mood and a psychotic disorder, but at least two weeks during which their delusions and/or hallucinations are the only symptoms that they show.
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17. Delusional Disorders Erotomanic Grandios Jealous Persecutory Somatic
Erotomanic type: Individuals falsely believe that another person is in love with them.
Grandiose type: An exaggerated view of oneself as possessing special and extremely favorable personal qualities and abilities.
Jealous type: Individuals falsely believe that their romantic partner is unfaithful to them.
Persecutory type: Individuals falsely believe that someone or someone close to them is treating them in a malevolent manner.
Somatic type: Individuals falsely believe that they have a medical condition.
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18. Biological Theories Brain structure and genetics
Ventricular enlargement and cortical atrophy
Diffusion tensor imaging (DTI)
Dopamine hypothesis
Brains of people with schizophrenia have enlarged ventricles.
Ventricular enlargement - Occurs in people with schizophrenia alongside cortical atrophy.
Cortical atrophy - A wasting away of brain tissue.
Diffusion tensor imaging (DTI): Method to investigate abnormalities in the white matter of the brain.
Chlorpromazine blocked dopamine receptors, giving rise to the dopamine hypothesis of schizophrenia.
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19. Biological Theories Genetic abnormalities affects:
Brain development
Synaptic transmission
Immune functioning
Manufacturing of important proteins involved in neurotransmission
Neurodevelopmental hypothesis
Neurodevelopmental hypothesis: Proposing that schizophrenia is a disorder of development that arises during the years of adolescence or early adulthood due to alterations in the genetic control of brain maturation.
Support for the hypothesis - Individuals having their first psychotic episodes have a number of inexplicable brain abnormalities as the result of the illness.
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20. Biological Treatment Neuroleptics Consequences
“Typical” or “first generation”
“Atypical” or “second generation”
Consequences
Extrapyramidal symptoms (EPS)
Tardive dyskinesia
Medication used in treating schizophrenia was:
Antipsychotic chlorpromazine (Thorazine)
Haloperidol (Haldol)
Extrapyramidal symptoms (EPS): Rigid muscles, tremors, shuffling movement, restlessness, and muscle spasms affecting their posture.
Tardive dyskinesia: Involuntary movements of the mouth, arms, and trunk of the body.
Atypical (second generation) antipsychotics operate on both serotonin and dopamine neurotransmitters called serotonin-dopamine antagonists.
For treatment-resistant clients, clozapine is the only approach that has empirical support.
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21. Figure 6.2 - Neuropsychological Performance Profile of Schizophrenia
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22. Psychological Perspective
Deficit in social cognition
Brains become less activated when given a social cognition task
Difficulty in working on people-oriented jobs
Substance abuse
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23. Psychological Treatment
Token economy
Cognitive-behavioral therapy
Cognitive training
Token economy: A form of contingency management in which a client who performs desired activities earns chips or tokens that can later be exchanged for tangible benefits.
Cognitive-behavioral therapy
Treat individuals with symptoms of psychosis.
Teach their clients coping skills.
One promising cognitive training approach involves training in speech recognition and auditory perception.
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24. Figure 6.4 - Developmental Cascade toward Schizophrenia
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25. Sociocultural Perspective
Focus on the family system
Faulty modes of behavior and communication
Cognitive distortions
High degree of expressed emotion
Social class and income
Associated with environmental stressors of poverty
Contracting the disease leads to social and economic “downward drift”
Expressed emotion (EE) - Provides a measure of the degree to which family members speak in ways that reflect criticism, hostile feelings, and emotional overinvolvement or overconcern.
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26. Sociocultural Treatment
Assertive Community Treatment (ACT): A team of professionals from psychiatry, psychology, nursing, and social work reach out to clients
ACT’s focus is on engendering empowerment and self-determination on its “consumers,” the term they use to refer to their clients.
ACT is combined with another program, called Illness Management and Recovery (IMR).
IMR is based on the premise that consumers should be given the resources they need to make informed choices.
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27. Biopsychosocial Perspective
Theories focus on underlying brain mechanisms as expressed in cognitive deficits
Individuals with these disorders receive integrated care:
Maximizing their chances of recovery
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