Schizophrenia

1. Schizophrenia Definition Psychotic disorder Thought Disorder Loose associations “Split” from reality NOT split or multiple personality

2. Symptoms of Schizophrenia Positive Symptoms Loose associations Word salad Delusions Hallucinations Negative Symptoms Poverty of speech content Flat or blunted affect Avolition or apathy Anhedonia

3. Subtypes of Schizophrenia Paranoid Disorganized Catatonic Undifferentiated Residual

4. Paranoid Subtype Intact cognitive skills and affect Do not show disorganized behavior Hallucinations and delusions – grandeur or persecution The best prognosis of all types of schizophrenia

5. Disorganized Subtype Marked disruptions in speech and behavior Flat or inappropriate affect Hallucinations and delusions – tend to be fragmented Develops early, tends to be chronic, lacks remissions

6. Catatonic Subtype Show unusual motor responses and odd mannerisms Examples include echolalia and echopraxia Tends to be severe and quite rare

7. Additional Subtypes • Undifferentiated type • Catch all category • Major symptoms of schizophrenia • Fail to meet criteria for another type • Residual type • One past episode of schizophrenia • Continue to display less extreme residual symptoms

8. Age of Onset

9. Biological Aspects Runs in Families Increased Risk Based on Genetic Relatedness

10. Genetics and Schizophrenia

11. Biological Aspects Search for Marker Genes Still inconclusive Likely involves multiple genes Smooth Pursuit Eye Tracking Tracking deficit in persons with schizophrenia, including their relatives Brain Structure and Functioning Enlarged ventricles and reduced tissue volume Hypofrontality

12. Biological Aspects Dopamine Hypothesis Drugs that increase dopamine (agonists), result in schizophrenic-like behavior (e.g., amphetamines) Drugs that decrease dopamine (antagonists), reduce schizophrenic-like behavior Considered too simplistic (multiple NTs involved)

13. Psychosocial Influences The Role of Stress Diathesis-Stress Model Also seems related to relapse (not just onset) Family Interactions Communication patterns High expressed emotion associated with relapse Psychological factors seem relatively small

15. Socioeconomic Status and Schizophrenia

16. Treatment of Schizophrenia Seldom Results in Complete Recovery Early Methods Insulin Coma Therapy Psychosurgery ECT Biological Treatments (Current) Neuroleptics (Major Tranquilizers) Haldol, Thorozine, others Clozaril, Risperdal, Zyprexa, others

17. Treatment of Schizophrenia Biological Treatment Issues Major (Social) Reform in Treatment Revolving Door Process Trial and Error Extrapyramidal Side Effects Tardive Dyskinesia Address Positive Symptoms Only Medication Compliance Problems

18. Antipsychotic Drugs and Inpatient Treatment

19. Psychosocial Treatment Psychosocial Approaches Behavioral (i.e., token economies) on inpatient units Community care programs Social and living skills training Behavioral family therapy Vocational rehabilitation Facilitate Medication Compliance

20. Psychosocial Treatment

21. Myths About Schizophrenia People with schizophrenia have “split personalities.” People with schizophrenia are intellectually disabled People with schizophrenia are dangerous People with schizophrenia are addicted to their drugs

22. Other Psychotic Disorders Brief Psychotic Disorder Psychotic symptoms for a few weeks Schizophreniform Disorder Schizophrenic symptoms for a few months Schizoaffective Disorder Symptoms of schizophrenia and a mood disorder independent of each other

23. Other Psychotic Disorders • Delusional disorder • Delusions without hallucinations or most other schizophrenic symptoms • Types of delusions • Erotomanic • Grandiose • Jealous • Persecutory • Somatic

24. Other Psychotic Disorders • Folie a Deux • Shared Psychotic Disorder