1 / 32

Chapter 12

Chapter 12. Schizophrenia and Other Psychotic Disorders. Perspectives on Schizophrenia. Schizophrenia vs. psychosis Psychosis – broad term (e.g., hallucinations, delusions) Schizophrenia – a type of psychosis Psychosis and schizophrenia are heterogeneous

halia
Télécharger la présentation

Chapter 12

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 12 Schizophrenia and Other Psychotic Disorders

  2. Perspectives on Schizophrenia • Schizophrenia vs. psychosis • Psychosis – broad term (e.g., hallucinations, delusions) • Schizophrenia – a type of psychosis • Psychosis and schizophrenia are heterogeneous • Disturbed thought, emotion, behavior

  3. History of schizophrenia • Historical background • Emil Kraepelin – used the term dementia praecox • Subtypes of schizophrenia – Catatonia, hebephrenia and paranoia • Eugen Bleuler – introduced the term “schizophrenia” • “Splitting of the mind” (1856-1926) (1857-1939

  4. Schizophrenia: The “Positive” Symptom Cluster • The positive symptoms • Excess or distortion of normal behavior • Delusions: The basic feature of madness • Gross misrepresentation of reality • Include delusions of grandeur (mistaken belief that one is famous or powerful) • or delusions of persecution (others out to get me)

  5. Schizophrenia: The “Positive” Symptom Cluster • Hallucinations • Experience of sensory events without environmental input • Can involve all senses

  6. SPECT study on auditory hallucination

  7. Schizophrenia: The “Negative” Symptom Cluster • The negative symptoms • Absence or insufficiency of normal behavior • Spectrum of negative symptoms • Avolition (or apathy) – lack of initiation and persistence • Alogia – relative absence of speech • Anhedonia – lack of pleasure, or indifference • Affective flattening – little expressed emotion

  8. Schizophrenia: The “Disorganized” Symptom Cluster • The disorganized symptoms • Severe and excess speech, behavior, and emotion • disorganized speech • Cognitive slippage – illogical and incoherent speech • Tangentiality – “going off on a tangent” • disorganized affect • Inappropriate emotional behavior • disorganized behavior • Catatonia spectrum

  9. Subtypes of Schizophrenia: • Paranoid type • Intact cognitive skills and affect • Do not show disorganized behavior • Hallucinations and delusions – grandeur or persecution • The best prognosis

  10. Subtypes of Schizophrenia: Paranoid and Disorganized • Disorganized type • 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

  11. Subtypes of Schizophrenia: Catatonic, Undifferentiated, and Residual • Catatonic type • Show unusual motor responses, grimacing • Examples include echolalia and echopraxia • Tends to be severe and quite rare

  12. Subtypes of Schizophrenia: Catatonic, Undifferentiated, and Residual • Undifferentiated type • Wastebasket 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

  13. Other Disorders with Psychotic Features: Schizophreniform and Schizoaffective Disorder • Schizophreniform disorder • Schizophrenic symptoms for a few months • Associated with good premorbid functioning • Most resume normal lives

  14. Other Disorders with Psychotic Features: Schizophreniform and Schizoaffective Disorder • Schizoaffective disorder • Symptoms of schizophrenia and a mood disorder • Both disorders are independent of one another • Prognosis - persons do not tend to get better on their own such as in schizophrenia

  15. Other Disorders with Psychotic Features: Delusional Disorder • Delusional disorder • Delusions that are contrary to reality • Lack other positive and negative symptoms • Types of delusions include • Erotomanic • Grandiose • Jealous • Persecutory • Somatic • Extremely rare (24-30/100,000) • Better prognosis than schizophrenia

  16. Additional Disorders with Psychotic Features • Brief psychotic disorder • One or more positive symptoms of schizophrenia that lasts less than 1 month • Usually precipitated by extreme stress or trauma • Tends to remit on its own

  17. Additional Disorders with Psychotic Features • Shared psychotic disorder • Delusions from one person manifest also in another person • Little is known about this condition • Schizotypal personality disorder • May reflect a less severe form of schizophrenia

  18. Schizophrenia: Statistics • about 1% population) • Often develops in early adulthood but can emerge at any time • Most have moderate-to-severe lifetime impairment • Life expectancy is slightly less than average • Schizophrenia affects males and females about equally • Females tend to have a better long-term prognosis • Onset differs between males and females

  19. Causes of Schizophrenia:Findings From Genetic Research • Genetic factors • Family studies • Inherit a tendency for schizophrenia, not forms of schizophrenia • Risk increases with genetic relatedness

  20. Causes of Schizophrenia:Findings From Genetic Research • Twin studies • Monozygotic twins (48%) • Fraternal (dizygotic) twins (17%) • Adoption studies – risk for schizophrenia remains high but less if adopted in good functioning home

  21. Search for Genetic andBehavioral Markers of Schizophrenia • Genetic markers: Linkage and association studies • Endophenotypes • Schizophrenia is likely to involve multiple genes • Behavioral markers: Smooth-pursuit eye movement • Eye movement tracking deficiency • Emotion identification

  22. Causes of Schizophrenia: Neurobiological Influences • The dopamine hypothesis • Drugs that increase dopamine (agonists) • Result in schizophrenic-like behavior such as L-Dopa for Parkinson’s disease, amphetamines • Drugs that decrease dopamine (antagonists) • Reduce schizophrenic-like behavior – neuroleptics • Dopamine hypothesis is problematic and overly simplistic • Current theories emphasize many neurotransmitters

  23. Causes of Schizophrenia:Other Neurobiological Influences • Structural and functional abnormalities in the brain • Enlarged ventricles and reduced tissue volume • Hypofrontality – less active frontal lobes • A major dopamine pathway • Viral infections during early prenatal development

  24. Causes of Schizophrenia:Psychological and Social Influences • The role of stress • May activate underlying vulnerability • May also increase risk of relapse • Family interactions • Families – show ineffective communication patterns • Schizophrenogenic mother • Double blind communication • High expressed emotion (EE)– associated with relapse

  25. Medical Treatment of Schizophrenia • Historical precursors • Development of antipsychotic (neuroleptic) medications • Often the first line treatment for schizophrenia • Began in the 1950s • Most reduce or eliminate positive symptoms

  26. Acute and permanent side effects are common • Extrapyramidal and Parkinson’s-like side effects (Tardive dyskinesia) • Compliance with medication is often a problem

  27. Psychosocial Treatment of Schizophrenia • Psychosocial approaches: • Behavioral (i.e., token economies) on inpatient units • Community care programs • Social and living skills training • Behavioral family therapy • Vocational rehabilitation • Cultural considerations • Prevention

More Related