Schizophrenia and Other Psychotic Disorders

1. Schizophrenia and Other Psychotic Disorders Chapter 12

2. Outline • Perspectives on Schizophrenia • Clinical Description, Symptoms and Subtypes • Prevalence and Causes of Schizophrenia • Treatment of Schizophrenia

3. Perspectives on Schizophrenia • Schizophrenia is characterized by a broad spectrum of disturbances in thinking (delusions), perception (hallucinations), speech, emotions, and behavior • Diagnosis of schizophrenia requires that two or more positive, negative and/or disorganized symptoms be present for at least 1 month • Affects 1% of population • Complete recovery from schizophrenia is rare

4. Perspectives on Schizophrenia • Emil Kraepelin • Dementia praecox (premature loss of mind) shares following symptoms • Catatonia (disorder of movement involving immobility or excited agitation) • Hebephrenia (silly and immature emotionality) • Paranoia (delusions of grandeur or persecution) • Eugen Bleuler • Introduced the term schizophrenia (split of mind) • Associative splitting of basic functions of personality (cognition, emotions, perception etc.) • Does not mean split of personality or multiple personality

5. Clinical Description, Symptoms and Subtypes • Psychotic behavior • Unusual behavior characterized by hallucinations, delusions and loss of contact with reality • Positive symptoms • More active manifestations of abnormal behavior (delusions and hallucinations) • Negative symptoms • Deficit in normal behavior (avolition, alogia, anhedonia, affective flattening) • Disorganized symptoms • Rambling speech, erratic behavior, inappropriate affect

6. Clinical Description, Symptoms and Subtypes Positive symptoms • Delusions • Disorder of thought content, strong beliefs that misrepresent reality • Delusion of grandeur, delusions of persecution, Capgras syndrome, Cotard’s syndrome • Hallucinations • Perceptual disturbance in which things are seen or heard or otherwise sensed although they are not real or actually present • Auditory hallucinations are most frequent (Broca’s area)

7. Clinical Description, Symptoms and Subtypes Negative symptoms • Avolition • Apathy, inability to initiate and persist in activities • Alogia • Absence of speech (poor communication skills) • Anhedonia • Lack of pleasure • Affective flattening • Don’t show emotions when a reaction would be expected  Pos vs. neg symptoms

8. Clinical Description, Symptoms and Subtypes Disorganized symptoms • Disorganized speech • Lack of insight • Jump from topic to topic, talk illogically, lack of coherence • Inappropriate affect and disorganized behavior • Laugh or cry at improper times • Motor dysfunctions (agitation or immobility)

9. Clinical Description, Symptoms and Subtypes • Schizophrenia subtypes  Etta • Paranoid type • Delusions, hallucinations but cognitive skills and affect are relatively intact, better prognosis • Disorganized type • Disrupted speech and behavior, delusions, hallucinations, flat or silly affect, self-absorbed • Catatonic type • Motor disturbance predominate (echolalia, echopraxia) • Undifferentiated type • Major symptoms of schizophrenia (no particular type) • Residual type • People who experienced at least one episode of schizophrenia but no longer manifest major symptoms

10. Clinical Description, Symptoms and Subtypes • Other psychotic disorders • Schizophreniform disorder • Experience symptoms of schizophrenia for a few months only (up to 6 months) • Schizoaffective disorder • Symptoms of schizophrenia and also major mood disorder • Delusional disorder • Persistent belief contrary to reality (delusion) without other symptoms of schizophrenia (onset between 40 and 49) • Brief psychotic disorder • involves delusions, hallucinations, disorganized speech or behavior that lasts less than 1 month (often reaction to stressor) • Shared psychotic disorder • A person develops a delusion similar to that of a person with whom he or she shares a close relationship

11. Prevalence and Causes of Schizophrenia • 0.2% to 1.5% of population (equivalent for men and women) • Onset in early adulthood (16-25) • Children who later develop schizophrenia have abnormal emotional reactions very early (less positive and more negative affect) • Genes are responsible for making some individuals vulnerable to schizophrenia (the risk varies according to how many genes an individual shares with someone who has the disorder) • Family studies, twin studies, adoption studies, genetic markers

12. Prevalence and Causes of Schizophrenia

13. Prevalence and Causes of Schizophrenia • Dopamine system is too active in people with schizophrenia (neuroleptics – dopamine antagonists) • Enlargement of ventricles • Hypofrontality (DLPFC) • Viral infections (second-trimester) • Stress • If the level of criticism, hostility and emotional overinvolvement expressed by families is high, patients tend to relapse

14. Treatment of Schizophrenia • Neuroleptic drugs  treatment • Problem with compliance of patients • Psychological treatment • Self-care training • Social skills training • Self-help groups • Prevention (family environment)