Transcript Theory to Treatment

Theory to Treatment
Schizophrenia
Psychopathology
Julianne Carroll
The Schizophrenic Picture
Between a half and two thirds of sufferers:
• can’t work
• live alone
• don’t develop adequate social relations
• die younger
• are at a higher risk of HIV
• more likely to be victims of crime
• are often painfully aware of their situation
DSM IV Diagnostic Assumptions
• There are no biological indicators.
• Negative symptoms play a predominant role
• there must be a prodromal period of at least 6
months
• schizophrenia (Sz) is a discrete disease entity
• there is the possibility that Sz may lie at the end of
a continuum of psychopathology or
neurophysiological dysfunction
Any Way Out?
• Kaepelin suggests a deteriorating course
• Harding et al (1987) reported that after 32
years 1/2 to 2/3 of chronic patients
discharged were symptom free and had
reasonable adjustments to community life
Heterogeneity
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Crow’s 2 Syndrome Model
Buchanan & Carpenter’s 3 Factor Model
Deficit Syndrome
Core Deficit Hypothesis
Positive and Negative Symptoms
Neurotransmitter  positive symptoms
disturbance
(responsive to neuroleptics)
neuroanatomical  negative symptoms
disturbance(s)
(unresponsive to neuroleptics)
3 Factor Model
• hallucinations and delusions
• negative symptoms
• cognitive impairment
Deficit Syndrome
• Fundamental question: which negative symptoms
are primary and enduring?
• Criteria for diagnosis:
1) DSM IV Sz
2) 2 symptoms present for 12 months
- affective flattening - alogia - avolition *not accounted for by:
- depression/anxiety - drug effects - environmental
deprivation
Core Deficit
• Bleuler (1911, 1950) proposed thought
disorder as the hallmark symptom of Sz and
made the first attempt to specify a primary
cognitive deficit theorized to underly an
array of symptoms.
• It’s the disconnection of ‘associative
threads’ that leads to confused & bizarre
thinking.
Social Competence
• Pre-morbid social competence is among the
best predictors of long term outcome
 which comes first? The chicken or the
egg?
• Social dysfunction is now considered quite
fundamental in the diagnosis of Sz and has
been linked to cognitive functioning,
specifically an inability to learn specific
Stress - Vulnerability Model
Predisposing Factors:
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Dopaminergic anomalies
Cognitive (info. Processing) deficits
Autonomic hyperactivity to aversive stimuli
Schizotypal personality traits
Precipitating Factors:
• An unsupportive/critical family
environment
• overstimulated social environment
• stressful life events
Perpetuating Factors:
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Processing capacity overload
Tonic autonomic hyperarousal
impaired processing of social stimuli
further impairment to processing of social
cues
• disruption of coping abilities
• Dysfunctional behaviors create
environmental stressors
Protective Factors
• Coping abilities (cognitive and behavioral)
• A supportive family
• Psychosocial interventions
Stress-Vulnerability Model
Psychotic episode
Precipitating factors
+ve
Predisposing factors
Protective factors
-ve
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Where Do We Fit In?
Psychosocial Treatments:
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Individual Psychotherapy
CBT
Behaviour Therapy
Cognitive Family Therapy
Family Education ”psychoeducation”