Transcript Schizophrenia and Related Disorders

Schizophrenia
and
Related Disorders
Schizophrenia
A disorder with a range of psychotic
symptoms involving disturbances in
content of thought, form of thought,
perception, affect, sense of self,
motivation, behavior, and interpersonal
functioning.
Schizophrenia
A disorder with a range of psychotic
symptoms involving disturbances in
content of thought, form of thought,
perception, affect, sense of self,
Psychosis
motivation,
behavior, and interpersonal
Behavior involving
functioning.
loss of contact with
reality.
Overview
• Onset and Prevalence of Schizophrenia
worldwide
– About 0.2% to 1.5% (or about 1% population). Higher
in urban areas
– Usually develops in early adulthood, but can emerge
at any time
• Schizophrenia Is Generally Chronic
• Schizophrenia Affects Males and Females About Equally
PHASES OF SCHIZOPHRENIA
Active
Prodromal
Residual
Diagnostic Features
Disturbances for least 6 months (1 month of active symptoms) of at
least 2 of the following
• Perception
– Hallucinations (Experience of sensory events without
environmental input) Slide 33
• Thoughts Slide 35
– Delusions (Beliefs that are gross
misrepresentations of reality)
– Lack cohesiveness and logic
• Language Schizophrenia: Disorganized Speech
• Actions
• Negative symptoms
SYMPTOMS
Positive symptoms:
Exaggerations or
distortions of normal
thoughts, emotions,
and behavior.
Negative symptoms:
Symptoms that
involve functioning
below the level of
normal behavior.
TYPES OF SCHIZOPHRENIA
Characterized by preoccupation with
one or more bizarre delusions, or with
auditory hallucinations that are
related to a particular theme of being
persecuted or harassed.
Without disorganized speech or
disturbed behavior.
TYPES OF SCHIZOPHRENIA
Characterized by a combination of
symptoms, including disorganized
speech and behavior and flat or
inappropriate affect.
Even delusions and hallucinations lack
a coherent theme.
TYPES OF SCHIZOPHRENIA
Characterized by at least two bodily
movement abnormalities:
• Motor immobility or stupor.
• Purposeless motor activity.
• Mutism or extreme negation.
• Peculiarities of movement or odd
mannerisms and grimacing.
• Echolalia or echopraxia.
TYPES OF SCHIZOPHRENIA
Characterized by a complex of schizophrenic
symptoms that does not meet the criteria for
other types of schizophrenia.
TYPES OF SCHIZOPHRENIA
Applies to people previously diagnosed
as schizophrenic if they no longer
show prominent psychotic symptoms
but still show lingering signs of the
disorder.
Other
Psychotic
Disorders
The schizophrenia-like
disorders share three
features:
1. Serious break with reality.
2. Not caused by cognitive
impairment.
3. Not primarily affective.
BRIEF PSYCHOTIC DISORDER
• with marked stressor(s),
• without marked stressor(s), or
• with postpartum onset
A disorder characterized by the
sudden onset of psychotic
symptoms that are limited to a
period of less than a month.
SCHIZOPHRENIFORM
DISORDER
A disorder with essentially the same
symptoms as schizophrenia, but lasts
less than 6 months (and more than 1).
SCHIZOAFFECTIVE DISORDER
Symptoms of schizophrenia
alternating with mood
disorder symptoms.
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DELUSIONAL DISORDERS
People with delusional disorders have a
single striking psychotic symptom: an
organized system of nonbizarre false
beliefs.
Erotomanic
Somatic
Persecutory
Grandiose
Jealous
Erotomanic Delusions
• Santa Fe woman contended that David Letterman used
code words to show he wanted to marry her and train
her as his co-host.
• A state judge granted a temporary restraining order to
Colleen Nestler, who alleged that Letterman had forced
her to go bankrupt and caused her "mental cruelty" and
"sleep deprivation" since May 1994.
• Nestler requested that Letterman stay at least 3 yards
away and not "think of me, and release me from his
mental harassment and hammering."
• She said he asked her to be his wife during a "teaser" for
his show by saying, "Marry me, Oprah." Her letter said
Oprah was the first of many code names for her and that
the coded vocabulary increased and changed with time.
SHARED PSYCHOTIC
DISORDER
In shared psychotic disorder, the person
develops a delusional system as a result
of a close relationship with a psychotic
person who is delusional.
Intervention calls for:
• Separating them.
• Focusing on personal issues related to this person’s
vulnerability to being dominated.
• Bolstering the client’s self-esteem.
ETIOLOGY
Genetic loading in Schizophrenia
Additional BIOLOGICAL THEORIES
• Stressors
– Stressful events during pregnancy
– Influenza
– Seasonal rates
– Obstetric complications/brain injury
BIOLOGICAL THEORIES
BRAIN STRUCTURE AND FUNCTION
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Cortical atrophy Slide 39
Reduced brain activation
Dopamine hypothesis
Possible serotonin deficit
Lines of evidence for dopamine hypothesis
Biological THEORIES
Endophenotypes
biobehavioral abnormalities
linked to genetic and
neurobiological causes of
mental illness
In other words, they are
 heritable traits or characteristics that are not
direct symptoms of the disorder but have
been found to be associated
Abnormalities in Cognitive Processes
associated with biological markers
Three measures of cognitive
functioning stand out as
particularly important in the
search for biological markers:
Seen in people with schizophrenia and their
non-diagnosed relatives:
 Sustained attention
 Smooth pursuit eye movements
 Antisaccade eye movements
Also problems in
Sensory Gating
PSYCHOLOGICAL
PERSPECTIVE
No credible theory proposes that
schizophrenia develops exclusively as
the result of psychological phenomena.
PSYCHOLOGICAL
PERSPECTIVE
No credible theory proposes that
schizophrenia
develops exclusively
as have
However, behavioral
psychologists
the result
psychological
phenomena.
found of
factors
influencing
whether the
likelihood the the schizophrenic individual
will act in a “normal” way or not.
PSYCHOLOGICAL
PERSPECTIVE
No credible theory proposes that
schizophrenia
develops exclusively
as have
However, behavioral
psychologists
the result
psychological
phenomena.
found of
factors
influencing
the likelihood the
schizophrenic individual will act in a
“normal” way or not.
•
•
•
•
•
•
Failure to learn important social cues.
Lack of attention from others.
Retreat into fantasy world.
Behaviors become odd and eccentric.
Being labeled as odd or schizophrenic.
Hospitalization exacerbates maladaptive
behaviors.
BIOLOGICAL THEORIES
HALLUCINATIONS
SYMPTOMS
DELUSIONS
SYMPTOMS
Schizophrenia: Disorganized
Speech
• Loosening of Associations
– Ideas jump from one to another, with the result that the person wanders
further and further away from the topic
• Poverty of content
– Poor communication despite correct grammar and adequate vocabulary
• Neologisms
– The use of new words and phrases, often by formed by combining parts
of two or more regular words
• Clanging
– The pairing of words that have no relation to one another beyond the
fact that they rhyme or sounds alike
• Word salad
– Words and phrases are combined in what appears to be a completely
disorganized fashion SYMPTOMS
WORD SALAD