Transcript Schizophrenia and Other Psychotic Disorders - U

Schizophrenia and Other
Psychotic Disorders
Chapter 12
Outline
• Perspectives on Schizophrenia
• Clinical Description, Symptoms and
Subtypes
• Prevalence and Causes of Schizophrenia
• Treatment of Schizophrenia
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
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
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
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)
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
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)
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
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
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
Prevalence and Causes of
Schizophrenia
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
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)