CHAPTER 13 SCHIZOPHRENIA

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1 1 Psychotic Disorders Bio Treatment Last Prev 2 CHAPTER 13 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (PP ) History Kraepelin Positive Delusions Hallucinations Avolition Perspectives Bleuler Symptoms Diverse Symptoms Negative Alogia Disorganized Speech Clinical Description Anhedonia Types Emotion & Behav Aff-Flat Stats Paranoid Catatonic Causes Genes Undiff Dev Disorganized Residual Asociality PsySoc Neuro Dop Cult Brain Other PsyDis Culture Psy/Soc Stress Schizophreniform Schizoaffective Delusional Brief Psy Dis Families & Relapse Shared Psy Dis SCHIZOPHRENIA & PSYCHOSIS: PERSPECTIVES (PP ) Schizophrenia vs. Psychosis Psychosis: broad term refers to hallucinations and/or delusions Schizophrenia: type of psychosis with disturbed thought, language, and behaviour Psychoses and Schizophrenia heterogeneous (mixed) Canadian National Outcomes Measurement Study: most people with schizophrenia unemployed and poor (Smith et al., 2006) Historical Background Benedict Morel: Demence (loss of mind) precoce (early, premature) Emil Kraepelin: Dementia Praecox, focus on onset and outcomes (+1) Eugen Bleuler: introduced Schizophrenia or Splitting of Mind (+2) 3 KRAEPELIN S SYMPTOMS (1919) 1. Hallucinations A. Auditory Unpleasant voices Voices that comment on thoughts and doings of patient Commanding voices Patient's own thoughts spoken aloud B. Tactile Somatic Sexual C. Smell and Taste 2. Delusions Delusions of influence Delusions of persecution Grandiose delusions Sexual delusions Ideas of reference 3. Incoherence of thought and speech Stereotypy of speech Poverty of speech Mutism Neologisms 4. Catatonic symptoms Automatic obedience Echolalia and echopraxia Stereotypy of movement Catatonic excitement Mannerisms Negativism 5. Disordered Attention 6. Disordered Judgement 7. Emotional dullness 8. Avolition 9. Autism 4 BLEULER S FUNDAMENTAL SYMPTOMS (1911) 1. Association Lack of purpose or goal in speech; poverty of ideas Thought condensations Stereotypy; echolalia Thought blocking Pressure of thoughts; clang associations 2. Affectivity Lack of depth to affect; restricted affect Lack of consistency of affective manifestation Inappropriate or blunted affect 3. Attention Lack of selectivity of attention; impaired active attention 4. Ambivalence Affective ambivalence: same concept accompanied simultaneously by pleasant and unpleasant feelings Ambivalence of will: patient wishes and does not wish same thing at same time Intellectual ambivalence: patient expresses contradictory thoughts in same sentence 5. Autism 5 SCHIZOPHRENIA AND PSYCHOSIS: PERSPECTIVES 6 Impact of Early Ideas on Current Thinking About Schizophrenia Many of Kraepelin and Bleuler s ideas still with us Understanding onset and course still considered important Identifying symptoms No shared set of characteristics Number of distinct symptoms not shared by all diagnosed with Schizophrenia Serious disorder and quite prevalent (+1) Associated with much stigma (+2) 1

RELATIVE PREVALENCE 7 STIGMA AND SCHIZOPHRENIA 8 8 SCHIZOPHRENIA: CLINICAL

Positive Negative Disorganized Types of Schizophrenia Other Psychotic Disorders

479-482) 12 Positive Symptoms Active displays of abnormal behaviour, distortions

, delusions, hallucinations, disorganized speech Delusions: The Basic Feature of

, delusions of grandeur or persecution (+1) Hallucinations: Auditory and/or Visual

2 RELATIVE PREVALENCE 7 STIGMA AND SCHIZOPHRENIA 8 8 SCHIZOPHRENIA: CLINICAL DESCRIPTION Clinical Description DSM criteria (+1) Symptoms (+2): 3 Clusters Positive Negative Disorganized Types of Schizophrenia Other Psychotic Disorders Statistics Development Culture SCHIZOPHRENIA: POSITIVE SYMPTOM CLUSTER (PP ) 12 Positive Symptoms Active displays of abnormal behaviour, distortions of normal behaviour e.g., delusions, hallucinations, disorganized speech Delusions: The Basic Feature of Madness Gross misrepresentations of reality e.g., delusions of grandeur or persecution (+1) Hallucinations: Auditory and/or Visual Experience of sensory events without environmental input Can involve all senses, primarily auditory (+2) Nature of auditory and visual hallucinations: SPECT studies (+3) and verbal reports (+4) 2

Thought broadcasting (false belief that affected person's thoughts are heard aloud), thought insertion, and thought withdrawal (belief that outside force, person, or group of people is removing or

3 Delusion of control 13 False belief that people or external forces control one's thoughts, feelings, impulses, or behavior. May describe experience that aliens actually make him or her move in certain ways and that person affected has no control over bodily movements. Thought broadcasting (false belief that affected person's thoughts are heard aloud), thought insertion, and thought withdrawal (belief that outside force, person, or group of people is removing or extracting person's thoughts). Delusion of reference Falsely believes insignificant remarks, events, or objects in environment have personal meaning or significance. May believe that he or she is receiving special messages from news anchor person on television. Usually meaning assigned to these events is negative, but "messages" can also have grandiose quality. Persecutory delusions Most common type. Involve theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or obstructed in pursuit of goals. Sometimes delusion is isolated and fragmented (such as false belief that co-workers are harassing), but sometimes well-organized complex set of delusions ("systematized delusions"). Person with persecutory delusions may believe, for example, that he or she is followed by government organizations because "persecuted" person has been falsely identified as a spy. Systems can be so broad and complex that they explain everything that happens to person. Religious delusion Delusion with religious or spiritual content. May be combined with other delusions, such as grandiose delusions (belief that affected person chosen by God, for example), delusions of control, or delusions of guilt. Beliefs normal for religious or cultural background not delusions. Hallucinations 14 Perceive something that is not really there Affect about 70% of Schizophrenia patients Auditory hallucinations, or hearing things Most common type of hallucination in Schizophrenia Person may hear voice calling his or her name or hear many voices talking, sometimes saying things that are frightening May hear voices telling them to do things (command hallucinations), such as harm themselves or someone else Visual hallucinations, or seeing things Person may see another person, animal, or object that other people do not see Sometimes pleasant, and sometimes frightening Other types of hallucinations Include tasting (gustatory hallucination), smelling (olfactory hallucination), or feeling (tactile hallucination) something that is not there Not all hallucinations are symptoms of mental illness May occur when person is about to fall asleep (hypnagogic hallucinations) or when person is just waking up (hypnopompic hallucinations) People may wrongly hear someone call their name Widows and Widowers imagine sounds associated with dead partner Auditory hallucinations associated with Broca s area (speech production) 15 How people with Schizophrenia describe their hallucinations (Nayani et al, 1995) Commanding, Critical, Abusive, Frightening, Third person or neutral, Arguing, Pleasant, Questioning, Laughing, Sad 16 SCHIZOPHRENIA: NEGATIVE SYMPTOM CLUSTER (PP ) Negative Symptoms Absence or insufficiency of normal behaviour e.g., emotional / social withdrawal, apathy, poverty of thought / speech Spectrum of Negative Symptoms Avolition (or apathy): inability to initiate and persist in activities Alogia: relative absence of speech Anhedonia: lack of pleasure, or indifference to pleasurable activities Affective flattening: show little expressed emotion, but may still feel emotion Asociality: Poor social skills, little interest in socializing 17 SCHIZOPHRENIA: DISORGANIZED SYMPTOM CLUSTER (P. 484) Disorganized Symptoms Include severe and excess disruptions in speech, behaviour, emotion e.g., rambling speech, erratic behaviour, inappropriate affect Disorganized Speech ( ) Cognitive slippage: illogical and incoherent speech Tangentiality: Going off on a tangent and not answering a question directly Loose associations or derailment: taking conversation in unrelated directions 18 3

Tangentiality 19 Replying to questions in tangential or irrelevant manner. e.g: Q: "What city are you from? A: "Well, that's a hard question. I'm from Iowa.

"The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California". Circumstantiality Speech that is delayed at reaching goal. Excessive long windedness. e.

" "Well, sometimes when people ask me that I have to think about whether or not I will answer because some people think its an odd name even though I don t really because my mom gave it to me but its

4 Tangentiality 19 Replying to questions in tangential or irrelevant manner. e.g: Q: "What city are you from? A: "Well, that's a hard question. I'm from Iowa. I really don't know where my relatives came from, so I don't know if I'm Irish or French". Derailment Ideas slip off track on to another which is obliquely related or unrelated. e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California". Circumstantiality Speech that is delayed at reaching goal. Excessive long windedness. e.g. "What is your name?" "Well, sometimes when people ask me that I have to think about whether or not I will answer because some people think its an odd name even though I don t really because my mom gave it to me but its as good a name as any in my opinion but yeah it's Tom. Loss of goal Failure to show chain of thought to natural conclusion. Distractible speech During mid speech, subject is changed in response to a stimulus. e.g. "Then I left San Francisco and moved to... where did you get that tie?" Blocking Interruption of train of speech before completed. 20 Pressure of Speech Increase in amount of spontaneous speech compared to what is considered customary. Incoherence (word salad) Speech that is unintelligible: real words strung together in incoherent gibberish, e.g. question "Why do people believe in God?" elicits response like "Because he makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons. Hello, beautiful." Illogicality Conclusions are reached that do not follow logically (non sequiturs or faulty inductive inferences). e.g. "Do you think this will fit in that box?" draws a reply like "well duh, its brown, isn t it?" Clanging Sounds rather than meaningful relationships appear to govern words. e.g. "I'm not trying to make noise. I'm trying to make sense. If you can't make sense out of nonsense, well, have fun". Echolalia Echoing other people's speech e.g. "Can we talk for a few minutes?", "Talk for a few minutes". Neologisms: 21 New word formations: e.g. "I got so angry I picked up a dish and threw it at the geshinker". Word approximations Old words used in new and unconventional way. e.g. "His boss was a seeover". Perseveration Persistent repetition of words or ideas. e.g. "I'll think I'll put on my hat, my hat, my hat, my hat, my hat..." Stilted speech Speech excessively stilted and formal: e.g. "The attorney comported himself indecorously". Self-reference Patient repeatedly and inappropriately refers back to self: e.g. "What's the time?", "It's 7 o'clock. That's my problem". Phonemic paraphasia Mispronunciation; syllables out of sequence: e.g. "I slipped on the lice broke my arm". Semantic paraphasia Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book". SCHIZOPHRENIA: DISORGANIZED SYMPTOM CLUSTER (PP ) Nature of Disorganized Affect Inappropriate emotional behaviour: e.g., crying when should be laughing Nature of Disorganized Behaviour Variety of unusual behaviours Catatonia: spectrum from wild agitation, waxy flexibility, to complete immobility 22 SUBTYPES OF SCHIZOPHRENIA (PP ) Subtypes (+1) Paranoid Type (DSM +2) Intact cognitive skills and affect Do NOT show disorganized behaviour Hallucinations and delusions thematic (grandeur or persecution) Best prognosis of all types Disorganized Type (DSM +2) Marked disruptions in speech and behaviour, flat or inappropriate affect Hallucinations and delusions have theme, but fragmented Develops early, tends to be chronic, lacks periods of remissions 4

25 SUBTYPES OF SCHIZOPHRENIA (P. 486) Catatonic Type (DSM +1) Unusual motor responses and odd mannerisms: e.g.

Residual Type (DSM +2) One past episode of schizophrenia Continue to display less extreme residual symptoms (e.g.

486-487) Schizophreniform Disorder Schizophrenic symptoms for few months Good premorbid functioning; most resume normal lives Schizoaffective Disorder Independent symptoms of

other major symptoms Many show other negative symptoms of schizophrenia Type of delusions include erotomanic, grandiose, jealous, persecutory, and somatic Extremely rare, better

5 25 SUBTYPES OF SCHIZOPHRENIA (P. 486) Catatonic Type (DSM +1) Unusual motor responses and odd mannerisms: e.g., echolalia, echopraxia Tends to be severe and quite rare Undifferentiated Type Wastebasket category Major symptoms of schizophrenia, but fail to meet criteria for another type Residual Type (DSM +2) One past episode of schizophrenia Continue to display less extreme residual symptoms (e.g., odd beliefs) OTHER DISORDERS WITH PSYCHOTIC FEATURES 29 (PP ) Schizophreniform Disorder Schizophrenic symptoms for few months Good premorbid functioning; most resume normal lives Schizoaffective Disorder Independent symptoms of schizophrenia and mood disorder Prognosis similar to people with schizophrenia Do not tend to get better on their own Delusional Disorder Delusions contrary to reality without other major symptoms Many show other negative symptoms of schizophrenia Type of delusions include erotomanic, grandiose, jealous, persecutory, and somatic Extremely rare, better prognosis than schizophrenia OTHER DISORDERS WITH PSYCHOTIC FEATURES (PP ) Brief Psychotic Disorder Experience one or more positive symptoms of schizophrenia Usually precipitated by extreme stress or trauma Tends to remit on its own Shared Psychotic Disorder Delusions from one person manifest in another person Little is known about this condition Schizotypal Personality Disorder May reflect less severe form of schizophrenia 30 5

SCHIZOPHRENIA: SOME FACTS AND STATISTICS (PP. 488-490) Onset and Prevalence of Schizophrenia worldwide About 0.2% to 1.

throughout lives Life expectancy in persons with schizophrenia slightly less than average : Suicide, Lifestyle (Smoking, Overweight) Affects Males and Females About Equally Females tend to have

6 SCHIZOPHRENIA: SOME FACTS AND STATISTICS (PP ) Onset and Prevalence of Schizophrenia worldwide About 0.2% to 1.5% (or about 1% population) : implies about 300,000 in Canada; 10,000 in Manitoba Usually develops in early adulthood, but can emerge at any time Generally Chronic Most moderate-to-severe impairment throughout lives Life expectancy in persons with schizophrenia slightly less than average : Suicide, Lifestyle (Smoking, Overweight) Affects Males and Females About Equally Females tend to have better long-term prognosis Schizophrenia Appears to Have Strong Genetic Component (see Causes) STATISTICS Development (Natural History) Some signs of disorder in children prior to full manifestation Early onset, earlier for males than females (+1) Positive symptoms tend to diminish in older adults and Negative symptoms increase Relapse Rates (F ) Repeated episodes common Relapse rates high; see also Expressed Emotion Gender differences in onset of schizophrenia in a sample of 470 patients STATISTICS Cultural Factors Disorder observed in many diverse cultures: some debate about whether prevalence varies Universally causes distress Course and outcome varies somewhat (see later discussion of relapse and Emotional Expression) Incidence higher in Immigrants to developed countries Blacks and other minorities more likely to be diagnosed with Psychotic disorder (+1) Bias and stereotyping during diagnosis Stress of racism and discrimination EDELSOHN (2005) 36 Reviewed psychiatric emergency visits from 1997 to visits for 1362 patients 13 to 17 years old Measured age, sex, ethnicity, voluntary or involuntary arrival status, involvement of child protection services, and violent behavior (used weapon, fought with or without implement, inflicted property damage, or made threats) African Americans 3.3 times as likely as Whites to be diagnosed with schizophrenia or psychosis Latinos 2.9 times more likely than Whites to have these diagnoses Results present controlling for gender, age, substance abuse, involvement of protective services, arrival status 6

CAUSES OF SCHIZOPHRENIA 37 CAUSES OF SCHIZOPHRENIA: GENETIC

490-491) Family Studies Inherit tendency for schizophrenia,

genes alone not enough Twin Studies (+1 +2) Risk in

(dizygotic) twins Genetic Relatedness Risk increases as

symptoms to pass on genes (+4) Adoption Studies Risk high in

Genain quadruplets All identical twins All affected with

7 CAUSES OF SCHIZOPHRENIA 37 CAUSES OF SCHIZOPHRENIA: GENETIC RESEARCH (PP ) Family Studies Inherit tendency for schizophrenia, not specific form Other family members at increased risk, but genes alone not enough Twin Studies (+1 +2) Risk in monozygotic twins is 48% Risk drops to 17% for fraternal (dizygotic) twins Genetic Relatedness Risk increases as function of genetic relatedness (+3) One need not show symptoms to pass on genes (+4) Adoption Studies Risk high in adopted children of biological parent with schizophrenia 38 Genain quadruplets All identical twins All affected with Schizophrenia, two more seriously CAUSES OF SCHIZOPHRENIA: GENETIC RESEARCH (P. 492) 42 CAUSES OF SCHIZOPHRENIA: GENETIC RESEARCH (P. 491) 7

GENETIC & BEHAVIOURAL MARKERS OF SCHIZOPHRENIA (P.

replicate Schizophrenia likely to involve multiple genes (polygenic) Search for Behavioural Markers: Smooth-Pursuit Eye Movement Method: track moving object visually with head kept still Tracking

493-496) Neurobiology and Neurochemistry: Dopamine Hypothesis Drugs that increase dopamine (agonists), result in schizophreniclike behaviour(+1) Drugs that decrease dopamine (antagonists), reduce

, neuroleptics and L-Dopa for Parkinson s disease Dopamine hypothesis problematic and overly simplistic Current theories emphasize several neurotransmitters and their interaction 44 CAUSES:

8 GENETIC & BEHAVIOURAL MARKERS OF SCHIZOPHRENIA (P. 493) Search for Genetic Markers: Linkage and Association Studies Identify sites on chromosomes with relevant genes Search for genetic markers is still inconclusive Promising effects often fail to replicate Schizophrenia likely to involve multiple genes (polygenic) Search for Behavioural Markers: Smooth-Pursuit Eye Movement Method: track moving object visually with head kept still Tracking deficit in persons with schizophrenia, and relatives 43 CAUSES : NEUROTRANSMITTER INFLUENCES (PP ) Neurobiology and Neurochemistry: Dopamine Hypothesis Drugs that increase dopamine (agonists), result in schizophreniclike behaviour(+1) Drugs that decrease dopamine (antagonists), reduce schizophrenic-like behaviour(+1) e.g., neuroleptics and L-Dopa for Parkinson s disease Dopamine hypothesis problematic and overly simplistic Current theories emphasize several neurotransmitters and their interaction 44 CAUSES: NEUROTRANSMITTERS (P. 494) 45 CAUSES: OTHER NEUROBIOLOGICAL 46 INFLUENCES (PP ) Structural and Functional Abnormalities in Brain Enlarged ventricles and reduced tissue volume (+1 +2) Hypofrontality: less active frontal lobes (major dopamine pathway) Viral Infections During Early Prenatal Development Relation between early viral exposure and schizophrenia inconclusive Conclusions About Neurobiology and Schizophrenia Schizophrenia is associated with diffuse Neurobiological Dysregulation Structural and functional abnormalities in brain not unique to Schizophrenia CAUSES OF SCHIZOPHRENIA: NEUROTRANSMITTER INFLUENCES (P. 495) 8

stressors, birth complications (+1) e.g., increase in incidence during WW II famine in Netherlands (+2) Incidence higher in cities, especially core, and in immigrants: social disadvantage?

Factors Psychological factors likely minimal effect as cause Diathesis-Stress Models (+6 +7) SCHIZOPHRENIA AND WAR-TIME FAMINE 51 52 DISTRIBUTION OF SCHIZOPHRENIA IN CHICAGO: SOCIAL CLASS?

emotional responses regarding patient High Expressed Emotion "I always say, 'Why don't you pick up a book, do a crossword or something like that to keep your mind off it.

9 CAUSES: PSYCHOLOGICAL & SOCIAL (PP ) Stress and other environmental factors May activate underlying vulnerability or increase risk of relapse Obstetric factors: maternal exposure to viruses while pregnant, other prenatal stressors, birth complications (+1) e.g., increase in incidence during WW II famine in Netherlands (+2) Incidence higher in cities, especially core, and in immigrants: social disadvantage? (Chicago data +3) Family Interactions Families show ineffective communication patterns High Expressed Emotion in family associated with relapse (+4 +5 and slide 72 in treatment) Role of Psychological Factors Psychological factors likely minimal effect as cause Diathesis-Stress Models (+6 +7) SCHIZOPHRENIA AND WAR-TIME FAMINE DISTRIBUTION OF SCHIZOPHRENIA IN CHICAGO: SOCIAL CLASS? EXPRESSED EMOTION Definition Criticism: Statements of dislike, annoyance, resentment with negative tone Over-involvement: Extreme over-protectiveness, overconcern, self-sacrifice, exaggerated emotional responses regarding patient High Expressed Emotion "I always say, 'Why don't you pick up a book, do a crossword or something like that to keep your mind off it.' That's even too much trouble." "I've tried to jolly him out of it and pestered him into doing things." "He went round the garden 90 times, in the door, back out the door. I said 'Have a chair, sit out in the sun.' Well he nearly bit my head off." Low Expressed Emotion "I know it's better for her to be on her own, to get away from me and try to do things on her own." "Whatever she does suits me." "I just tend to let it go because I know that when she wants to speak she will speak." 53 CAUSES OF SCHIZOPHRENIA: PSYCHOLOGICAL AND SOCIAL INFLUENCES (P. 498) 54 9

Schizophrenia results from elevated Susceptibility plus exposure to stress Example of Cannabis use (+1 +2)

influences neurotransmitter functioning, especially in frontal lobes Inherit Val or Met variant of COMT gene from

cannabis during adolescence (Caspi et al, 2005) Hypothetical outcome (right) DIATHESIS-STRESS AND CANNABIS USE 56

499-501) Historical Precursors 59 Antipsychotic (Neuroleptic) Medications Medication treatment often first line

modify brain functioning (+3) Acute and permanent extrapyramidal and Parkinson-like side effects are common (+1

10 Schizophrenia results from elevated Susceptibility plus exposure to stress Example of Cannabis use (+1 +2) DIATHESIS-STRESS MODEL 55 Genetic Predisposition interacts with Cannabis Abuse Risk & Cannabis Use (+1) COMT gene influences neurotransmitter functioning, especially in frontal lobes Inherit Val or Met variant of COMT gene from Mother and Father: 4 possibilities: M+M, M+V, V+M, and V+V V+V group increased risk IF they regularly consume cannabis during adolescence (Caspi et al, 2005) Hypothetical outcome (right) DIATHESIS-STRESS AND CANNABIS USE 56 SCHIZOPHRENIA AND CANNABIS USE 57 TREATMENT OF SCHIZOPHRENIA TREATMENT: BIOLOGICAL (PP ) Historical Precursors 59 Antipsychotic (Neuroleptic) Medications Medication treatment often first line treatment (+1) Began in 1950s: reduced hospitalizations (+2) Most reduce or eliminate positive symptoms, and modify brain functioning (+3) Acute and permanent extrapyramidal and Parkinson-like side effects are common (+1 +4) Compliance often problem because of side effects Transcranial Magnetic Stimulation Relatively untested procedure for treatment of hallucinations 60 10

61 62 63 Frequency of Side Effects in Schizophrenics 64 Muscle Spasms, Tremors, Inner Restlessness, Weight Gain, Loss Of Energy (sedation), Loss of Sex Drive, Effects on Eyes PSYCHOSOCIAL

view and Goals Behavioural (i.e., token economies) on inpatient units (+1) Community care programs Social and living skills training Behavioural family therapy Vocational rehabilitation 1996 British

11 Frequency of Side Effects in Schizophrenics 64 Muscle Spasms, Tremors, Inner Restlessness, Weight Gain, Loss Of Energy (sedation), Loss of Sex Drive, Effects on Eyes PSYCHOSOCIAL INTERVENTIONS (PP ) Historical Precursors Psychosocial Approaches: Overview and Goals Behavioural (i.e., token economies) on inpatient units (+1) Community care programs Social and living skills training Behavioural family therapy Vocational rehabilitation 1996 British Review of treatments (+2) Recent Review of Cognitive-Behavioral Approaches (+3) Psychosocial approaches provide benefits over medication therapy alone Relapse rates lower with psychosocial interventions added to medication (+4) Early Interventions (+5) include Family (& EE +6) 65 Dickerson et al (2005). The token economy for schizophrenia: Review of the literature and recommendations for future research. Schizophrenia Research, 75, principles of operant conditioning and social learning Developed in 1950s and 1960s for long-stay hospital patients 66 Fallen out of favor since 13 controlled studies of token economy reviewed Evidence of token economy's effectiveness in increasing adaptive behaviors of patients with schizophrenia Most studies limited by methodological shortcomings and historical context More research needed to determine specific benefits of token economy when used in combination with contemporary psychosocial and psychopharmacological treatments Wong (2006) Describes successful behavioral programs in 1960s and 1970s, including token economies Argues that behavioral approaches were undermined by perhaps questionable efforts of drug companies and psychiatrists to promote biological model for disorders, a perspective that Wong challenges 11

schizophrenia Effect sizes calculated for 7 studies involving 340 subjects Mean effect size for reduction of psychotic symptoms was 0.

93) Findings suggest that CT effective treatment for schizophrenics with persistent psychotic symptoms Further research needed to: Determine replicability of standardized cognitive interventions

12 67 Gould et al (2004). Cognitive Therapy for Psychosis in 68 Schizophrenia: An Effect Size Analysis Meta-analysis used all available controlled treatment outcome studies of cognitive therapy (CT) for psychotic symptoms in schizophrenia Effect sizes calculated for 7 studies involving 340 subjects Mean effect size for reduction of psychotic symptoms was 0.65 Follow-up analyses in 4 studies indicated that CT patients continued to make gains over time (ES = 0.93) Findings suggest that CT effective treatment for schizophrenics with persistent psychotic symptoms Further research needed to: Determine replicability of standardized cognitive interventions Evaluate clinical significance of cognitive therapy for schizophrenia Determine which patients most likely to benefit PSYCHOSOCIAL TREATMENT (P. 504) Early Interventions for Schizophrenia FAMILY INTERVENTION AND EE 71 SUMMARY OF SCHIZOPHRENIA AND PSYCHOTIC DISORDERS (P. 508) 72 Schizophrenia includes spectrum of cognitive, emotional, and behavioural dysfunctions Positive, Negative, and Disorganized symptom clusters DSM-IV divides schizophrenia into five subtypes Other DSM-IV disorders include psychotic features Several causative factors implicated for schizophrenia Successful treatment rarely includes complete recovery 71 12

Chapter 12. Schizophrenia and Other Psychotic Disorders. PSY 440: Abnormal Psychology. Rick Grieve Western Kentucky University

Chapter 12. Schizophrenia and Other Psychotic Disorders. PSY 440: Abnormal Psychology. Rick Grieve Western Kentucky University Chapter 12 Schizophrenia and Other Psychotic Disorders PSY 440: Abnormal Psychology Rick Grieve Western Kentucky University psychotic disorders disorders so severe that the person has essentially lost