Schizophrenia. Psychotic Disorders. Schizophrenia. Chapter 13

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Schizophrenia Chapter 13 Psychotic Disorders Symptoms Alternations in perceptions, thoughts, or consciousness (delusions and hallucination) DSM-IV categories Schizophrenia Schizophreniform disorder

1 Schizophrenia Chapter 13 Psychotic Disorders Symptoms Alternations in perceptions, thoughts, or consciousness (delusions and hallucination) DSM-IV categories Schizophrenia Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder Psychotic disorder due to general medical condition Substance-induced psychotic disorder Schizophrenia Symptoms Disturbance lasts at least 6 months, including One month of active phase that includes 2 positive or one positive and one negative symptom, and Decline in social or occupational functioning. DSM-IV subtypes Paranoid Catatonic Disorganized Undifferentiated Residual 1

DSM-IV-TR Criteria for Schizophrenia Positive and Negative Symptoms Positive Delusions Faulty interpretations of reality Hallucinations Faulty sensory perceptions Disordered speech Disorganized and

2 DSM-IV-TR Criteria for Schizophrenia Positive and Negative Symptoms Positive Delusions Faulty interpretations of reality Hallucinations Faulty sensory perceptions Disordered speech Disorganized and bizarre behavior Negative Flat affect Poverty of speech Lack of motivation or directedness Loss of energy Loss of feelings of pleasure Positive Symptoms: Delusions Schizophrenia Variety of bizarre content Being controlled or persecuted by others Finding reference to oneself in other s behavior or in printed materials Depression Unjustified guilty Perceived bodily changes Mania Great self-importance Grandiosity Delusional disorder Loved by celebrity/high-status person Suspect spouse or lover of being unfaithful Possession of special and unrecognized talent 2

Negative Symptoms Flat affect Avoid eye contact Immobile, expressionless face Lack of emotion when discussing emotional material Apathetic and uninterested Monotonous voice, low and difficult to hear

3 Negative Symptoms Flat affect Avoid eye contact Immobile, expressionless face Lack of emotion when discussing emotional material Apathetic and uninterested Monotonous voice, low and difficult to hear Poverty of speech Long lapses before responding to questions or failure to answer Restriction on quantity of speech Slow speech Loss of directedness Slow movements Reduction of voluntary movements Inability to initiate activities Little interest in social participation Models of Schizophrenia No known cause, but research has focused on Genetic factors Schizophrenic spectrum disorders Neuro-developmental model Family studies Twin studies Adoption studies Diathesis-stress theory and family and community vulnerability High-risk studies focusing on family and birth history and markers of attention and cognition deficits 3

4 The Familial Risk of Schizophrenia Brain pathology in schizophrenia 4

5 Loss of Brain Tissue in Adolescents with Early-Onset Schizophrenia 5

6 PET scans of the Genain Sisters (Normal) 6

CET (Computer EEG Tomographic) scans of the Genain Sisters (Normal) PET Scans of People with

between the substantia nigra to the caudate nucleus-putamen (neostriatum) compared with normal.

tuberoinfundibular system dopamine transmission is reduced.

7 CET (Computer EEG Tomographic) scans of the Genain Sisters (Normal) PET Scans of People with Schizophrenia Versus Normals Dopamine In schizophrenia there is an increase in dopamine transmission between the substantia nigra to the caudate nucleus-putamen (neostriatum) compared with normal. While in the other major dopaminergic pathways to the mesolimbic forebrain and the tuberoinfundibular system dopamine transmission is reduced. The dopamine hypothesis of schizophrenia proposes that increased levels of dopamine or dopamine receptors in the dorsal and or ventral striatum underlie the disorder. 7

Glutamate In the normal brain the prominent glutamatergic pathways are: the cortico-cocortical pathways; the pathways between the thalamus and the cortex; and the extrapyramidal pathway (the

8 Glutamate In the normal brain the prominent glutamatergic pathways are: the cortico-cocortical pathways; the pathways between the thalamus and the cortex; and the extrapyramidal pathway (the projections between the cortex and striatum). Other glutamate projections exist between the cortex, substantia nigra, subthalmic nucleus and pallidum. The glutamatergic pathways are hypoactive in the brains people diagnosed with schizophrenia and this is thought to cause the confusion and psychosis associated with the disorder. Serotonin The two key serotonergic pathways in schizophrenia are the projections from the dorsal raphe nuclei into the substantia nigra and the projections from the rostral raphe nuclei ascending into the cerebral cortex, limbic regions and basal ganglia. The up-regulation of these pathways leads to hypofunction of the dopaminergic system, and this effect may be responsible for the negative symptoms of schizophrenia. The serotonergic nuclei in the brainstem that give rise to descending serotonergic axons remain unaffected in schizophrenia. Diathesis-Stress Model of Schizophrenia 8

tardive dyskinesia) Skills training programs Family therapy programs Community

9 Family Dynamics in Schizophrenia Treatment of Schizophrenia Antipsychotic drugs Some have side effects (e.g. tardive dyskinesia) Skills training programs Family therapy programs Community support Combined treatment approaches Long-term outcome studies- Prognosis poor though deteriorative effects plateau after 5 to 10 years 9

The role of therapy in preventing relapse Skills Training in Schizophrenia Social skills Self-awareness Affect regulation Social cue recognition Cognitive skills Training in elementary cognitive

10 The role of therapy in preventing relapse Skills Training in Schizophrenia Social skills Self-awareness Affect regulation Social cue recognition Cognitive skills Training in elementary cognitive functions Strategies for dealing with cognitive deficits Cognitive restructuring about source of hallucinations Self-care and symptom-identification Improved grooming and self-care Self-monitoring for symptoms of relapse Skills for dealing with stress Identify indicators of stress Apply cognitive and behavioral techniques Family Interventions in Schizophrenia Education about probable causes, symptoms. and course Information about treatment Instruction in problem-solving and crisis management skills Decease negative expressed emotion (EE) Relapse recognition 10

11 Other Psychotic Disorders Schizoaffective disorder Delusions or hallucinations combined with symptoms of depression or manic mood Delusional disorder Less bizarre than schizophrenia delusions; usually related to a particular topic and have some foundation in real life. Shared psychotic disorder Two or more people who share shame delusional belief; one originates, the other follows. Occurrence is rare. 11

Schizophrenia and Other Psychotic Disorders

Schizophrenia and Other Psychotic Disorders Chapter 14 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display,