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, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: 0-205-50294-6 Allyn & Bacon copyright 2000 1 What Is Schizophrenia? Thought Disorder--NOT multiple personalities Characterized by: Bizarre thinking Inappropriate emotional response Lack of reality testing Deterioration of social and intellectual functioning Symptoms must begin before age 45 Must be present for at least 6 months 1 month more or less continuously Impaired reality testing and disturbance in functioning makes schizophrenic disorder a type of Psychosis Schizophrenia Must have 2 of the 5 symptoms: Delusions Hallucinations Disorganized behavior Disorganized speech Negative symptoms Substances and Medical MUST be ruled out first! Allyn & Bacon copyright 2000 3 1
Schizophrenia Psychosis: Significant loss of contact with reality Symptoms: Positive: Delusions and hallucinations Negative: Inability to read others emotions Allyn & Bacon copyright 2000 4 Positive Symptoms in Schizophrenia Reflect an excess or distortion in a normal repertoire of behavior and experience such as: Delusions Hallucinations Disorganized speech Disorganized behavior Something has been added Allyn & Bacon copyright 2000 5 Delusions Thought Distortions: Disordered thinking False beliefs Grandeur: Believe they are someone great (God, president) Persecution: People are out to get them. Reference: People are talking about them. Thought Broadcasting: People can read their minds. Thought Insertion: Others are putting bad thoughts into their minds. 2
Delusions Guilt: Feel they have committed an error or something grave Ill health: Believe they have a terrible disease Jealousy: Believe their partner s unfaithful Passivity: Controlled or manipulated by outside influence-radio, TV Poverty: Fear of destitution despite evidence of the contrary Allyn & Bacon copyright 2000 7 Hallucinations False sensory perceptions Perceptual Distortions Compelling perceptual experiences that occur without any physical stimulus Auditory hallucinations (hearing voices) most common Voices are perceived as coming from outside the person Voices comment on or direct behavior Illusions Misinterpretation of actual stimuli usually occurring at night due to decreased sensory input Common/usually normal Allyn & Bacon copyright 2000 9 3
Hallucinations Visual: Seeing things (demons) Olfactory: Smelling things (smoke, decaying fish) Tactile: Sensation that something is crawling on or under the skin Allyn & Bacon copyright 2000 10 Disorganized Speech AKA: Loose associations Impaired language use: Word salad Memory deficits Working and long-term memory Attention problems So badly impaired that it interferes with communication Allyn & Bacon copyright 2000 11 Disorganized Behavior Physical actions that do not appear to be goal-directed For example: taking clothes off in public Repeatedly making the sign of the cross Assuming and maintaining posture Allyn & Bacon copyright 2000 12 4
Negative Symptoms in Schizophrenia Reflect an absence or deficit of behaviors that are normally present Reduced range of expression Flat or blunted emotional expressiveness (affect) Alogia: Poverty of speech Avolition: Lack of desire, motivation, persistence to do things Negative-gives the impression that something has been taken away Allyn & Bacon copyright 2000 13 Distortions in Emotional Reactions Inappropriate affect Emotional responses that are not appropriate for the situation Sometimes there is absence of affect Flat Affect Sometimes a range of emotions are experienced very quickly Ambivalent Affect Subtypes of Schizophrenia Paranoid Type 295.30 Disorganized Type 295.10 Catatonic Type 295.20 Undifferentiated Type 295.90 Residual Type 295.60 Allyn & Bacon copyright 2000 15 5
Schizophrenia, Paranoid Type No negative symptoms Delusions of grandeur and/or persecution Possibly hallucinations Both organized around a theme E.g., Aliens are stealing my thoughts. Often little cognitive or other impairments Higher rates of recovery than other types Schizophrenia, Disorganized Type Most psychotic Delusions and hallucinations are less prominent than negative symptoms Severely disturbed thought processes, disorganized behavior, incoherent, inappropriate affect Disintegration of normal personality Total lack of reality testing Schizophrenia, Catatonic Type Impairments in motor activity. Excited Catatonic Schizophrenia Bursts of violent or excited motor activity Excessive talking and shouting Withdrawn or Retarded Catatonic Schizophrenia Little to no motor or verbal activity at all (Stupor) Muscular rigidity Waxy Flexibility: Molded into different positions And Bizarre Behavior 6
Emil Kraeplin First described Schizophrenia in 1874 Subgroup dementia praecox During the early 20 th century each of the subtypes constituted 1/3 of US hospital admissions for schizophrenia. Now unusual Allyn & Bacon copyright 2000 19 Schizophrenia, Undifferentiated Type All the essential features of a schizophrenic disorder Symptoms do not fit easily into one of the other types Some of all of the 5 basic types of psychotic symptoms None of the symptoms dominate Residual Schizophrenia After an acute psychosis has markedly improved, they appear as odd, unusual, peculiar In touch with reality despite schizophrenic symptoms At least one previous episode of another type Allyn & Bacon copyright 2000 21 7
Schizophrenia-Like Disorders Schizoaffective Disorder Schizophreniform Disorder Brief Psychotic Disorder Allyn & Bacon copyright 2000 22 Schizoaffective Disorder Symptoms of Schizophrenia for at least one month. Positive symptoms of mania or depression Allyn & Bacon copyright 2000 23 Schizophreniform All of the symptoms of Schizophrenia Ill for Less than 6 months Allyn & Bacon copyright 2000 24 8
Brief Psychotic Disorder One psychotic symptom for at least one month Psychotic for at least one day and then return to normal Allyn & Bacon copyright 2000 25 Disorders with Delusions Delusional Disorder Shared Psychotic Disorder Allyn & Bacon copyright 2000 26 Delusional Disorder Non-bizarre delusions No symptoms of Schizophrenia Allyn & Bacon copyright 2000 27 9
Shared Psychotic Disorder Extremely rare Effects women more than men Runs in families Persons develops delusions similar to those held by a close relative or associate Allyn & Bacon copyright 2000 28 Disorder with Psychosis as Symptoms Mood Disorder w/ Psychosis: Pt w/ Major Depressive Episode or Manic Episode can have hallucinations and mood-congruent delusions Allyn & Bacon copyright 2000 29 Cognitive Disorder W/ Psychosis Dementia with hallucinations Allyn & Bacon copyright 2000 30 10
Personality Disorder Borderline Personality Disorder: transient periods (minutes to hours) when they appear delusional Allyn & Bacon copyright 2000 31 Other Psychotic Disorders Psychotic Disorder Due to General Medical Condition Substance Induced Psychotic Disorder Psychotic Disorder NOS Allyn & Bacon copyright 2000 32 Causes of Schizophrenia Biological Factors Concordance rates Degree to which the disorder is shared by two or more individuals or groups Higher for identical than fraternal twins 86% versus 15% Neurotransmitters Dopamine theory of schizophrenia» Symptoms caused by too much dopamine 11
Environmental Factors Prenatal malnutrition and infection, birth injuries/complications Exposure to lead, poverty, city life Family factors Loss of a parent in childhood Childhood Depression or Bipolar Disorder Psychosocial and Cultural Aspects Many theories about bad families causing schizophrenia have not stood the test of time including The idea of the schizophrenic mother The double-bind hypothesis Instead, communication problems may be the result of having a schizophrenic in the family Patients with schizophrenia are more likely to relapse if their families are high in expressed emotion Allyn & Bacon copyright 2000 35 Treatment Antipsychotic Drugs: Block Dopamine receptors Two types of antipsychotics Conventional (neuroleptics) Novel Patients taking novel antipsychotics Have fewer extrapyramidal (motor abnormality) side effects Tend to do better overall Allyn & Bacon copyright 2000 36 12
Psychosocial Approaches Case Management Social-Skills Training Cognitive-Behavioral Therapy Other forms of individual treatment Family Therapy Allyn & Bacon copyright 2000 37 Family Therapy Provides families with communication skills Reduces high levels of expressed emotion Allyn & Bacon copyright 2000 38 13