Chapter 12 Schizophrenia & Related Disorders PDF
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This document provides information on schizophrenia and related psychological disorders. It covers key features, duration, lifetime prevalence, and other relevant details. It also briefly explores the diagnostic criteria and types of symptoms.
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Problems of Psychosis Chapter 12 - Schizophrenia and Related Disorders Differential Diagnosis Disorder Key Features Duration Lifetime Prevalence Schizophrenia...
Problems of Psychosis Chapter 12 - Schizophrenia and Related Disorders Differential Diagnosis Disorder Key Features Duration Lifetime Prevalence Schizophrenia arious psychotic symptoms (delusions, hallucinations, disorganized speech, V 6 months or more 1.0% restricted/inappropriate affect, catatonia) Brief Psychotic Disorder Various psychotic symptoms as above Less than 1 month Unknown Schizophreniform Disorder Various psychotic symptoms as above 1 to 6 months 0.2% Schizoaffective Disorder arked symptoms of both schizophrenia and a major depressive or manic M 6 months or more Unknown episode Delusional Disorder ersistent delusions not bizarre, not due to schizophrenia; persecutory, jealous, P 1 month or more 0.1% grandiose, and somatic delusions common sychotic Disorder due to Another P allucinations, delusions, or disorganized speech caused by medical illness or H No minimum length Unknown Medical Condition brain damage ubstance/Medication-Induced S allucinations, delusions, or disorganized speech caused directly by a H No minimum length Unknown Psychotic Disorder substance (e.g., abused drug) Schizophrenia Psychosis ○ State in which a person loses contact with reality in key ways. ○ Most commonly appears as schizophrenia. Schizophrenia ○ A psychotic disorder in which personal, social, and occupational functioning deteriorates as a result of: Unusual perceptions Odd thoughts Disturbed emotions Motor abnormalities Prevalence: ○ 1 of 100 experience schizophrenia during lifetime. ○ 20 million worldwide; 3.2 million in the United States. ○ Equally distributed between men and women. Average age at onset→23 for men; 28 for women. Criteria: ○ For 1 month, individual displays two or more of the following symptoms much of the time: Delusions Hallucinations Disorganized speech Very abnormal motor activity, includingCATATONIA(stuck in a physical state) Negative symptoms ○ At least one of the individual’s symptoms must be delusions, hallucinations, or disorganized speech. ○ Poor Functioning →Individual functions much more poorly in various life spheres than prior to the symptoms. ○ Beyond 1 month →Individual continues to display some degree of impaired functioning (MOST IMPORTANT SYMPTOM) for at least 5 additional months Extra: ○ Symptoms Can Decline After Adulthood ○ Delusions→ fixed beliefs not based in reality ○ Hallucinations→ false sensory experiences ○ Inappropriate affect ○ Diagnosis→ Males > Females → B/c females have delayed onset but It is equally distributed between genders. Overlap→ Gen/Bio overlap with AUTISM SES(Socioeconomic Status)Correlation: ○ Lower SES→ More frequently found in lower-SES groups. ○ Downward Drift Theory →Disorder causes sufferers to fall into lower SES. 3 Types of Symptoms )Positive Symptoms(Positive = APPLYING (or 1 )Negative Symptoms(Negative = REMOVING 2 3)Psychomotor Symptoms implying) something): Something): Awkward movements, repeated grimaces, and Pathological excesses or bizarre additions to a Pathological Deficits: odd gestures. person’s behavior. ○Poverty of Speech (ALOGIA):Reduction of ○Movements seem to have a ritualistic or magical Most often found: quantity of speech or speech content. quality. ○Delusions May also say quite a bit but convey little Symptoms may take extreme forms, collectively meaning. calledCATATONIA: ○Disorganized thinking and speech ○Restricted Affect: ○Stupor ○Heightened perceptions and hallucinations Show less emotion than most people. ○Rigidity ○Inappropriate affect Avoidance of eye contact. ○Posturing Delusions →Single or many, including: Immobile, expressionless face. ○Excitement ○Persecution ○Blunted Affect →Less Emotion Experienced by about 10% of people with ○Reference→ Be;oef that neutral events have schizophrenia. personal significance or directed at the individual ○Flat Affect →NO emotion at all (robotic like) ○Grandeur→ Feeling of grandiosity Worse than blunted ○Control Similar to depression symptoms ○FOR EXAM→ Remember categories Loss of Volition (AVOLITION): Disorganized Thinking & Speech: ○Feeling drained of energy and interest in normal goals. ○Loose associations or derailment(Loose associations = jumping topics) ○Inability to start or follow through on a course of action. ○Neologisms→ Made up words ○AMBIVALENCE:Conflicted feelings about most ○Perseveration things. ○Clang or rhymes→ Repetition of words Social Withdrawal: Heightened Perceptions & Hallucinations ○Illogical and confused ideas. (Hallucinations = NO External Stimuli): ○Withdrawal from social environment, focusing ○Problems of perception and attention. only on own ideas and fantasies. ○Perceptions in the absence of external stimuli ○Leads to social skill breakdown, including (auditory, tactile, visual, gustatory). inability to recognize needs and emotions of ○May occur together and/or involve other senses. others. ○Hallucinations= NO external stimuli Inappropriate AffectEmotional Mismatch) ○Situationally unsuitable→Responding in a way that does not make sense ○May sometimes be an emotional response to other disorder features. Course and Diagnosis of Schizophrenia Course of Schizophrenia: ○ When→ Usually first appears between the late teens and mid-thirties. ○ 3 Phases: 1)PRODROMAL →Beginning of deterioration; mild symptoms. 2)ACTIVE →Symptoms become apparent (Active Phase = Visible Symptoms). (VERY QUICK) 3)RESIDUAL →Return to prodromal-like levels. → No longer constantly/actively psychotic but there is still something off. Types(Dominated by…): ○ TYPE ISchizophrenia →POSITIVE (+) symptoms. → Better treatment response. (ACTING ON DOPAMINE) ○ TYPE IISchizophrenia →NEGATIVE (-) symptoms. → Has defects on the brain 3 Theoretical Explanations/VIEWS 1)Biological Views 2)Psychological Views Inheritance and brain activity play key roles. Psychodynamic Explanation: Genetic Factors (DIATHESIS-STRESS PERSPECTIVE= Diathesis-Stress→ Interaction of genes ○Fromm-Reichmann:Schizophrenogenic mothers(little research and stress): support). ○Relatives of people with schizophrenia. Moms were blamed ○Twins with schizophrenia(Twin Studies = STRONG Evidence). Refrigerator Mom = autism ○People with schizophrenia who are adopted. Self Theorists: ○Direct genetic linkage research and molecular biology. ○Biological deficiencies cause development of a fragmented self. ○Extra: 3)Sociocultural Views Stress impacts → Stress in family or transgenerational Social Labeling: + genetically similar = + chance of having it ○Features influenced by diagnosis (self-fulfilling prophecy). Biochemical Abnormalities ○Rosenhan study →Impact of pseudopatients. ○Dopamine Hypothesis: Sort of like confirmation bias Certain neurons using dopamine fire too often, producing symptoms. Examined effects of psychiatric labeling on schizophrenia diagnosis Based on the effectiveness of antipsychotic drugs. and treatment. ○Challenge to Dopamine Hypothesis: Family Dysfunction: But Dopamine isn’t the whole story! ○Linked to family stress. Discovery of new antipsychotic drugs (ATYPICAL/SECOND-GENERATION ○HIGH EXPRESSED EMOTIONcorrelates with relapse. ANTIPSYCHOTICS). ○People with schizophrenia are often difficult to live with Atypical Antipsychotics→ Broader neurotransmitter impact. Relation may involve abnormal activity of multiple neurotransmitters. Viral Problems: ○Exposure to viruses before birth triggers a passed-on immune response that interrupts fetal brain development. ○If mom exposed to flu on 3rd trimester = Autism or schizophrenia Dysfunctional Brain Structures & Circuitry: ○Brain circuit structures and interconnections unique to schizophrenia. ○Schizophrenia-related circuits may involve two distinct, sometimes overlapping structures. ○Abnormal neurotransmitter activity contributes to circuit dysfunction. ○Dysfunctional brain structure or circuit = key to understanding complexity. 7 Treatments 1)Antipsychotic Medications 2)First-Generation Antipsychotics(Neuroleptics) 3)Second-Generation Antipsychotics Discovered in the 1940s (Antihistamines → General Biological Operations: Phenothiazines). ○Reduce symptoms in about 70% (A LOT) of ○More effective for negative symptoms. ○ANTIHISTAMINESused for allergies were used to patients. ○Fewer extrapyramidal effects and seem less likely calm patients about to undergo surgery → Acting ○More effective for positive symptoms than to cause tardive dyskinesia on DOPAMINE (were most helpful at the time) negative symptoms. ○ Carry a risk of a life-threatening drop in white ○First-gen drugs = Dopamine-targeted. blood cells (AGRANULOCYTOSIS) ○Reduce positive symptoms ○May cause weight gain, dizziness and significant elevations in blood sugar Unwanted Effects 4)Psychotherapy ○Extrapyramidal Effects →Parkinsonian 6)Family Therapy symptoms. Rare before antipsychotics. Many persons recovering from schizophrenia and VERY UNWANTED SIDE EFFECTS other severe disorders live with family members. Today, it includes cognitive-behavioral and family therapies. ○Neuroleptic Malignant Syndrome →Severe ○Special pressures created. reaction. ○Cognitive-Behavioral Therapies ○High levels of negative expressed emotions by ○Tardive Dyskinesia →Involuntary movements, family members related to higher relapse rate. ○Sociocultural Interventions → often permanent. Family Therapy Prescribing Today Social Therapy ○For some, only small dosage reductions are )Effective Community Care & Assertive 7 possible, and treatment typically involves Community Treatment long-term use of monitored high dosages. Coordinated services ○Strategies When Patients do NOT Improve Short-term hospitalization ○Coordinated Specialty Care Increase the dose Partial hospitalization Add additional drug to achieve a synergistic Supervised residences 5)Cognitive-Behavioral Therapies effect (called polypharmacy) Occupational training and support Hallucination reinterpretation and acceptance Stop drug and try alternative one or stop all Therapists help change how clients view and react to medications Historical Institutional Care their hallucinations. Before→ Schizophrenia= Automatic Hospitalization Combination of behavioral and cognitive techniques Often help improve feeling more control over hallucinations and reduction of delusional ideas Homelessness & Schizophrenia People with schizophrenia and other severe disorders have become homeless. ○ Because they are released or don't have someone to care for them
