Lect 6 Schizophrenia (2).pdf

Schizophrenia Spectrum and Other Psychotic Disorders Prof. Faris Alsaraireh Copyright ©2021 F.A. Davis Company  Introduction ▪ The word schizophre...

Schizophrenia Spectrum and Other Psychotic Disorders Prof. Faris Alsaraireh Copyright ©2021 F.A. Davis Company  Introduction ▪ The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind). ▪ Schizophrenia is probably caused by a combination of factors. Genetic predisposition Biochemical dysfunction Physiological factors Psychosocial stress Copyright ©2021 F.A. Davis Company  Introduction (continued_1) ▪ There is not now and may never be a single treatment that cures schizophrenia. ▪ Schizophrenia requires treatment that is comprehensive and presented in a multidisciplinary effort. Copyright ©2021 F.A. Davis Company  Introduction (continued_2) ▪ Of all mental illnesses, schizophrenia probably causes more Lengthy hospitalizations Chaos in family life Exorbitant costs to people and governments Fears ▪ Risk for suicide is a major concern. About one-third of people with schizophrenia attempt suicide and about 1 in 10 die from the act. Copyright ©2021 F.A. Davis Company  Nature of the Disorder ▪ Psychosis A severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of, reality. May be evidence of hallucinations and delusional thinking Can occur with or without organic impairment Copyright ©2021 F.A. Davis Company  Nature of the Disorder (continued_1) ▪ Schizophrenia causes disturbances in Thought processes Perception Affect ▪ With schizophrenia, there is a severe deterioration of social and occupational functioning. ▪ In the United States, the lifetime prevalence of schizophrenia is about 1 percent. Copyright ©2021 F.A. Davis Company  Nature of the Disorder (continued_2) ▪ Schizophrenia may be viewed in four phases The premorbid phase The prodromal phase The active psychotic phase (acute schizophrenic episode) The residual phase Copyright ©2021 F.A. Davis Company  Phase I-Premorbid Phase ▪ Personality and behavior indicators: Shy and withdrawn Poor peer relationships Poor school performance Antisocial behavior ▪ Current research is focused on the premorbid phase to identify potential biomarkers and at- risk individuals in an effort to prevent transition to illness or provide early intervention. Copyright ©2021 F.A. Davis Company  Phase II-Prodromal Phase ▪ Personality and behavior indicators (continued): Significant deterioration in function 50 percent have depressive symptoms Social withdrawal Cognitive impairment Obsessive-compulsive behavior Copyright ©2021 F.A. Davis Company  Phase III-Active Psychotic Phase ▪ Personality and behavior indicators (continued): Psychotic symptoms are typically prominent. Delusions Hallucinations Disorganized speech and behavior Decreased level of functioning in work, personal relationships, or self-care Copyright ©2021 F.A. Davis Company  Phase IV-Residual Phase ▪ Personality and behavior indicators (continued): Active psychotic phase symptoms are either absent or no longer prominent. Positive symptoms may remain. Flat affect and impairment in role functioning are common. ▪ Current research indicates that negative symptoms can improve over time; residual impairment often increases with additional episodes of active psychosis. Copyright ©2021 F.A. Davis Company  Prognosis ▪ A return to full premorbid functioning is not common. ▪ Factors associated with a positive prognosis include: Good premorbid functioning Later age at onset Female gender Abrupt onset precipitated by a stressful event Associated mood disturbance Brief duration of active-phase symptoms Copyright ©2021 F.A. Davis Company  Prognosis (continued_1) ▪ Positive prognosis factors (continued): Minimal residual symptoms Absence of structural brain abnormalities Normal neurological functioning Family history of mood disorder No family history of schizophrenia Copyright ©2021 F.A. Davis Company  Predisposing Factors ▪ Biological influences Genetics ‒ A growing body of knowledge indicates that genetics play an important role in the development of schizophrenia. ▪ Lifetime risk in population studies (1%) ▪ Sibling of identified patient risk (10%) ▪ Child of identified parent risk (5% to 6%) Copyright ©2021 F.A. Davis Company  Predisposing Factors (continued_1) ▪ Biological influences (continued) Biochemical influences ‒ One theory suggests that schizophrenia may be caused by an excess of dopamine activity in the brain. ‒ Abnormalities in other neurotransmitters have also been suggested. Copyright ©2021 F.A. Davis Company  Predisposing Factors (continued_2) ▪ Biological influences (continued) Physiological influences ‒ Factors that have been implicated include ▪ Viral infection ▪ Anatomical abnormalities Copyright ©2021 F.A. Davis Company  Predisposing Factors (continued_3) ▪ Psychological factors These theories no longer hold credibility. Researchers now focus their studies of schizophrenia as a brain disorder. Psychosocial theories probably developed early on out of a lack of information related to a biological connection. Copyright ©2021 F.A. Davis Company  Predisposing Factors (continued_4) ▪ Environmental influences Sociocultural factors ‒ Poverty has been linked with the development of schizophrenia. Stressful life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse. Studies of genetic vulnerability for schizophrenia have linked certain genes to increased risk for psychosis and particularly for adolescents who use cannabinoids. Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders ▪ Delusional disorder ‒ Erotomanic type ‒ Grandiose type ‒ Jealous type ‒ Persecutory type ‒ Somatic type ‒ Mixed type Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders (continued_1) ▪ Brief psychotic disorder Sudden onset of symptoms May or may not be preceded by a severe psychosocial stressor Lasts less than 1 month Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders (continued_2) ▪ Substance-induced psychotic disorder The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders (continued_3) ▪ Psychotic disorder associated with another medical condition Prominent hallucinations and delusions are directly attributable to a general medical condition. Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders (continued_4) ▪ Catatonic disorder due to another medical condition Metabolic disorders (e.g., hepatic encephalopathy, diabetic ketoacidosis, hypo- and hyperthyroidism, hypo- and hyperadrenalism, hypercalcemia, and vitamin B12 deficiency) Neurological conditions (e.g., epilepsy, tumors, cerebrovascular disease, head trauma, and encephalitis) Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders (continued_5) ▪ Schizophreniform disorder Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months Copyright ©2021 F.A. Davis Company  Other Schizophrenia Spectrum and Psychotic Disorders (continued_6) ▪ Schizoaffective disorder Schizophrenic symptoms accompanied by a strong element of symptomatology associated with either mania or depression Copyright ©2021 F.A. Davis Company  symptomatology ▪ Positive symptoms: Disturbances in thought content ‒ Delusions: False personal beliefs ‒ Paranoia: Extreme suspiciousness of others ‒ Magical thinking: Ideas that one’s thoughts or behaviors have control over specific situations Copyright ©2021 F.A. Davis Company  (continued_1) ▪ Disturbances in thought processes manifested in speech Loose associations: Shift of ideas from one unrelated topic to another Neologisms: Made-up words that have meaning only to the person who invents them Clang associations: Choice of words is governed by sound Copyright ©2021 F.A. Davis Company  (continued_2) ▪ Disturbances in thought processes manifested in speech (continued) Word salad: Group of words put together in a random fashion Circumstantiality: Delay in reaching the point of a communication because of unnecessary and tedious details Tangentiality: Inability to get to the point of communication due to introduction of many new topics Copyright ©2021 F.A. Davis Company  (continued_3) ▪ Disturbances in thought processes manifested in speech (continued) Perseveration: Persistent repetition of the same word or idea in response to different questions Echolalia: Echolalia refers to repeating words or phrases spoken by another Copyright ©2021 F.A. Davis Company  (continued_4) ▪ Disturbances in perception Hallucinations may involve any of the five senses: ‒ Auditory ‒ Visual ‒ Tactile ‒ Gustatory ‒ Olfactory Illusions are misperceptions or misinterpretations of real external stimuli. Echopraxia imitates movements made by others. Copyright ©2021 F.A. Davis Company  (continued_5) ▪ Negative symptoms Disturbances in affect: Feeling state or emotional tone ‒ Inappropriate affect: Emotions are incongruent with the circumstances ‒ Bland: Weak emotional tone ‒ Flat: Appears to be void of emotional tone Avolition: Inability to initiate goal-directed activity Copyright ©2021 F.A. Davis Company  (continued_6) ▪ Negative symptoms (continued) Lack of interest or skills in interpersonal interaction Lack of insight Anergia Lack of abstract thinking ability Associated features ‒ Waxy flexibility ‒ Posturing ‒ Pacing and rocking ‒ Regression ‒ Eye movement abnormalities Copyright ©2021 F.A. Davis Company  (continued_7) ▪ Outcome criteria The patient: ‒ Demonstrates an ability to relate satisfactorily to others ‒ Recognizes distortions of reality ‒ Has not harmed self or others ‒ Perceives self realistically ‒ Demonstrates the ability to perceive the environment correctly ‒ Maintains anxiety at a manageable level Copyright ©2021 F.A. Davis Company  (continued_8) ▪ Outcome criteria (continued) The patient (continued): ‒ Relinquishes the need for delusions and hallucinations ‒ Demonstrates the ability to trust others ‒ Uses appropriate verbal communication in interactions with others ‒ Performs self-care activities independently Copyright ©2021 F.A. Davis Company  Treatment Modalities ▪ Psychological treatments Individual psychotherapy Group therapy Family therapy ▪ Behavior therapy Copyright ©2021 F.A. Davis Company  Treatment Modalities (continued_1) ▪ Psychopharmacological treatment Antipsychotics ‒ Used to decrease agitation and psychotic symptoms of schizophrenia and other psychotic disorders Copyright ©2021 F.A. Davis Company  Treatment Modalities (continued_2) ▪ Psychopharmacology (continued) Indications ‒ Antipsychotic medications are used in the treatment of schizophrenia and other psychotic disorders. Action Dopaminergic blockers Copyright ©2021 F.A. Davis Company  Antipsychotics ▪ Side effects Anticholinergic effects Agranulocytosis Nausea, gastrointestinal Extrapyramidal upset symptoms Skin rash Sedation Orthostatic hypotension Photosensitivity Hypersalivation Weight gain Copyright ©2021 F.A. Davis Company  Antipsychotics (continued_1) ▪ Extrapyramidal symptoms (EPS) Pseudoparkinsonism Akinesia (the inability to perform a clinically perceivable movement.) Akathisia (inability to remain still) Dystonia (person's muscles contract uncontrollably) Oculogyric crisis (the involuntary upward deviation of both eyes due to spasms and increased tone in the extraocular muscles) Antiparkinsonian agents may be prescribed to counteract EPS. Copyright ©2021 F.A. Davis Company  Thank You Copyright ©2021 F.A. Davis Company