Schizophrenia Spectrum and Other Psychotic Disorders PDF

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS WHAT COMES TO YOUR MIND WHEN YOU HEAR THE WORD “SCHIZOPHRENIA”?  At times, people with schizophrenia think and communicate clearly, have an accurate view of reality, and function well in dai...

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS WHAT COMES TO YOUR MIND WHEN YOU HEAR THE WORD “SCHIZOPHRENIA”?  At times, people with schizophrenia think and communicate clearly, have an accurate view of reality, and function well in daily life During the active phase of their illness, their thinking and speech are disorganized, they lose OVERVIEW OF touch with reality, and they have difficulty caring for themselves SCHIZOPHRENIA They live independently or with their families Psychosis is its core symptom SCHIZOPHRENIA Reflects the fact that there are five domains of symptoms that define SPECTRUM psychotic disorders, and their number, severity, and duration distinguish psychotic disorders from each other SYMPTOMS Positive symptoms Negative symptoms Often shows cognitive deficits  Delusions Hallucinations POSITIVE Disorganized thought and SYMPTOMS speech Disorganized behavior DELUSIONS Are ideas that an individual believes are true but that are highly unlikely and often simply impossible. DELUSIONS TYPES DEFINITION Persecutory delusion False belief that oneself or one’s loved ones are being persecuted, watched, or conspired against by others Delusion of reference Belief that everyday events, objects, or other people have an unusual personal significance Grandiose delusion False belief that one has great power, knowledge, or talent, or that one is a famous or powerful person Delusion of being controlled Beliefs that one’s thoughts, feelings, or behaviors are being imposed or controlled by an external force DELUSIONS TYPES DEFINITION Thought broadcasting Belief that’s one’s thoughts are being broadcast from one’s mind for others to hear Thought insertion Belief that another person or object is inserting thoughts into one’s mind Thought withdrawal Beliefs that thoughts are being removed from one’s mind by another person or by an object Delusion of guilt or sin False belief that one has committed a terrible act or is responsible for a terrible event Somatic delusion False belief that one’s appearance or part of one’s body is diseased or altered DELUSIONS Also occur in severe forms of depression and bipolar disorder and it is often consistent with their moods All though all types of delusions occur in all cultures, they likely differ across cultures The DSM-5 changed the definition of delusions to “fixed beliefs that are not amenable to change in light of conflicting evidence” from “erroneous beliefs” HALLUCINATIONS Unreal perceptual experiences More frequent, persistent, complex, sometimes more bizarre, and often entwined with delusions Not precipitated simply by sleep deprivation, stress, or drugs AUDITORY HALLUCINATIONS Hearing voices, music, etc. that may come in from inside the person’s head or from someone outside The most common hallucination Often have a negative quality, criticizing or threatening the individuals or telling them to hurt themselves or others May talk back to the voices even as they are trying to talk back to people who are actually in the room with them VISUAL HALLUCINATIONS Most common type of hallucination Often accompanied by auditory hallucinations TACTILE HALLUCINATIONS Perception that something is happening outside the person’s body Somatic hallucinations involve the perception that something is happening inside the person’s body DISORGANIZED THOUGHT AND SPEECH Often referred to as formal thought disorder One of the most common forms in schizophrenia is loose associations or derailment At times, a person’s speech is so disorganized as to be totally incoherent to the listener– word salad DISORGANIZED THOUGHT AND SPEECH The person may make up words that mean something only to him or her, known as neologisms The person may make associations between words based on the sounds of the words rather than on the content– clangs They may repeat the same word over and over Men with schizophrenia tend to show more severe deficits in language than do women with schizophrenia DISORGANIZED OR CATATONIC BEHAVIOR May display unpredictable and apparently untriggered agitation They often have trouble organizing their daily routines of bathing, dressing properly, and eating regularly They may engage in socially unacceptable behavior Many are disheveled and dirty DISORGANIZED OR CATATONIC BEHAVIOR May display unpredictable and apparently untriggered agitation They often have trouble organizing their daily routines of bathing, dressing properly, and eating regularly They may engage in socially unacceptable behavior Many are disheveled and dirty DISORGANIZED OR CATATONIC BEHAVIOR CATATONIA- a disorganized behavior that reflects unresponsiveness to the environment -ranges from negativism to showing a rigid, inappropriate, or bizarre posture, to a complete lack of verbal response (e.g. mutism) CATATONIC EXCITEMENT- the person shows purposeless and excessive motor activity for no apparent reason -the individual articulate a number of delusions or hallucinations or maybe incoherent  NEGATIVE Restricted affect SYMPTOMS Avolition/Asociality RESTRICTED AFFECT Refers to a severe reduction in or absence of emotional expression Show fewer facial expression of emotion May avoid eye contact Less likely to use gestures to communicate emotional information AVOLITION/ ASOCIALITY Refers to the inability to initiate or persist at common, goal-directed activities, including those at work, school, and at home Physically slowed down in their movements Personal hygiene and grooming are lacking May be expressed as asociality COGNITIVE DEFICITS Deficits in attention, memory, and processing speed They have greater difficulty in focusing and maintaining their attention at will They show deficit in their working memory COGNITIVE DEFICITS Deficits in attention, memory, and processing speed They have greater difficulty in focusing and maintaining their attention at will They show deficit in their working memory COGNITIVE DEFICITS Deficits in attention, memory, and processing speed They have greater difficulty in focusing and maintaining their attention at will They show deficit in their working memory COGNITIVE DEFICITS Deficits in attention, memory, and processing speed They have greater difficulty in focusing and maintaining their attention at will They show deficit in their working memory HISTORICAL OVERVIEW Emil Kraeplin labeled the disorder as dementia praecox HISTORICAL OVERVIEW Eugen Bleuler introduced the label schizophrenia from the Greek words, “schizein” meaning “to split,” and “phren,” meaning “mind”  Must show at least two or more symptoms of psychosis (at least one of which should be delusions, DIAGNOSIS hallucinations, or disorganized speech) that are consistently and acutely present for at least one month The individual must have some symptoms of the disorder for at least six months to a degree that impairs social or occupational functioning When symptoms of catatonia are present, these symptoms must be specified in the diagnosis DIAGNOSIS During the six months before and after the active phase, the individual may show predominantly negative symptoms, with milder forms of the positive symptoms– prodromal symptoms (before the acute phase) and residual symptoms (after the acute phase) DIAGNOSIS Left untreated, it is both chronic and episodic After the first onset of an acute episode, individuals may have chronic residual symptoms punctuated by relapses into acute episodes The odd behaviors and asociality of schizophrenics can resemble the symptoms of autism spectrum disorders DIAGNOSIS People with schizophrenia who show many negative symptoms have lower levels of educational attainment and less success holding jobs, poorer performance on cognitive tasks, and a poorer prognosis than do those with predominantly positive symptoms (Andreasen et al., 1990; Messinger et al., 2011) DIAGNOSIS “PARANOID SCHIZOPRENIA” The DSM-5 dropped the DSM-IV subtypes of schizophrenia PROGNOSIS One of the most severe and debilitating disorders Many people with Schizophrenia suffer symptoms and impairment for many years, even with treatment (Harrow, Grossman, Jobe, & Herbener, 2005 Rehospitalization among Schizoprenia patients is between 50 and 80 percent (Eaton, Moortensenk, Herrman, & Freeman, 1992; Harrow et al., 2005). PROGNOSIS Their life expectancy is 10 years shorter compared to people without the disorder (McGlashan, 1988; Mortensen, 2003) They suffer from infectious and circulatory diseases at a higher rate than do people without the disorder for reasons that are unclear As many as 10 to 15 percent of people with schizophrenia commit suicide (Joiner, 2005) PROGNOSIS Women tend to have better prognosis than men (Seeman, 2008) With both men and women functioning seems to improve with age (Jablensky, 2000; Harrow et al., 2005) Schizophrenia tends to have a more benign course in developing countries than in developed countries (Anders, 2003; Jablensky, 2000) THE SPECTRUM DEFICITS IN ATTENTION AND WORKING MEMORY DELUSIONAL DISORDER BRIEF PSYCHOTIC DISORDER SCHIZOAFFECTIVE DISORDER FUNCTIONAL SCHIZOTYPAL PERSONALITY NO LONGER DISTINGUISHED SCHIZOPHRENIFORM SCHIZOPHRENIA DISORDER IN THE DSM-5 DISORDER DYSFUNCTIONAL OTHER PSYCHOTIC DISORDERS SCHIZOAFFECTIVE DISORDER- a mix of Schizophrenia and a mood disorder -mood symptoms must be present for the majority of the period of illness -requires at least 2 weeks of hallucinations or delusions without mood symptoms OTHER PSYCHOTIC DISORDERS SCHIZOPHRENIFORM DISORDER- requires that individuals meet Criteria A, D, and E for schizophrenia but show symptoms that last only 1 to 6 months OTHER PSYCHOTIC DISORDERS SCHIZOPHRENIFORM DISORDER- requires that individuals meet Criteria A, D, and E for schizophrenia but show symptoms that last only 1 to 6 months OTHER PSYCHOTIC DISORDERS BRIEF PSYCHOTIC DISORDER- a sudden onset of delusions, hallucinations, disorganized speech, and/ or disorganized behavior. -the episode lasts only between 1 day and 1 month, after which the symptoms completely remit OTHER PSYCHOTIC DISORDERS DELUSIONAL DISORDER- have delusions lasting at least 1 month regarding situations that occur in real life -its general population is rare with an estimated lifetime prevalence of 0.2 percent -appears to affect females more than males -onset tends to be later in life with an average age of first admission to a psychiatric facility of 40 to 49 (Munro, 1999) OTHER PSYCHOTIC DISORDERS SCHIZOTYPAL PERSONALITY DISORDER- a lifelong pattern of significant oddities in their self-concept, their ways of relating to others, and their thinking and behavior -they do not have a strong and independent sense of self and may have trouble setting realistic or clear goals -their emotional expression may be restricted, as in schizophrenia, or odd for the circumstances -they may have few close relationships and trouble understanding the behaviors of others. They tend to perceive other people as deceitful and hostile and may be socially anxious and isolated because of their suspiciousness -they think and behave in ways that are very odd, although they maintain their grasp on reality OTHER PSYCHOTIC DISORDERS SCHIZOTYPAL PERSONALITY- on neuropsychological tests, people with schizotypal personality disorder show deficits in working memory, learning, and recall (Barch, 2005) They also share some of the same genetic traits and neurological abnormalities of people with schizophrenia (Cannon, van Erp, & Glahn, 2002) BIOLOGICAL THEORIES Family, twin, and adoption studies all indicate the presence of a genetic component to the transmission of schizophrenia (Allen et al., 2008) The children of two parents with schizophrenia and monozygotic twins of people with schizophrenia share the greatest number of genes with people with schizophrenia As the genetic similarity to a person with schizophrenia decreases, an individual's risk of developing schizophrenia also decreases. BIOLOGICAL THEORIES Genetics plays an important role in schizophrenia BIOLOGICAL THEORIES Most theorists think of schizophrenia as a neurodevelopmental disorder, in which a variety of factors lead to abnormal development of the brain in the uterus and early in life Gross reduction in gray matter, particularly in the medial, temporal, superior temporal, and prefrontal areas People who are at risk for schizophrenia because of a family history but have not yet developed the disorder show abnormal activity in the prefrontal cortex (Lawrie et al., 2008) BIOLOGICAL THEORIES The hippocampus is another brain area that consistently differs from the norm in people with schizophrenia (Karlsgodt et al., 2010) BIOLOGICAL THEORIES The brains of people with schizophrenia show reductions and abnormalities in white matter, particularly in areas associated with working memory (Karlsgodt et al., 2008) BIOLOGICAL THEORIES People with schizophrenia show enlargement of ventricles, fluid-filled spaces in the brain (Lawrie et al., 2008) BIOLOGICAL THEORIES What causes the neuroanatomical abnormalities in schizophrenia? Birth complications Prenatal viral exposure Traumatic Brain Injury Nutritional Deficiencies Deficiencies in cognitive stimulation BIOLOGICAL THEORIES Neurotransmitters o Dopamine ❖ The Original Dopamine Theory- states that the symptoms of schizophrenia are caused by excess levels of dopamine in the brain, particularly in the prefrontal cortex and the limbic system. BIOLOGICAL THEORIES Neurotransmitters o Dopamine ❖Kenneth Davis and colleagues (1991) proposed a revised theory that suggests that different types of dopamine receptors and different levels of dopamine in various areas of the brain can account for the symptoms of schizophrenia BIOLOGICAL THEORIES Neurotransmitters o Serotonin-regulate dopamine neurons in the mesolimbic system and some of the newest drugs for treating schizophrenia bind to serotonin receptors (Howes & Kapur, 2009) o Glutamate o GABA PSYCHOSOCIAL THEORIES SOCIAL DRIFT AND URBAN BIRTH o Social Drift- Because schizophrenia symptoms interfere with a person’s ability to complete an education and hold a job, people with schizophrenia tend to drift downward in social class compared to the class of their family of origin o Urban Birth- E. Fuller Torrey and Robert Yolken (1998) argue that the link between urban living and psychosis is due not to stress but to overcrowding, which increases the risk that a pregnant woman or a newborn will be exposed to infectious agents PSYCHOSOCIAL THEORIES Stress and Relapse o Stressful circumstances may trigger new episodes in people with schizophrenia o Immigration Schizophrenia and the Family o Expressed Emotions COGNITIVE THEORIES Aaron Beck and Neil Rector (Beck & Rector, 2005) suggest that fundamental difficulties in attention inhibition, and adherence to the rules of communication lead people with schizophrenia to try to conserve their limited cognitive resources CROSS-CULTURAL PERSPECTIVE Different cultures vary greatly in how they explain schizophrenia (Anders, 2003; Karno & Jenkins, 1993): o Most have a biological explanation for the disorder, including the general idea that it runs in families o Intermingled with biological explanations are theories that attribute the disorder to stress, lack of spiritual piety, and family dynamics TREATMENTS BIOLOGICAL TREATMENTS o Typical Antipsychotic Drugs- about 25 percent of people with schizophrenia do not respond to them (Adams, A wad, Rathbone, & Thornley, 2007). Among people who do, antipsychotics are more effective in treating the positive symptoms of schizophrenia than in treating the negative symptoms SIDE EFFECTS: ❖Visual disturbances ❖Grogginess ❖Weight gain or loss ❖Dry mouth ❖Constipation ❖Blurred vision ❖Menstrual irregularities ❖Drooling ❖Depression ❖Sexual dysfunction ❖Akinesia ❖Tardive Dyskinesia TREATMENT BIOLOGICAL TREATMENTS o Atypical Antipsychotic Drugs- seem to be more effective in treating schizophrenia than neuroleptics ❖ Clozapine SIDE EFFECTS: Dizziness Seizures Nausea Hypersalivation Sedation Weight gain Tachycardia Agranulocytosis TREATMENT PSYCHOLOGICAL AND SOCIAL TREATMENTS o BEHAVIORAL, COGNITIVE, AND SOCIAL TREATMENTS ❖ Cognitive treatments include helping people with schizophrenia recognize and change demoralizing attitudes they may have toward their illness so that they will seek help when needed and participate in society to the extent that they can (Beck& Rector, 2005) ❖ Behavioral treatments, based on social learning theory, include the use of operant conditioning and modeling to teach persons with schizophrenia skills such as initiating and maintaining conversations with others, asking for help or information from physicians, and persisting in an activity, such as cooking or cleaning (Liberman, 2008) TREATMENT PSYCHOLOGICAL AND SOCIAL TREATMENTS o BEHAVIORAL, COGNITIVE, AND SOCIAL TREATMENTS ❖ Social interventions include increasing contact between people with schizophrenia and supportive others, often through self-help support groups (Liberman, 2008) TREATMENT PSYCHOLOGICAL AND SOCIAL TREATMENTS o Family Therapy o Assertive Community Treatment Programs o Cross-cultural treatments: Traditional Healers