PSYC 407 1st Edition Lecture 23Outline of Last Lecture I. What is Schizophrenia?II. Nature of Schizophrenia and Psychosis: An Overviewa. Historyb. Current ThinkingIII. Positive and Negative Symptoms of HallucinationsIV. Positive and Negative Symptoms of DelusionsOutline of Current Lecture I. Subtypes of Schizophreniaa. Paranoidb. Disorganizedc. Catatonicd. Undifferentiatede. Residualf.Current LectureDiagnostic Ruleouts1. Schizophrenia/ Substance AbuseIf substance present and involved in etiologysubstance-induced psychotic disorder2. Schizophrenia/ Mood DisordersAre psychotic sx present in the absence of mood symptoms?2. Social/Occupational Dysfunction3. Duration: continuous signs for at least 6 monthsThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.Including 1 month of sx that meet criterion A4. Not due to mood disorder or schizoaffective disorder5. Not due to SA or medical conditionDiagnostic Ruleouts1. Schizophrenia/ Substance AbuseIf substance present and involved in etiologysubstance-induced psychotic disorder2. Schizophrenia/ Mood DisordersAre psychotic sx present in the absence of mood symptoms?3. Schizoaffective Disorder/SchizophreniaFor Schizoaffective Disorder must meet:1. Period of illness w/depressive ormanic episode concurrent w/sx of schiz that meet Criterion A.2. During the same period at least two weeks of schiz sx without mood symptoms.3. Mood sx present for a substantial part of the illness.Delusional Disorder• Delusions found in:– Schizophrenia– Schizoaffective disorder– Severe mood disorders– Organic conditions• Dementia, delirium• Essential Feature:– One or more non-bizarre delusions that last for at least one month• Also:-Auditory or visual hallucinations not prominent-No previous hx of schizophrenia-May have tactile or olfactory hallucinations if related to delusional themeEx: insects and delusions of infestationcont.• Psychosocial functioning not markedly impaired• Behavior not odd or bizarre• BIZARRENESS= clearly implausible and• not derived from person’s life experience• Subtypes:• Erotomania• Grandiose• Jealous• Persecutory• Somatic (emit foul order)• Some evidence of family characteristics of secrecy, suspiciousness, and jealousySubtypes of Schizophrenia• 1. Paranoid• 2. Disorganized• 3. Catatonic• 4. Undifferentiated• 5. ResidualParanoid Schizophrenia• Preoccupation with one or more delusions or frequent auditory hallucinations. Delusionsare organized around a theme and are typically persecutory or grandiose • None of the following is prominent:– Disorganized speech– Disorganized catatonic behavior– Flat or inappropriate affect• continued• Paranoid schizophrenia, cont…..• Presentation usually aloof, angry, anxious, and argumentative. May have superior or patronizing manner, stilted formal quality w/people.• Onset later, characteristics stable over time.• Not much cognitive impairment.• Better prognosis than other typesSchizophrenia-Disorganized Type• All of the following are prominent:– Disorganized speech– Disorganized behavior– Flat or inappropriate affect– May have silliness not closely related to content of speech– Lack of goal orientation and disorganized behavior leads to impaired ADLcont– Disorganized type, cont…..–-delusions fragmented, poorly organized– -may show facial grimaces, odd mannerisms– -impaired performance on cognitive tests– early, insidious onset, continuous course– without remissionCatatonic Schizophrenia• MUST SHOW 2:• Motoric immobility– Waxy flexibility or stupor• Excessive motor activity, non purposeful• Extreme negativism (motiveless resistance to all instruction) or mutism• Peculiar voluntary movements (posturing, grimaces, stereotyped movements, prominent mannerisms) cont. • echolalia, echopraxiaSchizophrenia-Undifferentiated Type• Sx. meet criteria A for schizophrenia but do not fit any of the subtypesSchizophrenia- Residual Type• Absence of prominent positive sx. • Continued evidence of the disturbance as indicated by the presence of negative sx.– (flat affect, avolition, poverty of speech) Ortwo or more of the sx. Listed in Criterion A present in an attenuated form (odd beliefs,unusual perceptual experiences)Schizophreniform Disorder• Criterion A met• Episode lasts one month but less than 6 months• Person has either recovered or will be progressing to the 6 month requirement for schizophreniaBrief Psychotic Disorder• The sudden onset of one positive sx:– Delusions, hallucinations, disorganized speech, disorganized behavior, catatonic behavior. – Episode lasts at least ONE DAY but less than one month– Person experiences emotional turmoil or overwhelming confusion. Rapid shifts ofaffect. Person needs to be supervised– Requires full return to premorbid functioningAssessment• SCID: other psychotic scales• Tests of cognitive functioning• Functional assessment of social skills• Assessment of community functioning• Family assessment– Interviews– Home visits• Biological assessment– Cat scans• 1/3 to ½ show ventricular enlargement• Structural changes prefrontal and temporal lobes, -hippocampus, amygdala- PET scans• Tests of cerebral blood flow -reduced metabolism, blood flow in prefrontal and temporal lobes.EtiologyThe Genain Quadruplets4 sisters with identical genes raised in same family had 4 types of schizophrenia…. But symptoms, diagnoses, treatment, and outcome all different……Explanation?Psychological Considerations• Learning and modeling– Hallucinations increase when rf’d– Good role models provide the learning of good coping skills• Life events related to development• Gender– Women have later onset and milder cases. More men in studies receiving tx. – More women marryEthnic Considerations• Course of illness more benign in developing countries than industrialized nations– Less stigma, social rejection– Stronger family ties– Tx includes family, vs aimed at individual– Different interpretations of individual’s role in society– Availability of adaptive concepts for understanding mental illnessDopamine and Schizophrenia• Enduring and controversial theory of the cause of schizophrenia:• The Dopamine Hypothesis: when antagonists drugs used that decrease dopamine activity, schizophrenic