Chapter 13 Review:Symptoms:- Positive symptoms:o Delusions- rigidly held beliefs that are inaccurate or inconsistent with realityo Hallucination-most common is auditory and they strike the patient as being real- Negative symptoms:o Anhedonia- inability to experience pleasure o Blunted/flat affect- fail to exhibit signs of emotions/feelingso Alogia- impoverished thinking (speechless)o Avolition- lack of will - Disorganized:o Disorganized speech- tangential speech, very difficult to follow o Disorganized behavior- child-like silliness or unpredictable agitation o Catatonic posturing- unnatural postures, facial expressions, or body movementCriteria for Schizophrenia: duration of entire disorder must be at least 6 months. - Prodromal phase- marked by obvious deterioration in the role of functioning as a student, employee, orhomemaker. Change in personality.o Outburst of anger, increased tension, restlessness o Social withdrawal, indecisiveness, lack of will power o Negative symptoms become more stable - Active Phase- At least 1 month. Hallucinations, delusions, and disorganized speech are symptoms- Residual Phase- signs and symptoms that are similar in many respects to those seen in prodromal. Mostdramatic symptoms of psychosis have improved. Only negative symptomsSchizophrenia Subtypes:- Paranoid- one or more delusions or frequent hallucinations- Disorganized- disorganized speech and behavior, flat/inappropriate affect - Catatonic- Undifferentiated- does not fit any other subtypes- Residual- reduced symptoms in criterion a or presence of negative symptoms Different types: - Mood Disorder with Psychotic symptoms- which symptoms are strongero Schizophrenia with mood symptoms Duration of mood symptoms are brief in relation to the duration of active and residual schizophrenia symptomso Mood disorder with psychotic symptoms The psychotic symptoms only occur during a manic or depressive episode- Schizoaffective disorder- mood symptoms must be present for a substantial portion of psychotic disturbance. Hallucinations must be present for at least 2 weeks without prominent mood symptoms - Brief psychotic disorder: less than a month- Schizophreniform Disorder: less than 6 months- Schizophrenia: at least 6 months - Delusional Disorder: non-bizarre delusions are prominent psychotic symptoms.Epidemiology: - 1% lifetime prevalence - Men onset: 18-25 Female onset: 26-45- More common in urban areas with low socioeconomic status - Developing nations have better recovery rate than USEtiology:- Before birtho Maternal exposure to viruso Genes The closer related someone with schizophrenia is the more of a chance you have o Complications during pregnancy- During Birtho Complications during delivery- Brain abnormalities: enlarged ventricles- abnormal structure sizes - Neurotransmitters:o Dopamine- low numbers of dopamine receptors in frontal lobes, as well as increased production(possibly to compensate for reduced receptors) o Dopamine hypothesis- proposes that an overproduction of dopamine or an increased in sensitivity of dopamine receptors is responsible for schizophrenia. - Cognitive deficits-o Deficits in attentiono Deficits in working memory o Deficits in executive functioning - Expressed Emotions- family members’ negative critical and hostile attitudes and behaviors toward patient and/or emotional over-involvement and intrusiveness of familyo High EE environments are more likely to relapse (western cultures) - Social Causation- negative factors related to low SES lead to developmental issues- Social Selection- cognitive/social impairments associated with illness lead individuals to drift into a lower SES Treatment:- Antipsychotic medicationso Target dopamine receptors o Effective for 75% of patients o Side effects Extrapyramidal symptoms- neurological disturbances. Tremors, agitation, involuntary posturing, motor rigidity, and inertia Tardive dyskinesia- involuntary movements of mouth and face- Psychological o Family treatment programs- educational component to the family (most effective)o Social skills training-modeling, role playing, provision of social reinforcemento Vocational rehabilitationo Cognitive therapy- improve cognitive abilities, attention, working memory, and problem solvingo Assertive community treatment- team of clinicianso Institutional- increase frequency of desired