Psych 2510 – Trull Chapter 12: Schizophrenia and Other Psychotic DisordersWhat are psychotic disorders?- People with psychotic disorders have bizarre thoughts, emotions, and behaviors that greatly interfere with many different areas of daily functioning. Types of Psychotic Disorders - Schizophrenia- Schizophreniform disorder (1-6 months)- Schizoaffective disorder (scz +manic or depressive episode)- Delusional Disorder- Brief psychotic disorder (1 day – 1 month) Schizophrenia- Schizophrenia is the most well known psychosis- Positive or excessive symptoms o Usually treated well with medications o Delusions: rigid, bizarre, irrational beliefs o Hallucinations: sensory experiences in the absence of actual stimuli Hearing is most common  Visual is less common- Rule out brain dysfunction first o Disorganized speech and behavior Jumbled speech or speech conveys little information Loose affect o Inappropriate affect: showing emotions that do not suit a given situation Affect inappropriate to the context  EX: laughing at funeral Blunted affect – no emotion when there should be o Catatonia: unusual motor symptoms marked by severe restriction or movement or extreme excitability  Catatonic excitement – movement without purpose - Excess of motor activity Waxy flexibility  Lack of normal movement - Negative or deficit symptoms of schizophreniao Not treated well with medications - best treated with psychosocial treatment (learning how to react) o Flat affect: showing little emotion in different situations  Not same as depression o Alogia: speaking very little to others  Poverty of speech o Avolition: inability or unwillingness to engage in goal-directed activities  Do not engage in goal seeing behavior o Anhedonia: lack of pleasure or interest in life activities o Lack of insight: poor awareness of one’s mental condition- EX: This is a portrait of Andre, who is suffering from schizophrenic disorder. o What are his positive and negative symptoms?  Positive  Delusions – thinks has children Negative  Lack of affect – doesn’t seem to have much emotion Trouble holding jobs - The dimensions of schizophrenia can occur along a continuum of mixed symptomso Hallucinations o Delusionso Disorganized speech1Psych 2510 – Trull o Abnormal psychotic behavioro Negative symptomso Impaired cognitiono Depressiono Mania - Subtypes of Schizophreniao Paranoido Disorganizedo Catatonico Undifferentiatedo Residual subtypes Psychotic, disorganized, and negative dimensions have also been proposed- Phases – all has to be together to be considered an episode (without breaks) o Prodromal Peculiar behaviors and negative symptoms o Psychotic prephase First positive symptom such as hallucination o Active Many positive and negative symptoms o Residual  Low-grade symptoms similar to prodromal phase Other Psychotic Disorders- Schizophreniform disordero Very similar to schizophrenia but lasts 1-6 months o May not involve serious impairment in daily functioning- Schizoaffective disordero Applies to those who have features of schizophrenia and a mood disorder- Delusional disorder o Involves non-bizarre delusions and no symptoms of schizophreniao Do not show much impairment o If mood symptoms are present, they are brief compared to the delusional symptoms- Brief psychotic disorder o Involves features of schizophrenia that last 1 day to 1 month and can be triggered by a traumatic evento One or more of: Delusions Hallucinations  Disorganized speech Grossly disorganized or catatonic behavioro 1 day to 1 month Epidemiology- Schizophrenia is a rare disorder but is more commonly seen in males- The disorder is often viewed along a spectrum of disorders2Psych 2510 – Trull Biological Risk Factors- Geneticso Family, twin (MZ = 50%, DZ = 10-15%), and adoption studies indicate that schizophrenia has a strong genetic basis- Brain Featureso Some people with schizophrenia have certain brain features that may help produce the disordero Ventricular size is increased in an affected braino Neural communication disruption- Neurochemical Featureso One of the most prominent theories of schizophrenia is that symptoms are caused by an excess of certain neurotransmitters in the brain, especially dopamine (DA) `D2 receptors denser in those with SCZ- Cognitive Deficitso Brain changes and other biological factors may help explain why many people with schizophrenia have several key cognitive deficits. o Key deficits include  Memory Attention Learning Language Executive functions – such as problem-solving and decision-making abilitiesEnvironmental Risk Factors- Include:o Prenatal complicationso Diseaseo Famineo Stressful life events3Psych 2510 – Trull o Substance abuse- People with schizophrenia, especially early-onset schizophrenia, tend to have had more complications during prenatal development than the general population- Biological and environmental risk factors can make a person vulnerable to having a psychotic disorder. o These risk factors may produce early brain changes that, over time, do not allow a person to fully address life’s stressful and complex tasksCauses- One causal theory for psychosis is a neurodevelopmental model whereby an early disease state leads to key brain changes and stable psychotic symptoms. Assessment- Assessing people with psychotic disorders is important because of their complicated symptoms and is often based on family discussions and observations.- Interviews have been created for people with psychotic disorders, though brief rating scales in the form of interviews are often employed.- Behavioral observations of people with psychotic disorders often focus on social and self-care skills.Biological Treatments- Treating psychotic disorders often involves a biological approach first, and many typical and atypical neuroleptics drugs are available. Side effects, compliance, and relapse are common problems, however. Psychological Treatments- Psychological treatments for people with psychotic disorders aim to improve quality of life and focus on milieu therapy, token economy, cognitive-behavioral and supportive psychotherapies, compliance with medication, social skills training,cognitive and vocational rehabilitation, and family therapy. Long-term Outcome- Long-term outcome for people with psychotic disorders is best for females and those with less severe prenatal complications and brain volume reduction,