Schizophrenia and Related Disorders Chapter 6 Schizophrenia Disturbances in Content of thought Form of thought Perception Affect Sense of self Motivation Behavior Interpersonal functioning Schizophrenic Symptoms POSITIVE NEGATIVE Positive symptoms Negative symptoms Exaggerations or distortions of normal thoughts emotions and behavior Symptoms that involve functioning below the level of normal behavior Schizophrenic Symptoms POSITIVE NEGATIVE Delusions Hallucinations Disturbed speech Neologisms invented new words Disturbed behavior Inappropriate affect Restricted affect Avolition Asociality Specify if Catatonia Extreme motor disturbances in a psychotic disorder not attributable to physiological causes Severity level 0 4 with 4 being most severe Paranoia The irrational belief or perception that others wish to cause you harm May be associated with delusions or auditory hallucinations related to a theme that somebody is persecuting or harassing them History Benedict Morel first identified it as demence precoce brain dementia of the young Emil Kraepelin renamed it dementia praecox Eugen Bleuler changed both the name and understanding According to him the disorder was not one but instead a set of diseases which he labeled schizophrenias The term schizophrenia is not a splitting of personalities as in dissociative identity disorder but a splitting of schiz the functions of the mind Bleuler s four a s Fundamental features of the disorder 1 Association thought disorder as might be evident through rambling and incoherent speech 2 Affect 3 Ambivalence 4 Autism Withdrawal from reality Disorder of the experience and expression of emotion Inability to make or follow through on decisions Diagnostic feature of Schizophrenia A Active phase Positive and Negative symptom B Occupational dysfunction C Period of disturbance Duration of at least 6 months D no evidence of schizoaffective depressive or bipolar disorder E Symptoms are not due to substance use disorder or general medication What s new in dsm 5 Eliminated subtypes of schizophrenia Using a scale that is in section 3 clinicians assign a diagnosis to which they can add a rating of the individual s symptoms along a set of dimensions Diagnosis includes cognitive impairment Courses of Schizophrenia Active stage Continuous Remission Recurrent Extended Term used to refer to the situation when the individual s symptoms no longer interfere with his or her behavior and are below those required for a DSM diagnosis Other Psychotic Disorders Brief Psychotic Disorder Symptoms one of these four must be happening Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Requires that the individual experience symptoms for more than a day but recover in less than a month Schizophreniform Disorder A disorder with essentially the same symptoms as schizophrenia but that lasts from 1 to 6 months Schizoaffective Disorder Schizophrenia with co occurring mood disorder A disorder involving the experience of a major depressive episode a manic episode or a mixed episode while also meeting the diagnostic criteria for schizophrenia Individuals with depressive or bipolar disorder also have delusions and or hallucinations Diagnosis is complicated because individuals must have at least a 2 week period in which they have no mood disorder symptoms but do have psychotic symptoms Delusional Disorders Erotomanic Grandios Jealous Persecutory Somatic Shared Psychotic Disorder Delusional disorder in which one or more people develop a delusional system As a result of a close relationship with a psychotic person who is delusional Biological Theories Brain structure and genetics Ventricular enlargement and cortical atrophy Dopamine hypothesis Physicians believed that the drug chlorpromazine had its effect by blocking dopamine receptors giving rise to the dopamine hypothesis of schizophrenia Biological Theories Genetic abnormalities affects Brain development Synaptic transmission Immune functioning Manufacturing of important proteins involved in neurotransmission Neurodevelopmental hypothesis Theory proposing that schizophrenia is a disorder of development that arises during the years of adolescence or early adulthood due to alterations in the genetic control of brain maturation Biological Treatment Neuroleptics seize of the nerve Reduce the frequency and severity of the individual s psychotic symptoms Typical or first generation Atypical or second generation Consequences Extrapyramidal symptoms EPS Motor disorders involving rigid muscles tremors shuffling movement restlessness and muscle spams affecting their posture Tardive dyskinesia Motor disorder that consists on involuntary movements of the mouth arms and trunk of the body Psychological Perspective Deficit in social cognition Brains become less activated when given a social cognition task Difficulty in working on people oriented jobs Substance abuse Psychological Treatment Cognitive behavioral therapy Cognitive training Sociocultural Perspective Focus on the family system Faulty modes of behavior and communication Cognitive distortions High degree of expressed emotion Social class and income Associated with environmental stressors of poverty Contracting the disease leads to social and economic downward drift Biopsychosocial Perspective Theories focus on underlying brain mechanisms as expressed in cognitive deficits Individuals with these disorders receive integrated care Maximizing their chances of recovery