Chapter 8 Schizophrenia and Related Psychotic Disorders Psychotic Phenomena unreal o Psychosis inability to tell the difference between what is real and o Psychotic disorder when this inability is impairing and distressing o Schizophrenia the more common psychotic disorder Schizophrenia diagnostic criteria includes two broad themes o Positive symptoms 2 parts Characterized by the presences of unusual perceptions thoughts or behaviors Positive refers to the fact that symptoms are added experiences Normal experience something else 2 parts of Positive Symptoms Psychotic delusions hallucinations Disorganized speech thought behavior o Negative symptoms Characterized by losses or deficits in certain domains Negative refers to the absence of behaviors feelings experiences etc Normal experience something 3 core negative symptoms Affective flattening Alogia Avolition inability to persist in common goal directed activities Negative symptoms are less obvious BUT associated with more impairment Less responsive to medication Delusions positive symptom o Ideas that an individual believes are true but are highly unlikely or simply impossible o Involved a phenomenon that the person s culture would be implausible Types of Delusions o Persecutory being persecuted watched conspired against o Reference random events are directed at oneself o Grandiose great power knowledge talent or is a famous powerful person event o Guilt of Sin committed a terrible act or responsible for a terrible o Somatic appearance or part of body is diseased o Being controlled thoughts feelings behaviors are being imposed controlled by an external force Delusions vs Normal Self Deception o Delusions are different from thoughts in at least 3 ways Bizarreness Preoccupation Resistance More Delusions belief system o Multiple different types of delusions are woven together in a complex o Specific content of delusions differs in cultures o Cultural relativism is important to consider when diagnosing delusions Hallucinations positive symptom o Unreal perceptual experiences bizarre and impairing in schizophrenia o Not caused by sleep deprivation or drugs Types of hallucinations o Auditory hallucinations Most common More common in women Voices talk to each other can be threatening o Visual hallucinations Second most common o Tactile hallucinations Outside the body o Somatic hallucinations Inside the body Disorganized thought and speech negative symptom o Formal thought disorder disorganized thinking of people with schizophrenia Loosening of associations or derailment tendency to slip from one topic to an unrelated topic Disorganized Catatonic Behavior negative symptom o Disorganized unpredictable and untriggered o This can explain Disheveled appearances inappropriate hygiene shouting swearing o Catatonia group of disorganized behaviors that reflect extreme lack of responsiveness to the environment o Catatonic Excitement the person shows excessive motor activity and wild agitation that is difficult to subdue Cognitive Deficits in Schizophrenia o Deficits in working memory cognition and attention may cause Difficulty suppressing unwanted irrelevant information Difficulty paying attention to relevant info Overall difficulty in reasoning communication problem solving Emotional Social Deficits in Schizophrenia o Inappropriate Affect laughing at sad things vice versa o Anhedonia lack of interest in everything o Impaired Social Skills not symptoms of the disorder rather result of symptoms Phases of Schizophrenia o Prodromal Phase symptoms present before full criteria is met symptoms with mild symptoms o Acute active psychosis see Schizophrenia criteria o Residual Phase symptoms present after acute phase Schizophrenia Criteria o At least 2 for greater than 1 month acute phase Delusions Hallucinations Disorganized speech Catatonic behavior Negative symptoms o Social work dysfunction o Duration continuous signs of the disturbance for at least 6 months The Schizophrenias Symptom Heterogeneity o Subtypes no longer in DSM 5 but main symptom categories remain the same Prevalence o 1 2 lifetime in US o 5 2 lifetime worldwide o More common in men Prognosis and Course o Life expectancy 10 years shorter o High relapse o Higher rates of circulatory diseases o 10 15 die by suicide Gender Differences o Age of onset Women late 20 s 30 s Men around 21 o Course women have better prognosis o Cognitive deficit women show fewer deficits Other Psychotic Disorders o Schizoaffective mix of mood and SZ symptoms at same time o Schizophreniform SZ symptoms preset 1 6 months rare o Brief Psychotic Disorder sudden onset lasts 1 day to 1 month o Delusional Disorder delusions lasting at least one month don t show any psychotic symptoms o Schizotypal Personality Disorder Psychotic and PD mild form of SZ Biological Theories o Genetics 50 rate MZ twins 14 DZ twins 50 likelihood of schizophrenia if both parents have the disorder o Structure Brain Abnormalities o Birth Enlarged ventricles Prefrontal Cortex Limbic system hippocampus complications Perinatal hypoxia o Prenatal Virus Exposure High rates of schizophrenia associated with flu during pregnancy Strong during second trimester of pregnancy o Neurotransmitters Overactive DA in mesolimbic pathway hallucinations Underactive DA in prefrontal areas Dopamine Hypothesis Positive symptoms of schizophrenia involve other activity of brain dopaminergic synapses Negative symptoms involve under activity in prefrontal area of the brain o Hypothesized Role of Dopamine Abnormal functioning of dopamine in prefrontal cortex deficits working memory difficulty in attending relevant info difficulties in communication problem solving Psychosocial Theories o Schizophrenia associated with low SES o Social Drift vs Urban Birth People with schizophrenia drift downward in social class compared to the class of their family of origin Stressful circumstances at birth mother of a schizophrenic o The Schizophrenogenic Mother o Communication Problems Double binds o Expressed Emotion people with schizophrenia whose families are high in expressed emotion are more likely to suffer relapses of psychosis o Two Hit Hypothesis Genetic and environmental factors disrupt early central nervous system These disruptions produce second hit that leads to schizophrenia symptoms Biological Treatments o Meds Narcoleptics revolutionized treatment of schizophrenia Dopamine antagonist Prophylactic reduction of positive symptoms Ex Thorazine Haldol Navene o Issues 25 don
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