Schizophrenia and Other Psychotic Disorders Nature of Schizophrenia and Psychosis: An Overview Schizophrenia vs. Psychosis ƒ Psychosis – Broad term (e.g., hallucinations, delusions) ƒ Schizophrenia – A type of psychosis ƒ Psychosis and Schizophrenia are heterogeneous ƒ Disturbed thought, emotion, behavior Schizophrenia: Some Facts and Statistics ƒ Onset and Prevalence of Schizophrenia worldwide ƒ About 0.2% to 1.5% (or about 1% population) ƒ Often develops in early adulthood ƒ Can emerge at any time ƒ Schizophrenia Is Generally Chronic ƒ Most suffer with moderate-to-severe lifetime impairment ƒ Life expectancy is slightly less than average ƒ Schizophrenia Affects Males and Females About Equally ƒ Females tend to have a better long-term prognosis ƒ Onset differs between males and females ƒ Schizophrenia has a Strong Genetic Component Classification Systems and Their Relation to Schizophrenia ƒ Process vs. Reactive Distinction o Process – Insidious onset, biologically based, negative symptoms, poor prognosis o Reactive – Acute onset (extreme stress), notable behavioral activity, best prognosis ƒ Good vs. Poor Premorbid Functioning in Schizophrenia o Focus on functioning prior to developing schizophrenia o No longer widely used ƒ Type I vs. Type II Distinction o Type I – Positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment o Type II – Negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments Symptoms of Schizophrenia: The “Positive” Symptom Cluster ƒ The Positive Symptoms ƒ Active manifestations of abnormal behavior ƒ Distortions of normal behavior ƒ Delusions: The Basic Feature of Madness ƒ Gross misrepresentations of reality

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Include delusions of grandeur or persecution Hallucinations: Auditory and/or Visual Experience of sensory events without environmental input Can involve all senses

The “Negative” Symptom Cluster ƒ The Negative Symptoms ƒ Absence or insufficiency of normal behavior ƒ Spectrum of Negative Symptoms ƒ Avolition (or apathy) – Lack of initiation and persistence ƒ Alogia – Relative absence of speech ƒ Anhedonia – Lack of pleasure, or indifference ƒ Affective flattening – Little expressed emotion The “Disorganized” Symptom Cluster ƒ The Disorganized Symptoms ƒ Include severe and excess disruptions ƒ Speech, behavior, and emotion ƒ Nature of Disorganized Speech ƒ Cognitive slippage – Illogical and incoherent speech ƒ Tangentiality – “Going off on a tangent” ƒ Loose associations – Conversation in unrelated directions ƒ Nature of Disorganized Affect ƒ Inappropriate emotional behavior ƒ Nature of Disorganized Behavior ƒ Includes a variety of unusual behaviors ƒ Catatonia – Spectrum ƒ Wild agitation, waxy flexibility, immobility Subtypes of Schizophrenia: ƒ Paranoid Type o Intact cognitive skills and affect o Do not show disorganized behavior o Hallucinations and delusions – Grandeur or persecution o The best prognosis of all types of schizophrenia ƒ

Disorganized Type o Marked disruptions in speech and behavior o Flat or inappropriate affect o Hallucinations and delusions – Tend to be fragmented o Develops early, tends to be chronic, lacks remissions

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Catatonic Type o Show unusual motor responses and odd mannerisms o Examples include echolalia and echopraxia o Tends to be severe and quite rare

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Undifferentiated Type o Wastebasket category o Major symptoms of schizophrenia o Fail to meet criteria for another type Residual Type o One past episode of schizophrenia o Continue to display less extreme residual symptoms

Causes of Schizophrenia: Findings From Genetic Research ƒ Family Studies o Inherit a tendency for schizophrenia o Do not inherit specific forms of schizophrenia o Risk increases with genetic relatedness ƒ Twin Studies o Monozygotic twins – Risk for schizophrenia is 48% o Fraternal (dizygotic) twins – Risk drops to 17% o Adoption Studies -- Risk for schizophrenia remains high ƒ Cases where a biological parent has schizophrenia ƒ Summary of Genetic Research o Risk for schizophrenia increases with genetic relatedness o Risk is transmitted independently of diagnosis o Strong genetic component does not explain everything Neurotransmitter Influences ƒ The Dopamine Hypothesis ƒ Drugs that increase dopamine (agonists) ƒ Result in schizophrenic-like behavior ƒ Drugs that decrease dopamine (antagonists) ƒ Reduce schizophrenic-like behavior ƒ Examples – Neuroleptics, L-Dopa for Parkinson’s disease ƒ Dopamine hypothesis is problematic and overly simplistic ƒ Current theories – Emphasize many neurotransmitters Neurobiological Influences ƒ Structural and Functional Abnormalities in the Brain ƒ Enlarged ventricles and reduced tissue volume ƒ Hypofrontality – Less active frontal lobes ƒ A major dopamine pathway ƒ Viral Infections During Early Prenatal Development ƒ Findings are inconclusive ƒ Conclusions About Neurobiology and Schizophrenia ƒ Schizophrenia – Diffuse neurobiological dysregulation ƒ Structural and functional brain abnormalities ƒ Not unique to schizophrenia

Psychological and Social Influences ƒ The Role of Stress ƒ May activate underlying vulnerability ƒ May also increase risk of relapse ƒ Family Interactions ƒ Families – Show ineffective communication patterns ƒ High expressed emotion – Associated with relapse ƒ The Role of Psychological Factors ƒ Exert only a minimal effect in producing schizophrenia Treatment of Schizophrenia: ƒ Medical Treatment of Schizophrenia ƒ Historical Precursors ƒ Development of Antipsychotic (Neuroleptic) Medications o Often the first line treatment for schizophrenia o Began in the 1950s o Most reduce or eliminate positive symptoms o Acute and permanent side effects are common ƒ Extrapyramidal and Parkinson-like side effects ƒ Tardive dyskinesia o Compliance with medication is often a problem ƒ Transcranial Magnetic Stimulation ƒ Relatively untested procedure for hallucinations

Psychosocial Treatment of Schizophrenia ƒ Historical Precursors ƒ Psychosocial Approaches: Overview and Goals ƒ Behavioral (i.e., token economies) on inpatient units ƒ Community care programs ƒ Social and living skills training ƒ Behavioral family therapy ƒ Vocational rehabilitation ƒ Psychosocial Approaches ƒ A necessary part of medication therapy Other Disorders with Psychotic Features ƒ Schizophreniform Disorder o Schizophrenic symptoms for a few months o Associated with good premorbid functioning o Most resume normal lives ƒ

Schizoaffective Disorder o Symptoms of schizophrenia and a mood disorder o Both disorders are independent of one another o Prognosis is similar for people with schizophrenia o Such persons do not tend to get better on their own

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Delusional Disorder o Delusions that are contrary to reality o Lack other positive and negative symptoms o Types of delusions include ƒ Erotomanic ƒ Grandiose ƒ Jealous ƒ Persecutory ƒ Somatic o Extremely rare o Better prognosis than schizophrenia

Additional Disorders with Psychotic Features ƒ Brief Psychotic Disorder o One or more positive symptoms of schizophrenia o Usually precipitated by extreme stress or trauma o Tends to remit on its own ƒ

Shared Psychotic Disorder o Delusions from one person manifest in another person o Little is known about this condition

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Schizotypal Personality Disorder o May reflect a less severe form of schizophrenia