. 4 symptoms1) associations: thoughts become disturbed2) affect: emotional response becomes flattened or inappropriate.3) ambivalence: hold conflicting feelings towards others.4) autism: withdrawal into private fantasy world.According to Bleuler, hallucinations and delusions were secondary.His definition was broader than Kraepelin's..
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1. Schizophrenia The most puzzling/disabling syndrome
History of the concept
Emil Kraepelin first defined demenita praecox
out of oneís mind before maturity
loss of inner unity of thought, feeling, & acting.
Eugene Bleuler renamed dementia praecox to schizophrenia
3. Schneider A contemporary view
He felt Bleulerís criteria were too vague.
First rank symptoms
Symptoms that are central to the diagnosis and not present in other disorders. For example, halucinations, delusions. Today we recognize that some of his first-rank symptoms are found among other disorders such as bipolar d/o
Second rank symptoms
Symptoms may be present in other disorders. For example, disturbance in mood/thinking.
4. In contemporary Diagnostic practices, criteria has become tighter.
Approximately 2 million people (1%) in US treated for schizophrenia.
No clear gender differences in rate.
Typically develops in adolescence or early adulthood. People disengage from society.
5. For some, the onset is acute; while for others, it may take years before behaviors emerge.
Prodromal phase - the period of decline that precedes the development of the first acute psychotic episode.
Residual phase - the phase that follows an acute phase, characterized by a return to a level of functioning that was typical of the prodromal phase.
6. Briefer forms of Psychosis Brief Psychotic Disorder
A psychotic disorder that lasts from 1 wk to 1 month
Characterized by 1 of the following:
catatonic or disorganized behavior.
7. Cont. briefer Schizophreniform
identical behavior to schizophrenia but lasts at least 1 month to less than 6 months.
Other parts of the schizophrenia spectrum
Schizotypal personality d/o (mild)
Schizoaffective D/o : psychotic features with mood disturbance
Distinction is in degree
8. Features of Schizophrenia Males have an earlier onset.
A poorer history of adjustment prior to onset,
more cognitive impairment,
more behavioral deficits and,
poorer response to medication.
9. Disturbances in thought/speech
content - for example, delusions such as
delusions of persecution,
delusions of reference,
delusions of being controlled
delusions of grandeur
Disturbance in the form of thought
breakdown in organization, processing
10. Control of thoughts
looseness of associations
neologisms: a word made up by the speaker
perseveration (repetition of words or train of thought)
clanging (stringing together words on the basis of rhyming)
blocking (involuntary abrupt interruption of speech or thought)
Thought Disorder persisting beyond acute episodes are connected with poorer prognoses.
11. Deficits in attention
Appear to have difficulty filtering out irrelevant distracting stimuli
Deficiencies in orienting response
Orienting responses - involuntary pattern of responses to incoming stimulus, ie., pupil dilation, brain waves associated with attention and changes in GSR) Schizophrenics show abnormal ORís
12. Eye movement dysfunction may be genetic marker, but there are people with the EMD who are bipolar.
Event related potentials - Schizophrenics show greater early ERP components than normal > difficult with attention.
13. Perceptual Disturbances
auditory most common
tactile/somatic are also common
visual, gustatory, olfactory are rarer.
Command hallucinations = more aggression > hospitalization.
Sometimes normals hallucinate during grief but the individual can distinguish from reality. May have hallucinations when withdrawing from ETOH/or as side-effects from medications
14. Emotional disturbances - flat affect
Other disturbances - loss of ego boundaries (fail to recognize themselves as unique individuals)
Motor behavior may be excited or slow (stupor)
15. Types of Schizophrenia Disorganized
Confused behavior, incoherence, loose association, vivid, frequent hallucination, flattened affect, disorganized delusions with sexual/religious themes.
marked impaired motor behavior. Catatonics are mute/how no evidence of attending to those around.
16. Cont. types of schizophrenia Paranoid
preoccupied with one/more delusions or have frequent auditory hallucinations. Delusions involve themes of grandeur or persecution.
17. Dimensions of Schizophrenia Process-reactive dimension
Process schizophrenia - develops more slowly insidiously (less favorable recovery)
Reactive schizophrenia - follows a precipitating stressor (premorbid adjustment)
18. Cont. Dimensions Positive/Negative symptoms
hallucinations, delusions, thought disorder
behavioral deficits: low motivation, flat affect, loss of pleasure
Presence of negative symptoms associated with poorer premorbid functioning, lower education, more gradual onset, enduring disability.
19. Cont. Dimensions Type I and Type II
has an abrupt onset
symptoms such as hallucinations, delusions, and loose associations.
Favorable response to medication.
20. Type II
social withdrawal and
poverty of speech
21. Theoretical Perspectives Psychodynamic
Schizophrenia represent the ego overtaken by primitive sexual/aggressive impulses of the id. Regresses to an early stage, oral known as primary narcissism. Because ego mediates between self/outer world, the breakdown in ego functioning accounts for detachment from reality. Input from id causes fantasies to become mistaken for reality resulting in hallucinations/delusions.
22. Cont. Psychodynamic Sullivan
Emphasized impaired mother/child relationship.
Anxious/hostile interactions lead child to take refuge in fantasy.
Produces a cycle: the more the child withdraws, the less opportunity there is to develop a sense of trust that is necessary to establish intimacy.
Have not been able to demonstrate early childhood experiences predict schizophrenia.
23. Learning Although learning theory may not account for schizophrenia, the principles of conditioning and observational learning may play a role in the development of some forms of schizophrenic behavior. Behavior is learned through reinforcement.
24. Biological Genetic
contribution is strong. Mode of transmission is unknown.
Most prevailing view is diathesis-stress model: combines biological and psychosocial.
overreactivity of dopamine receptors: they use more dopamine. Studies with neuroleptics such as phenothiazines, and amphetamines.
25. Brain abnormalities
enlarged brain ventricles
Neurotransmitter disturbances shown by tracking blood flow with PET scans, EEG and MRIís in the preforntal cortex. Some evidence that the hippocampus and amygdala are involved.
supporting evidence: schizophrenia usually begins in adolescence when stress increases.
Schizophrenia is twice as likely to occur among the poor.
Children of schizophrenia: 10-25% chance with one schizophrenic parent; 45% chance with two schizophrenic parents.
26. Family theory Schizophrenigenic mother
Communication deviance (excessive vagueness/blurring -attack children/double-bind)
Another measure of disturbed family communication is expressed emotion- measured by the # of critical comments by the relative about the patient, hostility toward the patient, emotional overinvolvement. Some research suggests high EE may play a role in course of schizophrenia.
27. Treatment Biological
Neuroleptics led to deinstitutionalization
Examples of neuroleptics
phenothiazines: Haldol, Thorazine, Clozapine (new)
affects both dopamine/norephinphrine,
traditional neuroleptics affect + symptoms and not the - symptoms as well but the new neuroleptics address both.
Side-effects: Traditional neuroleptics can cause tardive dyskinesia (a movement disorder affecting mouth, face, neck, trunk, extremities, lip smacking, grimacing. Most common is eye blinks. Risks of TD increase with age/more common with older, female patients.
28. Cont. Biological Clozapine doesnít lead to TD but may cause agrnulocytosis, not enough white blood cells. Users must have routine blood tests.
29. Psychodynamic Freud did not believe psychoanalysis was well suited to treat schizophrenia because unable to form meaningful relationship.
30. Learning Direct modification of behavior and development of more adaptive behavior.
Paul/Lentz study with 2 groups: applied social -learning principles and a therapeutic community. Social learning group did better, but programs require strong administration, skilled leaders, extensive staff training.
31. Cont. Learning Social skills training (another application of social-learning) use of role playing to encourage modeling, direct instruction, shaping, coaching.
Sheltered workshops that provide training, modeling of task, rehearsal with + feedback was beneficial to schizophrenia. Fountain House, a self-help club provided some of these services.
Family intervention program showed decrease in recurrence rates.
32. Delusional Disorder Relatively uncommon
persistent delusions that often but not always involve paranoid themes.
No confused/jumbled thinking.
Hallucinations, when they occur, are not as prominent.
Distinguish between paranoid personality (exaggerated or unwarranted suspicions of others but not outright delusions as in delusional d/o or schizophrenia.