Schizophrenia Spectrum and Other Psychotic Disorders

1. Schizophrenia Spectrumand Other PsychoticDisorders Chapter 6

2. Schizophrenia is now classified as a spectrum disorder rather than a single disease entity. in this group: • Schizophrenia • Brief Psychotic Disorder • Schizoaffective Disorder • Schizophreniform Disorder • Delusional Disorder • Schizotypal Personality Disorder criteria in Personality Disorders • Substance/Medication-Induced Psychotic Disorder • Psychotic Disorder Due to Another Medical Condition • Catatonia Associated with Another Mental Disorder (Catatonia Specifier) • Other Specified… and Unspecified…

3. Schizophrenia • The broad category of schizophrenia includes a set of disorders in which individuals experience distorted perception of reality and impairment in thinking, behavior, affect, and motivation. • A disorder with a range of symptoms involving disturbances In: • Content of thought • Form of thought • Perception • Affect • Sense of self • Motivation • Behavior • Interpersonal functioning

4. Symptoms of schizophrenia • The symptoms the individual experiences during the active phase fall into two categories: positive symptoms and negative symptoms. • Active phase: A period in the course of schizophrenia in which psychotic symptoms are present.

5. Symptoms of schizophrenia • Delusions: Deeply entrenched false belief not consistent with the client’s intelligence or cultural background. • Hallucinations: A false perception not corresponding to the objective stimuli present in the environment. • Incoherent speech:Language that is incomprehensible. • Loosening of associations: Flow of thoughts that is vague, unfocused, and illogical. • Restricted affect:Narrowing of the range of outward expressions of emotions. • Avolition:A lack of initiative, either not wanting to take any action or lacking the energy and will to take action. • Asociality:Lack of interest in social relationships.

6. Features of schizophrenia • Inappropriate affect is the extent to which a person’s emotional expressiveness fails to correspond to the content of what is being discussed. • Paranoia is 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.

7. Courses of Schizophrenia • Continuous • Remission • Recurrent • Extended • Continuous In the most serious cases, the individual experiences continuous positive symptoms with no remission. • Remission: Situation when the individual’s symptoms no longer interfere with his or her behavior and are below those required for a DSM diagnosis. • Schizophrenia have more recurrent episodes and their chances of completely recovering are worse than those of people with other disorders. • People with schizophrenia for extended periods of time propose a model in which 25 to 35 percent show chronic psychotic symptoms. • Factors that contribute to poorer prognosis: • Poorer cognitive skills, a longer period of time without treatment, substance abuse, a poorer course of early development, higher vulnerability to anxiety, and negative life events.

8. Other Psychotic Disorders

9. Other Psychotic Disorders • Schizophrenia-like disorders that involve abnormalities in one or more of the five domains: • Delusions • Hallucinations • Disorganized thinking (speech) • Grossly disorganized or abnormal motor behavior (including catatonia) • Negative symptoms

10. Brief Psychotic Disorder • A diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time. • Symptoms must be present for more than a day, but recover in less than a month. • Symptoms • Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior • The diagnosis requires that the individual experience symptoms for more than a day, but recover in less than a month. • Clinician must take the following factors into account: • Client’s cultural background. • Whether the client has experienced a recent stressor. • If a woman develops this disorder within four weeks • brief psychotic disorder is a diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time. To receive this diagnosis, an individual must experience one of four symptoms, which include delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Th e diagnosis requires that the individual experience symptoms for more than a day, but recover • in less than a month.

11. Schizophreniform Disorder • A disorder with essentially the same symptoms as schizophrenia, but that lasts from 1 to 6 months • People with this disorder have larger ventricles in the brain, a phenomenon also observed with schizophrenia. • People have good chances of recovering: • When they show a rapid development of symptoms (within a span of four weeks) • Confusion or perplexity while in the peak of the episode • Good social and personal functioning prior to the episode. • Likely to have a good prognosis if they do not show the negative symptoms of: • Apathy, withdrawal, and asociality.

12. Schizoaffective Disorder • Schizophrenia with co-occurring mood disorder • Schizoaffective disorder: Experience of a major depressive episode, a manic episode, or a mixed episode while also meeting the diagnostic criteria for schizophrenia. The individual must have both a mood and a psychotic disorder, but at least two weeks during which their delusions and/or hallucinations are the only symptoms that they show

13. Delusional Disorders • Erotomanictype: Individuals falsely believe that another person is in love with them. • Grandiosetype: An exaggerated view of oneself as possessing special and extremely favorable personal qualities and abilities. • Jealous type:Individuals falsely believe that their romantic partner is unfaithful to them. • Persecutory type: Individuals falsely believe that someone or someone close to them is treating them in a malevolent manner. • Somatic type:Individuals falsely believe that they have a medical condition.

14. Biological Theories • Genetic abnormalities affects: • Brain development • Synaptic transmission • Immune functioning • Manufacturing of important proteins involved in neurotransmission • Neurodevelopmental hypothesis • 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.

15. Biological Treatment • Medication used in treating schizophrenia was: • Antipsychotic chlorpromazine (Thorazine) • Haloperidol (Haldol) • Symptoms: Rigid muscles, tremors, shuffling movement, restlessness, and muscle spasms affecting their posture. • Tardive dyskinesia:Involuntary movements of the mouth, arms, and trunk of the body. • Antipsychotics operate on both serotonin and dopamine neurotransmitters called serotonin-dopamine antagonists. • For treatment-resistant clients, clozapine is the only approach that has empirical support.

16. Psychological Treatment • Token economy: A form of contingency management in which a client who performs desired activities earns chips or tokens that can later be exchanged for tangible benefits. • Cognitive-behavioral therapy • Treat individuals with symptoms of psychosis. • Teach their clients coping skills. • One promising cognitive training approach involves training in speech recognition and auditory perception.

17. 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”