Psychology help
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schizophreniappt-spring2018.ppt
Ch. 13
Schizophrenia
Schizophrenia is a psychotic disorder involving disturbance of thought, emotion and behavior, and a loss of touch with reality.
- Effects 1% of the population
- Onset is usually in late adolescence, but can strike after age 45
- Substance abuse is co-morbid in 50% of schizophrenia patients
Broad Impairments
Delusions & Hallucinations
Disorganized Speech & Behavior
Inappropriate Emotions
Psychosis: extreme mental unrest with loss of reality contact (Davison & Neale, p. 134)
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- Cause is Unknown
- Affects 1 out of 100 People
- Often Begins (Ages 16 - 30)
- More Hospital Beds Than Any Other Medical Illness
2.5% of Total U.S. Healthcare Budget
- Characterized by distortions: perception, thought, language, emotions
- Greece – Hippocrates had knowledge of the basic symptoms.
- Eugen Bleuler – Swiss psychiatrist – coined “schizophrenia”
- Greek words for “split mind” - separation of cognitive and emotional functions – mental confusion, inappropriate or absent emotional expression.
- Not the same as multiple personality disorder
- Heinz Leshmann – chlorpromazine, first modern anti-psychotic drug – made positive symptoms disappear.
The History of Schizophrenia
- Often Chronic
- Affects Men and Women Equally
- Age of Onset Varies Across Time
- Lower Life Expectancy
- Increased Risk of Suicide
People with schizophrenia have “split personalities.”
People with schizophrenia are intellectually disabled?
People with schizophrenia are dangerous?
People with schizophrenia are addicted to their drugs?
- Schizophrenia is caused by bad parenting or an unhappy childhood.
- Schizophrenia is due to a weakness in character.
- Schizophrenia is due to a negative social label.
- Schizophrenia is a hopeless situation.
- Delusions
- Misrepresentation of Reality
- “Basic Feature of Madness”
- Examples
- Grandeur -- Importance
- Persecution -- Out to Get Me
- Hallucinations
- Absence of Sensory Stimulation
- Involve Any of the Senses
- Auditory -- Voices (70%)
- Visual -- Seeing Things (25%)
- Tactile -- Crawling Sensation
- Flat Affect -- “The Mask”
- Avolition -- “No Initiative”
- Alogia -- “Speech is Vacant”
- Anhedonia -- “No Pleasure”
- Asociality--”No social interest”
Positive Symptoms of Schizophrenia
- Positive symptoms involve excesses or distortions
- Disorganized speech (thought disorder)
- Hallucinations are sensory experiences that occur in the absence of environmental stimulation
- Hallucinations are commonly auditory
- Delusions are beliefs that are contrary to reality
- Persecutory delusions are common
Ch 11.2
Negative Symptoms of Schizophrenia
- Negative schizophrenia symptoms are characterized by behavioral deficits
- Avolition refers to a lack of energy and an inability to persist in routine activities
- Alogia refers to a reduction in the amount or content of speech
- Anhedonia is an inability to experience pleasure
- Asociality refers to a severe impairment in social relationships
Ch 11.3
- Paranoid Type
- Disorganized Type
- Catatonic Type
- Undifferentiated Type
- Residual Type
DSM-V Schizophrenia Categories or Subtypes
- Disorganized schizophrenia involves
- Disorganized speech and flat affect
- A general disruption of behavior
- Catatonic schizophrenia involves
- Prolonged motor immobility states that alternate with periods of excitability
- Paranoid schizophrenia involves the presence of prominent delusions including persecution and grandiosity
- Undifferentiated schizophrenia and residual schizophrenia
- Disorganized Symptoms
- Disorganized Speech
- Difficulty in Communication
- Examples
- Tangentiality
- Loose Association or Derailment
- Positive
Symptoms
- Disorganized Behaviors
- Catatonia
- Spectrum
- Wild Agitation to Immobility
- Example
- Waxy Flexibility
- Disorganized Symptoms
- Positive
Symptoms
Disorganized Schizophrenia
- Confused functions
- Incoherent speech/thought
- Improper emotional expression
- Act silly/bizarre
- Withdrawal from world
- Delusions & Hallucinations
- Intact Cognition and Affect
- No Disorganized Speech
- Best Prognosis
Paranoid Schizophrenia
- Delusions, hallucinations, misinterpretation of facts
- Violent, suicidal behavior - high risk
- Ex: patient imagines that he is someone else or someone is trying to harm him.
- Imaginary voices
Catatonic Schizophrenia
- Negative Symptoms
- Abnormal posture/movements
- Repeated motions
- Motionlessness
- Inactivity/Excitement periods
- Impulsiveness
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- Disorganized Speech
- Disorganized Behavior
- Waxy flexibility, rigidity, odd mannerisms, mimicry
- Flat or Inappropriate Affect
- Hallucinations and Delusions
- Fragmented or Lacking a Theme
- Often Chronic
Undifferentiated Schizophrenia
- Decrease in outside interests/relationships
- Absence of mental activity
- Lack of emotion
- Mixture of symptoms
- Does not fit any of the categories
Residual Schizophrenia
- Moderate symptoms which occur after partial recovery of an acute episode of schizophrenia
- Less severe symptoms: flat affect, Absence of emotion, limited speech
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- Beginnings of Breakdown
- DO NOT Meet Other Criteria
- “Wastebasket” Category
- Have Had One Episode
- Now Mostly Symptom Free
Once a Schizophrenic,
Always a Schizophrenic?
- No one knows the exact cause, but multiple possible factors have been discovered
- Genetics
- Women infected with influenza virus during their pregnancy are more likely to give birth to children who will develop the disorder
- Brain’s contain larger fluid-filled areas than their healthy brain counterparts
Causes of Schizophrenia
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- Ventricle Enlargement
- Genetic
- Neurobiological
Influences
- Brain Structure
Etiology of Schizophrenia
- Genetic studies using twin, family and adoption techniques reveal that a predisposition for schizophrenia is transmitted genetically
- Brain pathology, possibly including damage to the fetal brain from virus-like diseases, are likely biological vulnerabilities for schizophrenia
Ch 11.5
Genetic Studies of Schizophrenia
Relation to Percentage
Patient Schizophrenic
Spouse 1.00
Grandchildren 2.84
Nieces/nephews 2.65
Children 9.35
Siblings 7.30
DZ twins 12.08
MZ twins 44.30
Ch 11.6
- Runs in Families
- Increased Risk Based on Genetic Relatedness
- Search for Marker Genes
- Genetic Influences
Biochemistry of Schizophrenia
- Dopamine theory holds that the positive symptoms of schizophrenia result from excessive activity of dopamine in brain
- Anti-schizophrenia drugs block dopamine receptors
- The anti-schizophrenia drugs take several weeks to act clinically, yet rapidly block dopamine receptors
- Ingestion of amphetamine can induce psychosis; amphetamine causes the release of dopamine from neurons
Brain Pathology in Schizophrenia
- Brains of schizophrenic patients show
- Reduced volume of temporal and frontal cortex
- Enlarged ventricles (reflecting loss of brain cells)
- For 12 of 15 twins, the schizophrenic twin could be identified by enlarged ventricles
- Reduced metabolic activity within prefrontal cortex (frontal hypoactivation)
Ch 11.9
