Schizophrenia spectrum disorders

What does it influence

 Influences thinking, feeling, and behavior

Lifetime prevalence, gender ratio, onset:

 1%, men slightly more, appears late adolescence/early adulthood 

Widespread disruptions in: 

maintaining job, living independently, having close relationships 

DSM criteria: 

2+ symptoms for 1+ month (one of which has to be 1-3)

1. Delusions 2. Hallucinations 3. Disorganized speech 4. disorganized or catatonic behavior 5. Negative symptoms (diminished motivation or emotional expression)

2. Functioning declined since onset; signs for 6+ months; 

3. OR during prodromal/residual phase—neg symptoms or 2+ less severe 1-4 symptoms 

Prodromal phase:

before manifestation of 1st episode, consists of cognitive and social decline; 1/3 go on to develop full “

Positive symptoms:

delusions and hallucinations, most severe during acute episodes (important to consider culture) 

Delusions examples (know what they are):

 thought insertion, thought broadcasting, grandiose delusions, ideas of reference 

Negative symptom domains (2) and symptoms (5):

domains: motivation/pleasure and expression. 5 types of symptoms: avolition, anhedonia (not consummatory but anticipatory), alogia, blunted affect (only outward!!), asociality  

Disorganized symptoms:

speech (loose associations, derailment) and behavior (e.g catatonia)

Other schizophrenia spectrum disorders:

• Schizophreniform: same symptoms but 1-6 month duration 

• Brief psychotic disorder: 1 day-1 month

• Schizoaffective: mix of schizophrenia and mood disorder symptoms 

• Delusional disorder: persistent delusions

Etiology of schizophrenia (genetics):

 through family and adoption studies/familial high-risk: higher risk with closer genetic tie to affected person (e.g. MZ twins 44% concordance); GWAS show genetic heterogeneity!

Etiology (Neurotransmitters and brain structure):

 dopamine, seratonin, GABA, glutamate ; Enlarged ventricles, reduced activation of PFC, dysfunction in temporal cortex 

Etiology (Environmental):

obstetric complications, prenatal infections, cannabis use(+ predisposition) 

Etiology (Sociocultural):

 poverty, urbanicity, migration 

Family dynamics (e.g. EE):

  Expressed emotion impacts affected person – family hostility, criticism, emotional over involvement leads to relapse. Also, communication issues are bidirectional 

Retrospective markers:

 lower IQ, withdrawn, poor motor skills  

Treatment options:

short term hospital stays; medication; psychosocial treatment 

Issue with treatment:

many lack insight 

Antipsychotics general info:

 maintenance doses for people who respond well; HIGH rates of quitting 

First gen antipsychotics:

reduce positive and disorganized symptoms but not negative; serious adverse side effects; 1/2 quit after a year  

Second gen antipsychotics:

also side effects, slightly better at reducing negative symptoms and cognitive deficits 

Psychological treatment:

adjunctive!, 1) social skills training; 2) family therapies; 3) CBT; 4) cognitive remediation, also residential  

Social skills training:

 managing interpersonal situations, aim for higher quality of life

Family therapies:

 education about disorder and about pros/cons of meds, blame reduction, communication and problem solving skills, social network expansion, hope

CBT:

can reduce negative symptoms by challenging beliefs tied to expectations for success and pleasure; can “test out” delusional beliefs 

Cognitive remediation

enhance basic cognitive functions like attention