Schizophrenia spectrum & other psychotic disorders

Schizophrenia

Chronic psychotic disorder

• Acute episodes involving a break w/ reality

Kraepelin & schizophrenia

Called it dementia praecox

• Thought it was a disease caused by a specific pathology in the body

• Proposed a deteriorating course beginning early in life

Kraepelin’s description of schizophrenia

Included

• Delusions

• Hallucinations

• Odd motor behaviours

Eugen Bleuler & schizophrenia

Focused on the splitting of brain functions that give rise to cognitive, feelings/affective responses & behaviour

• Proposed a more variable course

Bleuler’s description of schizophrenia

Involved four primary features/symptoms - the four As'

• Associations

• Blunted or inappropriate affect

• Ambivalence

• Autism

The 4 A’s

• Associations

• Blunted or inappropriate affect

• Ambivalence

• Autism

Associations, the 4 A’s

relationships among thoughts become disturbed

• Speaker is unaware of the lack of connectedness

• Rambling & confused speech

Looseness of associations

Ideas are strung together w/ little or no relationships among them

Affect, the 4 A’s

Emotional response becomes flattened or inappropriate

Ambivalence, the 4 A’s

Conflicting feelings towards others

Autism, the 4 A’s

Withdrawal into private fantasy world that is not bound by principles of logic

Secondary symptoms of schizophrenia according to Bleuler

Symptoms that do not define the disorder

• Hallucinations

• Delusions

Kurt Schneider & schizophrenia

Distinguished between 2 sets of symptoms

• First-rank symptoms

• second-rank symptoms

Schneider, first-rank symptoms

Primary features that distinctly characterize the disorder

• Hallucinations

• Delusions

Schneider, second-rank symptoms

Symptoms that also occur in other psychological disorders

• Associated w/ schizophrenia but not unique to it

Prodromal phase

Period of deterioration that precedes development of the first acute psychotic episode

• Waning interest in social activities

• Increasing difficulty in meeting the responsibilities of daily living

• Changes start so gradually that they raise little concern

When does schizophrenia typically develop?

In the late teens or early 20s, when the brain is reaching full maturation

Men vs women risk of developing schizophrenia?

Men have slightly higher risk of developing the disorder than women & typically develop it sooner

Acute phase

When psychotic symptoms develop

• Hallucinations

• Delusions

• Disorganized speech & behaviour

Residual phase

Behaviour returns to level that was characteristic of prodromal phase

• Follows acute episodes

Delusions

Disturbance in the content of thought

• False beliefs that remain fixed in the person’s mind despite their illogical bases & lack of supporting evidence

Delusions of grandeur

Thinking you are Jesus or on a special mission or saving the world

Broadcasting delusion

Belief that one’s thoughts are transmitted to the external world & others can hear them

Thought insertion delusion

Believing that one’s thoughts have been planted in their mind by an external source

Thought withdrawal delusion

Believing that thoughts have been removed from their mind

Disorganized speech

Form or structure of thought processes is disturbed in schizophrenia. They think in a disorganized, illogical fashion

Speech pattern of people w/ schizophrenia

Often disorganized or jumbled

• Parts of words combined incoherently

• Words strung together to make meaningless rhymes

Thought disorder

Disturbances in thinking

• Breakdown in logical associations between thoughts

Poverty of speech

Speech is coherent but limited in production or vague, little informational value is conveyed

Neologisms

Words made up by the speaker that have little or no meaning to others

Perserveration thought disorder

Inappropriate but persistent repetition of the same words or train of thought

Clanging thought disorder

Stringing together words or sounds on the basis of rhyming

Blocking thought disorder

Involuntary abrupt interruption of speech or thought

Hallucinations

Most common form of perceptual disturbance in schizophrenia

• Perceptions that occur in the absence of external stimulus

• Difficult for them to distinguish from reality

Most common form of hallucinations in schizophrenia

• Auditory

• Tactile

• Somatic

Tactile hallucinations

Tingling, electrical, or burning sensations

Command hallucinations

Voices that instruct you to perform certain acts

Causes of hallucinations

Unknown, dopamine is thought to be implicated

• Antipsychotic drugs that block dopamine also tend to reduce hallucinations

Catatonia

Gross disturbances in motor activity & cognitive functioning

Stupor

Relative or complete unconsciousness where person is not generally aware of or responsive to the environment

Waxy flexibility

Adopting a fixed posture where people w/ schizophrenia have been positioned by others

Positive symptoms

Presence of abnormal behaviour

Negative symptoms

Absence of normal behaviour

• Represent the more enduring or persistent characteristics

Blunted affect

Reduction in emotional expression

Flat affect

Absence of emotional expression

Loss of ego boundaries

May fail to recognize themselves as unique individuals & be unclear about how much of what they experience is part of themselves

Event-related potentials

Brain wave patterns occurring in response to external stimuli like sounds & flashes of light

Schizophrenia & event-related potentials

Weaker event-related potentials. Shows people w/ schizophrenia have a harder time filtering out distracting stimuli

Primary narcissism

Early period in the oral stage

• Infant has not yet learned that it and the world are distinct entities

• person regresses to this in schizophrenia

Genetic factors & schizophrenia

Strongly influenced by genetic factors & tends to run in families

• Closer relationship w/ person w/ schizophrenia = higher risk

Cross-fostering study

Examining differences in prevalence among adoptees raised by adoptive parents or biological parents who possessed the trait or disorder in question

Dopamine theory

Schizophrenia involves an overreactivity of dopamine receptors in the brain

• People w/ schizophrenia do not appear to produce more dopamine, but they use more of it

Time of year of birth & schizophrenia

Risk of schizophrenia is greater in people who are born in the winter & early spring months in the northern hemisphere

• This is the time of year associated w/ greater risk of the flu

Brain scans & schizohrenia

Show evidence of structural abnormalities & disturbed brain functioning

• Loss or thinning of grey matter

• Abnormally enlarged ventricles

Hypofrontality

Reduced neural activity in the prefrontal cortex

Diathesis-stress model & schizophrenia

People possess a genetic predisposition to schizophrenia which is only expressed behaviourally if they are reared in stressful environments

Schizophrenogenic mother

Type of mother who was believed to be capable of causing schizophrenia in her children

• Cold but overprotective

• No research supporting this

Double-bind communication

Pattern of communication including transmission of contradictory or mixed messages w/o acknowledgment of the inherent conflict

• May serve as source of family stress that increases risk of schizophrenia in genetically vulnerable individuals

Communication deviance

Pattern characterized by unclear, vague, disruptive, or fragmented parental communication

Expressed emotion (EE)

Form of disturbed family communication

• Family members of individual w/ schizophrenia tend to be hostile, critical, & unsupportive

• High EE - poorer adjustment & higher rates of relapse

Biological approaches to treatment

Antipsychotic drugs to control the more flagrant behaviour patterns. Reduces need for long-term hospitalization when taken on maintenance basis

• Major tranquilizers

• Neuroleptics

Tardive dyskinesia

Involuntary movement disorder that can affect any body part

• Potentially disabling side effect of long-term treatment w/ neuroleptic drugs

• No safe & effective treatment for this

Atypical antipsychotic drugs

Second generation antipsychotic drugs

• At least as effective

• Fewer neurological side effects & lower risk of tardive dyskinesia

Learning-based therapy methods

• Selective reinforcement of behaviour

• Token economy

• Social skills training

Social-skills training

Programs that help individuals acquire a range of social & vocational skills. Less relapse w/ this

• Can improve a wide range of skills

• Increase social adjustment

• Reduce psychiatric symptoms

• Improve community functioning.

Psychosocial rehabilitation

Teaches that people w/ emotional or physical disabilities can achieve their potential if they are given the structure & support they need

• Community programs offering services like housing, job, & educational opportunities

Canadian treatment guidelines

• Antipsychotic meds are the most effective treatment available

• Chronic patients typically receive maintenance doses once flagrant symptoms abate

Early intervention programs

Important to treat symptoms before they become severe. The earlier a person receives treatment, the better the outcome in reducing symptoms & improving daily functioning

2 forms of early intervention programs

• Initiating treatment ASAP once person has developed schizophrenia

• Intervene before onset of schizophrenia - prevention programs for high risk individuals

3 clinical varieties of dementia praecox

• Catatonia

• Hebephrenia

• Paranoia

Catatonia variety of dementia praecox

Motor activities are disrupted

• Either excessively active or inhibitied

Hebephrenia variety of dementia praecox

Inappropriate emotional reactions & behaviour

Paranoia variety of dementia praecox

Delusions of grandeur & persecution

Avolition

Inability to initiate & persist in goal directed activities