Chapter 14 - Psychosis

schizophrenia

• cognitive and emotinal dysfunctions

• ex. delusions, hallucinations, disorganized speech, behavioural and emotional dfificulties

emil kraepelin

• early figure in diagnosing schizophrenia

• combined symptoms of insanity under latin term “dementia praecox” and distinguished dementia praecox from bipolar disorder (then called manic-depressive illness)

catatonia

• alternating immobility and excited agitation

• withdrawn: silence, unusual posture, resist attempts to move them, stuck in that one position until moved

• excited: sudden and unpredictable behaviour changes, such as pacing, agitation, aggression, violent bhaviour

• think person sitting in fixed position for hours, not moving, even when uncomfortable

• disturbances in movement and behaviour essentially

hebephrenia

• silly and immature emotionality

• incoherent delusions

• inappropriate emotional responses, delusions, hallucinations, foolish or bizarre behaviour

• think giggling at inappropriate times, disorganized speech, childlike behaviour, and incongruency of affect and event (laughing while telling a sad story, crying while recounting a joyous event) (flat OR inappropriate affect)

paranoia

delusions of grandeur or persection

“omg!! someone’s out to get me!! that’s a stalker!! that one’s tryna kill me!!”

• unfounded belief, obviously not when there’s actually a threat

dementia praecox

cataonia, hebephrenia, and paranoia were combined and put under this term as kraeplin thought they shaerd similar underlying features.

common features of dementia praecox

• hallucinations

• delusions

• negativism (resistence or opposition to external stimuli without apparaent reason)

  • ex. raise your hand, just doesn’t (passive)

  • ex. when asked to turn right, turns left (active)

• stereotyped behaviour

  • repetitive, purposeless, automati actions in a uniform manner

  • ex. constnalty tapping figures, rocking back at forth, repeating the same word over and over again, maintaining a specific posture for extended periods

  • stereos —> solid, typos —> impression (solid impression, rigid, repetiive, unwavering)

whats eugen bleuler known for?

the term schizophrenia!!

skhizein —> split, phren —> mind

ifor bleuler, his belief that underlying all the unusual behaviours was an associative splitting of the basic functions of personality

whats associative splitting?

• the destruction of the forces that connect one function to the next

• difficulty keeping a consistent rain of thought

• krapelin —> early onsent and poor outcomes

• bleuler —> what he thought wsa the universal underlying problem

psychosis

• loss of contact with reality

• having delusions and/or hallucinations

  • delusions —> irrational beleifs

  • hallucinatons —> seeing, hearing, feeling thing that aren’t actually there (absence of external events)

positive symptoms

things that are added in.

symptoms around distorted reality.

ex. hallucinations, delusions

negative symptoms

things that are taken away.

deficits in normal behaviour in areas of speech, affect, and motivation.

ex. affective flattening (taking away expressions), catatonia (taking away movement)

• emotional and social withdrawal

• apathy

• poverty of thought or speech

disorganized symptoms

rambling speech, erratic behaviour, inappropriate affect

quite frankly, just chaotic symptoms

diagnostic criteria for schizophrenia

• two or more positive, negative, or disorganized symptoms be present for at least one month, with at least one of these symptoms including delusions, hallucinations, or disorganized speech

• dimensional assessment, rating severity of symptoms on a 0 (nonexistent) - 4 (present + severe) scale

• for signficant portion of time since onset, evel of functioning in 1+ major areas (work, interpersonal relations, self care) is below level before onset

  • if onset is in childhood or adolescence, we look at failure to achieve expected level of interpersonal, academic, occupational functioning

• 6+ months of continuous signs of disturbance, including at least 1 month of positive, negative or disorganized symptoms, and the rest of hte time, there may be milder or leftover symptoms

• cant be schizoaffective, depressive, or bipolar disorder bcz

  • no MDE or manic episodes during active-phase

  • if they have occured during active-phase, present for miority of total duration

• drugs, medical condition did not casue this!

• if history of ASD, childhood communicaiton disorder, additional diagnosis of schizophrenia only to made!! if prominent delusions or hallucinations are ALSO present for at least 1 month

specifier: with catatonia

delusions

• disorder of thought content

• ex. squireels are aliens sent to earth on a reconnaissance mission

• ex. im literally napoleon

delusion of grandeur

• mistaken belief that the person is famous or powerful

• ex. i have the secret to solving world hunger for everyone!!!!!

• ex. i can control the weather!!

delusions of persecution

• they’re out to get me! they’re gonna kill me!

• ex. the other competitors switched my sugar out for salt!!! (this is plausible, so its non-bizarre but its still a delusion)

cotard’s syndrome

• something in their body has changed in some impossible way

• ex. they are dead, they do not exist, tehy have lost their blood or internal organs, or they are decomposing

  • this is a delsuion. clearly not actulaly happening.

capgras syndrome

• believes someone they know has been replaced by a duplicate

• ex. “omg this isnt really my husband its osmeone else that looks exactly like my husband!!! im so stressed oh my god, i have to find the real person”

• may act violent towards the person tjey think is an imposter, act chill towards everyone but them

what may be the purpose of delusions?

• those who had delusoins expressed a much stronger sense of purpose and meaning in life as well as less depression!!

• it might be an adaptive function to help them cope iwth the changes in their body as they develop this disorder

hallucinations

• the experience of sensory events without any iinput from the surrounding environment

• ex. “theres bugs crawling up my sleeves!!!”

  • if someone says this, don’t try to convince them otherwise. simply pull sleeves down, treat like how you would if it was actually happening until they calm down. and then later they can understand they were being psychotic.

• auditory hallucinations

  • when you hear voices that aren’t actually there

what are auditory hallucinations and theories for why they develop?

• hearing things that aren’t there ex. your uncle’s voice!!!

• theory 1:

  • ppl who are hallucinating are not hearing voices of others, but their own in their head and they cna’t tell the difference

• theory 2:

  • auditory verbal hallucinations arise fro abnormal activation of the primary auditory cortex

    • fMRI scan of a woman while she was experiencing these hallucinations + whne she was listneing to external speech:

      • auditory hallucinations: increaesd activity in left primary auditory cortex and right middle temporal gyrus

    • this finding is ocnsistent iwth both theories!! more resarch needed.

avolition

• a - without, volition —> act of choosing/deciding

• inability to initiate and persist in activities

• SAME THING AS APATHY

• little interest in perofrming basic dialy functions

  • ex. brushing teeth, going to work, feeding dog

• highly associated with poor outcome than other schizophrenia symptoms

alogia

a - without, logos —> words

alogia —> relative absence of speech

• respond to questions with brief replies, little content, uninterestd in conversation

• ex. “do you have any children” “yes” “how many” “2”… instead of “yes, i have 2, theyre 6 and 12”

anhedonia

• an —> no, hedonia —> pleasure

• lack of pleasure associated with activities (much like MDD)

• ex. don’t really care for eating, talking to ppl, having sex

  • obvi, difference between hypoactive sexual desire disorders

asociality

• when it says social, it means “relating to society or its organization”

• lack of interest in social interactions

• worsened by limited opportunities to interact with each other (ex. isolated severely ill patients)

• asocial is different from antisocial

• patients who have poor social/interpersonal functioning before development of psychosis have greater levels of negative symptoms and greater social impairment

• difficulties in processing information may significantly contribute to social skills deficits

flat affect

• do not show emotions when you would normally expect them to

• ex. vacant stares, flat and toneless speaking, unaffected by things going on around them

• those with flat affect do experience emotion!!!!! they just have difficulty expressing it!!

• but another study showed that those with flat affect experienced the emotions less severely, so its under resaerch if its expression, experience or both being affected in schizophrenia

disorganized speech

tangentiality

going off on a tangent instead of answering a specific quesiton. i do this a lot.

“hey when’s your class?”

“i dont wanna go class stresses me out”

loose association/derailment

• chnged the topic of conversation to an unrelated area

• ex. “talking about tacos, all of a sudden we’re talking about trains”

ex. “hey! whens your class?”

ex. “oh my god that reminds me, i need to go see this band perform”

cognitive slippage

when a person makes tengential connections between concepts that are not immediatley understandable to litseners

in schizophrenia, think word salad

ex. “list some types of cars”

“let’s see, there’s ford, chevrolet, toyota, japan, rising sun, hiroshima, atomic bomb, enola gay, oh and miata”

• toyota, japan, rising sun, hiroshima, atomic bomb, and enola gray are all related but theyre not cars!! it takes a minute to figure out what the link is.

concept check 14.1

1. delusions

2. avolition

3. affective flattening

4. hallucinations

4/4!!

inappropriate affect

expressions of emotions that aren’t congruent with how you should respond at a specific social time

ex. laughing at a funeral, crying at your birthday (not tears of joy)

disorganized behaviours

• active behaviours that are viewed as unusual

• ex. catatonia —> motor dysfunctions ranging from agitation to complete immobility

• CATATONIA. IS ITS OWN SEPERATE SCHIZOPHRENIA SPECTRUM DISORDER

catatonia as a seperate schizophrenia spectrum disorder.

• need to find this, idk wher this is

• butt for now

• active side —> excited pacing, repeatd (stereotyped) moving on fingers, arms

• on other side —> unuusal postures, fearful of something terrible happening if tjhey moe (catatonic imobility)

  • also waxy flexiblity —> tendency to keep bodies and limbs in the position theyre put in by someone else

    • think of the wax of a candle!! it bends itslef to how you bend it and then it stays

diagnostic criteria for schizophreniform disorder

description: only expeirence symptoms of schizophrenia for a few months, then they can resume normal lives a

A: or more of following with at least 1 from the first three (just like schizophrenia)

1. delusions

2. hallucinations

3. disorganized speech

4. grossly disorganized/catatonic behaviour

5. negative symptoms

B: an episode of the disorder lasts at least 1 month but less than 6 months. when diagnosis must be made without waiting for recovery, it should be qualified as “provisional”

C: can’t be schizoaffective disorder + depressive/bipolar disorder with psychotic features bcz either 1. no MDE or manic epiosdes have occured concurrently with active-phase symtoms or 2. if they have occured during active-phase symptoms, they were like barely there for the total duration

D: drugs, medical condition didnt cause this

specifiers:

• with good prognostic features

  • presence of at least 2 of following:

    • onset of prominent psychotic symptoms within 4 weeks of first noticeable chnge in behaviour

    • confusion/perplexity

    • good premorbid social + occupational functioning

    • no flat affect

  • without good prognostic features

    • 2 of the following aren’t present

• specifier: with catatonia

schizophreniform disorder vs schizophrenia disroder

THE ONLY DIFFERENCE IS DURATION!!

for schizophreniform disorder, symptoms last 1-6 months. if longer than 6 months, might be schizophrenia.

for schizophrenia, we have at least 1 month of active-phase sypmtpoms (delusions, hallucinations, disorganized speech or behaviour) with the rest months possibly bieng milder symptoms, but then the symptoms do persist for over 6 months.

schizoaffective disorder

A. uninterrupted period of illness where thers a major mood episode (depressive or manic) concurrent with criterion A of schizophrenia (at least 2 of the following of criteria a symptoms)

B. delusions or hallucnations must be there in the absence of a major mood episode

C. symptoms that meet criteria for a major mood episode ar epresent for the MAJORITY of the total duration of the active + residul portions of the illness

• operationally define majority of time maybe?

D. not caused by drugs, meds, medical condition

specifiers: bipolar type (if a manic episode, or manic episode and depressive episodes)

depressive type (if only major depressive episodes are part of hte presentation)

specifier: with catatonia

delusional disorder

major feature: persistent belief that is contrary to reality (deluussionalll) in the absence of other characteristics of schizophrenia.

ex. women who believes coworkers are putting poison in her food

not because of brain seizures of severe psychosis. no flat affect, anhedonia, negative symptoms of schizophrenia.

subtypes of delusional disorder

• erotomanic

• grandiose

• jealous

• persecutory

• somatic

erotomanic delusion

• when someone believes that someone is intensely in love with them

• celebrity, or someone of a higher position

grandiose delusion

• believing in one’s inflated worth, power, knwoledge, identity, special relationsihp to a famous person

• ex. “i have the answer to solving all the world’s problems in thsi one textbook”

jealous delusion

• believes a sexual partner is unfaithful, even if they aren’t

persecutory delusion

involves person believing that someone is harming them

ex. poisoning their coffee, stealing their stuff, trying to kill them, stalking them

somatic delusion

• false beliefs about one’s body

• imagining a serious illness or feeling bugs crawling under your skin, saying their organs have been harvested, wtih no incisions, without explaining how theyre still alive

diagnostic crtieria for delusional disorder

A. presnce of one or more delusions with duration of 1 month or longer

B. criterion a for schizophrenia HAS NOT. NOT NOT NOT NOT. NOT BEEN MET.

if hallucinations are present in this disorder, they are not prominent and not related to the theme of the delusion

C. functioning is not markedly impaired, behaviour is not obviously bizarre or odd

D. if manic or major depressive episodes have occured, BRIEF rlated to duration of delusions

E. no drugs, emds, medical condtion, other mental disorders (BDD, OCD)

specifiers: erotomaniac, grandiose, jealous, persecutory, somatic, mixed, unspecified

the delusions here are usually not bizarre!!

shared psychotic disorder (folie a deux)

• condition where individual dvelops delusions simply because of a close relationship with a delusional individaul

• ex. three sisters with super emeshed lives became preoccupied with religion, with delusion that god was communicating with them.

• now this is specified as: delusional symptoms in the context of a relationship with an individual with prominent delusions

what other disorders can cause delusions?

• misuse of drugs (meth, alcohol, cocaine)

• brain tumours (think izzie and her hallucinations, and potential delusion that denny came back from the dead to be with her)

• huntington’s disease

• alzheimer’s disease

substance-induced psychotic disorder

• form of psychosis attributed to substance intoxication, withdrawal, or recent consumption of psychoactive drugs

• ex. prolonged use of meth leading to paranoia, auditory hallucinations…

psychotic disorder due to anotehr medical condition

• medical condition direclty causes psychotic symptoms, usually due to effects on the brain

• ex. epilepsy of temporal lobe causing auditory or visual hallucinations, delusions or paranoia

• ex. elevated cortisol levels leading to psychotic symptoms

diagnostic criteria for brief psychotic disorder

criteira a: same as schizophrenia (1 of the following, 1 has to be from the first 3. delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behaviour)

criteria b: duration of an episode is at least 1 day, but less than 1 month, with eventual full return to premorbid level of functioning

criteria c: disturbance is not better explained by MDD or bipolar with psychotic features, or schizophrenia or catatonia, not attributable to drugs or medical condition

specifiers:

• with marked stressor (in response to events that would be markedly stressful to almost anyone in similar circumstances within theri culture)

• without marked stressors (if symptoms do not occur in response to events that would be markedly stressful to almost anyonel.. (just the opposite)

• with peripartum onset (if onset is during pregnancy or within 4 weeks postpartum)

specifier: with catatonia

attenuated psychosis syndrome

• they start to develop psychotic symtpoms and are sufficiently distressed to seek help

• can be at high risk for developing schizophrenia and may be at an early stage of the disorder (prodromoal)

• but they dont meet the full criteria, but tehy are good candidates for early itnerventions to see how to prevent symptoms from worsening

• so like below threshold disorder

schizotypal personality disorder

• characteristics are like those expeirenced by people with schizophrenia but less severe

• schizophrenia + schizotypal personality disorder may be genetically related

• will be talked about more on personlaity disordres chapter

schizophrenia stats

• course: chronic

• delusions prevent them from getting married and functioning normally

• loneliness is a major problem

• more men have it than women

• double acute care hospitalization

• high rates of medical issues, so they tend to live less time

concept check 14.2

1. delusional disorder

2. schizoaffective disorder

3. schizophreniform disorder

4. shared psychotic disorder (roommate started believing it too)

prodromal stage

a period of 1-2 years when less severe but unusual behaviours start to show themselves befroe serious symptoms occur

ex. ideas of reference (believing that a strangers phone call is about you, magical thinking (believing they have speical abilities, like being telepathic), and illusions (feeling the pesence of another person when they’are alone)

also isolation, mrked impairment in fucntioning, lack of initiative, interests, energy

once symptoms begint o appear, it can 2-10 years before a high risk person meets full criteria for psychotic disorder

risk factors of giong from high risk to a full fledged disorder as is length of duration of symptoms, baseline functioning, presence of negative + disorganized symptoms.

whats the relapse rate like

• most iwll recover but go through a pattern of relapse and recovery

• those with schizophrenia have a poor prognosis than those with most other disorder (lotsof suicide, most experineced several episodes with differeing degrees of impairment between them)

what do children who go onto develop schizophrenia show?

• mild physical anomalies

• poor motor coordination

• mild cognitve and soical problems

• but these could be signs of other problems, like neurodevelopmental problems too or like nothign! so we’re not sure.

cultural factors of schizophrenia

• some say it doens’t really exist, is just a label for those who behave outside cultural norm

• but it appears similar across various ethnic groups

• black ppl have highest rates of schizophrenia of all immigrant groups

genetic influences of schizophrenia

• the more severe the parent’s schizophrneia, the more likely the children were to also develop it. but, its more a predisposition for general schizophrenia that can manifest like it did for ur parents, or manifests seperately

• familial risk for a spectrum of psychotic disorders related to schizohprenia

• crazy high risk factor for schizophrenia if you have a twin with it

• think the genain quadruplets who all grew up togehter withthe same genes, but symptoms, diagnoses, and courses of schizophrenia varied sister to sister. importnat to think about unshared environments + de novo mutations here, to see that even tho theyre super identical, they can still have different outcomes.

• gene-environment interaction, with a good home environment reducing the risk of schizophrenia

• you can have genes that predispose you to schizophrenia, but you don’t’ get the disorder, but you pass on teh genes, meaning you are a carrier for schizophrenia.

• gene-environment interactoins: those with a particular genetic profile combined with cannabis use as teens increases likelihood to develop schizophrenia. so if u have a vulnerability drug use can increase risk at crucial developmental stages

• genetic risk arises from many common genes, each with small effect

• eye-tracking deficit may be a marker for schizophrenia

• several genes at different chromosomal sites play a role in schizophrenia, this variation explains variances in severity and why risk increases with number of affectd relatives

concept check 14.3

1. d (severity)

2. i (general)

3. f (identical twin), a (greater than)

4. a (greater) —> bcz there is still a genetic component! but lower than if they stayed

what are de novo mutations?

• genetic mutations that can occur as a result of a mutation in an egg or sperm cell before conception or in a fertilized egg after conception

what are unshared environments?

• identical siblings can have v different prenatal and family experiences

• ex. myra refered preferential treatment from patients while hester received harsh treatment

• one was even circumcised at the advice of a physician cause she masturbated??????????///

• sisters also provided evidence that cognitive abilities may be maintained

neurobiological influences

• remember that its difficulty to establish directinalty in correlational studies

• dopamine theory: findings that when drugs adminstered that are known to increase dopamine, schizophrenic symptoms increase, and vice versa

• contradicting dopamine theory: lotta ppl with schiz are not helped with dopamine antagonists, relevant symptosm subside after several day or weeks which is slower than expected, drugs are only partially helpful in reducing negative symptoms

• strong evidence that schiz is partially bcz of excessive sitmulation of striatal dopamine receptors, where striatum is part of basal gnanglia which controls movement, balancing, walking.

• also potentially bcz of deficiency in stimulation of prefrontal receptors; so oveactive doapmine sites somehwere, but maybe less active dopamine sits in prefrontal cortex (may account for avolition)

• research on alterations in prefrontal activity involving gulatamate transmission, where its suggested that a deficit in glutamate or blocking of NMDA sites (a receptor implicaetd in schizophrenia) may be involved in symptoms of schizophrenia

hyperfrontality

lower prefrontal activity in ppl with schiz

brain structure

• some findings suggest brain damage or dysfunction may cause or accompany schizophrenia, although no single site is responsible for whole range of symptoms

• SIZE OF VENTRICLES!!! ENLARGED in some of brains of ppl with schizophrenia, showing that some parts of brain have not fully developed or atrophied, allowing ventricles to be larger.ventricles seem to enlarge in proportion to age and duration of schizophrenia.

• different experiences among twins (ex. birth complications) could damage brain and cause schizophrenia symptoms

• less frontal lobe activity in ppl with schizophrenia, performing poorer on cogntive tasks related to functioning of frontal lobes (hypofrontality). SPECIFICALLY!! in the dorsolateral prefrontal cortex, and this is associtaed with negative symptoms

• brain damage may develop progressively before symptoms are even apparent, and perhaps even prenatally. also many brain sites

viral infection

• hypothesis that schizophrenia is because of a virus-like disease

• findings that mothers exposed to influenza during pregnancy were more likely to have schizophrenia

• parasite in cat poop is implictaed wtih schizophrenia

• fingertip ridge count may be marker for prenatal brain damage (if something happpens during second-trimester fetal development, number of ridges are affected)

psychological and social influences

• stress

  • stress of urban living has increased risk of developing schizophrenia

  • high number of stressful lfie events in 3 weeks before started showing signs of the disorder

• being born in teh winter increases person’s chance for later developing schizophrenia by 5-8%. huh??????

• ppl more likely to relapse after having stressful events in the previous month, but not always bcz of stress, other factors too

• low SES and schizophrenia are correlated

  • bcz life is more stressful, u develop it (sociogenic hypothesis)

  • can’t hold down a job bcz of schizophrenia, you become poorer (social selection hypothesis)

• higher levels of social support predicted better outcomes 5 years after first episode

schizophrenogenic

term used to describe mother whose cold, dominant, and rejecting nature was thought to cause schizophrenia in her children

double bind

term used to portray a type of communication style that produced conflicting messages, which caused schizophrenia (ex. doesn’t wnan ahug kid, but goes “dont u love me anymore” when kid doesnt wanna hug them")

expressed emotion (EE)

• emotional communication style charcterized by levels of criticism, hostility and emotional overinvolvement of family members towards person wtih schizophrenia

• finding that those with limited contact with relatives did better than patients who spent more time with families

• why? bcz if level of criticism, hositlity, and intrusivness of families was high, patients tended to relapse (lol families are the problem! but esp in this cause when the symptoms sorta bounce off on each other..?)

• high EE, more likely to relapse than if low EE

• high EE —> intrusiveness, high levels of emotional response, negative attitude towards illness, low tolerance and unrelaistic expectations

• also reciprocal. patient behaviours evoke hositlity in family members, family members have high EE…

treamtnet of schizophrenia

• sometimes people do resort to lobotomies!

• neuroleptic drugs to help reduce symptoms

• used in combination with psychosocial treatments

• massive doses of insulin to induce comas, but this was acc a horrible idea, and caused tons of death

• prefrontal lobotomies

• ECT

neuroleptics in the treatment of schizophrenia

neuroleptics —> taking hold of hte nerves. they are antagonists for dopamine, but they also affect serotonin.

• ex. chlorpromazine

• help ppl think more clealry, reduce hallucinations nad delusions

• affect positve symtoms mainly, reduce negative and disorganized symptoms a little

• now we use a lot of clozapine

• newer antipsychotic can reeduce severity of long-standing tardive dyskinesia (neurological syndrome reuslting in involuntary and repetive body movements)

• newer anti-psychotics may be helful in imrpivng cognitive functioning, and treaitng flat affect

• most ppl DONT TAKE THEIR MEDS!!! bcz cost, stigma, lack of social support, poor doctor-patient relationsship, and negative side effects

why dont patients tkae their meds?

• poro social support

• cost of meds

• stigma

• poor doctor-patient relationship

• side effects of drug

side effects of antipsychotics

• grogginess

• blurred vision

• dry mouth

• extrapyramidal symptoms (more serious side effects)

  • motor difficulties similar to those expeirneced by ppl with parkinsons

  • akinesia —> slow motor activity, expressionless face, monotonous speech

  • tardive dyskinesia (involuntary movements of tongue, face, mouth, jaw)

    • irreversible ☹

concept check 14.4

1. serotonin + dopamine (c+d)

2. clozapine (agonist) (a)

3. extrapyramidal symptoms (b)

newer medical treatments in schizophrenia

• clozapine —> less negative side effects but still existent

• long-acting injectible antipsychotics every 2-4 weeks to help with non-adherence

• transcranial magnetic stimulation (TMS)

  • wire coils repeatedly generate magnetic fields that pass through the skull to the brian, interrupting normal communication to that part of the brian temporarily

  • ineffective in treating auditory hallucinations long term

purpose of psychosocial treatments in schizophrenia

1. reduce relapse

2. compensate for skill deficits

3. improve cooperation for taking the meds

psychosocial itnerventions in schizophrenia

• token economy

• teaching social skills

• behavioural family thearpy to teach families of ppl with schziophrenia to be more supportive

• CBT

EARLY INTERVENTION IS CRUCIAL!!

what is token economy in treating schizophrenia

• you earn access to meals and small luxuries by behaving appropriatley

• ex. you get cigarettes if you keep your room neat. but if you’re being disruptive, you lose tokens.

• showed that ppl with schizophrenia can learn to perform some of the skill they need to live more independently!!!!

how does teaching social skills go?

overall skill of making a friend

teaching how to make eye contact, provide affirmation to the friend. theyre practsed, and then combined until they can be used naturally

behavioural family therapy for schizophrenia

• psychoeduation aout schizophrenia and its treatment

• relief from the myth they caused the disorder

• practical facts about antipsychotic meds and side effects

• improving communicaiton skills

• expressing negtaive feelings appropriately

• conflict resolution skills

• must be ongoing for patients asnd families to benefit

cbt in schizophrenia

• developed to treat pos and neg symptoms

• essentially adaptation of cbt for drpession and anxiety

• actually very effective!!

• most pronounced effect is reduction in negative symptoms!!

• blurb talks about how they are able to think more rationally about their thoughts and not get stuff in a problematic thoguhts/delusional thoguhts loop

key elements of early intervention

• psychoeducation for professionals, teachers, families, community members abt what psychosis is

• building a therapeutic alliance so they trust you adn stay in care

• family engagement and support

• individualized treatmnet of antipsychotics, psychosocial support and psychoeducation

• prolonged engagement, bcz intervention can take 2+ years.

treatment of schizophrenia across cultures

china —> antipsychotics + herbal medicine, acuptuncture

south africa —> traditional healers who recommend the use of oral treatmnts to induce vomiting

native chinese hold more religious beliefs about causes and treamtnets of schizophrenia (ex. schizophrenia is due to evil done in a past life”…..

prevention of schizophrenia

• treatment of persons in the prodromal stages, which is when the indivuda is beginning to show early mild signs of schizophrenia, but is AWARE of these changes.