Module 12: Schizophrenia Spectrum Disorders

what is the stigma fear surrounding patients with schizophrenia?

-scared to tell doctors what real symptoms were so they could get treated

-"dirty word"

schizophrenia

-umbrella term for a group psychotic disorders involving disturbances of behavior, thinking, emotions, and perceptions

when is typical onset of schizophrenia?

-late adolescence

who does schizophrenia affect most?

-about 1% of population

-rate similar across cultures

-vary by SES

-affects men more than women

-less severe in women

what does a gradual onset of schizophrenia include?

-prodromal phase of decreasing social engagement

what is the prodromal phase?

-early stage preceding psychosis that can last weeks to years

who played a part in the history of schizophrenia?

-Emil Kraepelin

-Eugen Bleuler

-Kurt Schneider

what did Emil Kraepelin say about schizophrenia?

-dementia praecox

-believed it arose out of a body-level problem

-"loss of inner unity of thought, feeling, and acting"

What did Eugen Bleuler say about schizophrenia?

-said schizophrenia meant split brain

-split is between aspects of personality, not split into different personalities

-symptomology of four A's

what are the four A's under Bleuler?

-disconnect associations

-flat or inappropriate affect

-ambivalence toward other

-autism (living in a private fantasy world)

what did kurt schneider say about schizophrenia?

-thought bleuler was too vague

-tried to refine diagnostic criteria

-first and second rank symptoms

what are first rank symptoms under schneider?

-central to diagnosis of schizophrenia

-includes hallucinations and delusions

what are second rank symptoms under schneider?

-found in schizophrenia and also in other disorders

-disturbances in mood

what does the DSM say regarding social/ occupational dysfunction in schizophrenia?

-since onset of disturbance, one or more major areas of functioning are markedly below the level achieved prior to onset

what does the duration of the symptoms have to be in order to be schizophrenia?

-continuous disturbance for at least 6 months

what are the related disorders to schizophrenia?

-schizophreniform disorder

-brief psychotic disorder

-schizoaffective disorder

-delusional disorder

what is schizophreniform disorder?

-symptoms present for at least one month but not longer than six months

what is brief psychotic disoder?

-diagnosed when symptoms are present for less than one month

what is schizoaffective disorder?

-a hybrid classification with features of schizophrenia and an affective disorder, such as a major depressive bipolar disorder

what is delusional disorder?

-presence of at least one delusion that lasts for at least one month (but no hallucinations or disorganized speech)

what are the positive symptoms of schizophrenia?

-the presence of something abnormal

what are the negative symptoms of schizophrenia?

-absence of normal behavior

-often grouped in a state of catatonia

what are disturbances of thought related to schizophrenia?

-delusions

-thought disorder

-attentional deficiencies

what are delusions related to schizophrenia?

-false beliefs

-4 different types

-may reflect themes or values of local culture

what are the four different types of delusions?

-persecution

-reference

-of being controlled

-grandeur

what is persecution under delusion?

-delusions where you think someone is out to get you

what is reference under delusion?

-find meaning in randomness in a consistent way

what does "of being controlled" mean under delusion?

-feeling like you are doing things in everyday life not in your own will

what does grandeur mean under delusion?

-delusion that you are some very important figure in the world

what is thought disorder related to schizophrenia?

-breakdown in logical associations, organization and processing of thoughts

-may be reflected in poor language

what are the poor languages that fall thought disorder?

-neologisms

-perseveration

-clanging

-blocking

what is neologism under thought disorders?

-made up words

what is perseveration under thought disorders?

-repetition of words or syllables

what is clanging under thought disorders?

-connecting of words that rhyme

-may be part of a word salad

what is blocking under thought disorders?

-abruptly stopping speech

what are attentional deficiencies related to schizophrenia?

-difficulty filtering from the informational stream

-hyper vigilance

-eye movement dysfunction

what is hyper vigilance under attentional deficiencies?

-too much attention to unimportant stimuli

-have high event - related potentials and initial brain level response to new stimuli

what is eye movement dysfunction under attentional deficiencies?

-problems with jerky eye motion when tracking

what are disturbances of perception?

-hallucinations

what are hallucinations related to disturbances of perception?

-false perceptions

-exist across all sense, though auditory is most common

-hearing voices is not always pathological

-command hallucinations

what are command hallucinations under hallucinations?

-voices that command to act

-most involve committing harm

-Broca's area in the brain shows elevated activity when hearing voices

what other disturbances are caused under schizophrenia?

-emotional

-behavioral

what is emotional disturbance?

-often displayed inappropriate emotional response

-or, may display no affective response

what is behavior disturbance?

-may be excessively wild

-may be completely lacking

what does the diathesis-stress model say about schizophrenia?

-biological vulnerability triggered by environmental stressors

what are the biological vulnerabilities of schizophrenia?

-strong genetic influence on likelihood of developing schizophrenia

-but shared environments are also a factor

what receptors are overactive in schizophrenia?

-dopamine, which affects movement, emotional response, pleasure responses

what role does norepinephrine play in schizophrenia?

-tied to emotional response

-subdues logical thought

what role does GABA play in schizophrenia?

-low levels lower inhibition of inappropriate behavior

what does low dopamine sensitivity and overproduction of GABA lead to?

-negative symptoms

what are the brain abnormalities related to schizophrenia?

-enlarge ventricles

-faulty development of neuronal structure in first trimester of development

-lower activity in prefrontal cortex

-difficulties in communication between cortex and limbic system

what does the role of illness play in schizophrenia?

-exposure to viruses before birth seems to increase likelihood of predisposition being triggered

-influenze and toxoplasmosis

how does communication deviance in the parents play a role in schizophrenia?

-pattern of vague, unclear, fragmented negative communication within families

-speech is hard to follow, shared meaning hard to discern

-often very controlling of children

what may families also show in schizophrenia?

-high levels of expressed emotion

-more hostile and critical

-less empathetic and tolerant

-show higher relapse rate

what does the role of culture play in schizophrenia?

-progress of disease is more severe in industrialized countries

-lower SES can provide numerous stressors and delay diagnosis

what is a biological treatment for schizophrenia?

-antipsychotic drugs

-neuroleptics and phenothiazines

-block dopamine receptors

-primarily address positive symptoms

-side effect is irreversible ticks called tardive dyskinesia

how do learning therapies work in schizophrenia?

-use of selective reinforcement and token economies can increase appropriate behavior in some cases

-CBT can help with some delusions

-intensive approaches in hospital setting have had some success

how do you treat schizophrenia?

-milieu therapy

-family therapy may be used to address family communication problems

what is milieu therapy?

-humanists emphasize creation of an adaptive social milieu in which people with schizophrenia can develop sense of self respect and individual responsibility