PSYC212 - Ch 11 & 13, Schizophrenia & Substance Use Disorders

Positive Symptoms

aka. Psychotic symptoms: delusions, hallucinations

Negative Symptoms

Anhedonia, blunted Affect, alogia, avolition

Disorganized Symptoms

Disorganized speech, disorganized or catatonic behavior

Required symptoms of a psychotic break

positive symptoms or disorganized speech

Delusion vs Hallucination

delusions are strong, unreal beliefs, hallucinations are strong, false perceptions

Delusion vs Irrational Belief

it is held with such conviction and are often completely devoid of reality

Phases of Schizophrenia

Prodromal, Active, Residual

Required Phase of Schizophrenia

Active phase

Individual Phase Duration

only active phases have to last 1 month

Combined Phase Duration

6 total months of symptoms, before/during/or after active phase

When does Prodromal Occur

Anytime before an active phase, if at all

Prodromal Phase Symptoms

Negative symptoms and mild versions of positive or disorganized

Active Phase Symptoms

All symptoms, must include a positive symptom or disorganized speech

Residual Phase Symptoms

Similar to prodromal symptoms

Brief psychotic Disorder ≃ Schizophrenia

Must have a positive symptom or disorganized speech, but only need 1 symptoms lasting less than a month

Schizophreniform disorder ≃ Schizophrenia

Schizophrenia that lasted less than 6 months

Schizoaffective disorder ≃ Schizophrenia

Schizophrenia + Mood Episode during psychotic break

Delusional Disorder

1 month of delusions that don’t impair function, no hallucinations, no negative or disorganized symptoms

Schizoaffective disorder ≃ Mood disorder w/ psychotic features

Which came first? Which symptoms are there more often with than without the other?

Why is Schizophrenia “Universal”

~1% lifetime prevalence everywhere

Schizophrenia & Culture

Expression of symptoms differ and outcomes differ

Schizophrenia Epidemiology

male onset (18-25) earlier than women (25-35), women do better overall despite more positive symptoms

Psychosis & Violence

Violence is rare, actually more likely to be victims

Bio Factors of Schizophrenia

Genes, fetal environment (nourishment), brain structure (brain tissue volume, fluid-filled ventricles

Brain Structures & Schizophrenia

Decreased Left Hemisphere size of temporal, hippocampus, & thalamus ~ related to emotion and thinking

Dopamine Hypothesis

Schizophrenics have an overproduction/over-effective dopamine in the limbic system

Dopamine Hypothesis & Etiology/Treatment

Both antipsychotics target dopamine receptors

Endophenotype

aka. Vulnerability markers, infer greater risk for disorder, a predisposition

“Good” Endophenotype

Can distinguish between people who do and don’t develop the disorder, stable over lifetime, found in other family even when discordant

Schizophrenia Endophenotypes

Working Memory deficits, Eye-Tracking Dysfunction

Social Causation ≃ Social Selection

Low SES (lack of access) causes schizophrenia vs. Schizophrenia causes low SES (disrupted life)

Expressed Emotion

Surrounding people display negativity, hostility, criticism and/or are over-bearing

EE & Prognosis

High EE families are at greater risk for relapse, even worse if higher in contact time

Schizophrenia Medications

“Old” Antipsychotics and Atypical Antipsychotics

“Old” Antipsychotics

reduces conviction in positive symptoms, can cause worsening extrapyramidal symptoms and tardive dyskinesia

Extrapyramidal Symptoms

Tremors, involuntary posture, motor rigidity

Tardive Dyskinesia

Involuntary face and mouth movements

Atypical Antipsychotics

Equally as effective and less motor side effect, causes severe weight gain which strains the heart

Social Skills Training

Treating the patient how to interact day-to-day despite symptoms

Assertive Community Treatment

Living in a village of recovering patients, surrounded with providers and caregivers

ACT Benefits

Reduces hospitalization, increases treatment compliance, returns purpose to life

ACT Challenges

We have limited providers as it is, it’s expensive to build a small town, and our individualistic culture

Family Psychoeducation

Decreases likelihood of High EE, reduces relapses and hospitalizations, reduces family distress

Long-term Prognosis for Schizophrenia

33% each either improve, stay the same, or worsen

Psychoactive Substances

A chemical substance that alters mood, perception, or brain function and impairs life

Polysubstance Use

Common to continuously chase the high

Other Substance-related Disorders

Substance Intoxication and Substance Withdrawal

Impaired Control Symptoms

Consuming more or longer than intended, unsuccessful efforts to quit, excessive time spent, cravings

Social Impairment Symptoms

Use interferes with obligations, continued use despite interpersonal conflict, giving up alternative activities to use

Risky Use Symptoms

Recurrent use in physically dangerous situations, continued use despite knowledge of physical/psychological problems

Pharmacological Symptoms

Developed Tolerance or Withdrawal to substance

Substance Use Disorder Criteria

any 2 symptoms that occur for 1 month over a 12 month period

Metabolic Tolerance

Frequent use increases metabolism of the substance, enzymes clean up quicker

Pharmacodynamic Tolerance

Post-synaptic receptors are reduced to disallow the effects, leading to increased volume

Behavioral Conditioning Tolerance

the body predicts with given people, place, and time to counteract the drug’s effect, i.e. setting back metabolic processes, lowering mood

“Upper” Symptoms

insomnia, depressed mood, increased appetite, irritability

“Downer” Symptoms

nausea, pain, insomnia, depressed/anxious mood, agitation

Worst Withdrawal Symptoms

Opiates

Least Withdrawal Symptoms

Hallucinogens

Tobacco Effects

feeling more relaxed despite being physiologically aroused; cancers, heart complications, fertility problems, birth defects

Stimulant Effects

Physiological arousal/positive mood (depending on start mood); sexual dysfunction, cardiovascular problems, onset of psychosis, social impairment, financial problems, criminal engagement

Opiate Effects

Euphoric disorientation into extreme dysphoria; reduced libido, fertility problems, lethargy/motivation loss -> occupational impairment, financial issues, HIV/AIDS risk, withdrawal induced violence & suicide

Sedative Effects

Impaired judgement, slurred speech, coordination loss, impulsiveness; rebound of anxiety worse than before

Cannabis Effects

Increase in positive mood (or paranoia), difficulty concentrating & following train of thought; long term attention deficit

Hallucinogen Effects

vivid, surreal sensory-perceptual experience; persistent psychosis/flashbacks, instant death (cardiovascular failure)

Alcohol Effects

Positive mood, low inhibition; slowed reaction, lethargy; confusion, poor coordination; loss of bodily control; coma; death. Social impairment, legal struggle, physical/mental illness, death among men

Most Addictive Substances

Tobacco and Opioids (heroin)

Culture & Alcohol

it used to be common to be tipsy all day, not anymore.

Gender & Alcohol

Women excessively drink less due to social judgement and physical threat/risk

Age & Alcohol

The earlier you start, the more likely it is to be a problem

Vaillant Study of Alcohol

Many youth both in society and in college develop disorder, but all but 5-6% end up quitting; more city youths developed disorder than college, but more quit

Positive Beliefs & Alcohol

Expectations effect frequency and volume, you think you will have more fun, do better in bed, and be more social; but… you don’t

Personality & Alcohol

Individuals High in Extraversion tend to be more rebellious and more likely to experiment

Peer Influence & Alcohol

Drinkers hang out with drinkers, the opportunities present themselves more often

First Step of Substance Treatment

Remove the Substance… can take days or weeks and is extremely painful with intense withdrawal and cravings

AA

“Self-help” supportive environment with a goal of abstinence; can help, but will take time and patience

Motivational Intervention

Exploring why and if you should reduce usage, build motivation to quit; can help, but will take time and patience