Schizophrenia Spectrum + Psychotic Disorders Ch.23

Week 3

Schizophrenia

A psychotic disorder with 3 clusters of symptoms

1. psychotic/positive symptoms

2. Negative symptoms

3. Cognitive symptoms

Means “split mind”

DSM-5 Diagnostic Criteria of Schizophrenia

Two or more of the following symptoms (present for significant part of a month)
▪ Hallucinations
▪ Delusions
▪ Disorganized speech
▪ Disorganized or catatonic behavior
▪ Negative symptoms
o Condition persists for 6 months
o Impaired functioning At least one!

Psychosis

A disconnection from reality

Hallucinations

Delusions

Hallucinations

Distortion in perception

Auditory: Hearing sounds that aren’t real (voices, music, footsteps,commands)
o Visual: Seeing things that aren’t real (people, shapes, lights)
o Tactile: Feeling touch or movement that isn’t real (bugs crawling on skin, organs moving)
o Gustatory: Strange or unpleasant tastes (metallic)
o Olfactory: Experiencing smells that aren’t real

Delusions

Distortion in thought/false beliefs

Culturally situation

Persecutory: Paranoid beliefs (being targeted, followed, or threatened)
o Erotomanic: Unfounded beliefs about love (someone else is in love with them)
o Grandiose: Inflated sense of self (special powers, fame, God)
o Somatic: Something is wrong with the body (missing organs, being pregnant)

Thought Disorder

Disorganized thinking and speech

Tangential speech: Not following a clear train of thought
o Loose associations: Lack of connection between ideas, moving quickly between ideas
o Neologisms: Newly coined word that is meaningless to others
o Echolalia: Repetition of words or phrases said by others
o Magical thinking: More fleeting and flexible than delusions
o Concrete thinking: Difficulty with abstraction, takes things literally

Negative Symptoms: Scizophrenia

Alogia

Flat affect

Avolition

Asociality

Anhedonia

Alogia

Reduced amt of speech, impoverished content, limited spontaneity

Flat affect

Reduced intensity of emotional expression

Avolition

Difficulty initiating and carrying out goal directed behavior

Asociality

withdrawal or avoidance of social contact

Cognitive Impairment

NOT a diagnostic criteria but a core feature

Domains: processing speed, executive function, memory, sociaal cognition

Schizoaffective Disorder

Combination og psychotic + mood disorder

Must meet DSM-5 criteria for both schizophrenia AND depressive or manic episode

Mood disturbance must be present for majority of time of illness

Positive Experiences of Psychosis

Voices of encouragement

Identity and deeper meaning

Spirituality

Symptom or strength?

Etiology

Genetic Factors

Prenatal factors

Structural and functional neuroanatomical differences

Dopamine hypothesis

Environmental factors

Diathesis Stress Model

Also called the stress vulnerability model

Suggests that schizophrenia results from

1. a biological predisposition to schizophrenia and

2. 2. environmental stressors that triggers the onset of illness

Prevalence and Course

0.3-0.7% of population

Most commonly diagnosed in early 20s

The course and prognosis of schizophrenia is widely variable
o Symptoms
o Functioning
o Self-perceived wellbeing

Prodromal period

The period of time after the onset of symptoms but before diagnostic criteria
is met is called the prodromal period (can last for weeks or months)
o Early intervention during this period can reduce long-term disability and
impairment
o Oftentimes seen first through a change in cognition

Adaptive paranoia

Health suspicion that develops from experiences of racism and racial profiling

Impact on Occupational Performance: Cognitive Impairments

Information Processing

Executive Function

Social Cognition

Memory

Memory Cognitive Impairments: Schizophrenia

Short-term memory generally impacted less
o Difficulty with working memory (manipulating and processing information)
and episodic memory (remembering past events)
o Impairment in verbal fluency (retrieving verbal information)

Schizophrenia: Health and Wellness Impact

Associated with higher rates of morbidity and mortality

Life expectancy may be reduced by decades

Obesity

Smoking

Oral Health

Schizophrenia Medication: Antipsychotics

Most effective in reducing symptoms

1st Generation - Dopamine antagonists

2nd Generation - serotonin-dopamine antagonists

Side Effects: sedation, sun sensitivity, dry mouth, blurred vision, weight gain, orthostatic hypotension, movement disorders, clozaril (decreased WBC)

OT Intervention Approaches

Cognitive Remediation

Cognitive Adaptation

Social Skills Training

Permanent Supportive Housing

ADL and IADL training