Schizophrenia Spectrum Disorders

Schizophrenia

  • age of onset: late teens - mid 30’s (very uncommon to have symptoms onset later)

  • split between thought and emotion

  • psychosis = loss of contact with reality

  • split between thought and emotion

  • symptoms split into “positive” and “negative”

    • positive symptoms add something

    • negative symptoms take away

Schizophrenia - Positive Symptoms

  • delusions or false beliefs

    • e.g., I am superman

  • hallucinations

    • all 5 senses

  • disorganized speech

    • auto, tomorrow, swallow, Zoro, borrow

    • word salad

  • disorganized behavior

    • e.g., pacing or walking in circles, inappropriate self-care

Schizophrenia - Negative Symptoms

  • lack of emotion or emotional expression (flat effect)

  • lack of speech or slowed speech

  • avolition: lack of motivation

  • asociality: minimal interest in relationships

Schizophrenia - DSM-5-TR

  • A - 2+ following for a significant proportion of time during a 1-month period

    • delusions*

    • hallucinations*

    • disorganized speech*

    • grossly disorganized or catatonic behavior

    • negative symptoms (i.e., diminished expression)

    • *at least one of the symptoms must be 1, 2, or 3

  • B - for a significant portion of the time since the onset of the disturbance, level of functioning in work, interpersonal relations, or self care is below the level achieved prior to onset

  • C - continuous signs of disturbance persist for at least 6 months

    • 1 month of criterion A symptoms

    • may include prodromal (before active phase) or residual (following active phase) symptoms

      • “subthreshold” forms of psychotic symptoms that do not cause significant impairment in functioning

  • D - other psychological disorders (e.g., bipolar disorder with psychotic features) should be ruled out

  • E - not attributable to any physiological effects of a substance

Other Diagnoses Related to Schizophrenia

  • brief psychotic disorder - symptoms have been present for less than one month

    • impaired functioning not required for diagnosis

  • schizophreniform disorder - symptoms have been present for at least 1 month but not longer than 6 months

    • impaired functioning not required for diagnosis

  • brief psychotic disorder → schizophreniform → schizophrenia

  • schizoaffective disorder

    • schizo = psychotic symptoms + affective = mood symptoms (MDD or Bipolar)

    • meets diagnostic criteria for schizophrenia + symptoms of major depressive or manic episode that lasts the majority of the time schizophrenia symptoms are present

    • the psychotic features must continue for at least 2 weeks after symptoms of the manic or depressed episode have subsided

Delusional Disorder

  • delusions last for greater than or equal to 1 month

  • criteria for schizophrenia has not been met

    • any hallucinations are minor and make sense with the context of their delusions

  • outside of what the delusion causes, functioning is not impaired + behavior is not obviously odd or bizarre

  • if mood episode happen at the same time as delusions, the mood episodes are brief

  • not due to anything else (substance use, etc.)

Biological Etiology

  • genetics (48% in identical twins)

  • dopamine hypothesis

    • phenothiazines: block dopamine receptor sites

    • L-dopa: increases dopamine levels and sometimes produces schizophrenia-like symptoms

    • amphetamines: increase dopamine availability and produces symptoms similar to schizophrenia in people without schizophrenia

Psychological Etiology

  • deficits in empathy

  • deficits in theory of mind

  • association between early developmental delay and schizophrenia

    • slower to smile, lift head, sit, crawl, walk during infancy

Social Etiology

  • childhood maltreatment

  • expressed emotion

    • negative communication pattern among relatives of individuals with schizophrenia

Biological Treatment of Schizophrenia

  • conventional antipsychotic medication reduce dopamine levels (thorazine, haldol)

    • unpleasant side effects: muscle spasms, tremors, bodyweight

    • tardive dyskinesia - involuntary movements isolated to the tongue, mouth, and face

  • atypical antipsychotics impact dopamine-serotonin levels (risperdal, zyprexa, seroquel, abilify)

    • less likely to produce conventional antipsychotic side effects

    • increases cardiovascular conditions - heart arrythmia, elevated BP, etc.

Medication Compliance

  • too many side effects - 80%

  • belief that they do not need antipsychotics - 58%

  • mistrust of the physician or therapist - 31%

  • rejection of medication in general - 28%

  • friends or relatives advised them not to take the medication - 20%

Psychological Treatments

  • social cognition and interaction training (SCIT)

    • exercises to identify emotions, role-playing social interactions, and developing coping mechanisms for difficult situations

    • 20 week session-group based therapy

    • has online component sometimes - practice what the modules have in group setting

  • family interventions

    • benefits

      • improve the quality of life and family caregivers

    • what does it look like?

      • psychoeducation

      • demonstrate empathy for all family members

      • avoid blaming family

      • identifies strengths

      • teaches problem solving + stress management skills