FINAL CLO (copy)
Schizophrenia and psychotic disorders
Schizophrenia: A chronic and severe mental disorder that affects how a person thinks, feels, and behaves. Symptoms may include delusions, hallucinations, and disorganized thinking.
Schizophreniform Disorder: A mental health condition characterized by symptoms similar to schizophrenia, but lasting less than six months; it can occur in the absence of a mood disorder and may involve temporary psychotic episodes.
Confusion, no flat affect, symptoms within first month of behavior change
Schizoaffective disorder: A mental health condition that features symptoms of both schizophrenia and mood disorders, such as depression or bipolar disorder, with episodes of mood disturbances occurring alongside psychotic symptoms.
individuals tend not to get better on their own and are likely to continue experiencing major life difficulties for many years.
delusions or hallucinations for at least 2 weeks
Delusional disorder: A mental health condition characterized by the presence of one or more delusions that persist for at least one month, where the delusions are not attributable to other underlying issues or disorders.
Long-standing delusion not the effect of organic factor such as brain seizures
Absence of flat affect
Late onset ,35-55, Women > Men
folie à deux
Treatments
Treatment for schizophrenia:
Antipsychotic medications: These are the cornerstone of treatment and are used to manage symptoms such as hallucinations and delusions.
Neuroleptics: help people think more clearly and reduce hallucinations and delusions.
Psychotherapy: Cognitive-behavioral therapy (CBT) can help patients cope with the challenges of the disorder and improve their quality of life.
Cognitive remediation: cognitive practice exercises and learning cognitive strategies.
seems to improve cognitive abilities and overall functioning, especially when combined with other treatments, such as psychological rehabilitation
Supportive services: Programs that offer social skills training, occupational therapy, and case management can assist individuals in leading more independent lives.
'“Moral treatment” help with self-control, socialization, and the benefits of work and religion
Gordon Paul and Robert Lentz’s token economy: A behavioral strategy used to reinforce positive behaviors through the use of rewards, thereby encouraging individuals to achieve specific goals and improve their overall functioning.
Behavioral family therapy
Psychosocial + drug treatment may be helpful in preventing relapses
Positive and negative schizophrenia symptoms:
Positive symptoms: include hallucinations, delusions, and thought disorders that can significantly impact an individual's perception of reality.
Negative symptoms: encompass a lack of motivation (avolition), reduced emotional expression and speech (alogia) , and social withdrawal (asociality and ahedonia), which can hinder personal relationships and daily functioning.
Biological, environmental, and prenatal causes of schizophrenia:
Genetic predisposition: Family history of schizophrenia can increase the risk.
Likelihood of child developing schizophrenia is the severity of their parent’s symptoms.
Seen most in monozygotic twins
Two parents with schizophrenia
Dizygotic twins
Neurotransmitter abnormalities: Imbalances in dopamine and glutamate may contribute to symptoms.
Dopamine agonists cause an increase in schizophrenic behavior
Evidence against dopamine theory
Some with schizophrenia aren’t helped by dopamine antagonists - olanzapine
Drugs are only helpful in reducing negative schizophrenia symptoms
Despite dopamine reception blockers that move pretty quickly, symptoms subside slower than expect
Prenatal exposure: Factors such as maternal infections or malnutrition during pregnancy can affect fetal brain development.
Environmental stressors: Trauma, substance abuse, and urban living conditions have been linked to higher incidence rates.
Unstable experiences
Varying degrees of environmental stress among siblings
Gene-environment interaction: good home environment reducing the risk of schizophrenia among those with a genetic predisposition
Endophenotyping: a technique used to identify specific genetic markers and physiological traits associated with psychiatric disorders, facilitating a better understanding of how genetic risk factors manifest in behavior.
Risk factors of schizophrenia:
Genetic predisposition: Family history of schizophrenia increases the likelihood of developing the disorder.
Early behavioral issues: Aggressive or unusual behavior in childhood can signal an increased risk.
Substance abuse: Use of drugs like cannabis has been associated with higher rates of schizophrenia.
Neurodevelopmental disoorders
attention-deficit/hyperactivity disorder (ADHD): Developmental disorder featuring maladaptive levels of inattention, excessive activity, and impulsiveness.
Treatment for ADHD
Goal: reduce the children’s impulsivity and hyperactivity and to improve their attention skills.
Psychosocial: behavioral parent training, behavioral classroom management, behavioral peer interventions, and organization training programs
Programs with positive reinforcements to reward good and encourage behavior
Helpful
Biological treatment:
Drugs for ADHD: methylphenidate (Ritalin, Adderall)
as atomoxetine (Strattera), guanfacine (Tenex), and clonidine
stimulant medications reinforce the brain’s ability to focus attention during problem-solving tasks
Medicine + psychosocial intervention is recommended
Potential for misuse, especially in children
Specific learning disorder: A group of neurodevelopmental disorders that affect an individual's ability to acquire and use academic skills, resulting in difficulties in reading, writing, or mathematics.
Autism Spectrum Disorder: A complex neurodevelopmental disorder characterized by challenges in social interaction, communication, and repetitive behaviors, often varying widely in severity and symptoms.
Intellectual Developmental Disorder: A disorder that significantly impairs cognitive functioning and adaptive behavior, typically manifesting during the developmental period, which results in limitations in intellectual functioning as well as difficulties in practical aspects of everyday life.
Characteristics of disorders
Schizophrenia
Hallucinations: Sensory perceptions that occur without external stimuli, which can involve hearing voices or seeing things that are not present.
Delusions: Strongly held false beliefs that are resistant to reasoning or contrary evidence, often involving themes of persecution or grandiosity.
Disorganized Thinking: Impairment in the ability to logically sequence thoughts, leading to incoherent speech or difficulty in following a conversation.
Negative Symptoms: Absence of normal emotional responses or behaviors, such as reduced motivation, lack of emotion (flat affect), or withdrawal from social interactions.
Schizoaffective characteristics
mood disturbances that meet the criteria schizophrenia
mood disorder
episodes of psychosis alongside significant mood changes.
Specific Learning Disorder:
Difficulty in reading (dyslexia)
Difficulty in writing (dysgraphia)
Difficulty in mathematics (dyscalculia)
Autism Spectrum Disorder:
Difficulties with social communication
Restrictive and repetitive patterns of behavior
Sensory sensitivities or differences
Intellectual Developmental Disorder:
Limitations in IQ (typically below 70)
Challenges in practical skills
Variability in support needs based on severity and individual strengths.
Prevalence rates of schizophrenia
Prevalence: 0.2% to 1.5% in the general population
Lifespan: Tend to live 10 to 15 years less than average
High rate of suicide and accidents
Men have an earlier onset than women
Women are more likely to develop symptoms later in life
African Americans > European Americans
Reasons for disparity:
possible bias and misdiagnosis
environmental stressors with discrimination, stigma
History of Psychotic Disorders: Notable People
John Haslam: A 19th-century physician who contributed significantly to the study of mental illness and was one of the earliest champions of humane treatment for the mentally ill.
Phillippe Pinel: Pinel was an influential physician in the late 18th century who is often credited with the moral treatment movement, emphasizing the importance of compassionate care for patients suffering from mental disorders, including schizophrenia.
Benedict Morel: Morel was a French psychiatrist whose theories regarding the hereditary nature of mental illness helped identify and detail the symptoms of what would later be recognized as schizophrenia, coining the term 'dementia precox' to describe the condition.
dementia precox: Latin term meaning “premature loss of mind,”
Emil Kraeplin: combined several symptoms of “insanity” to describe schizophrenic symptoms and distinguished dementia praecox from manic-depressive illness (bipolar disorder)
Focused on early onset and poor outcomes
Eugen Bleuler: Swiss psychiatrist who introduced the term schizophrenia, signaling Bleuler’s departure from Kraepelin on what he thought was the core problem.
Believed schizophrenia was associative splitting
Positive and Negative Symptoms of Schizophrenia
Positive symptoms: more obvious signs of psychosis.
includes hallucinations, delusions, and thought disorders that can significantly impact an individual's perception of reality.
Negative symptoms: indicate the absence or insufficiency of typical behavior.
encompass a lack of motivation (avolition), reduced emotional expression and speech (alogia) ,and social withdrawal (asociality and ahedonia), which can hinder personal relationships and daily functioning.
Different types of schizophrenia:
Paranoid Schizophrenia: Characterized by prominent delusions and auditory hallucinations, often involving themes of persecution or conspiracy.
Disorganized Schizophrenia: Features disorganized speech and behavior, as well as significant disruptions in thought processes.
Catatonic Schizophrenia: Marked by motor immobility or excessive movement, often exhibiting unresponsive or bizarre postures.
Most Common Types of Hallucinations
Auditory Hallucinations: The most prevalent type, where individuals hear voices or sounds that are not present, often reflecting their inner turmoil or fears.
70%-80% of cases
Visual Hallucinations: Involving the perception of objects or people that do not exist, commonly linked to stress or extreme fatigue.
Tactile Hallucinations: These sensations involve feelings of touch or movement on the body, often described as crawling or bugs under the skin.
Olfactory Hallucinations: Less common, involving smells that are not present, which may trigger emotional responses or memories.
Genetic Causes of Schizophrenia
Genetic predisposition: Family history of schizophrenia can increase the risk.
Likelihood of child developing schizophrenia is the severity of their parent’s symptoms.
Seen most in monozygotic twins
Two parents with schizophrenia
Dizygotic twins
What neurotransmitter contributes to psychosis? Medication and side effects
Neurotransmitter abnormalities: Imbalances in dopamine and glutamate may contribute to symptoms.
Dopamine agonists cause an increase in schizophrenic behavior
Evidence against dopamine theory:
Some with schizophrenia aren’t helped by dopamine antagonists - olanzapine
Drugs are only helpful in reducing negative schizophrenia symptoms
Despite dopamine reception blockers that move pretty quickly, symptoms subside slower than expect
Antipsychotic medications: These are the cornerstone of treatment and are used to manage symptoms such as hallucinations and delusions.
Neuroleptics: help people think more clearly and reduce hallucinations and delusions.
Non-compliance issues due to medication not taken properly
Side effects:
Drowsiness
Confusion
Salivation
Blurred Vision
Other Treatments of Schizophrenia
Psychotherapy: Cognitive-behavioral therapy (CBT) can help patients cope with the challenges of the disorder and improve their quality of life.
Cognitive remediation: cognitive practice exercises and learning cognitive strategies.
seems to improve cognitive abilities and overall functioning, especially when combined with other treatments, such as psychological rehabilitation
Supportive services: Programs that offer social skills training, occupational therapy, and case management can assist individuals in leading more independent lives.
'“Moral treatment” help with self-control, socialization, and the benefits of work and religion
Gordon Paul and Robert Lentz’s token economy: A behavioral strategy used to reinforce positive behaviors through the use of rewards, thereby encouraging individuals to achieve specific goals and improve their overall functioning.
Behavioral family therapy
Psychosocial + drug treatment may be helpful in preventing relapses
Help with social skills: basic conversation, assertiveness, relationship building
Role-play with feedback
Maintaining eye-contact
Giving others feedback
Cross-Cultural Treatment of Schizophrenia
Xhosa, South Africa: traditional healers who recommend the use of oral treatments to induce vomiting, enemas, and the slaughter of cattle to appease the spirits
Latinos: less likely to seek psychological help, rely on family
Chinese: hold more supernatural/religious beliefs on the cause of schizophrenia, burning candles and joss sticks, believe its due to past-life evil
British: biological, psychological, and community treatments
Why are they called Neurodevelopmental Disorders?
Because the developmental disorders in this group are all believed to be neurologically based - revealed in a clinically significant way during a child’s developing years.
Symptoms of ADHD
inattention, hyperactivity, and impulsivity, which can affect a child's performance in school and relationships with peers.
What other disorders tend to overlap ADHD?
Oppositional Defiant Disorder (ODD): Characterized by a pattern of angry, irritable mood, argumentative behavior, or vindictiveness.
Conduct Disorder: Involves a more severe pattern of behavior, including aggression toward people or animals, destruction of property, and serious violations of rules.
Learning Disabilities: Such as dyslexia or dyscalculia, which can coexist with ADHD and impact a child's academic performance.
Hypothesis on the causes of ADHD
More common in families where one person has the disorder
Highly influenced by genetics
copy number variants: Genes that are deleted as a result of mutations; these deletions may play a role in the development of ADHD and other disorders.
genes associated with the neurochemical dopamine, although norepinephrine, serotonin, and gamma-aminobutyric acid (GABA) are also implicated in the cause of ADHD.
strong evidence that ADHD is associated with the dopamine4 receptor gene, the dopamine transporter gene (DAT1), and the dopamine receptor gene
DAT1 of interest because Ritalin inhibits this gene, making dopamine more available
Environmental influences play a small role
what are the medications of ADHD and what’re they classified as? side effects?
Drugs for ADHD:
methylphenidate (Ritalin, Adderall)
Nonstimulant Medications:
atomoxetine (Strattera)
guanfacine (Tenex)
clonidine
stimulant medications reinforce the brain’s ability to focus attention during problem-solving tasks
Non-stimulant medications such as atomoxetine, guanfacine, and clonidine can also improve attention and reduce impulsivity, serving as alternatives for individuals who may not respond well to stimulants.
Medicine + psychosocial intervention is recommended
Potential for misuse, especially in children
Effective as long as medication continues
unpleasant side effects, such as insomnia, drowsiness, or irritability
Learning disorders - how do they run in the family?
Run in families and observed in twins
Lack of specific genes - just learning disorders in general
Home reading habits of families can significantly affect outcomes of those predisposed to learning disorders
Different areas of brain impairment may lead to different learning disorders
Treatments for Learning Disorders
Educational intervention
Direct Instruction:
systematic instruction (using highly scripted lesson plans that place students together in small groups based on their progress)
teaching for mastery (teaching students until they understand all concepts)
Common Symptoms Related to Autism
Social communication challenges: Difficulty in understanding social cues, maintaining conversations, and establishing relationships with peers.
Repetitive behaviors: Engaging in repetitive movements, interests, activites or speech patterns, which may include hand-flapping, rocking, or echolalia.
Medications for people with autism
: While there is no specific medication to treat autism itself, certain medications can help manage symptoms such as anxiety, depression, or attention issues that often accompany the condition.
major tranquilizers and serotonin-specific reuptake inhibitors being most helpful to reduce agitation, along with behavioral therapies that can be used in conjunction to improve the overall well-being and daily functioning of individuals.
Main goal of modern therapies for those with ASD
Help with communication and socialization
Most helpful in children
As they grow older, intervention focuses on efforts to integrate them into the community
How do we diagnose intellectual disability? Criteria
experience impairments that affect most areas of functioning
conceptual (skill deficits in areas such as language, reasoning, knowledge, and memory)
social (problems with social judgment and the ability to make and retain friendships)
practical (difficulties managing personal care or job responsibilities)
significant atypical intellectual functioning, cutoff IQ score of 70
concurrent deficits or impairments in adaptive functioning: difficulty in areas such as communication, self-care, home living, social and interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.
Age of onset: must be evident before 18
Intellectual Disability
Intellectual Developmental Disorder (Intellectual Disability) (IDD). A diagnosis received when one achieves a significantly below-average score on a test of intelligence and by limitations in the ability to function in areas of daily life.
Down Syndrome
Characterized by a combination of physical and cognitive features, including distinct facial characteristics and varying degrees of developmental delay.
Alzheimer’s disease found link to 21st chromosome
Chromosomal impacts on IDD
chromosomal disorders (such as having an extra 21st chromosome, as in Down syndrome),
single-gene disorders
mitochondrial disorders (defects in mitochondria
Identifiable single-gene disorders
Someone who carries a dominant gene that results in IDD is less likely to have children and thus less likely to pass the gene to offspring.
PKU recessive disorder: a metabolic disorder that results from a deficiency of the enzyme phenylalanine hydroxylase, leading to the buildup of phenylalanine in the body, which can cause IDD if not treated.
Majority of people with this used to have IDD, now tested at birth
Fragile X syndrome: a genetic condition caused by the change of X chromosome, which can lead to intellectual disabilities and developmental delays, particularly in males; it is the most common inherited cause of IDD.
Men with the disorder
moderate-to-severe levels of IDD
higher rates of hyperactivity,
short attention spans, gaze avoidance
perseverative speech
Characteristics of those with Intellectual Disability Disorder
Mild to severe impairment in various aspects of life
This can manifest in challenges with communication, social interactions, and daily living skills, leading to varying degrees of dependency on caregivers.
Language and communication skills most obvious
Delirium and causes
impaired consciousness and cognition during the course of several hours or days.
Inattentivity, confusion, disorientation
Symptoms develop over hours or a few days, varying throughout the day
10-15% in acute care facilities
more prevalent among adults
children with high fevers
cancer patients, AIDS, and those undergoing medical procedures
High mortality - 40%-50% die within one year
Substance-induced delirium: A common complication in children with high fevers, particularly in those with underlying health conditions such as cancer or AIDS, resulting in altered mental status and potential exacerbation of the original illness.
Designer drugs like Molly
Older adults - tend to use prescription medication most
Causes
Intoxication, hypnotic drugs, controlled substances
Infections
Head injury
Brain trauma
Finding direct cause is difficult with multiple combinations of illness and drug use
Ethical concern - delirium patients cannot give informed consent, must be a spouse or relative
TREATMENT
Identify causes
goal of nonmedical treatment: reassure the individual to help them deal with the agitation, anxiety, and hallucinations
Inclusion of family member or loved one
Dementia and causes
gradual deterioration of brain functioning that affects memory, judgment, language, and other advanced cognitive processes.
damage to the brain
Amnestic disorder and its causes
Amnestic disorder: a condition characterized by significant memory deficits, often resulting from brain injury, chronic alcoholism, or specific neurological conditions such as Alzheimer's disease.
can arise from various factors, including traumatic brain injury, neurodegenerative diseases such as Alzheimer's, and certain medical conditions affecting blood flow to the brain.
Most common cause of major neurocognitive disorders
Alzheimer’s disease, most common cause
Huntington’s disease
Parkinson’s disease
head trauma
substance misuse
and others
findings from Alzheimer’s research are sometimes too quickly sanctioned
Alzheimer’s Disease and Genetics
a progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior.
forget important events and lose objects
tend to lose interest in others
Late onset heritability 58%-79%
Early onset 90%
50% chance of developing alzheimer’s with an affected parent
More prevalent among women
Genes on chromosomes 1, 12, 14, 19, and 21
Presenilin 1 and Presenilin 2 genes
Ab precursor gene
Rare
E4 gene more common
The difference between Vascular Neurocognitive Disorder vs. Alzheimer’s Disease:
Vascular Neurocognitive Disorder is primarily caused by problems in blood flow to the brain, while Alzheimer’s Disease is characterized by amyloid plaque and tau tangles accumulation.
If Neurocognitive disorder developed from HIV, what contributed to that?
In cases where Neurocognitive Disorder develops from HIV, factors such as
chronic inflammation,
direct neurotoxic effects of the virus,
and opportunistic infections that compromise brain function
can significantly contribute to cognitive decline.
Cognitive slowness, forgetfulness, and impaired attention
Clumsiness, apathy, social withdrawal
Parkinson’s Disease:
Degenerative brain disorder principally affecting motor performance
Motor problems
stooped posture
slow body movements
speak in soft monotone
Research indicates that similar mechanisms, including neuroinflammation and disrupted neurotransmitter systems, play crucial roles in the cognitive impairments observed in patients with Parkinson's Disease.
Primary goals of neurocognitive treatment
trying to prevent certain conditions (such as substance abuse or strokes) that may bring on neurocognitive disorder;
(2)trying to delay the onset of symptoms to provide better quality of life; and
(3)attempting to help these individuals and their caregivers cope with the advancing deterioration.
Sun downer syndrome:
A condition that causes increased confusion and agitation in individuals with dementia, often occurring in the late afternoon or evening.
Alzheimer disease risk factors:
Age: The risk of developing Alzheimer’s increases with age, particularly for those over 65.
Family history: Having a parent or sibling with Alzheimer’s increases the likelihood of developing the disease.
Genetic factors: Certain genes may increase the risk of Alzheimer's, notably the APOE-e4 allele.
Lifestyle factors: Factors such as lack of physical activity, poor diet, and smoking may also contribute to an increased risk.