Class Notes

Announcements:

• Exam:

  • 14 mc

  • 3/6 ID’s

  • 5 Vignette

Explaining and Treating Schizophrenia

• Biological Perspective

  • Brain structure abnormalities

    • enlarged ventricles

    • smaller/less active prefrontal cortex, associated with negative symptoms

    • less cortical gray matter

    • less white matter

    • smaller/less active hippocampus

  • Neurotransmitter abnormality

    • Dopamine Hypothesis

    • Mesolimbic pathway

    • Prefrontal cortex

  • Neuropsychological Deficits

    • Cognitive abilities reduced

      • Attention, concentration, and memory

    • Impaired sensory gating: difficulty processing sensory input

  • Predisposing causes

    • Brain abnormalities present early in life before disorder appears

    • Genetics

      • Strong polygenic genetic component

    • Environmental Causes

      • Pregnancy and birth complications

      • Maternal drug use

      • Viruses during infancy

      • Maltreatment during childhood

• Cognitive Perspective

  • Abnormal Attentional Processes

    • Positive Symptoms

      • Over-attention to irrelevant Stimuli

    • Negative Symptoms

      • Under-attention to important stimuli

  • Wright et. al

• Biological Treatment

  • 1st Generation Anti-Psychotics (1950s)

    • Neuroleptics: e.g. Proxlin, Haldol

    • Reduce positive symptoms in about 75%

    • Must take maintenance doses

    • Side effects:

      • Tardive Dyskinesia, Parkinsonianism, Depression, Sedation, Sexual Dysfunction

  • 2nd Generation Anti-Psychotics

    • Atypical anti-psychotics: e.g. Zyprexa, Risperdal, Clozaril

    • Treats positive and negative symptoms?

    • Less severe side effects?

      • Sedation, Weight Gain, Nausea, Dizziness

• Cognitive Treatments

  • Cognitive Rehabilitation

    • Techniques used to decrease over- and under attention

      • Learn to identify stressful situations and how to cope with them

      • Learn to dispute psychotic symptoms

• Behavioral Interventions

  • Reinforcement

    • Increase desire behaviors

      • Token Economies

        • Exchange tokens for wathcing tv/snacks

        • Commonly used in inpatient care

      • Social Skills

• Family and Community Interventions

  • Family therapy

    • Psychoeducation

    • Communication

    • Behavioral interventions

• Assertive Community Treatment Programs

  • Comprehensive services for reintegration

  • Skills training

  • Maintenance therapy needed

• Therapy is used to enhanve quality of life and improve dysfunction, distress and some deviance