Chapter 6 Schizophrenia Spectrum - PowerPoint Presentation

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Chapter 6

Schizophrenia Spectrum

and Other Psychotic

Disorders

Schizophrenia is now classified as a

spectrum disorder

rather than a

single disease entity

.

in this group:

Schizophrenia

Brief Psychotic Disorder

Schizoaffective Disorder

Schizophreniform Disorder

Delusional Disorder

Schizotypal Personality Disorder

criteria in Personality Disorders

Substance/Medication-Induced Psychotic Disorder

Psychotic Disorder Due to Another Medical Condition

Catatonia Associated with Another Mental Disorder (Catatonia Specifier)

Other Specified… and Unspecified…

Schizophrenia

The broad category of schizophrenia includes a set of disorders in which individuals experience distorted perception of reality and impairment in thinking, behavior, affect, and motivation.

A disorder with a range of symptoms involving disturbances In:

Content of thought

Form of thought

Perception

Affect

Sense of self

Motivation

Behavior

Interpersonal functioning

Symptoms of schizophrenia

POSITIVE +

NEGATIVE -

Positive symptoms:

Exaggerations or distortions of normal thoughts, emotions, and behavior

Negative symptoms:

Symptoms that involve functioning below the level of normal behavior

The symptoms the individual experiences during the active phase fall into two categories: positive symptoms and negative symptoms.

Active phase

: A period in the course of schizophrenia in which psychotic symptoms are present.

Symptoms of schizophrenia

POSITIVE +

NEGATIVE -

Delusions

Hallucinations

Disorganized

speechDisturbed behavior

Restricted affect

Avolition

A-sociality

Delusions

:

Deeply entrenched false belief not consistent with the client’s intelligence or cultural background.

Hallucinations

: A false perception not corresponding to the objective stimuli present in the environment.

Incoherent speech

:

Language that is incomprehensible.

Loosening of associations

: Flow of thoughts that is vague, unfocused, and illogical.

Restricted affect

:

Narrowing of the range of outward expressions of emotions.

Avolition

:

A lack of initiative, either not wanting to take any action or lacking the energy and will to take action.

Asociality

:

Lack of interest in social relationships.

Features of schizophrenia

Inappropriate affect

is the extent to which a person’s emotional expressiveness fails to correspond to the content of what is being discussed.

Paranoia

is the irrational belief or perception that others wish to cause you harm, may be associated with delusions or auditory hallucinations related to a theme that somebody is persecuting or harassing them.

Courses of Schizophrenia

Continuous

Remission

Recurrent

Extended

Continuous

In the most serious cases, the individual experiences continuous positive symptoms with no remission.

Remission

: Situation when the individual’s symptoms no longer interfere with his or her behavior and are below those required for a DSM diagnosis.

Schizophrenia have more

recurrent episodes

and their chances of completely recovering are worse than those of people with other disorders.

People with schizophrenia for

extended periods

of time propose a model in which 25 to 35 percent show chronic psychotic symptoms.

Factors that contribute to poorer prognosis:

Poorer cognitive skills, a longer period of time without treatment, substance abuse, a poorer course of early development, higher vulnerability to anxiety, and negative life events.

Other Psychotic Disorders

Other Psychotic Disorders

Schizophrenia-like disorders that involve abnormalities in one or more of the five domains:

Delusions

Hallucinations

Disorganized thinking (speech)

Grossly disorganized or abnormal motor behavior (including catatonia)

Negative symptoms

Brief Psychotic Disorder

A diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time.

Symptoms must be present for more than a day, but recover in less than a month.

Symptoms

Delusions

Hallucinations

Disorganized speechGrossly disorganized or catatonic behavior

The diagnosis requires that the individual experience symptoms for more than a day, but recover in less than a month.

Clinician must take the following factors into account:

Client’s cultural background.

Whether the client has experienced a recent stressor.

If a woman develops this disorder within four weeks

brief psychotic disorder

is a diagnosis that clinicians use when an individual develops symptoms of psychosis that do not persist past a short period of time. To receive this diagnosis, an individual must experience one of four symptoms, which include delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Th e diagnosis requires that the individual experience symptoms for more than a day, but recover

in less than a month.

Schizophreniform Disorder

A disorder with essentially the same symptoms as schizophrenia, but that lasts from 1 to 6 months

People with this disorder have larger ventricles in the brain, a phenomenon also observed with schizophrenia.

People have good chances of recovering:

When they show a rapid development of symptoms (within a span of four weeks)

Confusion or perplexity while in the peak of the episode

Good social and personal functioning prior to the episode.

Likely to have a good prognosis if they do not show the negative symptoms of:

Apathy, withdrawal, and

asociality

.

Schizoaffective Disorder

Schizophrenia with co-occurring mood disorder

Schizoaffective disorder

: Experience of a major depressive episode, a manic episode, or a mixed episode while also meeting the diagnostic criteria for schizophrenia.

The individual must have both a mood and a psychotic disorder, but at least two weeks during which their delusions and/or hallucinations are the only symptoms that they show

Delusional Disorders

Erotomanic

type

: Individuals falsely believe that another person is in love with them.

Grandiose

type: An exaggerated view of oneself as possessing special and extremely favorable personal qualities and abilities.Jealous type: Individuals falsely believe that their romantic partner is unfaithful to them.Persecutory type: Individuals falsely believe that someone or someone close to them is treating them in a malevolent manner.Somatic type: Individuals falsely believe that they have a medical condition.

Biological Theories

Genetic abnormalities affects:

Brain development

Synaptic transmission

Immune functioning

Manufacturing of important proteins involved in neurotransmission

Neurodevelopmental hypothesisProposing that schizophrenia is a disorder of development that arises during the years of adolescence or early adulthood due to alterations in the genetic control of brain maturation.

Biological Treatment

Medication used in treating schizophrenia was:

Antipsychotic chlorpromazine (

Thorazine

)

Haloperidol (Haldol)

Symptoms: Rigid muscles, tremors, shuffling movement, restlessness, and muscle spasms affecting their posture.Tardive dyskinesia: Involuntary movements of the mouth, arms, and trunk of the body.Antipsychotics operate on both serotonin and dopamine neurotransmitters called serotonin-dopamine antagonists.For treatment-resistant clients, clozapine is the only approach that has empirical support.

Psychological Treatment

Token economy

: A form of contingency management in which a client who performs desired activities earns chips or tokens that can later be exchanged for tangible benefits.

Cognitive-behavioral therapy

Treat individuals with symptoms of psychosis.

Teach their clients coping skills.

One promising cognitive training approach involves training in speech recognition and auditory perception.

Sociocultural Perspective

Focus on the family system

Faulty modes of behavior and communication

Cognitive distortions

High degree of expressed emotion

Social class and income

Associated with environmental stressors of povertyContracting the disease leads to social and economic “downward drift”