- “splitting of the
mind”
- psychotic disorder
o
out of touch with reality
o
disturbances about self, world
o
episodes uncontrollable
o
pervasive, chronic
- 1%
o
law of fourths
- symptoms
o
positive symptoms
§ exaggerations, distortions
· delusions
o
false beliefs
§ grandeur vs. persecution
· hallucinations
o
false perceptions
· disorganized speech
o
loose associations
o
word salad
o
perseveration
§ clang associations
o
pompous sounding
o
monotone
· disturbed behavior
o
catatonia
o
negative symptoms
§ function below normal
· affective flattening
o
little emotion, NVC
· alogia
o
communication
· avolition
o
lack of initiative
· anhedonia
o
loss of pleasure, interest
- phases
o
active phase
§ positive, negative symptoms
o
prodromal phase
§ progressive deterioration
o
residual phase
§ negative symptoms remain
- types
o
catatonic type
§ motor disturbances
§ echolalia
§ echopraxia
o
disorganized type
§ flat affect
§ positive symptoms not
organized
§ most severe
o
paranoid type
§ positive symptoms
· organized
§ interpersonal relations
§ little disorganization,
impairment
o
undifferentiated type
§ mixture of symptoms
o
residual type
§ some symptoms
§ partial remission
- course
o
several patterns
o
recovery
§ 20-67%
- gender differences
o
males
§ 2:1
§ 18-25
§ negative symptoms
§ why?
o
females
§ 25-mid 30’s
§ positive symptoms
§ better prognosis
- culture
o
African-American, Asian-American
- diagostic label
o
schizophreniform disorder
§ 6 months or less
o
schizophrenic disorder
§ 6 months or more
- biological factors
o
brain structure/function
§ enlarged ventricles
§ cortical atrophy
§ neurotransmitters
· dopamine hypothesis
o
overactive
o
D2 receptor
· serotonin
· glutamate
o
underactive
o
genetics
§ specific chromosomes
§ twin/family studies
· MZ = 40-65% concordance
· 1 parent
o
12%
· both parents
o
35-46%
o
biological stressors
§ prenatal development
· viral infections
· birth complications
· famine
o
psychological perspective
§ no credible theory
§ focus on cognitive deficits
§ biological markers
· sustained attention tests
· smooth pursuit eye movements
o
irregular
· sensory gating
o
difficulty filtering
o
sociocultural factors
§ family systems
§ EE
· expressed emotion
§ class and income
· social causation hypothesis
o
low SES triggers schizophrenia
· downward social drift
hypothesis
o
symptoms cause low SES
Treatment
- control symptoms, not cure
- biological
o
neuroleptics
§ sedate
§ reduce psychotic symptoms
§ block dopamine
§ side effects
· motor disturbances
· tardive dyskinesia
o
10-20%
§ atypical antipsychotics
· fewer side effects
· dangerous side effects
§ 6 weeks
§ usually lifelong
§ may stop taking meds
- psychological
o
behavioral therapy
§ token economies
· reward for appropriate
behavior
§ social skills training
- sociocultural
o
milieu therapy
§ therapeutic community works
together
§ ease transition outside of
community
o
family education