Abnormal Psych- Ch. 13 Notes PDF

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These are notes taken from the textbook and from lectures. Professor Marlin Killen...

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Chapter 13: Schizophrenia Spectrum and Other Psychotic Disorders Notes ● Perspectives on Schizophrenia ○ Schizophrenia: the startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including hallucinations and delusions ■ Disorganized speech and behavior ■ Inappropriate emotions ○ Can disrupt a person’s perception, thought, speech, and movement ○ Takes an emotional toll on everyone involved ○ Early Figures in Diagnosing Schizophrenia ■ Table on page 486 ■ John Haslam- Used to be known as a form of insanity ● Early loss of mine ■ Emil Kraepelin, german psychiatrist- gave us a modern day description ■ Dementia Praecox: believed these symptoms had similar features ● Early onset of age and poor outcome ● Catatonia: alternating immobility and excited agitation ● Hebephrenia: silly and immature emotionability ● Paranoia: delusions of grandeur or persecution ■ Distinguished dementia praecox from manic-depressive illness ■ Eugen Bleuler- introduced the term schizophrenia (means split mind) ● Associative splitting of the basic functions of personality ● Thought people could not keep a constant train of thought ○ Identifying Symptoms ■ Hallucinations and Delusions ● Clinical Description, Symptoms, and Subtypes ○ Psychotic behavior: many unusual behaviors (mainly delusions and hallucinations) ■ Delusions- irrational beliefs ■ Hallucinations- sensory experiences in the absence of external events ○ Schizophrenia spectrum disorder- the group of diagnoses we cover in this chapter as recognized by the field of schizophrenia ■ Ex: schizophrenia personality disorder ○ Positive Symptoms ■ Positive symptoms: the disturbing experiences of reality (hallucinations and delusions) ■ 50% to 70% of people with schizophrenia experience this ■ Delusions ● Delusion: a disorder of thought content

○ “The basic characteristic of madness” ■ Hallucinations ● Hallucination: The experience of sensory events without any input from the surrounding environment ○ Can involve any of the senses ○ Auditory hallucination- hearing things that aren’t there ■ Most common form ○ Broca's area is most active during hallucinations ○ Negative Symptoms ■ Negative symptoms: the absence or insufficiency of normal behavior ■ About 25% of people with schizophrenia experience these ■ Avolition ● Avolition: the inability to initiate and persist in activities ● Also referred to as apathy ● They show little interest in day to day functioning (Ex: hygiene) ■ Alogia ● Alogia: the relative absence of speech ● Deficiency in communication ■ Anhedonia ● Anhedonia: the presumed lack of pleasure ● Similar to mood disorders- showing no pleasure in usually pleasurable activities ■ Asociality ● A lack of interest in social interactions ● Similar to avolition or related to anhedonia ● May become worse with less opportunities to interact with others ■ Affective Flattening ● Flat affect: people that do not show emotions ○ May have difficult expression emotions rather than lacking them ● About ¼ of all schizophrenia people experience this ○ Disorganized symptoms ■ Erratic behaviors that affect speech, motor behavior, and emotional reactions ■ Little research or prevalence is known ■ Disorganized speech ● “Cognitive slippage” ● Disorganized speech: communication problems that include jumping from topic to topic and talking illogically

○ Tangentiality- not answering the question asked ○ Loose association or derailment- changing topics to unrelated areas ■ Inappropriate Affect and Disorganized Behavior ● Inappropriate affect: laughing or crying at improper times ● Bizarre behaviors (Ex: hoarding) ○ Catatonia- motor dysfunctions that range from wild agitation to immobility ○ Catatonic immobility: people who hold unusual postures as if they feared something terrible would happen if they moved ○ Waxy flexibility- the tendency to keep their bodies and limbs in the position that they are put in by someone else ○ Historic Schizophrenia Subtypes ■ Paranoid- delusions of grandeur or persecution ■ Disorganized- silly and immature emotionality ■ Catatonic- alternate immobility and excited agitation ○ Other Psychotic Disorders ■ Something that does not fit neatly in the heading of schizophrenia 4 ■ Schizophreniform Disorder ● Schizophreniform disorder: Symptoms may only last for a few months and may go away with successive treatment or for no reason ● Lifetime prevalence is 0.2% ● Before psychotic episode and absence of flat affect ■ Schizoaffective Disorder ● Schizoaffective Disorder: people who have symptoms of schizophrenia and who exhibit characteristics of mood disorders ● Delusions and hallucinations must be there for at least 2 weeks ■ Delusional Disorder ● Delusional disorder: A persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia ● Delusional subtypes: ○ Erotomanic- the irrational belief that one is loved by another person, usually oh higher status ○ Grandiose- believes their worth, power, knowledge, identity, or special relationship is similar to a deity or famous person ○ Jealous- believes sexual partner is unfaithful

○ Persecutory- believing oneself (or someone close to them) is being treated badly ○ Somatic- the person feels afflicted by a physical defect or medical condition ● Schizophrenia delusions are different because they are usually bizarre ● Shared psychotic disorder (folie a deux): the condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual ○ Can be bizzare or ordinary ● All are very rare ○ 2% to 8% of people with psychotic disorders have delusions disorders ● Onset is usually late- between the age of 35 to 55 years old ● Can lead relatively typical lives so will most likely not seek treatment ● Many other factors can cause delusions that are not delusion disorders (Ex alcohol or cocaine) ○ Substance-induced psychotic disorder ○ Psychotic disorder associated with another medical condition ■ Brief Psychotic Disorder ● Brief Psychotic Disorder: characterized by the presence of one or more positive symptoms that last 1 month or less ● Can be caused by extremely stressful events ■ Attenuated Psychosis Syndrome ● Prodromal- early stage of schizophrenia ● Attenuated Psychosis Syndrome: people that have symptoms of schizophrenia but are aware of the troubling and bizarre nature of these symptoms ● Schizotypal personality disorder: a relate psychotic disorder, characteristics are similar to those experienced by people with schizophrenia but are less severe ○ May be genetically related to schizophrenia and schizophrenia personality disorder through the “schizophrenia spectrum” ● Prevalence and Causes of Schizophrenia ○ Things researchers must consider ■ 1) the possible genes involved with schizophrenia

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■ 2) the chemical action of the drugs that may help people with this disorder ■ 3) abnormalities in the brain functioning of people with schizophrenia ■ 4) environmental risk factors that may precipitate the onset of symptoms Statistics ■ Symptoms may occur suddenly or slowly ■ Is usually chronic ■ Lifetime prevalence worldwide- 0.2% to 1.5% ■ Life expectancy is slightly lower because of the risk of suicide ■ Women are affected later in life, but women have more favorable outcomes Development ■ Severe symptoms start in late adolescents or early adulthood ■ Children who develop schizophrenia may display- mild physical abnormalities, poor motor coordination, and mild cognitive and social problems ● May not be just signs for schizophrenia, could led to other issues ■ Prodromal stage: a 1 to 2 year period before the serious symptoms occur but when less severe yet unusual symptoms start to show themselves ● Thinking all events relate directly to them ● Magical thinking (believing they have special abilities ● Illusions (thinking there is another person there when they are alone) ● Isolation, marked impairment in functioning, lack of interest and energy is also common ● Can take from 2 to 10 years for someone to become high risk Cultural factors ■ Some people believe that schizophrenia does not exist and it is just a label for people who do not fit the norm ■ More stress in countries can lead to worse outcomes for people with schizophrenia ■ African americans get diagnosed more than whites ■ Stigma, isolation, and discrimination Genetic Influences ■ Genes are responsible for making some individuals vulnerable to schizophrenia ■ No one gene is responsible, multiple genes variances combine to make the vulnerability ■ Family Studies ●

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● Franz Kallmann ○ The more severe a parents schizophrenia determined if the child would develop it ○ All forms of schizophrenia were seen within the families ○ A general predisposition to schizophrenia may be inherited ● Gottesman ○ The risk of having schizophrenia varies depending on how many genes the two people share ■ Ex: you have about at 48% chance of having it if your twin has it Twin Studies ● “Genin quadruplets” ● Identical twins- 48% chance ● Fraternal twins- 17% chance ● Depends on genes and environment Adoption Studies ● Children with biological parents who had schizophrenia still had a high chance of developing it ● Healthy supportive homes work as a protective factor The Offspring of Twins ● If one of your parent’s identical twins had schizophrenia you have a 17% chance ○ If it was a fraternal twin- 2% ● You can be a “carrier” for schizophrenia Linkage of Association Studies ● Focus on blood types inherited in families with the disorder ● Marker genes- the location of the genes for these traits ○ This allows scientists to guess the location of the genes associated with the disorder ○ Ex: chromosomes 1,2,3,5,6,8,10,11,13,20, and 22 ○ Specifically chromosome 8, 6 and 22 Endophenotypes ● Endophenotyping- trying to find basic processes that contribute to the behaviors or symptoms of the disorder and then find the gene or genes that cause these difficulties ○ Ex: smooth pursuit eye movement- eye tracking ● Other research focuses on the social, cognitive, and emotional deficits ○ Ex: emotional identification

○ Neurobiological Influences ■ Kraepelin- believed that schizophrenia involves a malfunctioning brain ■ Dopamine ● Dopamine system may be too active in people with schizophrenia ● Dopamine antagonists someone work in treating schizophrenia but not with everyone ● Prefrontal activity and glutamate transmission ■ Brain Structure ● Seen in children with parents with schizophrenia- abnormal reflexes and inattentiveness ● Size of ventricles (specifically the 3rd) ○ Ventricle enlargement ● Frontal lobes- hypofrontality ○ Prefrontal cortexes ■ Prenatal and Perinatal Influences ● Environments ○ Ex: exposure to viral infections, pregnancy complications, and delivery complications ○ Influenza during 2nd trimester of pregnancy ● Chronic and early use of marijuana ○ Psychological and Social Influences ■ Early brain trauma may lead to physical stress and schizophrenia ■ Stress ● It is important to know how much and which kind of stress would cause a person to develop schizophrenia ○ Possibly Stressful life events ● Living in a large city is associated with the risk of schizophrenia ● Combat during a war ● This research is hard because it focuses on after the fact things ● Vulnerability stress model- schizophrenia becomes worse with stressful life events ■ Family and Relapse ● There has been a lot of research on how interactions within a family can affect people who have schizophrenia ● Schizophrenogenic mother: a term used to describe a mother whose cold, dominant,and rejecting nature was thought to cause schizophrenia in her children

● Double Blind Communication: a term used to portray a communication style that produced conflicting messages, which in turn was thought to cause schizophrenia ○ Parents portray two different messages ● Recent studies have found that family interactions may also play a role in the relapse of schizophrenia ○ This work is similar to the research done of the vulnerability of stress ● Expressed Emotion (EE): A concept formed by George W. Brown and his colleges, it stated that if the levels of criticism/disapproval, hostility/animosity, and emotional overinvolvement/intrusiveness was high, then patients tended to relapse ● In different cultures, families react differently to those with schizophrenia ● Over-involvement in one culture may not be seen as over-involvement in another ● Treatment of Schizophrenia ○ 1500s-1950: Prefrontal lobotomies used to be performed to treat those with schizophrenia ○ Some cultures still practice surgeries like this (Ex: Kenya) ○ In Western world, treatment usually begins with a neuroleptic drug and are combined with psychological treatment to prevent relapse, teach skills, and improve cooperation with medication ○ Biological Interventions ■ 1930s- people would inject large amounts of insulin to induce comas (insulin coma therapy) ● Seemed helpful at the moment but it was later discovered that it led to great chance of illness and death ■ 1930s- psychosurgery (Ex: prefrontal lobotomies) ■ Late 1930s- electroconvulsive therapy (ECT) ● Not usually successful ● Combined with antipsychotic medication may help it work ● Is also used for people with severe episodes of depression ■ Antipsychotic Medications ● 1950s- neuroleptics were introduced ○ Help people to think more clearly and reduce hallucinations and delusions ○ Affect positive symptoms and lesser negative and disorganized

○ They are dopamine antagonists ○ They also affect the serotonergic and glutame system ● Patients must go through a trial and error process to find the right drug that works for them ● Antipsychotics may cause unpleasant side effects ○ The newer drugs had no benefits and still had the same amount of side effects ■ Noncompliance with Medication: Why? ● Antipsychotics only work when they are taken properly and many schizophrenia patients do not take their medication routinely ○ Reasons: negative doctor-patient relationship, cost of medication, stigma, and poor social support ● Negative side effects can be cause ○ Physical symptoms- grogginess, blurred vision, dryness of the mouth ○ Extrapyramidal symptoms ■ Parkinson’s symptoms ■ Akinesia- expressionless face, low motor activity, and monotonous speech ■ Tardive dyskinesia- involuntary movements of the tongue, face, and mouth ● 20% to 50% of patients taking medication are said to develop these symptoms ● Some people find the drugs as an unacceptable treatment ● Solution- researchers are trying to developing injectable medications that are only needed every few weeks and hoping compliance would improve ○ May be a problem because people do not return to the hospital ● Psychosocial treatment is not used to increase medication compliance ■ Additional Biological Treatments ● Transcranial magnetic stimulation- a treatment for hallucinations that involves exposing the person to magnetic fields ○ Has been found as helpful, specifically for auditory hallucinations ● Modafinil may be added to antipsychotic medications and can improve cognitive functions (such as memory or problem solving)

○ Psychosocial Interventions ■ Used based on the belief that the disorder results from problems adapting with the world because of early experiences ■ People with mild of severe schizophrenia used to be treated in hospitals ● Token economy: used to encourage good behavior by allowing residents to have access to meals and small luxury for behaving properly ■ Teach social skills through role-playing ■ Taught them how to look for signs of relapse and manage medications ■ Virtual reality has been used to stimulate multiple cognitive tasks ■ Improve cognitive and general motor skills ■ Levels of paranoia are tested ■ Cognitive remediation- used to improve cognitive processes such as attention, executive functioning, and memory ● Increase their functioning in the community ■ Families are told to reduce their expressed emotions (EE) ● Behavioral family therapy ■ Assertive community treatment (ACT): a program that involves using a multidisciplinary team of professionals to provide broad treatment across all domains ● Medication mediation ● Psychosocial treatment ● Vocational training and support ■ **table on page 514** ○ Treatment Across Cultures ■ Treatment of schizophrenia and it delivery differ across cultures ■ South Africa uses traditional healers and slaughters animals to appease the spirits ■ Latins rely mainly on family support ■ Chinese hold more religious beliefs about causes and treatment ■ British use biological, psychological, and community treatments ■ In Africa most people who have schizophrenia are kept in prison because they have no alternative ■ Western countries- moving people from large institutional settings to community care ○ Prevention ■ Identify and treat children who may develop schizophrenia later on ● Children of parents who have schizophrenia are at high risk and should be focused on

■ Instability of early family rearing environment- suggests that environmental influences may trigger the onset of schizophrenia ■ Poor parenting may place added stress on a child already at risk ■ Increased attention in the treatment of people in the prodromal stage...