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Psychology (6,258)
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Psychology 2310A/B
Rod Martin

Schizophrenia and Other Psychotic Disorders Introduction to Schizophrenia • Psychotic disorder • Most severely debilitating of mental disorders • Most patients unable to care for themselves • 10% - 20% of homeless people • Begins early in life (age 16-25) • Long-term disability • Suicide rates 8% - 10% • 2x as common asAlzheimer’s, 5x MS • Cystic fibrosis (Shinerama) – 300x • 300,000 Canadians - 1 / 12 hospital beds • Huge health care and social costs o Estimated $6.85 billion annually in Canada • Amajor worldwide health problem ABrief History • Apparently rare before 1800 o Increased urbanization, industrialization? • Emil Kraepelin o “Dementia praecox” (“early onset senility”) o Saw it as an organic condition o Believed prognosis is extremely poor • Eugene Bleuler o Coined the term “schizophrenia” (“split mind”) o Disordered thinking processes o Biology-environment interaction o Believed recovery is possible • On-going debate Symptoms of Schizophrenia • Disordered Thought Process (disorganized speech) o Incoherence o “Word salad” o Neologisms o Loose associations o Poverty of speech - alogia o Perseveration o Thought blocking • Disordered Thought Content o Ideas of reference o Delusions o Grandeur, control, persecution, somatic o Thought insertion o Thought broadcasting o Thought withdrawal • Ddisordered Perception o Hallucinations (most commonly auditory). • Attentional Deficits o Breakdown of selective filter o Over inclusiveness o Cognitive distractibility o Associative intrusions • Disordered MotorActivity o Disorganized behaviour o Catatonic immobility – “waxy flexibility”. • DisorderedAffect (Mood) o Flat or blunted affect - anhedonia o Inappropriate, silly affect • Impairment of Functioning o Social skills, occupational and social functioning o Schizoid withdrawal Positive vs. Negative Symptoms • Positive symptoms o Behavioral excesses or distortions o e.g., hallucinations, delusions, disorganized speech, disorganized behavior o Respond to antipsychotic medications • Negative symptoms o Behavioral deficits o E.g., poverty of speech (alogia), flat affect, social withdrawal, anhedonia, lack of motivation (avolition) o Less response to antipsychotic meds DSM-IV Diagnosis of Schizophrenia • Prodromal, active, and residual phases • Prodromal – clear deterioration of functioning • Active phase involves 2 or more symptoms: o Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms o Only 1 symptom if: (1) bizarre delusions, or (2) auditory hallucination of voice keeping running commentary, or (3) two or more voices conversing • Residual – attenuated symptoms following active phase • Active phase lasts at least 1 month • All phases last at least 6 months • If less than 6 months: o Schizophreniform Disorder (1-6 months) o Brief Psychotic Disorder (< 1 month) • Social and occupational dysfunction Subtypes of Schizophrenia • Paranoid Type o Delusions, auditory hallucinations o No disorganized speech, behavior, or affect o Most common, least severe type • Disorganized Type o Disorganized speech, behavior; inappropriate affect • Catatonic Type o Motoric immobility, waxy flexibility, mutism, posturing, grimacing, echolalia, echopraxia o Behavioral excitement, agitation • Undifferentiated Type o Doesn’t meet criteria for first three • Residual Type o Negative symptoms, attenuated positive symptoms o No prominent delusions, hallucinations, disorganized speech or behavior Prognosis • Overall, less sev
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