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Description : Check out this medical presentation on Neurology, which is titled "Schizophrenia", to know about the Clinical Descriptions of Schizophrenia, Etiology of Schizophrenia, and Treatment of Schizophrenia.

Tags : Neurology, Schizophrenia, Clinical Descriptions, Etiology, Treatment

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PowerPoint  Lecture Notes Presentation Chapter 9 Schizophrenia Abnormal Psychology, Thirteenth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale © 2015 John Wiley & Sons, Inc. All rights reserved.
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Chapter Outline Chapter 9: Schizophrenia I. Clinical Descriptions of Schizophrenia II. Etiology of Schizophrenia III. Treatment of Schizophrenia © 2015 John Wiley & Sons, Inc. All rights reserved.
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Schizophrenia Major disturbances in thought, emotion, and behavior Disordered thinking Ideas not logically related Faulty perception and attention Lack of emotional expressiveness Inappropriate or flat emotions Disturbances in movement or behavior Disheveled appearance Can disrupt interpersonal relationships, diminish capacity to work or live independently Significantly increased rates of suicide and death © 2015 John Wiley & Sons, Inc. All rights reserved.
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Schizophrenia Lifetime prevalence ~1% Affects men slightly more often than women Onset typically late adolescence or early adulthood Men diagnosed at a slightly earlier age Diagnosed more frequently in African Americans May reflect diagnostic bias © 2015 John Wiley & Sons, Inc. All rights reserved.
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DSM-5 Criteria for Schizophrenia Two or more of the following symptoms for at least 1 month; one symptom should be either 1, 2, or 3: (1) delusions (2) hallucinations (3) disorganized speech (4) disorganized (catatonic) behavior (5) negative symptoms (diminished motivation or emotional expression) Functioning in work, relationships, or self-care has declined since onset Signs of disorder for at least 6 months; if during a prodromal or residual phase, negative symptoms or two or more of symptoms 1-4 in less severe form © 2015 John Wiley & Sons, Inc. All rights reserved.
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Clinical Description of Schizophrenia Three major clusters of symptoms: Positive Negative Disorganized © 2015 John Wiley & Sons, Inc. All rights reserved.
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Positive Symptoms: Behavioral Excesses and Distortions Delusions Firmly held beliefs Contrary to reality Resistant to disconfirming evidence Types of delusions: Persecutory delusions “The CIA planted a listening device in my head” 65% have these Thought insertion Thought broadcasting Outside control Grandiose delusions Ideas of reference Hallucinations Sensory experiences in the absence of sensory stimulation Types of hallucinations: Auditory 74% have this symptom Visual Hearing voices Increased levels of activity in Broca’s area during hallucinations © 2015 John Wiley & Sons, Inc. All rights reserved.
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Negative Symptoms: Behavioral Deficits Avolition Lack of interest; apathy Asociality Inability to form close personal relationships Anhendonia Inability to experience pleasure Consummatory pleasure Anticipatory pleasure Blunted affect Exhibits little or no affect in face or voice Alogia Reduction in speech Can be grouped into 2 domains: Experience domain Motivation Emotional experience Sociality Expression domain Outward expression of emotion Vocalization © 2015 John Wiley & Sons, Inc. All rights reserved.
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Disorganized Symptoms Disorganized speech (formal thought disorder) Incoherence Inability to organize ideas Loose associations (derailment) Rambles, difficulty sticking to one topic Disorganized behavior Odd or peculiar behavior Silliness, agitation, unusual dress e.g., wearing several heavy coats in hot weather © 2015 John Wiley & Sons, Inc. All rights reserved.
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Movement Symptoms Catatonia Motor abnormalities Repetitive, complex gestures Usually of the fingers or hands Excitable, wild flailing of limbs Catatonic immobility Maintain unusual posture for long periods of time e.g., stand on one leg Waxy flexibility Limbs can be manipulated and posed by another person © 2015 John Wiley & Sons, Inc. All rights reserved.
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Other Psychotic Disorders Schizophreniform Disorder Same symptoms as schizophrenia Symptom duration greater than 1 month but less than 6 months Symptoms must include either hallucinations, delusions, or disorganized speech Brief Psychotic Disorder Symptom duration of 1 day to 1 month Often triggered by extreme stress, such as bereavement Symptoms must include either hallucinations, delusions, or disorganized speech Schizoaffective Disorder Symptoms of both schizophrenia and either a depressive or manic episode Symptoms of a major mood episode are present for a majority of the duration the illness © 2015 John Wiley & Sons, Inc. All rights reserved.
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Other Psychotic Disorders Delusional Disorder Delusions may include: Persecution Jealousy Being followed Erotomania Loved by a famous person Somatic delusions No other symptoms of schizophrenia © 2015 John Wiley & Sons, Inc. All rights reserved.
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Table 9.2: Family and Twin Genetic Studies © 2015 John Wiley & Sons, Inc. All rights reserved.
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Table 9.3: Characteristics of Adopted Offspring of Mothers with Schizophrenia © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Genetic Factors Genetically heterogeneous Not likely that disorder caused by single gene Family studies Relatives at increased risk Negative symptoms have stronger genetic component Twin studies 44% risk for MZ twins vs. 12% risk for DZ twins Children of non-schizophrenic MZ twin were more likely to develop schizophrenia (9.4% vs. 1% in general population) Adoption studies Increased likelihood of developing psychotic disorders Familial high-risk studies Differing negative vs. positive symptomatology © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Genetic Factors Association studies Two genes associated with schizophrenia DTNGP1 NGR1 Two genes associated with cognitive deficits COMT BDNF Genome-wide scans Identification of gene mutations Several identified but results need to be replicated © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Neurotransmitters Dopamine Theory Disorder due to excess levels of dopamine Drugs that alleviate symptoms reduce dopamine activity Amphetamines, which increase dopamine levels, can induce a psychosis Theory revised Excess numbers of dopamine receptors or oversensitive dopamine receptors Localized mainly in the mesolimbic pathway Mesolimbic dopamine abnormalities mainly related to positive symptoms Underactive dopamine activity in the mesocortical pathway mainly related to negative symptoms © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 9.2: The Brain and Schizophrenia © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 9.3: Dopamine Theory of Schizophrenia © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Evaluation of Dopamine Theory Dopamine theory doesn’t completely explain disorder Antipsychotics block dopamine rapidly but symptom relief takes several weeks To be effective, antipsychotics must reduce dopamine activity to below normal levels Other neurotransmitters involved: Serotonin GABA Glutamate Medication that targets glutamate shows promise © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Brain Structure and Function Enlarged ventricles Implies loss of brain cells Correlate with Poor performance on cognitive tests Poor premorbid adjustment Poor response to treatment © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Brain Structure and Function Prefrontal Cortex Many behaviors disrupted by schizophrenia (e.g., speech, decision making) are governed by prefrontal cortex Individuals with schizophrenia show impairments on neuropsychological tests of prefrontal cortex (e.g., memory) Individuals with schizophrenia show low metabolic rates in prefrontal cortex Failure to show frontal activaty related to negative symptoms Disrupted communication among neurons due to loss of dendritic spines Disconnection Syndrome © 2015 John Wiley & Sons, Inc. All rights reserved.
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Figure 9.4: Micrograph of a Neuron © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Brain Structure and Function Structural and functional abnormalities in temporal cortex Temporal gyrus Hippocampus Amygdala Anterior cingulate Reduced gray matter and volume evident Disrupted connectivity in the brain © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Brain Structure and Function Environmental Factors Damage during gestation or birth Obstetrical complications rates high in patients with schizophrenia Reduced supply of oxygen during delivery may result in loss of cortical matter Viral damage to fetal brain Presence of parasite, toxoplasma gondii, associated with 2.5x greater risk of developing schizophrenia In Finnish study, schizophrenia rates higher when mother had flu in second trimester of pregnancy © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Brain Structure and Function Developmental factors Prefrontal cortex matures in adolescence or early adulthood Dopamine activity also peaks in adolescence Stress activates HPA system, which triggers cortisol secretion Cortisol increases dopamine activity Excessive pruning of synaptic connections Use of cannabis during adolescence associated with increased risk May explain why symptoms appear in late adolescence but brain damage occurs early in life © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Psychological Stress Reaction to stress Individuals with schizophrenia and their first-degree relatives more reactive to stress Greater decreases in positive mood and increases in negative mood Socioeconomic status Highest rates of schizophrenia among urban poor Sociogenic hypothesis Stress of poverty causes disorder Social selection theory Downward drift in socioeconomic status Research supports social selection © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Family Factors Schizophrenogenic mother Cold, domineering, conflict-inducing No support for this theory Communication deviance (CD) Hostility and poor communication Inconclusive at this time © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Families and Relapse Family environment impacts relapse Expressed Emotion (EE) Hostility, critical comments, emotional overinvolvement Bidirectional association Unusual patient thoughts → increased critical comments Increased critical comments → unusual patient thoughts © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Developmental Studies Use of retrospective or “follow-back” studies Developmental histories of children who later developed schizophrenia Lower IQ More often delinquent (boys) and withdrawn (girls) Coding of home movies Poorer motor skills More expression of negative emotion © 2015 John Wiley & Sons, Inc. All rights reserved.
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Etiology of Schizophrenia: Developmental Studies New Zealand study Cognitive deficits evident at early age Australian study Reduced gray matter volume predicted later development of psychotic disorder North American Prodrome Longitudinal Study Identified factors associated with development of psychosis Having a biological relative with schizophrenia Recent decline in functioning High levels of pos © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Schizophrenia: Medications First-generation antipsychotic medications (neuroleptics; 1950s) Phenothiazines (Thorazine), butyrophenones (Haldol), thioxanthenes (Navane) Reduce agitation, violent behavior Block dopamine receptors Little effect on negative symptoms Extrapyramidal side effects Tardive dyskinesia Neuroleptic malignant syndrome Maintenance dosages to prevent relapse © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Schizophrenia: Medications Second-generation antipsychotics Clozapine (Clozaril) Impacts serotonin receptors Fewer motor side effects Less treatment noncompliance Reduces relapse Side effects Can impair immune symptom functioning Seizures, dizziness, fatigue, drooling, weight gain Newer medications may improve cognitive function: Olanzapine (Zyprexa) Risperidone (Risperdal) © 2015 John Wiley & Sons, Inc. All rights reserved.
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Table 9.4 Summary of Major Schizophrenia Drugs © 2015 John Wiley & Sons, Inc. All rights reserved.
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Treatment of Schizophrenia: Medications Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study Second-generation drugs were not more effective than the older, first-generation drug Second-generation drugs did not produce fewer unpleasant side effects Nearly three-quarters stopped taking the medications before study ended Second-generation antipsychotics have serious side effects Weight gain, diabetes, pancreatitis Disturbing trend for people of color: Not prescribed second-generation antipsychotics © 2015 John Wiley & Sons, Inc. All rights reserved.
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Psychological Treatments Patient Outcomes Research Team (PORT) treatment recommendation: Medication PLUS psychosocial intervention Social skills training Teach skills for managing interpersonal situations Completing a job application Reading bus schedules Make appointments Involves role-playing and other practice exercises, both in group and in vivo © 2015 John Wiley & Sons, Inc. All rights reserved.
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Psychological Treatments Family therapy to reduce expressed emotion Educate family about causes, symptoms, and signs of relapse Stress importance of medication Help family to avoid blaming patient Improve family communication and problem-solving Encourage expanded support networks Instill hope © 2015 John Wiley & Sons, Inc. All rights reserved.
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Psychological Treatments Cognitive behavioral therapy Recognize and challenge delusional beliefs Recognize and challenge expectations associated with negative symptoms e.g., “Nothing will make me feel better so why bother?” Cognitive remediation training or cognitive enhancement therapy (CET) Improve attention, memory, problem solving and other cognitive-based symptoms Case management Multidisciplinary team to provide comprehensive services Residential treatment Vocational rehabilitation © 2015 John Wiley & Sons, Inc. All rights reserved.
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COPYRIGHT Copyright 2015 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. © 2015 John Wiley & Sons, Inc. All rights reserved.