schizophrenia
a type of psychosis
positive symptom cluster
-active manifestations of abnormal behavior - presence of atypical behaviors and experiences-50-70% experience-delusions and hallucinations
delusions
gross misrepresentations of reality
hallucinations
experience of sensory events without environmental input
egodistonic
know it's not real, want help (better prognosis for recovery)
egosyntonic
accepts delusions/hallucinations as real
negative symptom cluster
-absence or insufficiency of normal behavior-25% experiences-avolition, alogia, anhedonia, affective flattening
avolition (or apathy)
lack of initiation and persistence
alogia
relative absence of speech
anhedonia
lack of pleasure, or indifference
affective flattening
little expressed emotion
disorganized symptom cluster
-severe and excess disruptions-speech, behavior, and emotion
nature of disorganized speech
-cognitive slippage-tangentiality-loose associations
cognitive slippage
illogical and incoherent speech
tangentiality
going off on a tangent
loose associations
conversation in unrelated directions
nature of disorganized affect
inappropriate emotional behavior (emotion & cognition don't fit together)
nature of disorganized behavior
-variety of unusual behaviors-catatonia: wild agitation, waxy flexibility, immobility
two or more of the following:
-delusions-hallucinations-disorganized speech-disorganized or catatonic behavior-negative symptoms-one of which must be either delusions, hallucinations, or disorganized speech
paranoid type
-intact cognitive skills and affect-do not show disorganized behavior-hallucinations and delusions of grandeur or persecution-best prognosis of all types (medications work well too)
disorganized type
-marked disruptions in speech and behavior-flat or inappropriate affect-hallucinations and delusions - tend to be fragmented-develops early, chronic, lacks remissions
catatonic type
-show unusual motor responses and odd mannerisms-echolalia: repetition of words or phrases just spoken by someone else-echopraxia: imitation of movements of another person-often severe & rare
undifferentiated type
-wastebasket category-major symptoms of schizophrenia-fail to meet criteria for another type
residual type
-one past episode of schizophrenia-continue to display less extreme residual symptoms
schizophreniform disorder
-schizophrenia symptoms lasting less than 6 months-associated with good premorbid functioning-most resume normal lives
brief psychotic disorder
-one or more positive symptoms-lasts less than 1 month-usually precipitated by extreme stress or trauma-typically return to premorbid baseline
schizoaffective disorder
-schizophrenia and a mood disorder at the same time-must have 2 weeks of hallucinations or delusions before or after mood symptoms-prognosis similar for schizophrenics-do not get better on their own
delusional disorder
-delusions that are contrary to reality but could be real-lack other positive and negative symptoms-better prognosis than schizophrenia
erotomanic delusion
other person is in love with you
grandiose delusion
great talent, insight, or important
jealous delusion
other person is unfaithful
persecutory delusion
being conspired against
somatic delusion
body functions or sensations
shared
folie a deux
schizotypal personality disorder
-symptoms are similar to schizophrenia-less severe-genetic relationship to schizophrenia (schizophrenia spectrum)
statistics for schizoprenia
-approx. 1%-onset: early adulthood-chronic-males : females is 1 : 1-strong genetic component
four causes of schizophrenia
-1) possible genes involved-2) chemical actions of the drugs that help many people with this disorder-3) abnormalities in the working of the brains of people with schizophrenia-4) environmental risk factors that may precipitate the onset of the symptoms
family studies
-inherit a tendency for schizophrenia-do not inherit specific forms of schizophrenia-risk increases with genetic relatedness
twin studies
-monozygotic: risk = 48%-fraternal (dizygotic): risk = 17%
adoption studies
risk for schizophrenia remains high in cases where a biological parent has schizophrenia
summary of genetic research
-risk for schizophrenia increases with genetic relatedness-risk is transmitted independently of diagnosis-strong genetic component does not explain everything
dopamine hypothesis
-too much dopamine-agonists (drugs that increase dopamine) result in schizophrenic-like behavior-antagonists (drugs that decrease dopamine) reduce schizophrenic-like behavior-hypothesis is problematic and overly simplistic
structural and functional abnormalities in the brain
-enlarged ventricles and reduced tissue volume-hypofrontality: less active frontal lobes (a major dopamine pathway)
the role of stress
-may activate underlying vulnerability-may also increase risk of relapse
family interactions
-families: show ineffective communication patterns-high expressed emotion: hostility, criticism, overinvolvement (associated with relapse)
the role of psychological factors
exert only a minimal effect in producing schizophrenia but influences course of disorder
antipsychotic (neuroleptic) medications
-first line of treatment-most reduce/eliminate positive symptoms-acute and permanent side effects are common (extrapyramidal and parkinson-like side effects)
psychosocial approaches
-behavioral (token economy, inpatient units)-community care programs-social and living skills training-behavioral family therapy (educate)-vocational rehabilitation-necessary adjunct to medication