Schizophrenia and Psychotic Disorders
November 7th, 2012 Kate Lieberman
What is psychosis?
What characterizes psychotic disorders?
Emotions
Flat affect Inappropriate affect Cognitions Delusions Disorganized thoughts Behaviors Hallucinations Catatonia Avolition
Schizophrenia
Schizophrenia
A psychotic disorder/ group of related disorders Lifetime prevalence: 1% of U.S. population
DSM-IV-TR Criteria
2 or more (or 1 if bizarre delusions/auditory hallucinations) during 1month period Delusions Hallucinations Disorganized speech Disorganized/catatonic behavior Negative symptoms Continuous sx for 6 months (at least 1 month active phase) Significant disturbance/ impairment in daily functioning Not due to affective disorder, substance or medical condition
What is it like to have schizophrenia?
(Paranoid) Schizophrenia Simulation
As you watch the clip, note symptoms and characteristics of the disorder that are portrayed.
Positive symptoms
What are positive symptoms of schizophrenia? Excessive or overt Unusual thoughts or perceptions, thought disturbances,
bizarre behavior
Delusions Irrational beliefs Fixed/resistant Types Persecutory Control Grandiose Referential Somatic
Positive symptoms contd
Hallucinations Sensory experiences not based in environmental
reality Auditory (hearing): most common Visual (seeing) Olfactory (smelling) Tactile (feelings) Gustatory (tasting)
Positive symptoms contd
Disorganized thoughts/speech Loose associations Neologisms Perseveration Clang Disorganized behavior Impaired ability to take care of self, work, interact with
others Unpredictable/inappropriate emotional responses Catatonic behavior
Negative symptoms
Deficits in behavior or absence of normal behaviors Flat affect Alogia Believed to reflect slowed cognitive processes, or to
result from cognitive overload (being overloaded with other sx) Avolition Anhedonia Lack of insight regarding mental condition
Cognitive symptoms
Difficulties with concentration and memory Disorganized thinking Slow thinking Difficulty comprehending Poor concentration and memory Difficulty expressing thoughts Difficulty integrating thoughts, feelings, behavior
Associated disorders and symptoms
Mood disorders and substance disorders often comorbid
Suicide more common in individuals with schizophrenia (4.9%)
than general population (.01-.03)
Risk factors for suicide in individuals with schizophrenia: Single Unemployed Socially isolated Male Violence towards others not typical More likely to harm self than others More likely to be victims of crime (e.g., rape or robbery)
Phases of schizophrenia
Prodromal phase Occurs before onset Symptoms typical of depression Psychotic prophase First full-blown positive symptoms appear May be triggered by stressful event Active phase 6 months or longer of positive and negative symptoms
Residual phase Less prominent symptoms, similar to prodromal phase May constitute the majority of life for individuals with
schizophrenia
Long-term outcomes
Complete remission not likely
10 year study Majority of patients improved over time; minority
deteriorated
15 year study 40% showed periods of improvement Sizable minority were not on medication Long-term outcome may be more positive than
portrayed in DSM-IV-TR
Paranoid subtype
Marked by paranoia
Usually persecutory or grandiose delusions and
auditory hallucinations
Paranoia may lead to difficulties in relationships Long term prognosis: better than other subtypes; less
disordered cognition and behavior
Disorganized subtype
Disorganized speech and behavior
Blunted or inappropriate affect
Difficulty taking care of self Impaired communication, incomprehensible speech If delusions and hallucinations- not coherent or consistent Appears earlier than other subtypes, with gradual onset Poorer prognosis
Disorganized schizophrenia clip
Catatonic subtype
Characterized by abnormal motor symptoms Immobility Excessive movement Odd postures maintained, motor unresponsiveness Waxy flexibility: others can move their posture, and
they will maintain it Echolalia or echopraxia
Catatonic schizophrenia clip
Undifferentiated and Residual types
Undifferentiated Mixture of symptoms/subtypes, cannot be
characterized by any 1 of the other subtypes
Residual Occurs after active phase of schizophrenia Usually involves more negative symptoms Continuance of symptoms like social withdrawal,
blunted affect, odd beliefs or unusual perceptions (not full blown delusions or hallucinations), odd speech tendencies
Problem with categorical approach
Heterogeneity in behavior of individuals with
schizophrenia People present with different combinations of symptoms and severity May not fall into discrete types
Dimensional approach: sx rated as absent, mild,
moderate, or severe Psychotic dimension Disorganized dimension Negative dimension
Other psychotic disorders
Schizophreniform disorder Schizophrenic episode that lasts only 1-6 months Not necessarily marked by impairment in social or
occupational functioning
Schizoaffective disorder Symptoms of schizophrenia and mood disorder Primary symptoms of schizophrenia Depressive type Bipolar type
Other psychotic disorders contd
Delusional disorder Only psychotic symptom of delusions for at least 1
month Delusions not bizarre Erotomanic Grandiose Jealous Persecutory Somatic No significant interference in daily functioning
Other psychotic disorders contd
Brief psychotic disorder One or more of following sxs for less than 1 month: Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Tends to follow environmental stressor (e.g., spouse dying)
Postpartum psychosis Postpartum depression plus psychosis Shared psychotic disorder Folie a deux Person close to someone with a delusion comes to believe the
delusion as well
