Schizophrenia

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					Schizophrenia

      If you talk to God, you are
      praying;
      if God talks to you, you
      have schizophrenia.
                     Thomas Szasz
Some Facts About Schizophrenia
   Schiz: “Split” with reality
   Occurs in all cultures
   Affects 1.5% of American population
    at any one time, 10-15X more
    vulnerable
   1/2 of psychiatric hospitalizations
   M=F; more common in lower SES
    (downward drift)
   Blacks less severely impaired than
    whites; females less severely
    impaired than males
   Onset typically in late
    adolescence/early adulthood
Characteristics of Schizophrenia

   Gross impairment of reality testing
    (psychosis) that affects more than
    one psychological process
    (thought, perception, emotion,
    communication, psychomotor)
   Ego-syntonic (but if not,
    depression)
   High comorbidty: anxiety,
    dissociation, substance abuse
Positive (Type I) Symptoms
   Hallucinations: False perceptions
   Delusions: False beliefs
   Disorganized speech
     –   Loose associations
     –   Neologisms
     –   Clang associations
     –   Echolalia
     –   Echopraxia
     –   Word salad
   Disorganized behavior
Negative (Type II) Symptoms

   Flat affect
   Alogia (poverty of speech)
   Avolition
   Anhedonia
Other Criteria

   Symptoms present at
    least 6 months
    (chronic)
   Significant impairment
    and deterioration over
    time
Types of Schizophrenia

   Disorganized (hebephrenic) -- silly
    and incoherent (most severe)
   Catatonic -- grossly abnormal motor
    behavior and negativism (least
    common)
   Paranoid -- grossly delusional but
    better prognosis (most common)
   Undifferentiated -- All others
   Residual -- After it’s all over
Differential Diagnosis

   The Personality Disorders:
     – Schizoid
     – Schizotypal
     – Paranoid
   The Mood Disorders:
     – Schizoaffective Disorder
     – Mood Disorder with Psychotic features
   The other Psychotic Disorders:
     – Brief Psychotic Disorder (< 1 month)
     – Schizophreniform Disorder (1-6 months)
     – Delusional Disorder (nonbizarre)
Course of Schizophrenia

   Prodromal phase-->
    Acute phase-->Residual phase
   Full return to normal behavior
    uncommon, but may occur
    (particularly if no prodromal
    phase)
   60% oscillate between acute and
    residual phases (chronic or
    episodic schizophrenia)
   1/4 will attempt suicide; 1/10
    succeed
Course of Schizophrenia:
Biological Markers and
Risk Factors

   Genetic contributions (MZ = .48)
   Pregnancy and birth
    complications
   Childhood indicators:
     –   difficult temperament,
     –   less positive facial expressions,
     –   difficulties in social adjustment,
     –   delays in motor development
         and weaknesses/ unusual
         positioning of left arm and leg,
     –   poor academic performance,
     –   deficits in attention
Etiology of Schizophrenia

   Psychodynamic
    explanations?
   Learning explanations?
   Cognitive explanations?

     Probably Not The
          CAUSE
Etiology of Schizophrenia
Biological Explanations

   Biochemical explanations
    –   The Dopamine Hypothesis & D2
        receptors
    –   The Role of Serotonin
   Brain abnormalities
    –   Hypofrontality
    –   Enlarged ventricles
    –   Decreased medial temporal
        structures (hippocampus &
        amygdala)
    –   Abnormalities in frontal and
        parietal lobes
More on Etiology--Lots of Suggestions, No
Answers

   Hypothesis 1: Reversed
    hemispheric dominance
   Hypothesis 2: Delayed
    neural migration
   Other possibilities:
    perinatal problems, viral
    infections, prenatal
    stressors
Treating Schizophrenia

   The antipsychotic
    medications
    –   Low potency neuroleptics
        (1st generation)
    –   High potency neuroleptics
    –   Atypical neuroleptics (2nd
        generation)
   The community approach
    and preventing relapse

				
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posted:2/23/2012
language:English
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