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Chapter 12 Schizophrenia
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Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Positive Symptoms
Delusions Rigid, bizarre, irrational beliefs
HallucinationsSensory experiences in the absence of actual stimuli
Disorganized speechJumbled speech or speech conveys little information
Inappropriate affectShowing emotions that do not suit a given situation
CatatoniaUnusual motor symptoms marked by severe restriction of movement or extreme excitability
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Negative Symptoms
Alogia Speaking very little to others
AvolitionInability or unwillingness to engage in goal-directed activities
Anhedonia Lack of pleasure or interest in life activities
Flat affect Showing little emotion in different situations
Lack of insight Poor awareness of one’s mental condition
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Psychotic Disorganized NegativePossible
Others
Degree to which one experiences positive symptoms of delusions and hallucinations
Degree to which one experiences reality distortions, fragmented speech, odd behavior, and inappropriate affect
Degree to which one experiences deficit behaviors such as flat affect, alogia, and avolition
Degree to which one experiences depressive, manic, and motor behaviors
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
• Paranoid• Disorganized• Catatonic• Undifferentiated• Residual
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.
Possible interference in daily functioning.
An episode of the disorder, including prodromal, active, and residual phases, lasts 1-6 months.
Characteristic Symptoms of Schizophrenia
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Characteristic Symptoms of Schizophrenia
(Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms) with a major depressive, manic, or mixed episode.
Delusions or hallucinations for at least 2 weeks without prominent symptoms of a mood disorder.
Symptoms of a mood disorder are present during a substantial portion of the active and residual phases of the psychotic disorder.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
No characteristic symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms), though tactile or olfactory hallucinations may be present if they are related to the person’s delusion.
If mood symptoms are present, they are brief compared to the delusional symptoms.
No significant interference in daily functioning and the person’s behavior is not obviously odd or bizarre.
Delusions that are not bizarre but last at least one month.
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Schizotypal Paranoid
Schizoid
“Distorted reality”Odd ideasEccentricityUnusual experiencesSuperstition, religiositySuspiciousnessReclusiveness
ParanoiaDistrustful nature
Doubts loyaltyKeeps grudgesEasily offended
“Delusional/paranoid”
“Social withdrawal”Aloof
Uninterested in othersSolitary, socially withdrawn
Unaffected by praise and criticism
Negative symptoms of schizophrenia
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Genetics
Brain differences
Neurochemical differences
Cognitive defects
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Prevalence Rate0 2 4 6 8 10 14
General Population
Siblings
Uncles and Aunts
Grandchildren
Half Siblings
25% Overlap
50% Genetic Overlap
Nephews and Nieces
Parents
Children
12
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Cognitive Deficits
Memory
Attention
Learning
Language
Executive functions
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
1.15
0.95
1.00
1.05
1.10
First Admission
Readmissions
0.85
0.90
MonthsJan Feb Apr May Jun Sep NovOctMar Jul Aug Dec
Ob
se
rve
d O
ve
r E
xp
ec
ted
Ra
tio
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Biological vulnerabilities: Early viruses and infections, genetic contributions, pregnancy complications
Key brain and neurochemical differences: Enlarged ventricles, frontal and temporal lobe differences, excess dopamine
Psychological vulnerabilities: Cognitive deficits, academic and motor problems, comorbid substance abuse and depression
Stressful life events, increased life demands, lack of social support and intervention
Possible psychotic disorder
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
The idea that you should be punished for your sins.
The idea that something serious is wrong with your body.
The idea that something is wrong with your mind.
The idea that someone else can control your thoughts.
Hearing voices that other people do not hear.
Other people being aware of your private thoughts.
Having thoughts that are not your own.
Sample Items from the Psychoticism Subscale of the Symptom Checklist 90-R
How much were you distressed by:
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
Features and Epidemiology
Causes and Prevention
Assessment and Treatment
74% improve over time
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