Abnormal Psychology Chapter 13 Schizophrenia Spectrum and other Psychotic Disorders

Precedes an active phase-deterioration in role functioning, may be seen by others as a change in personality, peculiar behaviors, unusual perceptual experiences, outbursts of anger, increased tension, restlessness, social withdrawal, indecisiveness, lack of willpower

hallucinations, dellusions

lack of initiative, social withdrawal, emotional deficits

verbal communication problems, bizarre behavior

sensory experiences not caused by actual external stimuli

idiosyncratic beliefs that are rigidly held in spite of their preposterous nature

fail to express emotion, neither happy nor sad, indifferent, apathetic, expressionless, no normal fluctuations in pitch and intonation in voice, lack of concern,

inability to experience pleasure

lack of willpower, indecisiveness, ambivalence, apathy

impoverished thinking
-poverty of speech
-thought blocking: train of thought interrupted before complete

reductions in the amount of speech

changing topics too abruptly

persistently repeating a word or phrase

irrelevant responses to questions

obvious reduction in reactivity to external stimuli
immobility
marked muscle rigidity
reduced/awkward spontaneous movements
OR
excitement and overactivity (pacing, repetitive motions)

Criteria A: must exhibit 2+ active symptoms for at least one month (at least one being 1,2, or 3)
1 Delusions
2 Hallucinations
3 Disorganized Speech
4 Grossly disorganized or catatonic behavior
5 Negative Symptoms (diminished emotional expression or avolition)

Criteria B: Lower level of functioning for significant time since onset

Criteria C: Continuous for 6+ months (at least one month of active-phase but may include prodromal and residual periods–negative symptoms or lesser form of active symptoms)

Criteria D: No MDD or Manic episodes with active phase and any mood disorders occur for only a minority of the active and residual phases

Criteria E: no other attributable medical cause

Criteria F: if already diagnosed with autism spectrum disorder or childhood onset communication disorder then there must be prominent hallucinations or delusions for at least one month in addition to other symptoms to make a diagnosis of schizophrenia

associated with catatonic posturing
=generally reduced responsiveness

incongruity and lack of adaptability in emotional expression
-responses are inconsistent with the persons situation (ex. feel one thing in result of situation but respond in unrelated way)

shows symptoms more than one month but less than 6 months

eliminated subtyping based on symptoms (paranoid, disorganized, catatonic, undifferentiated)

do not meet full criteria
at least one month
realistic delusions (followed, poisoned…could occur but are not)
Only impaired in regards to delusions, not other aspects of life

NO
-hallucinations
-negative symptoms
-disorganized speech
-catatonic behavior

psychotic symptoms for 1+ days but <1 month -often follows a stressful event -return to normal functioning after

– Schizophrenic symptoms overlap with Major Depressive or Manic episode
—-so psychotic symptoms must be present in the absence of mood disturbance for at least two weeks otherwise it is just MD/Manic episode with psychotic features

1% of US and Europe

Men
-30-40% more likely
– onset 4-5 years earlier (18-25 v. 25-30W)
-poor social functioning, more schizotypal traits
-more negative symptoms
-more chronic course, more resistant to treatment

Woment
-more hallucinations and paranoia, more emotional and impulsive

Seen in all cultures
More in Urban areas
IPSS and DOS studies
—> outcomes better in developing countries, possibly because of greater tolerance and acceptance of pt

hippocampus
thalamus
amygdala
Ventricles enlarged

dorsolateral prefrontal cortex

possibly more dopamine receptors–> more sensitive to dopamine (D2 receptor targeted with antipsychotics)

High EE :negative or hostile attitudes toward pt
overprotective, overinvolved
–> pt with High EE family member more likely to relapse

distinguish between those that have it and not
stable characteristic over time
be able to predict future development of disorder

1) working memory impairment
2) eye-tracking dysfunction

responsible for the manipulation and transformation of data in storage buffers
—> impaired in pts

trouble following swinging pendulum
pt have trouble with smooth-pursuit eyemovement

First and Second generation
-first had slightly more side effects
-block dopamine receptors

pathway that connects brain to motor neurons in spinal cord –> motor disturbances

abnormal uncontrollable movements of face and mouth and spastic movements of limbs –> from long term use of antipsychotics

less side effects
used in europe
clozapine

educational component
moderate expectations

structured modeling, role playing, social reinforcement

team of clinicians that provide many types of treatment during crisis periods(whenever they are) to keep disordered pts in the community

prodromal, active, residual

psychotic – 1 day
schizophreniform – <6 months Schizophrenia >6months