SchizophreniaSchizophrenia

This term refers to the early idea that This term refers to the early idea that there is a split (schism) between affect there is a split (schism) between affect (feelings) and cognition (thoughts)(feelings) and cognition (thoughts)

Early physicians, Emil Kraepelin and Early physicians, Emil Kraepelin and others, studied this disorder and term and others, studied this disorder and term and called it called it Dementia PraecoxDementia Praecox

Schizophrenia consists of bothSchizophrenia consists of both positive positive (excesses) (excesses) andand negative negative symptoms symptoms (deficits).(deficits).

SchizophreniaSchizophrenia

Bleuler coined the notion of the “A’s” Bleuler coined the notion of the “A’s” of schizophrenia:of schizophrenia:– Affect (flat)Affect (flat)– ApatheticApathetic– AvolitionAvolition– Alogia (poverty of speech)Alogia (poverty of speech)– AutisticAutistic– AsocialAsocial– AnhedoniaAnhedonia

DSM-IV CriteriaDSM-IV Criteria

Two or more of the following symptoms for Two or more of the following symptoms for at least one monthat least one month– Delusions (+)Delusions (+)– Hallucinations (+)Hallucinations (+)– Disorganized speech (content & form)Disorganized speech (content & form)– Grossly disorganized, bizarre, or catatonic Grossly disorganized, bizarre, or catatonic

behaviorbehavior– Negative symptoms (previous slide)Negative symptoms (previous slide)

Dysfunction at work, interpersonal Dysfunction at work, interpersonal relationships or self-carerelationships or self-care

Signs of disturbance for at least 6 months Signs of disturbance for at least 6 months with at least one month of symptomswith at least one month of symptoms

Etiology of SchizophreniaEtiology of Schizophrenia* Essentially unclear* Essentially unclear* Family studies/twin studies* Family studies/twin studies* Social Class Hypothesis* Social Class Hypothesis* Schizophrenigenic Mother Hypothesis* Schizophrenigenic Mother Hypothesis* Brain Disorder Hypothesis – Dopamine * Brain Disorder Hypothesis – Dopamine Hypothesis Hypothesis

* Biology involves the mesolimbic system * Biology involves the mesolimbic system and prefrontal lobes and prefrontal lobes* The Dopamine Hypothesis suggests that there * The Dopamine Hypothesis suggests that there

are massive amounts of NE and Dopamine similar to are massive amounts of NE and Dopamine similar to what occurs in amphetamine psychosis.what occurs in amphetamine psychosis.

* OR, the dopamine receptors are over-sensitive * OR, the dopamine receptors are over-sensitive or there are more of them or there are more of them

Antipsychotic medicines lessen the positive Antipsychotic medicines lessen the positive symptoms but do little for the negative symptoms but do little for the negative

symptomssymptoms

Brain injury to the prefrontal cortex leads toBrain injury to the prefrontal cortex leads to Dopamine underactivity in the prefrontal cortex (the Dopamine underactivity in the prefrontal cortex (the

negative symptoms result) which leads tonegative symptoms result) which leads to The release of mesolimbic dopamine and lessens The release of mesolimbic dopamine and lessens

inhibitory control (the positive symptoms) inhibitory control (the positive symptoms)

Types of SchizophreniaTypes of Schizophrenia SchizophreniaSchizophrenia

– ParanoidParanoidPreoccupation with delusions or frequent Preoccupation with delusions or frequent

auditory hallucinationsauditory hallucinationsNo evidence of marked disorganized speech, No evidence of marked disorganized speech,

disorganized or catatonic behavior, flat or disorganized or catatonic behavior, flat or inappropriate affect.inappropriate affect.

– DisorganizedDisorganizedDisorganized speechDisorganized speechDisorganized behaviorDisorganized behaviorFlat or inappropriate affectFlat or inappropriate affectNo evidence of catatoniaNo evidence of catatonia

Types of SchizophreniaTypes of Schizophrenia– CatatonicCatatonic

At least two of the following: At least two of the following: – immobile body or stupor, immobile body or stupor, – excessive motor activity that is purposeless and excessive motor activity that is purposeless and

unrelated to outside stimuli, unrelated to outside stimuli, – Extreme negativism or mutismExtreme negativism or mutism– Assumption of bizarre postures, or stereotyped Assumption of bizarre postures, or stereotyped

movements or mannerismsmovements or mannerisms– Echolalia or echopraxiaEcholalia or echopraxia

– UndifferentiatedUndifferentiated Symptoms that do not meet the criteria for Paranoid, Symptoms that do not meet the criteria for Paranoid,

Disorganized or Catatonic SchizophreniaDisorganized or Catatonic Schizophrenia

– ResidualResidual Absence of delusions, hallucinations, disorganized Absence of delusions, hallucinations, disorganized

speech, and grossly disorganized or catatonic speech, and grossly disorganized or catatonic behaviorbehavior

Other types of Thought DisordersOther types of Thought Disorders Schizoaffective Schizoaffective

– Previous episode of Major Depression or Previous episode of Major Depression or Manic Disorder, or bothManic Disorder, or both

– This co-occurs with schizophrenic This co-occurs with schizophrenic symptomssymptoms

– At two weeks of either delusions or At two weeks of either delusions or hallucinations without mood disorderhallucinations without mood disorder

– The mood symptoms are present for a The mood symptoms are present for a substantial amount of timesubstantial amount of time

Other types of Thought DisordersOther types of Thought Disorders SchizophreniformSchizophreniform

– Symptoms of schizophreniaSymptoms of schizophrenia– Duration of disorder is at least 1 month Duration of disorder is at least 1 month

and no longer than 6 monthsand no longer than 6 months Delusional DisorderDelusional Disorder

– Bizarre delusions for at least one monthBizarre delusions for at least one month– No full blown schizophreniaNo full blown schizophrenia– Apart from the delusions, the Apart from the delusions, the

individual’s functioning in not markedly individual’s functioning in not markedly impairedimpaired

Other types of Thought DisordersOther types of Thought Disorders Brief Psychotic DisorderBrief Psychotic Disorder

– Presence of one or more of the following: Presence of one or more of the following: delusions, hallucinations, disorganized speech, delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavioror grossly disorganized or catatonic behavior

– The episode lasts for at least one day but less The episode lasts for at least one day but less than one monththan one month

Shared Delusional DisorderShared Delusional Disorder– A delusion develops in the context of a close A delusion develops in the context of a close

relationship with another person who already relationship with another person who already has an established delusionhas an established delusion

– The delusion is similar in content to that of the The delusion is similar in content to that of the person who already has the established person who already has the established delusiondelusion