Schizophrenia. Nick Gruberg

Transcription

1 Schizophrenia Nick Gruberg

2 Nature of Schizophrenia and Psychosis: An Overview! n Schizophrenia vs. Psychosis! n Psychosis Cluster of disorders; hallucinations and/ or loss of contact with reality! n Schizophrenia A type of psychosis! n Affects 1 in 100 persons, $65 Billion annually! n Historical Background! n Emil Kraeplin 1896; Used the term dementia praecox, focused on onset and outcomes! n Eugene Bleuler 1911 he introduced the term schizophrenia or splitting of the mind!

3 Prevalence of Schizophrenia! n Prevalence of 1% worldwide! n 2 Alzheimer s! n 5 Multiple Sclerosis! n 6 Insulin-dependent (Type I) Diabetes! n 60 Muscular Dystrophy! n Schizophrenia Is Generally Chronic! n Moderate-to-severe lifelong impairment! n Life expectancy is slightly less than average! n Equal Gender Distribution! n Women - better long-term prognosis! n Onset differs between men and women!

4 Gender differences in onset of schizophrenia in a sample of 470 patients Howard et al., 1993

5 Diagnosis: DSM IV! n Symptoms (2 or more):! n Delusions (content)! n Hallucinations! n Disorganized speech (form)! n Disorganized or catatonic behavior! n Negative symptoms (flat affect etc.)! n Social / Occupational Dysfunction! n Duration: 6-months (1 month of symptoms)! n Not caused by substances! n Not Schizoaffective/Mood Disorder!

6 Symptoms of Schizophrenia! Positive (Type 1) Negative (Type II) Disorganized Thematic Delusions Avolition (apathy) Grossly Bizarre Behavior Thematic Hallucinations Alogia (Poverty of Speech/ Content) Incoherent hallucinations or delusions Bizarre Behavior Anhedonia Disorganized Affect Good intellect Flat Affect Disorganized Speech Asociality Better Prognosis Poor Prognosis Poor Prognosis Lenzenweger, Dworkin & Wethington (1991)

7 The Positive Symptoms! n Active manifestations of abnormal behavior or distortions of normal behavior! n Delusions - 90%! n Somatic: Snake living inside my abdomen! n Grandeur: Chosen by God! n Persecution: They are monitoring me! n Manifestations: Thought broadcasting, ideas of reference, thought withdrawal!

8 The Positive Symptom n Hallucinations! Cluster! n Sensory events without environmental input! n Auditory are the most common (can be any sensory modality)! n Speech vs. auditory processing studies!

9 Some major language areas of the cerebral cortex

10 The Negative Symptom Cluster! n Absence or insufficiency of normal behavior! n Spectrum of Negative Symptoms! n Avolition (or apathy) Inability to initiate and persist in activities! n Alogia A relative absence of speech! n Anhedonia Inability to experience pleasure or engage in pleasurable activities! n Flat affect Show little expressed emotion, but may still feel emotion!

11 Disorganized Symptoms:! n Severe and excess disruptions in:! n Speech! Therapist: I was sorry to hear that your uncle Bill died a few years ago. How are you feeling about him these days?! David: Yes, he died. He was sick, and now he s gone. He likes to fish with me, down at the river. He s going to take me hunting. I have guns. I can shoot you and you d be dead in a minute.!

12 Disorganized Symptoms" Speech! n Cognitive slippage Illogical and incoherent speech! n Tangentiality Going off on a tangent and not answering a question directly! n Loose associations or derailment Taking conversation in unrelated directions! n??!

13 Disorganized Symptoms! n Affect! n Inappropriate affect (e.g., crying when one should be laughing)! n Behavior! n Disruption in goal directed behavior! n Decline in routine daily functioning! n Catatonia Spectrum from wild agitation, waxy flexibility, to complete immobility!

14 Symptoms of Schizophrenia! Positive (Type 1) Negative (Type II) Disorganized Thematic Delusions Avolition (apathy) Grossly Bizarre Behavior Thematic Hallucinations Alogia (Poverty of Speech/ Content) Incoherent hallucinations or delusions Bizarre Behavior Anhedonia Disorganized Affect Good intellect Flat Affect Disorganized Speech Asociality Better Prognosis Poor Prognosis Poor Prognosis Lenzenweger, Dworkin & Wethington (1991)

15 Subtypes of Schizophrenia! n Paranoid Type! n Intact cognitive skills and affect, and do not show disorganized behavior! n Hallucinations and delusions thematic (e.g., grandeur or persecution)! n Disorganized Type! n Marked disruptions in speech, behavior, affect! n Fragmented hallucinations and delusions! n Develops early, tends to be chronic, lacks periods of remissions!

16 Subtypes (cont.)! n Catatonic Type! n Unusual motor responses and odd mannerisms (e.g., echolalia, echopraxia)! n? Need for consistency! n Tends to be severe and quite rare! n Undifferentiated Type! n Symptoms, but don t meet criteria for another type! n Residual Type! n One past episode of schizophrenia! n Continue to display less extreme residual symptoms (e.g., odd beliefs)!

17 Problems with Diagnosis! Schizophrenia appears to be a disorder with no particular symptoms, no particular course, no particular outcome and which responds to no particular treatment [Bentall, 1990] n Heterogeneity of symptoms! n Symptoms change as the disorder develops! n Schizophrenics slip back into reality! n Treatment response varies! n Is it a unitary disorder?! n Is it distinct from normal experience?!

18 Other Psychotic Disorders! n Schizophreniform Disorder! n Schizophrenic symptoms for less than 6 months! n Associated with good premorbid functioning; most resume normal lives! n Schizoaffective Disorder! n Symptoms of schizophrenia and a mood disorder! n 10-year outcome better than Schizophrenia (Harrow et al., 2000)!

19 Other Psychotic Disorders! n Delusional Disorder! n Delusions without other major schizophrenia symptoms! n May show other negative symptoms! n Type of delusions include erotomanic, grandiose, jealous, persecutory, and somatic! n This condition is extremely rare!

20 Additional Disorders with Psychotic Features! n Brief Psychotic Disorder! n One or more positive symptoms of schizophrenia! n Usually precipitated by extreme stress or trauma! n Lasts < 1 month! n Shared Psychotic Disorder! n Delusions from one person manifest in another person! n Little is known about this condition! n Schizotypal Personality Disorder! n May reflect a less severe form of schizophrenia!