Emil Kraepelin

Unified distinct symptoms under the name dementia praecox

- Catatonia

-Hebephrenia

-Paranoia

-Manic Depressive

• Associative splitting of the basic functions of the personality

• Difficulty in keeping ones train of thought

Two or more of the following each present for a month(active phase)

• delusions(if bizarre satisfies)
• Hallucinations(if 2 voices conversing satisfies)
• disorganized speech
• grossly disorganized catatonic behavior
• ngative symptoms

 No single essential symptom

Hereogeneity of symptoms across patients

Postive Symptoms

Delusions(A1)

Delusions(A1)

• False beliefs
• Misinterpretation of perceptions or experiences
• Resistant to disconfirming evidence
• may be bizarrre thought and body control
• 50-70%experience positive symptoms
• Jaspers basic characteristic of madness

Theories of Delusions

McKay et al., 2007

Motivational-means of avoiding/dealing with anxiety

• Attempts to deal with and relieve anxiety felt
• Creates stories around some issue
• Become preoccupied

Deficit

• Beliefs result from brain dysfunction which creates disordered thoughts

Positive Symptoms

Hallucinations (A2)

Any sensory modality

- absence of sensory stimulation

Auditory

- Audible thoughts

- running commentary

- voices conversing

-satisfy criterion A

Increased levels of activity in Brocas area during auditory hallucinations

Broca area involved in speech

Wernicke involved in language comprehension

Auditory hallucinations involveunderstanding the speech

consistent with Metacognition theory

Erratic behaviors that affect speech, motor behavior and emothional reactions

Disorganized speech A3(Formal thought disorder)-must impair effective communication

Incoherence

speech severly disorganized

illogical speech

Loose Association

Rambles difficulty sticking to one topic

Tangentiality-not answering specific questions

Grossly disorganized behavior A4

Supports Bleulers associative splitting

Odd or peculiar behavior

-silliness agitation, unusual dress

     -wearing several heavy coats in hot weather

     - inappropriate sexual behavior

     - hoarding

Inappropriate affect

Catatonia

- motor abnormalities

- repetitive complex gestures

     -usually of the fingers and hands

- excitable wild flailing of limbs

- catatonic immobility at other end of spectrum

         - Unusual posture for long periods of time

         - Could reflect fear of something bad will happen

-Waxy Flexibility

-Diminished or loss of function on a continuum

- Flat affect

     - Range of emotional expressiveness limited

- Avolition or apathy

     - Lack of initiation of goal-directed behavior

- Alogia (example)

     - poverty of speech

     - poverty of content

- Anhedonia- w/o pleasure

     - inability to experience pleasure

-Association- w/o close relationships

     - inability to form close personal relationships

- Identify symptoms that may predict develoment of the disorder

-Schiffman et al

     -videotaped children eating lunch

     - more negative affect

Depends on presentation of symptoms

Follows algorithm

-3 of Kraepelins division persist

-Catatonic Type-prominent catatonic symptoms present; echolalia(repeat what someone says) or echopraxia(repeat what someone does)

-Disorganized Type- inappropriate affect; disorganized speech and behavior

-Paranoid

     -Delusions hallucinations related to persucution or graniosity 

     - Ideas of reference

-Undifferentiated

     - Meet criterial for schizo but not for a subtype

-Residual

     -NO longer meets criteria for schizopheria but still eshibits sions of disorder

     - Leftover symptoms from at least 1 episode

- Diagnosis of subtypes diffiult

- Poor predictive balidity

- overlap of symptoms among subtypes

Other associated descriptive features

- sleep disturbances

- abnormalities of psychomotor activity

- poor insioght regarding illness

     - anosognosia

- Disorder impacts families & friends

- Substance abuse 80-90% smoke

- Suicide rates hign

- Lifetime prevalence

- Slightly more men

- late teens early adult

     -Men- 18-25

     -Women 25-35 and after 40

- diagnosed more frequently in African American

-Schizophreniform Disorder

     -symptons duration >1 month but < 6 months

-Brief Psychotic Disorder

     - symptom duration 1 day to 1month extreme stress

- Schizoaffective Disorder

     - symptoms of both mood disorder and schizophrenia

     - prognosis similar to schizophrenia

-Shared disorder

     -develops delusions as a result of a close relationship with a delusional person

- Delusional disorder

     -non bizarre delusions

     -subypes: jealous, erotomania, somatic

     -persecutory and grandiose

     -no other symptoms