A psychotic disorder in which personal, social, or occupational functioning deteriorate as a result of strange perceptions, unusual emotions, and motor abnormalities.

Various psychotic symptoms such as delusions, hallucinations, disorganized speech, flat or inappropriate affect, and catatonia.

Duration: 6 months or more

A state in which a person loses contact with reality in key ways.

Symptoms may include hallucinations (more than likely auditory) and/or delusions (more than likely).

Psychosis may be substance induced or caused by brain injury, but most psychoise appear in the form of schizophrenia.

Symptoms of schizophrenia that seem to be excesses of or bizarre additions to normal thoughts, emotions, or behaviors.

Pathological excesses - bizarre additions to a person's behavior.

Delusions, Disordered thinking and speech,loose associations, Neologisms, Clang, Heightened perceptions, Hallucinations, Inappropriate affect.

A strange false belief firmly held despite evidence to the contrary.

Faulty interpretations of reality.

May have a variety of bizarre content: being controlled by others; persecution; reference; grandeur; control.

A disturbance in the production and organization of thought.

A common thinking disturbance in schizophrenia, characterized by rapid shifts from one topic of conversation to another. Also known as derailment.

Ex: "The problem is insects. My brother used to collect insects. He's now a man 5 ft 10 inches. You know 10 is my favorite number; I also like to dance, draw, and watch TV."

The experiencing of sights, sounds, or other perceptions in the absence of external stimuli.

Most common are auditory: generally involve a running commentary and/or accusations; spoken directly to or overheard by the hallucinator.

Hallucinations can involve any of the other senses: tactile, somatic, visual, gustatory, or olfactory.

Display of emotions that are unsuited to the situation; a symptom of schizophrenia.

Symptoms of schizophrenia that seem to be deficits in normal thought, emotions, or behaviors.

These "pathological deficits - are characteristics that are lacking in an individual.

Poverty of speech, Blunted and Flat Affect,Loss of Violition, Social Withdrawl.

A marked lack of expressed emotions; a symptom of schizophrenia.

Avoidance of eye contact

Immobile, expressionless face

Lack of emotion when discussing emotional material

Apathetic and uninterested

Monotonous voice, low, and difficult to hear.

A symptom of schizophrenia marked by apathy and an inability to start or complete a course of action.

Loss of violition: (motivation and directedness)

Feeling drained of energy and interest in normal goals.

Inability to start or follow through on a course of action.

A pattern of extreme psychomotor symptoms founds in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing.

SCHIZOPHRENIA

DSM-IV-TR Checklist

1. At least 2 of the following symptoms, each present for a significant portion of time during a 1 month period.
(a) Delusions (b) Hallucinations (c) Disorganized Speech (d) Grossly disorganized or catatonic behavior (e) Negative symptoms.

2. Functioning markedly below the level achieved prior to onset.

3. Continuous signs of the disturbance for at least 6 months, at lease 1 month of which includes symptoms in full and active form. (as opposed to attenuated form). 

Various pshchotic symptoms such as delusions, hallucinations, disorganized speech, flat or innappropriate affect, and catatonia.

Duration: Less than 1 month.

Various psychotic symptoms such as delusions, hallucinations, disorganized speech, flat or inappropriate affect, and catatonia.

Duration: 1 to 6 months.

Marked symptoms of both schizophrenia and a mood disorder.

Duration: 6 months or more.

Persistent delusions that are not bizarre and not due to schizophrenia; persecutory, jealous, grandiose, and somatic delusions are common.

Duration: 1 month or more

Person adopts delusions that are held by another individual, such as a parent or sibling; also known as folie a deux.

Duration: No minimum length

Hallucinations or delusions cause by a medical illness or brain damage.

Duration: No mimimum length

Hallucinations or deulsions caused directly by a substance, such as an abused drug.

Duration: No minimum length

The theory that schizophrenia results from excessive activity of the neurotransmitter dopamine.

Drugs that help correct grossly confused or distorted thinking.

A group of antihistamine drugs that became the first group of effective antipsychotic medications.

A relatively new group of antipsychotic drugs whose biological action is different from that of traditional antipsychotic drugs.

A type of mother-supposedly cold, domineering, and uninterested in the needs of others-who was once thought to cause schizophrenia in her child.

A theory that some parents repeatedly communicate pairs of messages that are mutually contradictory, helping to produce schizophrenia in their children.

The general level of criticism, disapproval, and hostility expressed in a family. People recovering from schizophrenia are considered more likely to relapse if their families rate high in expressed emotion.

The disorder has a severe impact on people's functioning and on the health care system. Increased rick of suicide and illness, Greater than $100 billion per yr. 

Affects 1 in 100 (1%) people worldwide; 2.5 million Americans.
All socioeconomic groups, more frequent in the lower levels.
Equal number of men and women. Men-symptoms begin earlier and are more severe.
Differ by ethnicity: 2% AA, 1.4% C - rates also differ between countries. *rates not as high in undeveloped countries.

Categorized into Three Categories

• Positive Symptoms
• Negative Symptoms
• Psychomotor Symptoms 

May include loose associations; neogisms; perseverations; and clang.

Neologisms: "This desk is a cramstile", "He's an  
                    easterhorned head."

Clang: How are you? "Well, hell, it's well to tell"

How's the weather? "So hot, you know it runs on a cot"

Withdrawal from social environment

Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people's needs and emotions.

People may feel that their senses are being flooded by sights and sounds, making it impossible to attend anything important.

Alogia - say very little

Long lapses before responding to questions, or failure to answer.

Reduction in quantity of speech

Slow Speech.

Awkward movements, repeated grimaces, odd gestures.

The movements seem to have a magical quality

These symptoms may take extreme forms, collectively called catatonia.

Includes stupor, rigidity, posturing, and excitement.

First appears between late teens and mid-30s

Many sufferers experience three phases:

• Prodromal: beginning of deteriorartion; mild symptoms.
• Active: symptoms become increasingly apparent.
• Residual: a return of Prodromal levels.
  One quarter of patients fully recover; three quarters continue to have residual problems.

Each phase of the disorder may last for days or years.

A fuller recovery from the disorder is more likely in people:

With high premorbid functioning

Whose disorder was triggered by stress

With rapid onset

With later onset

Schizophrenia - Five Subtypes per DSM-IV-TR

**KNOW THESE**

Disorganized- characterized by confusion, incoherence, and flat or inappropriate affect.

Catatonic- characterized by psychomotor disturbance of some sort.

Paranoid- characterized by an organized system of delusions and auditory hallucinations.

Undifferentiated- characterized by symptoms which fit no sub-type; vague category

Residual- characterized by symptoms which have lessened in strength and number; person may continue to display blunted or inappropriate emotions.

Most promising. Dominated clinical research.

A diathesis-stress relationship may be at work: People with a biological predisposition will develop schizophrenia only of certain kinds of stressors or events are also present. *theory has been supported by studies of relatives, twins, and adoptees, and by genetic linkage studies.

Family Pedigree Studies: the more closely related they are to the person with schizophrenia the greater the likelihood for developing the disorder. General Population- 1%,Second-degree relatives 3%, First-degree relatives 10%.

Twin Studies: identical twin 48% chance, fraternal twin 17%

Adoptee: also yielded likelihood of contracting disorder.

Genetic linkage and molecular biology studies indicate that possible gene defects on numerous chromosomes may predispose individuals to schizophrena.

Schizophrenia, like many other disorders, is a polygenic disorder, caused by a combination of gene defects.

Genetic factors may lead to the development of schizophrenia through two kinds of biological abnormalties:
Biochemical Anormalties and Abnormal Brain Abnormalties

One promising Theory is the dopamine hypothesis
"Neurons using dopamine fire too often." - based on the effectiveness of antipsychotic medications.

**Dopamine may be overactive in people with schizophrenia because of a larger-than-usual number of dopamine receptors (particularly D-2)

During the past decade, researchers have also linked schizophrenia (particularly cases dominated by Negative symptoms) to abnormalties in brain structure.

Brain scans have found enlarged ventricles-this enlargement may be a sign of poor development in related brain regions.

Additionally scans have revealed smaller temporal and frontal lobes, and abnormal blood flow to certain brain areas.

A growing number of researchers suggest that the brain abnormalities seen in schizophrenia result from exposure to viruses before birth.
Unusually high number of people born in winter months

Mother of children w/schizophrenia were more often exposed to the influenza virus during pregnancy.

Link between schizophrenia and a particular group of viruses found in animals.

Sociocultural theorists believe that people with mental disorders are victims of two main social forces:

Social Labeling and Family Disfunction

The features of schizophrenia are influenced by the diagnosis itself.

*the label becomes a self-fulfilling prophecy as demonstrated in the Rosenhan "pseudo-patient" study.

Double-bind hypothesis: parents sending contradictory messages.

Double-bind messages typically consist of a "primary" verbal communication and an accompanying contradictory nonverbal "metacommunication."

A childrepeatedly exposed will adopt a  special strategy for coping with them and may progress toward paranoid  schizophrenia.

Family Dysfunctioning cont..

Linked to family stress.

Parents of people with the disorder often: Display more conflict, Have greater difficulty communicating, and are more critical of and overinvolved with their children than other parents.

Some families are high in "expressed emotion" - family members frequently express critism and hostility and intrude on each others privacy.

Public Mental hospitals in the United States, run by the individual states.

A Humanistic approach to institutional treatment based on the belief that institutions can help patients recover by creating an climate that promotes self respect, responsible behavior, and meaningful activity.

A behavorial program in which a person's desireable behaviors are reinforced systematically throughout the day by the awarding of tokens that can be exchanged for ggods or privileges.

Drugs that help correct grossly confused or distorted thinking.

While milieu therapy and token economies helped improve treatment outcomes, it was the discovery of antipsychotic drugs in the 1950's that revolutionized treatment for those with schizophrenia.

Conventional antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders.

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional antipsychotic drugs.

Caused by the drugs' impact on the extrapyramidal areas of the brain.

*These effects are so common that they are listed as a seperate category of disorders- medication-induced movement disorders - in the DSM-IV-TR.

Extrapyramidal effects that appear in some patients after they have taken conventional antipsychotic drugs for an extended time.

Involves involuntary movements, usually of the mouth, lips, tongue, legs, or body.

affects more than 10% using conventional antipsychotic drugs and can be irreversible.

A life threatening reduction in white blood cells. This condition is sometimes produced by the atypical antipsychotic drug clozapine.

The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs.

A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community.

A program of posthospitalization care and treatment in the community.

A program that offers hospital-like treatment during the day only. Also known as day hospital.

A residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals. Also known as a group home or crisis home.

A supervised work-place for people who are not yet ready for competitive jobs.

A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patient's rights.

More than half the 20th century, people with schizophrenia were considered insane and were institutionalized in public mental institutions - whose primary goal was to restrain them and give them food, shelter, and clothing.
1793 - moral treatment began.
Because states were required by law to establish state hospitals for patients who could not afford private care - there were problems with overcrowding, understaffing, and poor patient outcomes led to loss of individual care and the creation of "back wards" - human warehouses filled with hopelessness.

Care in the past cont..

Most common pattern of decline was called the social breakdown syndrome, which involved: Extreme withdrawal, anger, and physical agressiveness. Loss of interest in personal appearance and functioning.

1950's - clinicians developed two institutional approaches that brought some hope to chronic patients. Milieu therapy & Token economies.
These approaches helped improve the personal care and self-image of patients, problem areas that were worsened by institutionalization.

1954 - chlorpromizine (under the trade name Thorazine) approved for sale in the USA as antipsychotic drug.

Since the discovery of phenothiazines, other kinds of psychotic drugs have been developed.

Those developed 1960s,1970s, & 1980s are referred to as conventional antipsychotic drugs. - these drugs are known as neuroleptic drugs because they often produce undesired movement effects.
Drugs developed in recent years are known as atypical or second generation antipsychotics.

Since men with the disorder tend to have more negative symptoms than women, they require higher doses and respond less quickly to the antipsychotic drugs.

The most common of these effects produce Parkinson's symptoms, reactions that closely resemble the features of the neurological disorder Parkinson's disease including:

*Muscle Tremor or rigidity

*Dystonia (bizarre movements of the face, neck, tongue, and back)

*Akathisia (great restlessness, agitation, and discomfort in the limbs

*these symptoms are not seen in newer drugs

Unwanted effects of conventional antipsychotic drugs

cont...

The Parkinson releated symptoms seem to be the result of medication-induced reductions of dopamine activity in the substantia nigra, a part of the brain that coordinates movement.

In most cases the symptoms can be reversed if the anti-Parkinson drug is taken along with the anitpsychotic.

A severe potentially fatal reaction to conventional antipsychotic drugs. In as many as 1% of patients, particuliarly elderly ones.

Symptoms include muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system.

As soon as the syndrome is recognized, drug use is discontinued and each symptom is treated medically. Individuals may be given dopamine-enhancing drugs.

Called "atypical" because their biological operation differs from that of conventional antipsychotic drugs.

appear more effective, especially for negative symptoms.

cause few extrapyramidal side effects

They do, however carry a risk of agranulocytosis, a potentially fatal drop in whithe blood cells.

Ex; Clozaril,Risperdal, Zyprexa, Seroquel, Geodon, and Abilfy.

Psychotherapy can be very helpful when used in combination with medication.

The most helpful forms include insight therapy and two broader sococultural therapies: family therapy and social therapy.

A variety of insight therapies have been used to treat schizophrenia.

Studies suggest that the orientation of the therapist is less important than their experience with schizophrenia.

Additionally, the most successful therapists are those who take an active role, set limits, express opinions, and challenge patients' statements.

approx 25% of people with schizophrenia live with family members.

Family therapy attempts to address issues, create more realistic expectations, and provide psychoeducation about the disorder.

Families may also turn to support groups and family psychoeducation programs.

Addresses social and personal difficulties

People recovering from schizophrenia and other severe disorders need: practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing

*Research finds that this approach reduces rehospitalization.

This is the broadest approach for the treatment of schizophrenia!

Coordinated Services: Community mental health centers provide medications, psychotherapy, and inpatient care. Coordination of services is especially important for mentally ill chemical abusers (MICAs).

Short-term Hospitalization- If treatment on an outpatient basis is unsuccessful, patients may be transferred to short-term hospital programs.

After being hospitalized for up to a few weeks, patient are released to aftercare programs for follow-up in the community.

Many people  recovering from schizophrenia recieve occupational training in a sheltered workshop - a supervised workplace for employees who are not ready for competitive or complicated jobs.

Fewer than half of all people who need them recieve appropriate community mental health services.

In any given year, 40 to 60% of all people with schizophrenia recieve no treatment at all.

Two factors responsible: Poor coordination of services and shortage of services.

8% enter an alternative care facility such as a nursing home) receive custodial care and medication

18% place privately run residences, boarding houses, foster homes -supervision provided by untrained individuals

31% placed in single-room occupancy hotels (run down environments-survive on govt disability)

Great number become homeless - approx one third of homeless people in America have a severe mental disorder-commonly schizophrenia.

created to find more effective ways for all levels of government to meet the need of people with such disorders.

Another important advancement has been the formation of national interest groups, including the National Alliance for the Mentally Ill (NAMI)