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Schizophrenia and Psychotic Disorders

November 7th, 2012 Kate Lieberman

What is psychosis?
What characterizes psychotic disorders?
Flat affect Inappropriate affect Cognitions Delusions Disorganized thoughts Behaviors Hallucinations Catatonia Avolition

A psychotic disorder/ group of related disorders Lifetime prevalence: 1% of U.S. population

DSM-IV-TR Criteria
2 or more (or 1 if bizarre delusions/auditory hallucinations) during 1month period Delusions Hallucinations Disorganized speech Disorganized/catatonic behavior Negative symptoms Continuous sx for 6 months (at least 1 month active phase) Significant disturbance/ impairment in daily functioning Not due to affective disorder, substance or medical condition

What is it like to have schizophrenia?

(Paranoid) Schizophrenia Simulation

As you watch the clip, note symptoms and characteristics of the disorder that are portrayed.

Positive symptoms
What are positive symptoms of schizophrenia? Excessive or overt Unusual thoughts or perceptions, thought disturbances,
bizarre behavior

Delusions Irrational beliefs Fixed/resistant Types Persecutory Control Grandiose Referential Somatic

Positive symptoms contd

Hallucinations Sensory experiences not based in environmental
reality Auditory (hearing): most common Visual (seeing) Olfactory (smelling) Tactile (feelings) Gustatory (tasting)

Positive symptoms contd

Disorganized thoughts/speech Loose associations Neologisms Perseveration Clang Disorganized behavior Impaired ability to take care of self, work, interact with
others Unpredictable/inappropriate emotional responses Catatonic behavior

Negative symptoms
Deficits in behavior or absence of normal behaviors Flat affect Alogia Believed to reflect slowed cognitive processes, or to
result from cognitive overload (being overloaded with other sx) Avolition Anhedonia Lack of insight regarding mental condition

Cognitive symptoms
Difficulties with concentration and memory Disorganized thinking Slow thinking Difficulty comprehending Poor concentration and memory Difficulty expressing thoughts Difficulty integrating thoughts, feelings, behavior

Associated disorders and symptoms

Mood disorders and substance disorders often comorbid

Suicide more common in individuals with schizophrenia (4.9%)

than general population (.01-.03)

Risk factors for suicide in individuals with schizophrenia: Single Unemployed Socially isolated Male Violence towards others not typical More likely to harm self than others More likely to be victims of crime (e.g., rape or robbery)

Phases of schizophrenia
Prodromal phase Occurs before onset Symptoms typical of depression Psychotic prophase First full-blown positive symptoms appear May be triggered by stressful event Active phase 6 months or longer of positive and negative symptoms

Residual phase Less prominent symptoms, similar to prodromal phase May constitute the majority of life for individuals with

Long-term outcomes
Complete remission not likely

10 year study Majority of patients improved over time; minority


15 year study 40% showed periods of improvement Sizable minority were not on medication Long-term outcome may be more positive than
portrayed in DSM-IV-TR

Paranoid subtype
Marked by paranoia

Usually persecutory or grandiose delusions and

auditory hallucinations

Paranoia may lead to difficulties in relationships Long term prognosis: better than other subtypes; less
disordered cognition and behavior

Disorganized subtype
Disorganized speech and behavior

Blunted or inappropriate affect

Difficulty taking care of self Impaired communication, incomprehensible speech If delusions and hallucinations- not coherent or consistent Appears earlier than other subtypes, with gradual onset Poorer prognosis
Disorganized schizophrenia clip

Catatonic subtype
Characterized by abnormal motor symptoms Immobility Excessive movement Odd postures maintained, motor unresponsiveness Waxy flexibility: others can move their posture, and
they will maintain it Echolalia or echopraxia

Catatonic schizophrenia clip

Undifferentiated and Residual types

Undifferentiated Mixture of symptoms/subtypes, cannot be
characterized by any 1 of the other subtypes

Residual Occurs after active phase of schizophrenia Usually involves more negative symptoms Continuance of symptoms like social withdrawal,
blunted affect, odd beliefs or unusual perceptions (not full blown delusions or hallucinations), odd speech tendencies

Problem with categorical approach

Heterogeneity in behavior of individuals with
schizophrenia People present with different combinations of symptoms and severity May not fall into discrete types

Dimensional approach: sx rated as absent, mild,

moderate, or severe Psychotic dimension Disorganized dimension Negative dimension

Other psychotic disorders

Schizophreniform disorder Schizophrenic episode that lasts only 1-6 months Not necessarily marked by impairment in social or
occupational functioning

Schizoaffective disorder Symptoms of schizophrenia and mood disorder Primary symptoms of schizophrenia Depressive type Bipolar type

Other psychotic disorders contd

Delusional disorder Only psychotic symptom of delusions for at least 1
month Delusions not bizarre Erotomanic Grandiose Jealous Persecutory Somatic No significant interference in daily functioning

Other psychotic disorders contd

Brief psychotic disorder One or more of following sxs for less than 1 month: Delusions Hallucinations Disorganized speech Disorganized or catatonic behavior Tends to follow environmental stressor (e.g., spouse dying)
Postpartum psychosis Postpartum depression plus psychosis Shared psychotic disorder Folie a deux Person close to someone with a delusion comes to believe the
delusion as well