Post on 25-Feb-2016
description
SchizophreniaSchizophreniaand Substance Use and Substance Use
DisordersDisordersHow do Thought Disorders and
Substance Use Disorders Interact?
Topic AreasTopic Areas
I. Description of Thought Disorders
II. Influential Factors on the Illness
III. Effect of Substance Use
IV. Implications for Recovery
I. Description of Thought Disorders
How is it decided if someone has a
“thought disorder?”
Diagnostic Criteria for Schizophrenia*Diagnostic Criteria for Schizophrenia*A. Characteristic symptoms: Two (or more) of the following, each
present for a significant portion of time during a 1-month period: (1) delusions(2) hallucinations(3) disorganized speech(4) grossly disorganized or catatonic behavior(5) negative symptoms, i.e., affective flattening, alogia, or avolition
B. Social/occupational dysfunction: One or more areas of functioning such as work, interpersonal relations, or self care are markedly below the level achieved prior to the onset.
C. Duration: Continuous signs of the disturbance persist for at least 6 months.
E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 312
Diagnostic Criteria for Diagnostic Criteria for Schizoaffective Disorder*Schizoaffective Disorder*
A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.
B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
C. The disturbance is not due to the direct physiological effects of a substance, or a general medical condition
* Diagnostic and Statistical Manual, 4 th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 323
Diagnostic Criteria for Diagnostic Criteria for Substance-Induced Psychotic Disorder*Substance-Induced Psychotic Disorder*A. Prominent hallucinations or delusions. B. There is evidence from the history, physical examination, or
laboratory findings of either (1) or (2):(1) the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal(2) medication use is etiologically related to the disturbance
D. The disturbance is not better accounted for by a Psychotic Disorder that is not substance-induced.
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 342
Terms and DefinitionsTerms and Definitions
“Positive” symptoms (“in addition to” what was experienced before the illness) include; – Delusions– Hallucinations (Auditory, Visual, etc.)– Disorganized Speech– Bizarre Behavior
Terms and DefinitionsTerms and Definitions“Negative” symptoms (“taken away
from” what was experienced before the illness) include; – Alogia– Affective Blunting or Flattening– Avolition– Anhedonia– Attentional Impairment
DelusionsDelusions
False beliefsAffects the “Inference” system of the
brain(ex.) “Conspiracy theories” are common
HallucinationsHallucinations
False perceptionAffect the “Perception” system of the
brainAuditory hallucinations are most
commonAny of the 5 senses may be involved
Disorganized SpeechDisorganized SpeechAffects the “Language” system of the
brain (ex.) Word salad is a jumble of
words/phrases that lacks comprehensible meaning;
(ex.) Tangentiality is a style of speech in which a person replies to questions in an irrelevant, “off the topic” manner).
Bizarre BehaviorBizarre Behavior
Affects the “Behavior-inducing” systems of the brain
(ex.) Ritualistic behaviors – may represent “normal” responses to the “abnormal” stimuli of active delusions or hallucinations
AlogiaAlogia
the inability to organize one’s thoughts and express them fluently
Affective Blunting or Affective Blunting or FlatteningFlattening
“Flat affect”
A deficiency in the ability to express a full range of emotion
May be expressed in a monotonal voice, a “poker face,” or a “schizophrenic stare”
AvolitionAvolition
The inability to initiate a behavior, or carry it out
(exs.) Withdrawal, apathy, decreased energy, decreased motivation
AnhedoniaAnhedonia
The inability to experience pleasure or enjoyment
May result in the discontinuation of hobbies or recreational activities
Attentional ImpairmentAttentional Impairment
Difficulty in focusing attention
Can lead to inability to complete tasks or activities that require focused attention
II. Influential Factors
Family History (Genetic) FactorsFamily History (Genetic) Factors
Individuals with schizophrenia are more likely to have relatives with psychiatric illness (or substance use disorders)
Indicates a genetic vulnerability to psychiatric illness (and substance use disorders)
Supersensitivity ModelSupersensitivity Model
Biological vulnerability + environmental stress = precipitate the onset of the disorder or trigger relapses
Medications decrease vulnerabilitySubstance use increases vulnerability
III. Effect of Substance Use
Alcohol UseAlcohol Use
Combining Alcohol and antipsychotic medication can cause life-threatening oversedation
Cocaine UseCocaine Use
Cocaine abuse can damage the brain and cause psychotic episodes to occur
Marijuana UseMarijuana Use
Marijuana use can contribute to the frequency and intensity of psychotic episodes – More severe positive symptoms– Quicker psychiatric relapses & re-
hospitalizations– Earlier age of onset
IV. Implications for Recovery
Special ConsiderationsSpecial Considerations
More likely to develop addiction with recreational use.
Many clients report using substances to facilitate social interactions with peers.
Principles of Integrated Treatment*Principles of Integrated Treatment*IntegrationComprehensivenessAssertivenessReduction of Negative ConsequencesLong-Term PerspectiveMotivation-Based TreatmentMultiple psychotherapeutic modalities
* Mueser, K.T. et al. (2003). Integrated Treatment for Dual Disorders. Guilford Press: Canada. p. 16-33