Kraepelin Credited with- Categorization of various symptoms &
putting emphasis on early onset of disorder
- Dementia (Loss of Mind) Praecox (Early, Premature)
Eugen Bleuler
- Coined Termed “Schizophrenia”
- Focused on Associative Splitting (thought process disconnected, not consistent)
Kraepelin Credited with- Categorization of various symptoms &
putting emphasis on early onset of disorder
- Dementia (Loss of Mind) Praecox (Early, Premature)
Eugen Bleuler
- Coined Termed “Schizophrenia”
- Focused on Associative Splitting (thought process disconnected, not consistent)
Positive Symptoms
– Hallucinations, Delusions Disorganized Symptoms
– Speech and Behavior Negative Symptoms
– Deficits in Affect, Speech, Motivation
Positive Symptoms
– Hallucinations, Delusions Disorganized Symptoms
– Speech and Behavior Negative Symptoms
– Deficits in Affect, Speech, Motivation
Positive (present) Symptoms Positive (present) Symptoms Delusions and paranoia (abnormal
thought content)– Misrepresentation of Reality– “Basic Feature of Madness”
Examples– Grandeur -- Importance– Persecution -- Out to Get Me
Delusions and paranoia (abnormal thought content)– Misrepresentation of Reality– “Basic Feature of Madness”
Examples– Grandeur -- Importance– Persecution -- Out to Get Me
Positive Symptoms Positive Symptoms Hallucinations
– Absence of Sensory Stimulation
– Involve Any of the Senses Examples
– Auditory -- Voices (70%)
– Visual -- Seeing Things (25%)
– Tactile -- Crawling Sensation
Hallucinations– Absence of Sensory Stimulation
– Involve Any of the Senses Examples
– Auditory -- Voices (70%)
– Visual -- Seeing Things (25%)
– Tactile -- Crawling Sensation
Disorganized Symptoms Disorganized Symptoms Disorganized Speech
– Difficulty in Communication Examples
– Tangentiality– Loose Association or Derailment– Circumstantiality
Disorganized Speech– Difficulty in Communication
Examples– Tangentiality– Loose Association or Derailment– Circumstantiality
Positive
Symptoms
Positive
Symptoms
Disorganized Behaviors Catatonia
– Spectrum of sx– Wild Agitation to Immobility
Examples– Waxy Flexibility– Innapropriate Affect
Disorganized Behaviors Catatonia
– Spectrum of sx– Wild Agitation to Immobility
Examples– Waxy Flexibility– Innapropriate Affect
Disorganized Symptoms Disorganized Symptoms
Positive
Symptoms
Positive
Symptoms
Negative Symptoms Negative Symptoms
Flat Affect -- “The Mask” Avolition -- “No Initiative” Alogia -- “Speech is Vacant” Anhedonia -- “No Pleasure”
Flat Affect -- “The Mask” Avolition -- “No Initiative” Alogia -- “Speech is Vacant” Anhedonia -- “No Pleasure”
Paranoid Type Disorganized Type Catatonic Type Undifferentiated Type Residual Type
*Exam prep: Why did DSM-5 drop these subtypes?
Paranoid Type Disorganized Type Catatonic Type Undifferentiated Type Residual Type
*Exam prep: Why did DSM-5 drop these subtypes?
Motor rigidity or excessive movement
Display odd mannerisms
ex. Grimacing, echolalia, echopraxia
**Infrequently occurring subtype -should it remain as separate classification?
Motor rigidity or excessive movement
Display odd mannerisms
ex. Grimacing, echolalia, echopraxia
**Infrequently occurring subtype -should it remain as separate classification?
Schizophreniform Disorder Schizoaffective Disorder Delusional Disorder: subtypes of
persecutory, jealous, grandiose, erotomanic, and somatic
Brief Psychotic Disorder Shared Psychotic Disorder
Folie a Deux
Schizophreniform Disorder Schizoaffective Disorder Delusional Disorder: subtypes of
persecutory, jealous, grandiose, erotomanic, and somatic
Brief Psychotic Disorder Shared Psychotic Disorder
Folie a Deux
People with schizophrenia have “split personalities.”
People with schizophrenia are intellectually disabled?
People with schizophrenia are dangerous?
People with schizophrenia are addicted to their drugs?
People with schizophrenia have “split personalities.”
People with schizophrenia are intellectually disabled?
People with schizophrenia are dangerous?
People with schizophrenia are addicted to their drugs?
Schizophrenia is NOT caused by bad parenting or an unhappy childhood.
Schizophrenia is NOT due to a weakness in character.
Schizophrenia is NOT a hopeless situation.
Schizophrenia is NOT caused by bad parenting or an unhappy childhood.
Schizophrenia is NOT due to a weakness in character.
Schizophrenia is NOT a hopeless situation.
Affects 1 out of 100 People Often Begins Between Ages 16 - 30 Cost of caring for these patients in the
billions each year
Affects 1 out of 100 People Often Begins Between Ages 16 - 30 Cost of caring for these patients in the
billions each year
Chronic Occurs in .2% to 1.5% Population Affects Men and Women Equally Lower Life Expectancy
– Increased Risk of Suicide
Chronic Occurs in .2% to 1.5% Population Affects Men and Women Equally Lower Life Expectancy
– Increased Risk of Suicide
Process vs. Reactive– Insidious vs. Acute
Poor vs. Good Premorbid Functioning Type I and Type II
– Type I: Positive Symptoms– Type II: Negative Symptoms
Process vs. Reactive– Insidious vs. Acute
Poor vs. Good Premorbid Functioning Type I and Type II
– Type I: Positive Symptoms– Type II: Negative Symptoms
Early Brain Damage? Children
– Attentional and Reflex Problems Runs In Families
– High Expressed Emotion & Relapse
– What is the Genetic Risk?
Early Brain Damage? Children
– Attentional and Reflex Problems Runs In Families
– High Expressed Emotion & Relapse
– What is the Genetic Risk?
Runs in Families Increased Risk Based on Genetic Relatedness Search for Marker Genes
Smooth Pursuit Eye Tracking
Runs in Families Increased Risk Based on Genetic Relatedness Search for Marker Genes
Smooth Pursuit Eye Tracking
Genetic Influences Genetic Influences
Genetic Influences Genetic Influences
Antagonists– Neuroleptics
– Drugs That Reduce Dopamine
– Negative Side Effects
– L-Dopa, Amphetamines (Agonists)
Antagonists– Neuroleptics
– Drugs That Reduce Dopamine
– Negative Side Effects
– L-Dopa, Amphetamines (Agonists)
Neurobiological Influences Neurobiological Influences
Excess Dopamine (D2 Receptors) Excess Dopamine (D2 Receptors)
Ventricle Enlargement Ventricle Enlargement
Genetic Neurobiological
Influences
Genetic Neurobiological
Influences
Brain Structure Brain Structure
Ventricle Enlargement Ventricle Enlargement
Genetic Neurobiological
Influences
Genetic Neurobiological
Influences
Brain Structure Brain Structure
Hypofrontality: D1 receptors Hypofrontality: D1 receptors
Early Forms of Treatment Insulin Coma Therapy Psychosurgery Electroconvulsive Therapy (ECT)
Early Forms of Treatment Insulin Coma Therapy Psychosurgery Electroconvulsive Therapy (ECT)
Chlorpromazine Haldol Trial and Error; Mechanism of antipsychotic action –
DA, D2 “dirty” Side Effects: Tics, pseudoparkinsonism; Tardive Dyskinesia
less common – involuntary movements tongue, face, jaw, mouth…
Chlorpromazine Haldol Trial and Error; Mechanism of antipsychotic action –
DA, D2 “dirty” Side Effects: Tics, pseudoparkinsonism; Tardive Dyskinesia
less common – involuntary movements tongue, face, jaw, mouth…
Biological Interventions Neuroleptics
Biological Interventions Neuroleptics
Biological Interventions Atypical antipsychotics
Biological Interventions Atypical antipsychotics
– Zyprexa, Abilify Clozaril– Side effects– Mechanisms of action: serotonin-dopamine
antagonists• increased risk of hyperglycemia, diabetes
• weight gain
• Decreased white blood cell counts (clozaril)
Psychosocial Interventions
- case management & advocacy
- structured living residences
- psychosocial rehab centers (social & work life)
- family education and therapy
Psychosocial Interventions
- case management & advocacy
- structured living residences
- psychosocial rehab centers (social & work life)
- family education and therapy
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