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