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schizophrenia and psychosis

onset of schizophrenia

typical onset between 18 and 30

incidence of schizophrenia

1 in 100 (1%) In the general population, in over 2.5 million Americans(schizophrenia)

Positive symptoms of schizophrenia

Behaviors in excess of those displayed by healthy people (hallucinations, delusions)(schizophrenia)

Negative symptoms of schizophrenia

Behaviors less than those displayed by healthy people (affective flattening, alogia, abolition, asociality, anergia(schizophrenia)

affective flattening

negative symptom of schizophrenia that consists of a severe reduction or the complete absence of affective responses to the environment(schizophrenia)


absence of thought:
Inferred from observing speech:
-Poverty of speech: Brief responses
-thought blocking: loses train of thought
-poverty of content: Circumstantial speech, typically with extraneous detail


lack of motivation, big difference prior to illness. Once they had the onset of schizophrenia it was an extreme difference.
Lack of social, work, and/or Academic Motivation. Unable to initiate and persia in Goal Directed Activities, persistent and pervasive


socially withdrawn


perception in absence of sensation.
ie: seeing Hillary Clinton when in fact no one is actually present

Auditory Hallucinations

Hearing voices or noises when no sounds are present, most commonly experienced hallucination of schizophrenics

Visual Hallucinations

seeing objects that are not present

Tactile hallucinations

perceptions that something is happening to the outside of one's body - for example, that bugs are crawling up one's back

olfactory Hallucinations

false perception of smell. IE: smelling feces or roses without actually having presence of those smells


misperceptions. A real stimulus is misperceived for example Seeing your friend Liz as Hillary Clinton.
* Not diagnostic of schizophrenia

hypnogogic Hallucinations

dreamlike auditory or visual ecperiences while dozing or falling asleep

Hypnopompic Hallucinations

Hallucinations that occur when awakening from sleep


A false personal belief, with 100% conviction despite all evidence to the contrary. The belief is not shared by society or subculture

Delusions of reference

Excessive meaning, special messages via TV, radio, newspaper. Seems like Everyone with their arms crossed assuming that they are all pointing to him assuming that they want to kill him.

Delusions of persecutions

paranoid delusions that people are out to get to you, to hurt you physically, or emotionally (i.e.: government or FBI)

Grandiose delusions

Believes to have special knowledge or power, intellect (IE: Barak Obama doesn't tell anyone, but I am his secret advisor)

Erotomatic Delusions

believing that they have a secret love relationship with someone (movie star, singer, or head cheerleader in high school) IE: I am secretly married to Jennifer Lopez

paranormal delusions

delusions involving ghosts, aliens, voodoo, black magic etc.

delusions of physical processes

delusions of technology: stealing brainwaves, affecting my thinking IE: people are recording me

delusions of control

a force other than themselves is moving their body against their will. IE: someone is moving them around like a puppet

delusions of thought broadcasting

their thoughts can be heard by everyone in the room/ world, no privacy (fairly common delusion)

Disorganized speech

Thought disorder, conceptual disorganization. Types: Tangentiality, derailment (loose associations), incoherence (word salad)


person responds to a question with oblique or irrelevant reply. IE:
Doctor: what city are you from?
Patient: That's a hard question to answer because my parents... I was born in Iowa, but I know that I am white instead of Black, so Apparently I came from the North Somewhere, and I don't know where, you know I don't know whether I'm Irish or Scandinavian


Changes subject mid sentence. Person is jumping the tracks- derailing, every sentence or every two sentences they are changing the subject.
Doctor: Did you enjoy college
Patient: I really enjoyed some communities, I tried it, and the, and the next day when I'd be going out, I took control, I put bleach in my hair in California

disorganized behavior or appearance

unusual or unproductive behavior, unusual appearance, catatonic behaviors


might be frozen (stuck) hospitalized waxy flexibility; able to move around like gumby, and rigid posture, statue like

unusual appearance

(IE: has metal container on his hair, or lining underwear with tin foil so the government wouldn't steal his sexual energy, or over dressing)

unusual behavior

bizarre behavior- licking doorknobs, picking up lids and putting them in their pocket, shoving thumbtacks up their nose


Lack of energy, lack of mental or physical exertion. 25 year old Naps three hours daily and sleeps ten hours nightly

circumstantial speech

Doctor: I heard you were late for your morning group.
Patient: I'm having a rough day. I woke up late, my alarm clock has been working poorly. Then it took forever for me to brush my teeth because I couldn't find my toothpaste. I started talking to my roommate and I lost track of time. I got to the bus stop just in time to see the bus pulling away. I caught the next bus and talked to a man from india....(goes on and on)

Diagnosis of Schizophrenia

Severe Dysfunction
Essential To Diagnosing Schizophrenia
The Severe Dysfunction InSocial Fxning, Work/School Fxning, And Self-Care Must Last at least 6 months
Phases Of Schizophrenia (Minimum of 6 Months)
Prodromal Phase
Progressive Deterioation In Social Fxning, Work/School Fxning, And Self-Care
Active phase Not Fully Developed
Active Phase (Minimum Of 1 Month)
At Least Two Of The Following Five Symptoms Are Displayed
Disorganized Speech
Disorganized Or Catatonic behavior
Negative Symptoms
Residual Phase
Active phases symptoms significantly reduced
Continued reduction In Social Fxning, Occupational Fxning, And Self-Care

Phases of schizophrenia

(minimum of 6 months) Prodromal phase, Active phase, Residual phase

Subtypes of Schizophrenia

Catatonic type, Disorganized type, Paranoid type, Undifferentiated type, residual type

Schizophrenia catatonic type

catatonic symptoms are prominent

Schizophrenia Disorganized type

Disorganized behavior and/or speech are prominent

Schizophrenia paranoid type

bizarre delusions involving persecution or hallucinations

Schizophrenia undifferentiated type

criteria for symptoms are met, but no one set of symptoms predominate

Schizophrenia residual type

active phase symptoms are present but substantially reduced, dysfunction continuing

other psychotic disorders

brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, delusional disorder

Brief psychotic disorder

Sudden onset of psychotic (delusions, hallucinations). Person Returns to normal functioning within one month. Sometimes brief psychotic disorder is precipitated by a stressor (IE: fired at work, sexual assault) and sometimes no precipitating event can be identified

scizophreniform disorder

positive and negative symptoms similar to schizophrenia. Duration of dysfunction: 1 month< X< 6months

schizoaffective disorder

Person Meets The symptom and dysfunction Duration Criteria For schizophrenia
Person Also experiences mood episodes (e.g., Manic, Major Depressive, mixed episodes)
delusions and hallucinations Have Been Experienced Without mood symptoms For At Least two weeks
Mood Episode Time (MET) Is Significant relative to psychotic dysfunction Time (PDT)
MET/ PDT < 20-25% then schizophrenia
MET/ PDT > 20-25% then schizoaffective disorder

Delusional Disorder

non-bizarre delusions
hallucinations Are Absent Or Very Infrequent
negative symptoms Are Absent Or Very mild
Normal Functioning (work, social, self-care)
Erotomanic Type
Grandiose Type (secret Millionare)
Jealous Type
Persecutory Type (FBI is following him)
Somatic Type (believes he has a heart illness-NO ANXIETY)

Ventricular enlargement

A stable trait in people diagnosed with Schizophrenia-enlarges this portion of the brain

reduced asymmetry

the left side of the brain and the right side of the brain are aligned or reversed that of a regular brain.

Dopamine Hypothesis

Symptoms of Schizophrenia are caused by overactive dopamine. Evidence For The Dopamine Hypothesis
typical antipsychotics (Thorazine, Haldol) Reduce Dopamine Transmission And Reduce positive symptoms
Stimulant drugs, Such As Amphetamines, That Are Biochemically Similar To Dopamine, Induce psychotic Sxs In Normals And Worsen Sxs Of Sz Patients
Evidence Against The Dopamine Hypothesis
_atypical antipsychotics (Clozaril, Zyprexa, Risperidol), That Have Their Greatest Effects On the serotonin system And Little Or No Effect On The Dopamine System, Reduce The positive symptoms of schizophrenia
Neurocognitive impairments (e.g., Inattention, Impaired Planning And Organization) Suggest That The Frontal Lobes Are underactive
Imaging Studies Indicate That The frontal lobes Are Underactive
dopamine transmission Plays A Role
Other Transmitters Involved
Neurotransmitters Are underactive In Some Brain Areas

Neuro Cognitive Impairments in Schizophrenia

Impaired verbal memory, impaired attention/ vigilance, Impaired executive Functioning (organization and planning, set/rule maintenance)

Neurocognitive as a genetic marker

Neurocognitive impairments are present prior to the onset of the disorder, neurocognitive impairments are not due to positive symptoms, neurocognitive impairments are observed in the siblings and children of persons with schizophrenia

Relations between Neurocognition and Functioning in Sz


Treatment of schizophrenia

Antipsychotic medications(Typical Antipsychotics, Atypical Antipsychotics),
Token economy, Skills training, Family education

Typical Antipsychotics

(e.g.,Thorazine, Haldol, Prolixin)
Reduce Dopamine Transmission
Therapeutic Effects
Suppress Positive Symptoms
No Effect On Negative symptoms
Side Effects
Muscle Stiffness/ Tardive Dyskinesia
Sedation / Mental Slowing

Atypical Antipsychotics

(e.g., Abilify, Zyprexa, Risperidol, Cloziril)
Reduce Transmission Of Multiple NTs, Little Effect On Dopamine
Therapeutic Effects
Suppress Positive Symptoms
Little Effect On On Negative Symptoms
Side Effects
Weight Gain
Liver Damage

Token Economy

Differential Reinforcement of Desirable and undesirable behaviors
Desired Behaviors Made Known To Patients
Group Attendance
Self-Care/ Hygiene
Prosocial Behaviors On The Ward
Patients Accumulate Tokens/Points
Patients Purchase Desirable Items With Their Tokens/ Points

Skills training

Psychoeducation With Intensive Role plays
Symptom Management
Warning signs
Persistent Symptoms
Txing(training) In Reporting Symptoms And Side Effects To Doctor
Medication Management
Person learns to appreciate their need for Medication ("Medication Insight")
Txing In Reporting Symptoms And Side Effect To Case Manager Or Psychiatrist
Training In Social Skills
Learning to elicit Rewarding Social Experiences
Training In Vocational Skills
Money Management/ Conservatorship

Family Education

Emphasize Biological Origins Of The Disorder To Reduce Feelings Of Blame and Shame
Management Of Expressed Emotion In Family By Increasing Communication skills
Expressed Emotion = Anger, Criticism, Negativity About The Patient
Educate Family And Pt About

"Disorganized" Symptom Cluster

includes severe and excessive speech, behaviors, and emotions
-cognitive slippage
-loose associations

Subtypes of Schizophrenia

paranoid, disorganized, catatonic, undifferentiated, residual

paranoid type

most common subtype of schizophrenia, characterized by the appearance of delusional thinking accompanied by frequent auditory hallucinations

disorganized type

subtype of schizophrenia characterized by confused behavior and disorganized delusions, among other features

Catatonic type

subtype of schizophrenia characterized by bizarre movements, postures, or grimaces

Undifferentiated type

a subtype of schizophrenia diagnosed if a patient does not meet criteria for paranoid, disorganized, or catatonic subtypes of schizophrenia

residual type

patients who no longer meet criteria for active phase symptoms but demonstrate continued signs of negative symptoms or attenuated forms of delusions, hallucinations or disorganized speech- in "partial remission"

Schizophreniform disorder

disorder in which individuals meet the primary criteria for schizophrenia but show symptoms lasting only 1 to 6 months.

Schizoaffective disorder

Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder.

Delusional disorder

A psychosis marked by severe delusions of grandeur, jealousy, persecution, or similar preoccupations

Brief psychotic disorder

Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor.

Shared psychotic disorder

a delusion develops in an individual in the context of a close relationship with another person who has an already established delusion - their delusion is similar in content

Schizotypal personality disorder

a personality disorder characterized by detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors

schizophrenia stats

Onset and prevalence of schizophrenia worldwide
About 0.2% to 1.5% (or about 1% population)
Often develops in early adulthood
Can emerge at any time

Schizophrenia life expectancy

generally chronic
Most suffer with moderate-to-severe lifetime impairment
Life expectancy is slightly less than average

Female with schizophrenia

tend to have a better long-term prognosis

family studies -schizophrenia

Inherit a tendency for schizophrenia, not forms of schizophrenia
Risk increases with genetic relatedness


Genetic mechanisms that contribute to the underlying problems causing the symptoms and difficulties experienced by people with psychological disorders.

Genetic and Behavioral Markers of Schizophrenia

Genetic markers: Linkage and association studies
Schizophrenia is likely to involve multiple genes
Behavioral markers: Smooth-pursuit eye movement
The procedure - eye-tracking a moving object
Tracking deficits - schizophrenics and their relatives

Causes of Schizophrenia: Neurobiological Influences

The dopamine hypothesis
Drugs that increase dopamine (agonists)
Result in schizophrenic-like behavior
Drugs that decrease dopamine (antagonists)
Reduce schizophrenic-like behavior
Examples - neuroleptics, L-Dopa for Parkinson's disease
Dopamine hypothesis is problematic and overly simplistic
Current theories - emphasize many neurotransmitters

Causes of Schizophrenia: Other Neurobiological Influences

Structural and functional abnormalities in the brain
Enlarged ventricles and reduced tissue volume
Hypofrontality - less active frontal lobes
A major dopamine pathway
Viral infections during early prenatal development
Findings are inconclusive

Medical Treatment of Schizophrenia

Development of antipsychotic (neuroleptic) medications
Often the first line treatment for schizophrenia
Began in the 1950s
Most reduce or eliminate positive symptoms
Acute and permanent side effects are common
Extrapyramidal and Parkinson's-like side effects
Tardive dyskinesia
Compliance with medication is often a problem
Noncompliance with medication

Psychosocial Treatment of Schizophrenia

Psychosocial approaches: Overview and goals
Behavioral (i.e., token economies) on inpatient units
Community care programs
Social and living skills training
Behavioral family therapy
Vocational rehabilitation
Cultural considerations

Research on symptoms of schizophrenia in deaf patients

16 empirical investigations of deaf persons with schizophrenia between 1929 and 2005 (Mompremier, 2009)

executive functioning

a set of mental processes that control and regulate other behaviors

treatment for ADHD

Reinforcement programs
To increase appropriate behaviors
Decrease inappropriate behaviors
May also involve parent training

Amnestic Disorder

Inability to learn new information despite normal attention. Can't recall previously learned info. Disoriented to place & time. Confabulation: imaginary events to fill memory gaps. Denial of problem, lack of concern, apathy. Acute or insidious. Variable duration and course.


Autism Spectrum Disorder
No subtypes

causes of amnestic disorder

Resulting from stroke or chronic heavy alcohol use

Causes of Dementia: Alzheimer's Disease

Neurofibrillary tangles
Amyloid plaques
The role of deterministic genes
Beta-amyloid precursor gene
Presenilin-1 and Presenilin-2 genes
The role of susceptibility genes - ApoE4 gene
Brains of Alzheimer's patients tend to atrophy

Neurofibrillary tangles

a structural change in the cerebral cortex associated with Alzheimer's disease in which bundles of twisted threads appear that are the product of collapsed neural structures

Substance-Induced Dementia

exposure/use of drugs causing dementia, but has worse deficits & permanent

Creutzfeldt-Jakob Disease

A neurological disease transmitted from animals to humans that leads to dementia and death resulting from abnormal protein accumulations in the brain. Linked to mad cow disease ( bovine spongiform encephalitis)

Pick's disease

a rare disorder that affects the frontal and temporal lobes and is clinically similar to Alzheimer's disease

Huntington's disease

progressive and fatal type of dementia caused by dominant alleles

Parkinson's disease

a progressive disease that destroys brain cells and is identified by muscular tremors, slowing of movement, and partial facial paralysis

Other Causes of Dementia

Head trauma - accidents are leading cause
Memory loss is the most common symptom
Causes neurological impairments and dementia
Cognitive slowness, impaired attention, and forgetfulness
Apathy and social withdrawal

Vascular Dementia

Progressive brain disorder involving loss of cognitive functioning, caused by blockage of blood flow to the brain that appears concurrently with other neurological signs and symptoms.

Dementia of the Alzheimer's Type: Extent of Deficits

Range of cognitive deficits
Aphasia - difficulty with language
Apraxia - impaired motor functioning
Agnosia - failure to recognize objects
Difficulties with
Abstracting information

Sundowner syndrome

When the sun goes down the elderly become confused and often combative.

Alzheimer DSM IV TR

Multiple cognitive deficits
Develop gradually and steadily
Memory, orientation, judgment, and reasoning deficits
Additional symptoms may include
Agitation, confusion, or combativeness
Depression and/or anxiety
"Sundowner syndrome"


Gradual deterioration of brain functioning
Deterioration in judgment and memory
Deterioration in language / advanced cognitive processes
Has many causes and may be irreversible

Dementia initial stage

Memory and visuospatial skills impairments
Agnosia - inability to recognize and name objects
Facial agnosia - inability to recognize familiar faces
Other symptoms
Delusions, apathy, depression, agitation, aggression

Dementia later stage

Cognitive functioning continues to deteriorate
Total support is needed to carry out day-to-day activities
Death due to inactivity and onset of other illnesses

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