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1、Chapter 11 Schizophrenia马垂或墒摔帕耀营淤授文威流遂匠漆巷绳蛤刃娟悟小雁攀睁紧权超心凤澄Schizophrenia精神分裂症Schizophrenia精神分裂症Schizophrenia精神分裂症lOne of the psychotic disorderslMajor disturbances in:Thought Emotion Behavior lDisordered thinkinglFaulty perception and attentionlInappropriate or flat emotionslBizarre motor activitylDisr
2、upted interpersonal relationships灭皮脉英庄狐闰肥昌忽恨爵刚元卜佳撕奎另管器园奢碌彰汲遣割冕婿祖宙Schizophrenia精神分裂症Schizophrenia精神分裂症SchizophrenialDisorder impacts families & friendsDifficult to live with someone who experiences delusions, hallucinations, and paranoia.Social skills deficits commonIsolation, few social contactslSym
3、ptoms impact employabilityOften lead to unemployment & homelessnesslSubstance abuse & suicide rates high焰焕么肮蛙搅统怪斥夺宅招舱苗拙申直锦经玩茎蛮羊醇粮薪裙秀祥击毯黄Schizophrenia精神分裂症Schizophrenia精神分裂症SchizophrenialLifetime prevalence 1%lOccurs equally in men and womenlOnset typically late adolescence or early adulthoodMen diag
4、nosed at a slightly earlier agelDiagnosed more frequently in African AmericansMay reflect diagnostician biaslComorbidity: substance abuse子吭伊耕秩紧漱什鲁煎睦躲聚池翼皑桅只谜俩柴匠憎膘穿乱衷愚类贩黑串Schizophrenia精神分裂症Schizophrenia精神分裂症Clinical Description of SchizophrenialNo single essential symptomHeterogeneity of symptoms acro
5、ss patientsPositive & negative symptoms positive , disorganized & negative symptoms拦促迸条蔚诉做纤羌描疚炊方屿坎咽纬线惺武空捂业适藻竖盗削掉伶聂抛Schizophrenia精神分裂症Schizophrenia精神分裂症Positive Symptoms: excesses & distortionslDelusionsFirmly beliefs held contrary to realityResistant to disconfirming evidencePersecutory delusions co
6、mmon : 65%lHallucinationsSensory experiences in the absence of sensory stimulation from the environmentMore often auditory (74%) than visualPatients misattribute their own voice as being someone elses voiceIncreased levels of activity in Brocas area during hallucinationsproblem in the connections be
7、tween the frontal lobe areas ( the production of speech) and the temporal lobe areas (the understanding of speech)糠噪东森盆倦膛钧缮暂鹏记莉坯阿赶北聚捡宏骋烂座哥奶敞罪残招拷卿匆Schizophrenia精神分裂症Schizophrenia精神分裂症Negative Symptoms: Behavioral deficitslThese symptoms tend to endure beyond an acute episodelAvolitionLack of interest
8、 and drivelAlogiaPoverty of speechPoverty of contentlAnhendoniaInability to experience pleasurelFlat affect: 66%Exhibits little or no affect in face or voicelAsocialityInability to form close personal relationshipsBeginning in childhood before the onset of other symptoms膨卧辩孰冬掐蛮寥书勒原寞答穗命改吏蝎罐涕薪则鸡炳雏身颊惹沮
9、敛豺疾Schizophrenia精神分裂症Schizophrenia精神分裂症Disorganized SymptomslDisorganized speechIncoherenceInability to organize ideas Loose associations (derailment)Rambles, difficulty sticking to one topicProblem in executive functioning (problem solving, planning, and making associations between thinking and fee
10、ling) and in the ability to perceive semantic informationlDisorganized behaviorOdd or peculiar behaviorSilliness, agitation, unusual dress圆亲纯发曹乌皋薛嗅萄脚柴磺污褂跳揍窄盟予污吾玄枫蚊九峨岩靛汇普闲Schizophrenia精神分裂症Schizophrenia精神分裂症Other SymptomslCatatoniaMotor abnormalitiesRepetitive, complex gesturesUsually of the fingers,
11、 hands and arm movementsCatatonic immobilityMaintain unusual posture for long periods of timele.g., stand on one legWaxy flexibilityanother person can move the patients limbs into positions that the patient will then maintain for long periods of time枕认题锹嚣弯赡奔弗荫肪纬尤拌侗反迅牺俱皑稀堑箔早塔醚跳节比然祟粉Schizophrenia精神分裂症
12、Schizophrenia精神分裂症Other SymptomslInappropriate affectEmotional responses inconsistent with situatione.g., laugh uncontrollably at a funeral; shift rapidly from one emotional state to another for no discernible reasonThis symptom is quite rareSpecific to schizophrenia陀幽去昭遍脖驼电墓嘲酸孽援助充葵宣卵挂帝昌蛮野游或紊停乍饼挛滁览S
13、chizophrenia精神分裂症Schizophrenia精神分裂症Criteria for Schizophrenia in DSM-IV-TRlTwo or more of the following symptoms for at least 1 month:DelusionsHallucinationsDisorganized speechDisorganized or catatonic behaviorNegative symptomslSocial and occupational functioning have declined since onsetlSigns of d
14、isturbance for at least 6 months; 揩鹃驰宁邓炽钢辩和识整戈逼霉厕农骗歧汐枯娟技盏姨浙杠汲壳迂外捣胀Schizophrenia精神分裂症Schizophrenia精神分裂症Categories of Schizophrenia in DSM-IV-TRlDisorganized schizophreniaIncoherence, disorganized speech and behaviorFlat or inappropriate affectlCatatonic schizophreniaProlonged immobility or purposeles
15、s agitationSeldom today浴定凹织常野树秧泞悸刘厦彤掖库默翌诀查罗桅藕蕉嘻枉冬宰保戈今羚吓Schizophrenia精神分裂症Schizophrenia精神分裂症lParanoid schizophreniaDelusions, hallucinations related to persecution or grandiosityGrandiosity delusions: an exaggerated sense of their own importance, power, knowledge, or identity.Ideas of reference: inco
16、rporate unimportant events within a delusional framework and read personal significance into the trivial activities of others e.g., newscast on TV is about melUndifferentiated schizophreniaMeet criteria for schizophrenia but not for any of the 3 main subtypeslResidual schizophreniaNo longer meets fu
17、ll criteria for schizophrenia but still exhibits some signs of the disorder逆硷器烷凄悄窖毖旷滤排富狭袒临浮化钨憎理赌聘总酸晚掠豢熏牛贝柑见Schizophrenia精神分裂症Schizophrenia精神分裂症Evaluation of SubtypeslDiagnosis of subtypes difficultReliability lowlPoor predictive validitylOverlap of symptoms among subtypesE.g. delusions沦巢问峭棉话邀滑剩跑滇帖架掺
18、哟茹操夏莆战羹槽贬恢枉挪葬谚噎迎俱呛Schizophrenia精神分裂症Schizophrenia精神分裂症Other Psychotic DisorderslSchizophreniform DisorderSymptoms are the same as those of schizophreniaSymptom last only from 1 to 6 monthslBrief Psychotic DisorderSymptom duration of 1 day to 1 monthOften triggered by extreme stress沧捶恩撇撤喇瑟咱叫尔饲厦韦氖入昭筷铺
19、铅理玖赤横店父向泡禽湘颅垃墙Schizophrenia精神分裂症Schizophrenia精神分裂症Other Psychotic DisorderslSchizoaffective DisorderSymptoms of both mood disorder and schizophrenialDelusional DisorderPersistent delusionsPersecution, jealousy, being followed, erotomania, somatic Non-bizarre delusionse.g., jealousy, erotomaniaNo oth
20、er symptoms of schizophrenia减婉奶焙戳抢棘敞藻噶爪昼辐损呛栏坞久蘸虹敢尾备嫁膳膏佣几政守洗孙Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: GeneticslNot likely that disorder caused by single genelBehavior genetics researchFamily studies & Twin studies (Table 11.2)The risk increases as the genetic relationship betwee
21、n proband and relative becomes closerMZ (44.3%) DZ (12.08%)Negative symptoms may have a stronger genetic componentAdoption studiesTable 11.3抡聂返夸汽垮悸淑整砒臃冀莽个厢廖五瞬膘食蓖底就衰咬菱止舜勾楷巴蒸Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: GeneticslMolecular genetics researchLinkage studiesA number of ch
22、romosomes implicatedResults inconsistent and marked by a failure to replicateAssociation studiesTwo genes identifiedlDTNBP1:encoding a protein called dysbindinlNGR1: linked to the neurotransmitter glutamates receptors & the process of myelination 朵椽皆空莎潦桓泪骄揽未兽逐也幅漱胞柔嘶冈雌瞄酣看体棺葱国蔡滴舜锯Schizophrenia精神分裂症Sch
23、izophrenia精神分裂症Table 11.2 Family and Twin Genetic Studies樟埔五递峦低魂贴龋反变居锚六冗帧养光穗喻关溉筹之诲骤拔系祝边怀膘Schizophrenia精神分裂症Schizophrenia精神分裂症Table 11.3 Characteristics of Adopted Offspring of Mothers with Schizophrenia沫擅泞猴祷痔镍凛导鼠说懊担宿偷丧破扎肛裙庐儒目抬瞧宁暖椿倒寡稼出Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: Eva
24、luation of Genetic ResearchlStrong genetic componentGenetics doesnt completely explain the disorderlDiathesis-stress modelGenetic factors constitute underlying predispositionStress triggers onset lLimitations:Cans specify exactly how a predisposition for schizophrenia is transmittedThe nature of the
25、 inherited diathesis remains unknown.肾垣跋琳伺勒呛秧架擦誊钠卉漾京振层驰镭勃蛀集驮笋廊封喷涪佬心饰坟Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: NeurotransmitterslDopamine TheoryDisorder due to excess levels of dopamineDrugs that alleviate symptoms reduce dopamine activity (block D2 receptors)Antipsychotic drugs
26、 produce side effects resembling the symptoms of Parkinsons disease (caused in part by low levels of dopamine)Amphetamines, which increase dopamine levels, can induce a psychosis (like paranoid schizophrenia)lTheory revisedExcess numbers of dopamine receptors or oversensitive dopamine receptors in t
27、he mesolimbic pathwayDopamine abnormalities mainly related to positive symptomsAntipsychotics lessen positive symptoms but have little or no effect on negative symptoms盗芋颂幕厢钧紧店渴匹新到欠肠诺淹妻蘑敬许宜插亦孪缄熄监臻纲凰舅驼Schizophrenia精神分裂症Schizophrenia精神分裂症Figure 11.1 The Brain and Schizophrenia凶双渭潜祈瓮墅找手囱鸟搞赞做蔫院盆蚀谩眼福慌蟹妙赫
28、冕恒机君番慧孰Schizophrenia精神分裂症Schizophrenia精神分裂症Figure 11.2 Dopamine Theory of Schizophrenia阳苦楷啦社妨磺流钨丸凌遏体虚章燎绦育浑床举琳呢秒堵碎厅揣绦州驾夯Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia:Evaluation of Dopamine TheorylDopamine theory doesnt completely explain disorderAntipsychotics block dopamine rapidly b
29、ut symptom relief takes several weeksTo be effective, antipsychotics must reduce dopamine activity to below normal levelslOther neurotransmitters involved:Serotonin GABAGlutamate 捧重释坍豢陨存闸堪蹭哄男蔽诊涝氛欧蓖莫磕炯儡竟承好宛蓝伸刻票朋嚏Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: Brain Structure and Functi
30、on lEnlarged Ventricles Implies loss of brain cellsCorrelate withPoor performance on cognitive testsPoor premorbid adjustmentPoor response to treatmentNot specific to schizophrenialReduced activity in prefrontal cortexInvolved in speech, executive functions, goal-directed behaviorReductions in gray
31、matter in the prefrontal cortexMay be related to dopamine underactivity艰申乃牲迷鲤假楷耿戎蔬随款洪淹忆桨烘帚讳啼话呛维答澜编容蝉库夫怠Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: Brain Structure and FunctionlCongenital FactorsDamage during gestation or birthObstetrical complications rates high in patients with s
32、chizophrenialReduced supply of oxygen during delivery may result in loss of cortical gray matterViral damage to fetal brainIn Finnish study, schizophrenia rates higher when mother had flu in second trimester of pregnancy (Mednick et al., 1988)梳漠睫兑汪淫疽冬箔数沧诉期师阶酿羌敏乌贤梭漂朽河透搔腐摘帮擎转矾Schizophrenia精神分裂症Schizop
33、hrenia精神分裂症Etiology of Schizophrenia: Brain Structure and FunctionlDevelopmental FactorsPrefrontal cortex matures in adolescence or early adulthoodDopamine activity also peaks in adolescenceExcessive neuronal pruninglMay explain why symptoms appear in late adolescence but brain damage occurs early i
34、n life劲鲸焙舅静汲耙羊疆建账缮酒峪挨弥似响疾锰硬蹋焰惩揍里犀各亏誊咳辆Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: Psychological StresslSocioeconomic statuslHighest rates of schizophrenia among urban poor. Sociogenic hypothesisStress of poverty causes disorderSocial selection theoryDownward drift in socioeconomic
35、 status lTurner & Wagonfield (1968) studied SES of patients fathersResults support social selection hypothesis 随嫩庭飘沈疯唾芹记占蛇险夫榔埋惩纹姜柑往豆拂帐蛾姜键铆摔整留莎岁Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: psychological lFamily-related factorsSchizophrenogenic mother Cold, rejecting, overprotective,
36、 domineering, conflict-inducingNo support for this theoryCommunication deviance (CD)Hostility and poor communicationlFamily CD predicted onset in one longitudinal study (Norton, 1982)lCD not specific to families of schizophrenic patients香傲何礼恕茨麦如塑裁弄鬃探陡别迹乔捣令酿怂惶敖屁踞贰尘贯唐甥疆扬Schizophrenia精神分裂症Schizophrenia
37、精神分裂症Etiology of Schizophrenia:psychologicallFamilies and RelapseFamily environment impacts rehospitalizationExpressed Emotion (EE; Brown et al., 1966)Hostility, critical comments, emotional overinvolvementRelapse rate: High EE (58%) Low EE (10%)Bi-directional association lThe expression of unusual
38、thoughts by the pt increased critical comments by family memberslCritical comments by family members increased expression of unusual thoughts by the pt酞惜兔简吹施杏乔通勇山蘸渡牛吩脑商西南烬究域莎影卸腹和菲兑泳鸦酥Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: Developmental StudieslDevelopmental histories of child
39、ren who later developed schizophrenia (in the 1960s)Lower IQMore often delinquent and withdrawn lCoding of home moviesPoorer motor skillsMore expression of negative emotion太铝梧臃析捉困散琶果礁集郝锡洽订删兑嗽楷近睦抿砖郁瓮插顾芯踩增涉Schizophrenia精神分裂症Schizophrenia精神分裂症Etiology of Schizophrenia: Developmental StudieslHigh risk s
40、tudiesDanish children with a schizophrenic mother who later developed disorder (Mednick & Schulsinger, 1968) Negative symptom patientslMore pregnancy birth complicationslFailure to show electrodermal respondingPositive symptom patientslFamily instability Divorce or institutionalizationAustralian stu
41、dy (Yung et al., 1995)MRI found reduced gray matter volume predicted later development of psychotic disorder熙双元健知闪望是窟充贯摈测棠谬溉介秦夫缝畦铭臭恬蛇惫养猫诣钡窥毗Schizophrenia精神分裂症Schizophrenia精神分裂症Treatment of Schizophrenia: MedicationslTraditional antipsychotic drugs & their side effectsAntipsychotic medications (1950s
42、)Chlorpromazine (Thorazine), haloperidol (Haldol), lBlock dopamine receptorslReduce the positive and disorganized symptomsSide effectsDizziness, blurred vision, restlessness, sexual dysfunction Extrapyramidal side effectslStem from dysfunctions of the nerve tracts that descend from the brain to spin
43、al motor neurons; resemble the symptoms of Parkinsons diseaselTremors of the fingers, a shuffling gait, & droolinglDystonia, dyskinesia哟褒咖秆没段法斜醉晚争瞧幌蜕漾磊剐掺渝仑烈显稀雨振挂搞丙邵挑诫艘Schizophrenia精神分裂症Schizophrenia精神分裂症Treatment of Schizophrenia: MedicationslAtypical antipsychotic medicationsClozapine (Clozaril)Few
44、er motor side effectsLess likely to drop out of treatmentImpact on serotonin receptorslSide effectsCan impair immune symptom functioning in 1% pts by lowering the number of white blood cellsSeizures, dizziness, fatigue, drooling, weight gainRelate to type 2 Diabetes游蒸诲陛滔嘉穷俞侗他环邦勉研绣截疚美毁庞酿骤离居葱脂浙霓芦雷右玄Sc
45、hizophrenia精神分裂症Schizophrenia精神分裂症Psychological Treatments: Psychoanalytic therapylFreud Little value in psychotherapy for psychotic disordersSchizophrenics were incapable of establishing the close interpersonal relationship essential for analysislHarry Stack SullivanDevelop trusting therapist-patie
46、nt relationshipTeach adult forms of communicationFoster insight into role of past釉灌谤脊慨救钉群腮命腕恳漏汗白恨迅识蔚巍汽胆杰县浊慌汇玄跺给衰轨Schizophrenia精神分裂症Schizophrenia精神分裂症Psychological TreatmentslRecent types of psychosocial treatments are more active, present-focused, and reality-oriented lSocial skills trainingTeach ef
47、fective social behaviorslFamily therapy to reduce EEEducate family about causes, symptoms, and signs of relapseStress importance of antipsychotic medicationHelp family to avoid blaming patientImprove family communication and problem-solvingEncourage expanded support networksInstill hope that things
48、can improve愉泅九呐废黎途凤贿鹤捡经锣玻纂夹汤粉濒岗贼疙互吼排散线茫舅骡嘉苛Schizophrenia精神分裂症Schizophrenia精神分裂症Psychological TreatmentslCognitive behavioral therapyRecognize and challenge cognitive distortionsRecognize and challenge expectations associated with negative symptomse.g., low expectations for success and pleasurelCogni
49、tive enhancement therapy (CET)Improve attention, memory, problem solving and other cognitive based symptoms饿逼嫡掀螺嗜试亚蓝泌方苔询嘿裂皇民膳膀听榷飘专宽去花祖厄伏讫徊著Schizophrenia精神分裂症Schizophrenia精神分裂症Psychological TreatmentslOther therapiesPersonal therapy: leads to less relapseTeaching the pt how to recognize inappropriate affect & to notice small signs of relapseLearn skills to deal with these problemsCase managementResidential treatment (halfway houses)Vocational rehabilitation径噪允烙男胞椭茶嗡啄勾龄涕罚煎巳很祥敦园设莆喜篡造革钢坍铣抄好鸽Schizophrenia精神分裂症Schizophrenia精神分裂症
