Lecture on Schizophrenia Spectrum

Introduction

• Speaker: Dr. Tom Field
• Topic: Schizophrenia Spectrum
• Misconceptions: Media portrayal of psychosis as dangerous is misleading.
  • Most people with psychosis are distressed, seek help, and are non-violent.

Biopsychosocial Perspective

Biological Factors

• Genetic Component: Inherited risk factors.
• Neurological Changes:
  • Alterations in default mode network and frontal limbic circuitry.
  • Dopamine dysregulation linked to hallucinations and delusions.
• Substance Use Impact:
  • Hallucinogens and stimulants can induce psychosis, especially at high doses.

Psychological Factors

• Spiritual Beliefs:
  • Beliefs outside accepted traditions can complicate diagnosis.
  • Example: Wiccan practices vs. delusional beliefs.

Social Factors

• Homelessness:
  • Connection to schizophrenia, difficult to determine causality.
• Family Dynamics:
  • High expressed emotion in families can exacerbate symptoms.

Neurological Considerations

• Default Mode Network:
  • Associated with wandering thoughts; dysregulated in ADHD, autism, schizophrenia.
  • Mindfulness practices are challenging for those affected.

Schizophrenia Spectrum Disorders

Spectrum Overview

• Similar to autism, it is seen as a spectrum with varying severity.
• Disorders covered: Schizophrenia, Schizophreniform, Brief Psychotic Disorder, Schizoaffective Disorder, Delusional Disorder, Cluster A Personality Disorders.

Differentiation Between Psychosis and Mood Disorders

• Short-lasting/Sub-threshold Psychosis: Schizophreniform, Brief Psychotic Disorder.
• Psychosis Only During Mood Episodes: Major Depression/Bipolar with Psychotic Features.
• Psychosis During & Outside Mood Episodes: Schizoaffective Disorder.
• Psychosis Without Mood Symptoms: Schizophrenia, Delusional Disorder.

Detailed Look at Schizophrenia

• Requires two or more symptoms for at least one month.
• Symptoms include: Delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms (flat affect, avolition).
• Importance of distinguishing positive (e.g., hallucinations) vs. negative symptoms (e.g., lack of motivation).

Schizophreniform and Brief Psychotic Disorder

• Schizophreniform: Symptoms last 1-6 months.
• Brief Psychotic Disorder: Symptoms last for one month, exclude negative symptoms.

Schizoaffective Disorder

• Concurrent major mood episode with schizophrenia symptoms.
• Subtypes: Bipolar and Depressive type.

Delusional Disorder

• Only delusions present, no hallucinations or other schizophrenia symptoms.
• Subtypes: Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed/Unspecified.

Cluster A Personality Disorders

Paranoid Personality Disorder

• Pervasive distrust and suspiciousness without evidence.

Schizoid Personality Disorder

• Detachment from social relationships, restricted emotional expression.

Schizotypal Personality Disorder

• Acute discomfort in relationships, eccentric behavior, and magical thinking.

Life Expectancy and Health Concerns

• Suicide Risk: High in individuals with schizophrenia.
• Tobacco Use: High prevalence, posing additional health risks.
• Course: Chronic, progressive illness with declining positive and increasing negative symptoms.

Prevention and Management

Preventative Measures

• Social connection during adolescence.
• Family-focused therapy to reduce negative emotional displays.
• Stress reduction and substance use prevention.

Case Management

• Coordination with psychiatrists, medication adherence.
• Family involvement for support.
• Supported employment and housing.

Treatment Planning

• Structured Therapies: Cognitive Behavioral Therapy (CBT) for hallucinations and delusions.
• Behavioral Activation: Encouragement of activity to combat negative symptoms.

Conclusion

• Psychosis associated with mood symptoms has better prognosis.
• Independence and coping as primary goals for clients.
• Emotional and social support are crucial for prevention and management.