Chapter 4 Reading Guide Module 12 Answers

2nd edition as of August 2020

Module Overview

In Module 12, we will talk over matters related to schizophrenia spectrum disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our word will consist of schizophrenia, schizophreniform disorder, schizoaffective disorder, and delusional disorder.  Exist sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).

Module Outline

• 12.1. Clinical Presentation
• 12.2. Epidemiology
• 12.iii. Comorbidity
• 12.4. Etiology
• 12.v. Treatment

Module Learning Outcomes

• Describe how schizophrenia spectrum disorders present.
• Depict the epidemiology of schizophrenia spectrum disorders.
• Depict comorbidity in relation to schizophrenia spectrum disorders.
• Describe the etiology of schizophrenia spectrum disorders.
• Depict treatment options for schizophrenia spectrum disorders.

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12.1. Clinical Presentation

Section Learning Objectives

• List and depict distinguishing features that make up the clinical presentation of schizophrenia spectrum disorders.
• Describe how schizophrenia presents.
• Describe how schizophreniform disorder presents.
• Describe how schizoaffective disorder presents.
• Describe how delusional disorder presents.

12.one.i. The Clinical Presentation of Schizophrenia Spectrum Disorders

For the purpose of this book, the schizophrenia spectrum disorder module volition cover, Schizophrenia, Schizophreniform disorder, Schizoaffective disorder, and Delusional disorder. These schizophrenia spectrum disorders are defined past ane of the following main symptoms: delusions, hallucinations, disorganized thinking (spoken communication), disorganized or abnormal motor behavior, and negative symptoms. Individuals diagnosed with a schizophrenia spectrum disorder experience psychosis, which is divers as a loss of contact with reality. Psychosis episodes brand it difficult for individuals to  perceive and respond to ecology stimuli, causing a significant disturbance in everyday functioning. While there are a vast number of symptoms displayed in schizophrenia spectrum disorders, presentation of symptoms varies profoundly among individuals, every bit there are rarely ii cases like in presentation, triggers, course, or responsiveness to handling (APA, 2013).

            12.i.i.one. Delusions. Delusions are "stock-still beliefs that are non amenable to change in light of conflicting evidence" (APA, 2013, pp. 87). This means that despite evidence contradicting one'southward thoughts, the individual is unable to distinguish their thoughts from reality. The inability to identify thoughts equally delusional is likely likely due to a lack of insight. In that location are a wide range of  delusions that are seen in the schizophrenia related disorders to include:

• Delusions of grandeur – belief they take exceptional abilities, wealth, or fame; belief they are God or other religious saviors
• Delusions of command – belief that others control their thoughts/feelings/deportment
• Delusions of thought broadcasting – belief that one's thoughts are transparent and everyone knows what they are thinking
• Delusions of persecution – belief they are going to exist harmed, harassed, plotted or discriminated confronting past either an individual or an institution; it is the most mutual delusion (Arango & Carpenter, 2010)
• Delusions of reference – belief that specific gestures, comments, or even larger environmental cues are directed direct to them
• Delusions of thought withdrawal – conventionalities that one's thoughts have been removed by another source

It is believed that the presentation of the delusion is primarily related to the social, emotional, educational, and cultural background of the private (Arango & Carpenter, 2010). For example, an individual with schizophrenia who comes from a highly religious family is more than likely to experience religious delusions (delusions of grandeur) than another type of delusion.

            12.one.i.2. Hallucinations. Hallucinations can occur in whatsoever of the 5 senses: hearing (auditory hallucinations), seeing (visual hallucinations), smelling (olfactory hallucinations), touching (tactile hallucinations), and tasting (gustatory hallucinations). Additionally, they can occur in a single modality or present across a combination of modalities (e.g., having auditory and visual hallucinations). For the near part, individuals recognize that their hallucinations are non real and endeavor to engage in normal beliefs while simultaneously combating ongoing hallucinations.

Co-ordinate to various enquiry studies, about half of all patients with schizophrenia report auditory hallucinations, 15% report visual hallucinations, and five% report tactile hallucinations (DeLeon, Cuesta, & Peralta, 1993). Amid the nigh common types of auditory hallucinations are voices talking to the patient or diverse voices talking to i some other. Generally, these hallucinations are not attributable to whatsoever ane person that the individual knows. They are usually articulate, objective, and definite (Arango & Carpenter, 2010). Additionally, the auditory hallucinations tin be pleasurable, providing comport to the patient; notwithstanding, in other individuals, the auditory hallucinations tin be unsettling as they produce commands or malicious intent.

            12.i.1.3. Disorganized thinking. Amidst the about mutual cognitive impairments displayed in patients with schizophrenia are disorganized thought, communication, and speech. More specifically, thoughts and speech patterns may appear to exist circumstantial or tangential. For instance, patients may give unnecessary details in response to a question before they finally produce the desired response. While the question is eventually answered in circumstantial speech patterns, in tangential speech patterns the patient never reaches the point. Another mutual cognitive symptom is speech retardation, where the private may take a long time before answering a question. Derailment, or the illogical connection in a chain of thoughts, is another common type of disorganized thinking. Although not always, derailment is often seen in illogicality, or the tendency to provide baroque explanations for things.

These types of distorted thought patterns are often related to physical thinking. That is, the individual is focused on ane attribute of a concept or thing and neglects all other aspects. This type of thinking makes handling hard as individuals lack insight into their disease and symptoms (APA, 2013).

            12.i.i.4. Disorganized/Abnormal motor behavior. Psychomotor symptoms can also exist observed in individuals with schizophrenia. These behaviors may manifest as awkward movements or even ritualistic/repetitive behaviors. They are often unpredictable and overwhelming, severely impacting their power to perform daily activities (APA, 2013).

            12.1.1.five. Catatonic behavior. Catatonic behavior, the decreased or complete lack of reactivity to the environs, is amongst the almost normally seen disorganized motor beliefs in schizophrenia. There runs a range of catatonic behaviors from negativism (resistance to teaching); mutism or daze (consummate lack of verbal and motor responses); rigidity (maintaining a rigid or upright posture while resisting efforts to be moved); or posturing (belongings odd, awkward postures for long periods; APA, 2013). There is ane blazon of catatonic behavior, catatonic excitement, where the private experiences hyperactivity of motor behavior, in a seemingly excited or febrile way.

            12.1.ane.6. Negative symptoms. Up until this indicate, all the schizophrenia symptoms tin be categorized as positive symptoms, or symptoms that are an over-exaggeration of normal encephalon processes; these symptoms are also new to the private. The final diagnostic criterion of schizophrenia is negative symptoms, which are defined equally the inability or decreased ability to initiate actions, speech, express emotion, or feel pleasure (Barch, 2013). Negative symptoms often present earlier positive symptoms and remain once positive symptoms remit. Considering of their prevalence through the course of the disorder, they are too more than indicative of prognosis, with more negative symptoms suggesting a poorer prognosis. The poorer prognosis may exist explained by the lack of effectiveness antipsychotic medications have in addressing negative symptoms (Kirkpatrick, Fenton, Carpenter, & Marder, 2006). There are 6 main types of negative symptoms seen in patients with schizophrenia. Such symptoms include:

• Melancholia flattening – Reduction in emotional expression; reduced display of emotional expression
• Alogia – Poverty of oral communication or speech communication content
• Anhedonia – Disability to feel pleasance
• Apathy – Full general lack of involvement
• Asociality – Lack of interest in social relationships
• Avolition – Lack of motivation for goal-directed behavior

12.1.2. Schizophrenia

Equally stated above, the hallmark symptoms of schizophrenia include the presentation of at to the lowest degree ii of the post-obit for at least one calendar month: delusions, hallucinations, disorganized speech, disorganized/aberrant behavior, or negative symptoms. These symptoms create significant harm in an individual's ability to appoint in normal daily functioning such as work, school, relationships with others, or self-intendance. Information technology should be noted that the presentation of schizophrenia varies significantly amid individuals, as it is a heterogeneous clinical syndrome (APA, 2013).

While the presence of symptoms must persist for a minimum of six months to meet the criteria for a schizophrenia diagnosis, it is not uncommon to have prodromal symptoms that precede the active stage of the disorder and residual symptoms that follow it. These prodromal and residual symptoms are "subthreshold" forms of psychotic symptoms that do not cause significant impairment in performance, with the exception of negative symptoms (Lieberman et al., 2001). Due to the severity of psychotic symptoms, mood disorder symptoms are also common among individuals with schizophrenia; however, these mood symptoms are singled-out from a mood disorder diagnosis in that psychotic features will exist beyond the remission of depressive symptoms.

12.ane.iii. Schizophreniform Disorder

Schizophreniform disorder is like to schizophrenia, except for the length of presentation of symptoms. Schizophreniform disorder is considered an "intermediate" disorder between schizophrenia and cursory psychotic disorder equally the symptoms are nowadays for at least 1 month but non longer than six months. As you may recall, schizophrenia symptoms must be present for at least half-dozen months; A cursory psychotic disorder is diagnosed when symptoms are present for less than one month. Approximately two-thirds of individuals who are initially diagnosed with schizophreniform disorder will have symptoms that last longer than six months, at which time their diagnosis is inverse to schizophrenia (APA, 2013).

Some other cardinal distinguishing feature of schizophreniform disorder is the lack of criteria related to dumb performance. While many individuals with schizophreniform disorder practise brandish impaired functioning, it is not essential for diagnosis. Finally, any major mood episodes—either depressive or manic— that are present meantime with the psychotic features must but exist nowadays for a short time, otherwise a diagnosis of schizoaffective disorder may be more appropriate (APA, 2013).

12.1.4. Schizoaffective Disorder

Schizoaffective disorder is characterized past the psychotic symptoms included in schizophrenia and a concurrent uninterrupted period of a major mood episode—either a depressive or manic episode. It should be noted that because the loss of involvement in pleasurable activities is a common symptom of schizophrenia, to run across the criteria for a depressive episode within schizoaffective disorder, the individual must present with a pervasive depressed mood (APA, 2013). While schizophrenia and schizophreniform disorder do non take a significant mood component, schizoaffective disorder requires the presence of a depressive or manic episode for the majority, if not the total elapsing of the disorder. While psychotic symptoms are sometimes nowadays in depressive episodes, they oft remit once the depressive episode is resolved. For individuals with schizoaffective disorder, psychotic symptoms should continue for at least ii weeks in the absence of a major mood disorder (APA, 2013). This is the key distinguishing feature between schizoaffective disorder and major depressive disorder with psychotic features.

12.1.v. Delusional Disorder

As suggestive of its championship, delusional disorder requires the presence of at least one delusion that lasts for at least i month in duration. It is of import to note that if an individual experiences hallucinations, disorganized oral communication, disorganized or catatonic beliefs, or negative symptoms—in add-on to delusions—they should not exist diagnosed with delusional disorder as their symptoms are more aligned with a schizophrenia diagnosis. Unlike nigh other schizophrenia-related disorders, daily functioning is not overly impacted due to the delusions. Additionally, if symptoms of depressive or manic episodes present during delusions, they are typically brief compared to the duration of the delusions.

The DSM-V (APA, 2013) has identified five main subtypes of delusional disorder to better categorize the symptoms of the individual's disorder. When making a diagnosis of delusional disorder, i of the post-obit modifiers (in add-on to mixed presentation) is included. Erotomanic delusion occurs when an private reports a delusion of another person existence in love with them. Generally speaking, the private whom the convictions are well-nigh is of higher status, such as a glory. Grandiose delusion involves the confidence of having groovy talent or insight. Occasionally, patients will report they take fabricated an important discovery that benefits the general public. Grandiose delusions may also have on religious affiliation, every bit people believe they are prophets or even God. Jealous delusion revolves around the conviction that ane'due south spouse or partner is/has been unfaithful. While many individuals may have this suspicion at some point in their human relationship, a jealous delusion is much more extensive and generally based on wrong inferences that lack testify. Persecutory delusion involves the private assertive that they are beingness conspired against, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in pursuit of their long-term goals (APA, 2013). Of all subtypes of delusional disorder, those experiencing persecutory delusions are the almost at risk of becoming aggressive or hostile, likely due to the persecutory nature of their distorted beliefs. Finally, somatic delusion involves delusions regarding bodily functions or sensations. While these delusions tin can vary significantly, the nearly common beliefs are that the individual emits a foul odor despite attempts to rectify the odour; there is an infestation of insects on the skin; or that they have an internal parasite (APA, 2013).

Key Takeaways

Yous should have learned the post-obit in this section:

• Schizophrenia spectrum disorders are characterized past delusions, hallucinations, disorganized thinking (spoken language), disorganized or abnormal motor behavior, and negative symptoms.
• Delusions are behavior that do not modify even when conflicting evidence is presented and can exist of grandeur, command, idea dissemination, persecution, reference, and thought withdrawal.
• Hallucinations occur in any sense modality and most individuals recognize that they are non real.
• Disorganized thinking, abnormal motor beliefs, catatonic behavior, and negative symptoms such as affective flattening, alogia, anhedonia, apathy, asociality, and avolition are too common to schizophrenia spectrum disorders.
• Schizophrenia is characterized by delusions, hallucinations, disorganized speech, disorganized/abnormal behavior, or negative symptoms.
• Schizophreniform disorder is considered an "intermediate" disorder between schizophrenia and brief psychotic disorder as the symptoms are present for at to the lowest degree one month but not longer than half dozen months.
• Schizoaffective disorder is characterized by the psychotic symptoms included in schizophrenia and a concurrent uninterrupted menstruation of a major mood episode—either a depressive or manic episode.
• Delusional disorder requires the presence of at least i delusion that lasts for at least 1 month in duration to include erotomanic, grandiose, jealous, persecutory, and somatic.

Department 12.1 Review Questions

1. What are the five positive symptoms identified in a schizophrenia diagnosis? Define and identify their difference.
2. What is meant by negative symptoms? What are the negative symptoms observed in schizophrenia related disorders?
3. Place diagnostic differences between Schizophrenia, Schizophreniform, Schizoaffective, and Delusional disorder.

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12.2. Epidemiology

Department Learning Objectives

• Describe the epidemiology of schizophrenia spectrum disorders.

Schizophrenia occurs in approximately 0.3%-0.7% of the general population (APA, 2013). There is some discrepancy in rates of diagnosis between genders; these differences appear to be related to the emphasis of various symptoms. For example, men typically present with more than negative symptoms, whereas women present with more mood-related symptoms. Despite gender differences in the presentation of symptoms, there appears to be an equal adventure for both genders to develop the disorder.

Schizophrenia typically occurs between late teens and mid-30s, with the onset of the disorder slightly earlier for males than females (APA, 2013). Before onset of the disorder is generally predictive of a worse overall prognosis. Onset of symptoms is typically gradual, with initial symptoms presenting similarly to depressive disorders; still, some individuals will present with an precipitous presentation of the disorder. Negative symptoms appear to be more predictive of prognosis than other symptoms. This may be due to negative symptoms beingness the most persistent, and therefore, virtually difficult to treat. Overall, an estimated 20% of individuals diagnosed with schizophrenia report complete recovery of symptoms (APA, 2013).

Schizoaffective disorder, schizophreniform disorder, and delusional disorder prevalence rates are all significantly less than that of schizophrenia, occurring in less than 0.3% of the general population. While schizoaffective disorder is diagnosed more in females than males (similar to schizophrenia), schizophreniform and delusional disorder appear to exist diagnosed as between genders. The gender discrepancy in schizoaffective disorder is probable due to the college charge per unit of depressive symptoms seen in females than males (APA, 2013).

Cardinal Takeaways

You should take learned the post-obit in this section:

• Less than 1% of the full general population is diagnosed with schizophrenia and 20% of these people fully recovery from the disorder.
• Both genders have an equal gamble of developing schizophrenia while men typically brandish more negative symptoms while women present with more mood-related symptoms.
• Schizoaffective disorder, schizophreniform disorder, and delusional disorder have prevalence rates less than 0.3%.

Department 12.two Review Questions

1. Discuss the unlike prevalence rates across the schizophrenia related disorders. Are there differences among the disorders? Between genders?
2. Are at that place differences in prevalence rates depending on symptom presentations? If so, what?

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12.iii. Comorbidity

Section Learning Objectives

• Describe the comorbidity of schizophrenia spectrum disorders.

There is a high comorbidity rate between schizophrenia-related disorders and substance abuse disorders. Furthermore, there is some evidence to suggest that the use of various substances (especially marijuana) may place an individual at an increased risk of developing schizophrenia if the genetic predisposition is besides nowadays (meet diathesis-stress model below; Corcoran et al., 2003). Additionally, there appears to be an increase in feet-related disorders—specifically obsessive-compulsive disorder and panic disorder—amid individuals with schizophrenia than compared to the general public.

It should too be noted that individuals diagnosed with a schizophrenia-related disorder are also at an increased adventure for associated medical atmospheric condition such every bit weight proceeds, diabetes, metabolic syndrome, and cardiovascular and pulmonary illness (APA, 2013). This predisposition to various medical conditions is probable related to medications and poor lifestyle choices, and also place individuals at risk for a reduced life expectancy.

Fundamental Takeaways

You lot should accept learned the following in this department:

• Schizophrenia-related disorders accept a high comorbidity with substance abuse disorders, anxiety-related disorders, and some medical weather condition.

Section 12.3 Review Questions

1. What comorbidities exist between schizophrenia and other conditions?

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12.four. Etiology

Department Learning Objectives

• Describe the biological causes of schizophrenia spectrum disorders.
• Depict the psychological causes of schizophrenia spectrum disorders.
• Describe the sociocultural causes of schizophrenia spectrum disorders.

12.iv.one. Biological

            12.4.1.1. Genetic/Family studies. Twin and family unit studies consistently support the biological theory. More specifically, if one identical twin develops schizophrenia, at that place is a 48% chance that the other volition also develop the disorder within their lifetime (Coon & Mitter, 2007). This percentage drops to 17% in fraternal twins. Similarly, family unit studies take also institute similarities in encephalon abnormalities among individuals with schizophrenia and their relatives; the more similarities, the higher the likelihood that the family member as well adult schizophrenia (Scognamiglio & Houenou, 2014).

            12.iv.1.2. Neurobiological. There is consistent and reliable evidence of a neurobiological component in the transmission of schizophrenia. More than specifically, neuroimaging studies have institute a pregnant reduction in overall and specific encephalon region volumes, equally well equally tissue density of individuals with schizophrenia compared to salubrious controls (Brugger, & Howes, 2017). Additionally, at that place has been show of ventricle enlargement equally well every bit volume reductions in the medial temporal lobe. Equally you may recall, structures such as the amygdala (involved in emotion regulation), the hippocampus (involved in memory), also as the neocortical surface of the temporal lobes (processing of auditory data) are all structures within the medial temporal lobe (Kurtz, 2015). Boosted studies also signal a reduction in the orbitofrontal regions of the brain, a part of the frontal lobe that is responsible for response inhibition (Kurtz, 2015).

            12.iv.1.3. Stress cascade. The stress-vulnerability model suggests that individuals have a genetic or biological predisposition to develop the disorder; nonetheless, symptoms volition not nowadays unless in that location is a stressful precipitating cistron that elicits the onset of the disorder. Researchers have identified the HPA axis and its consequential neurological furnishings as the likely responsible neurobiological component responsible for this stress cascade.

The HPA axis is one of the principal neurobiological structures that mediate stress. Information technology involves the regulation of iii chemical messengers (corticotropin-releasing hormone [CRH], adrenocorticotropic hormone [ACTH], and glucocorticoids) as they reply to a stressful state of affairs (Corcoran et al., 2003). Glucocorticoids, more than normally referred to as cortisol, is the final neurotransmitter released which is responsible for the physiological change that accompanies stress to set the torso to "fight" or "flight."

It is hypothesized that in combination with aberrant brain structures, persistently increased levels of glucocorticoids in brain structures may be the primal to the onset of psychosis in prodromal patients (Corcoran et al., 2003). More than specifically, stress exposure (and increased glucocorticoids) affects the neurotransmitter organisation and exacerbates psychotic symptoms due to changes in dopamine activity (Walker & Diforio, 1997). While research continues to explore the relationship between stress and onset of the disorder, evidence for the implication of stress and symptom relapse is strong. More than specifically, schizophrenia patients experience more stressful life events leading up to a relapse of symptoms. Similarly, it is hypothesized that the worsening or exacerbation of symptoms is also a source of stress as they interfere with daily functioning (Walker & Diforio, 1997). This stress alone may exist enough to initiate the onset of a relapse.

12.4.2. Psychological

            12.iv.2.1. Cognitive. The cognitive model utilizes some of the aspects of the diathesis-stress model in that information technology proposes that premorbid neurocognitive impairment places individuals at run a risk for aversive piece of work/bookish/interpersonal experiences. These experiences, in turn, lead to dysfunctional beliefs and cognitive appraisals, ultimately leading to maladaptive behaviors such as delusions/hallucinations (Beck & Rector, 2005).

Beck proposed the following diathesis-stress model of development of schizophrenia:

Based on this theory, an underlying neurocognitive impairment (every bit discussed higher up) makes an individual more vulnerable to experience aversive life events such as homelessness, conflict inside the family, etc. Individuals with schizophrenia are more likely to evaluate these aversive life events with a dysfunctional mental attitude and maladaptive cognitive distortions. The combination of the aversive events and negative interpretations produces a stress response in the individual, thus igniting hyperactivation of the HPA centrality. According to Brook and Rector (2005), information technology is the culmination of these events leads to the development of schizophrenia.

12.4.iii. Sociocultural

            12.4.iii.1. Expressed emotion. Inquiry regarding supportive family unit environments suggests that families loftier in expressed emotion, meaning families that accept high hostile, disquisitional, or overinvolved family members, are predictors of relapse (Bebbington & Kuipers, 2011). In fact, individuals who render postal service-hospitalization to families with high criticism and emotional involvement are twice as likely to relapse compared to those who render to families with low expressed emotion (Corcoran et al., 2003). Several meta-analyses have concluded that family atmosphere is causally related to relapse in patients with schizophrenia, and that these outcomes can be improved when the family surroundings is improved (Bebbington & Kuipers, 2011). Therefore, one major treatment goal in families of patients with schizophrenia is to reduce expressed emotion within family interactions.

            12.four.iii.2. Family dysfunction. Fifty-fifty for families with low levels of expressed emotion, there is oftentimes an increment in family stress due to the secondary effects of schizophrenia. Having a family unit member with schizophrenia increases the likelihood of a disruptive family environment due to managing the patient'due south symptoms and ensuring their condom while they are home (Friedrich et al., 2015). Because of the severity of symptoms, families with a loved one diagnosed with schizophrenia often written report more conflict in the home besides as more than difficulty communicating with one another (Kurtz, 2015).

Central Takeaways

Y'all should take learned the following in this section:

• Biological causes of schizophrenia spectrum disorders include genetics, several brain structures, and the HPA axis.
• Psychological causes of schizophrenia spectrum disorders include the diathesis-stress model.
• Sociocultural causes of schizophrenia spectrum disorders include families high in expressed emotion and family dysfunction.

Section 12.four Review Questions

1. What testify is in that location to support a biological model with respect to explaining the evolution and maintenance of the schizophrenia related disorders?
2. Talk over the stress-vulnerability model with respect to schizophrenia related disorders.
3. How does the sociocultural model explain the maintenance (and relapse) of schizophrenia related symptoms?

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12.5. Treatment

Section Learning Objectives

• Draw psychopharmacological treatment options for schizophrenia spectrum disorders.
• Draw psychological handling options for schizophrenia spectrum disorders.
• Depict family unit interventions for schizophrenia spectrum disorders.

While a combination of psychopharmacological, psychological, and family interventions is the most effective treatment in managing schizophrenia symptoms, rarely do these treatments restore a patient to premorbid levels of operation (Kurtz, 2015; Penn et al., 2004). Although more recent advancements in treatment for schizophrenia appear promising, the affliction itself is notwithstanding viewed as 1 that requires lifelong treatment and care.

12.5.1. Psychopharmacological

Amid the showtime antipsychotic medications used for the treatment of schizophrenia was Thorazine. Developed as a derivative of antihistamines, Thorazine was the first line of treatment that produced a calming effect on even the most severely agitated patients and allowed for the organization of thoughts. Despite their effectiveness in managing psychotic symptoms, conventional antipsychotics (such as Thorazine and Chlorpromazine) too produced significant  side effects similar to that of neurological disorders. Therefore, psychotic symptoms were replaced with muscle tremors, involuntary movements, and muscle rigidity. Additionally, these conventional antipsychotics also produced tardive dyskinesia in patients, which included involuntary movements isolated to the tongue, mouth, and face (Tenback et al., 2006). While only ten% of patients reported the development of tardive dyskinesia, this percentage increased the longer patients were on the medication, likewise as the higher the dose (Achalia, Chaturvedi, Desai, Rao, & Prakash, 2014). In efforts to avoid these symptoms, clinicians have been cognizant of not exceeding the clinically effective dose of conventional antipsychotic medications. If the management of psychotic symptoms cannot be resolved at this level, alternative medications are often added to produce a synergistic effect (Roh et al., 2014).

Due to the harsh side furnishings of conventional antipsychotic drugs, newer, arguably more effective 2d-generation or atypical antipsychotic drugs have been developed. The atypical antipsychotic drugs appear to act on both dopamine and serotonin receptors, as opposed to only dopamine receptors in the conventional antipsychotics. Because of this, common medications such equally clozapine (Clozaril), risperidone (Risperdal), and aripiprazole (Abilify), appear to be more than effective in managing both positive and negative symptoms. While there continues to be a risk of developing side effects such as tardive dyskinesia, recent studies advise it is much lower than that of the conventional antipsychotics (Leucht, Heres, Kissling, & Davis, 2011). Thus, due to their effectiveness and minimal side effects, atypical antipsychotic medications are typically the commencement line of treatment for schizophrenia (Barnes & Marder, 2011).

It should be noted that considering of the harsh side effects of antipsychotic medications in general, many individuals, virtually i half to three-quarters of patients, discontinue the use of antipsychotic drugs (Leucht, Heres, Kissling, & Davis, 2011). Because of this, it is too important to incorporate psychological treatment forth with psychopharmacological treatment to both accost medication adherence, as well as provide additional back up for symptom management.

12.5.2. Psychological Interventions

        12.v.2.1. Cognitive Behavioral Therapy (CBT). As discussed in previous chapters, the goal of treatment is to place the negative biases and attributions that influence an individual's interpretations of events and the subsequent consequences of these thoughts and behaviors. For schizophrenia, CBT focuses on the maladaptive emotional and behavioral responses to psychotic experiences, which is directly related to distress and disability. Therefore, the goal of CBT is not on symptom reduction, but rather to meliorate the interpretations and understandings of these symptoms (and experiences) which will reduce associated distress (Kurtz, 2015). Common features of CBT for schizophrenia patients include psychoeducation near their affliction and the course of their symptoms (i.eastward., ways to identify coming and going of delusions/hallucinations), challenging and replacing the negative thoughts/behaviors associated with their delusions/hallucinations to more positive thoughts/behaviors, and finally, learning positive coping strategies to deal with their unpleasant symptoms (Veiga-Martinez, Perez-Alvarez, & Garcia-Montes, 2008).

Findings from studies exploring CBT as a supportive treatment take been promising. Ane study conducted by Aaron Beck (the founder of CBT) and colleagues (Grant, Huh, Perivoliotis, Stolar, & Brook, 2011) found that recovery-oriented CBT produced a marked improvement in overall functioning too as symptom reduction in patients diagnosed with schizophrenia. This study suggests that by focusing on targeted goals such as contained living, securing employment, and improving social relationships, patients were able to slowly motility closer to these targeted goals. By besides including a diversity of CBT strategies such as role-playing, scheduling community outings, and addressing negative cognitions, individuals were also able to accost cognitive and social skill deficits.

12.v.3. Family Interventions

The diathesis-stress model of schizophrenia has primarily influenced family unit interventions. As previously discussed, the emergence of the disorder and exacerbation of symptoms is likely related to environmental stressors and psychological factors. While the degree in which environmental stress stimulates an exacerbation of symptoms varies among individuals, there is significant evidence to conclude that stress does touch on illness presentation (Haddock & Spaulding, 2011). Therefore, the overall goal of family interventions is to reduce the stress on the individual that is likely to elicit the onset of symptoms.

Unlike many other psychological interventions, there is not a specific outline for family-based interventions related to schizophrenia. All the same, the majority of programs include the following components: psychoeducation, trouble-solving skills, and cognitive-behavioral therapy.

Psychoeducation is important for both the patient and family members as it is reported that more than than half of those recovering from a psychotic episode reside with their family unit (Haddock & Spaulding, 2011). Therefore, educating families on the course of the illness, as well as means to recognize onset of psychotic symptoms, is of import to ensure optimal recovery.

Problem-solving is a crucial component in the family intervention model. Seeing as family unit conflict can increase stress within the home, which in return can pb to worsening of psychotic symptoms, family members benefit from learning effective methods of trouble-solving to address family unit conflicts. Additionally, teaching positive coping strategies for dealing with the symptoms of mental illness and its direct outcome on the family environment may as well alleviate some friction within the home

The 3rd component, CBT, is like to that described above. The goal of family-based CBT is to reduce negativity amid family member interactions, also every bit help family unit members conform to living with someone with psychotic symptoms. These three components within the family unit intervention programme accept been shown to reduce re-hospitalization rates, as well equally ho-hum the worsening of schizophrenia-related symptoms (Pitschel-Walz, Leucht, Baumi, Kissling, & Engel, 2001).

            12.5.three.one. Social Skills Grooming. Given the poor interpersonal functioning among individuals with schizophrenia, social skills grooming is another blazon of handling normally suggested to amend psychosocial operation. Research has indicated that poor interpersonal skills non only predate the onset of the disorder but also remain significant fifty-fifty with the management of symptoms via antipsychotic medications. Dumb ability to collaborate with individuals in a social, occupational, or recreational setting is related to poorer psychological aligning (Bellack, Morrison, Wixted, & Mueser, 1990). This tin lead to greater isolation and reduced social back up amongst individuals with schizophrenia. Every bit previously discussed, social support has been identified every bit a protective cistron of symptom exacerbation, equally it buffers psychosocial stressors that are often responsible for the exacerbation of symptoms. Learning how to collaborate with others accordingly (e.one thousand., establish eye contact, engage in reciprocal conversations, etc.) through role-play in a group therapy setting is one effective fashion to teach positive social skills.

            12.5.3.2. Inpatient Hospitalizations. More ordinarily viewed as customs-based treatments, inpatient hospitalization programs are essential in stabilizing patients in psychotic episodes. By and large speaking, patients volition be treated on an outpatient basis; however, there are times when their symptoms exceed the needs of an outpatient service. Short-term hospitalizations are used to modify antipsychotic medications and implement boosted psychological treatments so that a patient can safely return to their habitation. These hospitalizations mostly last for a few weeks as opposed to a long-term handling option that would last months or years (Craig & Power, 2010).

In addition to short-term hospitalizations, there are also partial hospitalizations where an individual enrolls in a total-twenty-four hour period program but returns home for the evening. These programs provide individuals with intensive therapy, organized activities, and grouping therapy programs that enhance social skills training. Research supports the apply of fractional hospitalizations as individuals enrolled in these programs tend to do better than those who enter outpatient intendance (Bales et al., 2014).

Key Takeaways

You should have learned the following in this section:

• Psychopharmacological treatment options for schizophrenia spectrum disorders include antipsychotic drugs such as Thorazine, Chlorpromazine, Clozaril, Risperdal, and Abilify.
• Psychological treatment options for schizophrenia spectrum disorders include CBT, the goal of which is to improve the interpretations and understandings of symptoms (and experiences) which will reduce associated distress.
• Family interventions for schizophrenia spectrum disorders include psychoeducation, problem-solving skills, cognitive-behavioral therapy (CBT), social skills training, and inpatient/fractional hospitalizations.

Section 12.v Review Questions

1. Define tardive dyskinesia.
2. What pharmacological interventions take been constructive in managing schizophrenia related disorder symptoms?
3. What is the master goal of family interventions? How is this achieved?

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Module Recap

In our first module of Office V – Block 4, we discussed the schizophrenia spectrum disorders to include schizophrenia, schizophreniform disorder, schizoaffective disorder, and delusional disorder. We started by describing their common features, such as delusions, hallucinations, disorganized thinking, disorganized/abnormal motor beliefs, catatonic beliefs, and negative symptoms. This led to a discussion of the epidemiology, comorbidity, etiology, and handling options of the disorders.

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Source: https://opentext.wsu.edu/abnormal-psych/chapter/module-12-schizophrenia-spectrum-and-other-psychotic-disorders/

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