Schizophrenia and Bipolar.ppt

Presentation on Schizophrenia and Bipolar

1. Schizophrenia Spectrum and
Other Psychotic Disorders

2. What is Schizophrenia Spectrum?

3. Schizophrenia
Spectrum and other
psychotic disorders
This spectrum includes schizotypal (personality)
disorder, delusional disorder, brief psychotic
disorder, schizophrenia, schizophreniform,
schizoaffective disorder, and other psychotic
disorders. These disorders are defined by
abnormalities in one or more of the following five
domains: delusions, hallucinations, disorganized
thinking (speech), grossly disorganized or abnormal
motor behavior (including catatonia), and negative
symptoms.

4. Four Causes of Schizophrenia:
Biological Views
1.Genetic Factors
•Following the principles of diathesis-stress perspective, it is believed that some people
inherit a biological disposition to develop the disorder when they face extreme stress,
usually during late adolescence or early adulthood.
2.Biochemical Abnormalities
•Serotonin excess causes both positive and negative symptoms in schizophrenia
•Dopamine hypothesis -certain neurons that use the neurotransmitter dopamine (particularly
neurons in the striatum region of the brain) fire too often and transmit too many messages,
thus producing the symptoms.
3.Abnormal Brain Structure
•Enlarged ventricles which implies loss of cells and correlates with poor cognitive
performance, poor premorbid adjustment, and poor response to treatment.
•Reduced activity in prefrontal cortex which is involved in speech, executive functions, and
goal-directed behavior.

5. Psychological Views
Psychodynamic Explanation-Schizophrenia develops from two psychological process: (1)
regression to a pre-ego stage and (2) efforts to reestablish ego control. Proposes that when the
world is extremely harsh or withholding, some people regress to the earliest point in their
development, to the pre-ego stage of primary narcissism, in which they recognize only their own
needs, and thus, setting the stage for schizophrenia.
Behavioral View -cites operant conditioning and principles of reinforcement as the cause of
schizophrenia. Proposes that most people become quite proficient at reading and responding to
social cues. Some, however, are not reinforced for their attention to social cues, eight because of
unusual circumstance or because important figures in their lives are socially inadequate. As a
result, they stop attending to such cues and focus instead on irrelevant cues, which the more
they attend to, makes their responses increasingly bizarre.
Cognitive View-During hallucinations and related perceptual difficulties, the brains of people
with schizophrenia are actually producing strange and unreal sensations triggered by biological
factors.

6. What is the course of
Schizophrenia?
Schizophrenia usually first appears between the person’s late teens and mid-thirties.
Usually has three phases—prodromal, active, and residual.
During the prodromal phase, symptoms are not yet obvious, but the person is
beginning to deteriorate.
During the active phase, symptoms become apparent. Sometimes this phase is
triggered by stress or trauma in the person’s life.
Many people with schizophrenia eventually enter a residual phasein which they
return to a prodromal-like level of functioning.
Each of these phases may last for days or for years. A fuller recovery from
schizophrenia is more likely in people who functioned quite well before the disorder
(had good premorbid functioning); whose initial disorder is triggered by stress, comes
on abruptly, or develops during middle age; and who receive early treatment,
preferably during the prodromal phase.
Relapses are apparently more likely during times of life stress.

7. Key Features that define the Psychotic
Disorders
Delusions-fixed beliefs that are not amenable to change in light of conflicting evidence. Belief that is
seen by most of society as a misrepresentation of reality.
•Persecutory delusions
•Referential delusions
•Grandiose delusions
•Erotomanic delusions
•Nihilistic delusions
•Somatic delusions
Hallucinations-experience of sensory events without any input from the surrounding environment.
Most common is auditory hallucinations.
Disorganized Thinking(Speech) -the individual may switch from one topic to another, answers to
questions may be obliquely related or completely unrelated, speech is disorganized that it is nearly
incomprehensible.
Grossly Disorganized or Abnormal Motor Behavior(including Catatonia) -may manifest in a
variety of ways, ranging from childlike “silliness” to unpredictable agitation.
Negative Symptoms-indicate indicate the absence or insufficiency of normal behavior.
•Affective Flattening
•Avolition
•Alogia
•Anhedonia
•Asociality

8. Schizotypal (Personality) Disorder
Pervasive pattern of social and
interpersonal deficits
Cognitive or perceptual distortions
Eccentricities of behaviorusually
beginning by early adulthood but in
some cases first becoming apparent in
childhood and adolescence.
Abnormalities of beliefs, thinking, and
perception are below the threshold for
the diagnosis of a psychotic
behavior.

9. Delusional Disorder
Characterized by at least 1
month of delusionsbut no
other psychotic symptoms.
The person has not met the
criteria for schizophrenia
Functional impairmentwithin
the specific impact of the
delusion
The duration of manic and
depressive episodes have
been briefrelative to the
duration of delusion.

10. Brief Psychotic
Disorder
Characterized by the presence of one or more
positive symptomsof schizophrenia such as
delusions, hallucinations, or disorganized speech
or behavior lasting one month or less.
Often precipitated by extremely stressful
situations.
Attenuated Psychosis Syndrome -mental
condition that causes clinically significant distress
and is distinguished by the onset of mild,
psychotic-like symptoms that do not meet the full
diagnostic criteria of one of the psychotic
disorders like schizophrenia, schizoaffective
disorder, or delusional disorder. Individual is
aware of these unusual experiences.

11. Schizophreniform
Disorder
Characterized by a symptomatic
presentation equivalent to that of of
schizophreniaexcept for its duration
(less than 6 months) and the absence of
a requirement for a decline in
functioning.

12. Schizophrenia
Characterized by two or
more of the following
symptoms for at least 1
month; 1 symptom should
either be 1,2, or 3:
•Delusions
•Hallucinations
•Disorganized speech
•Disorganized behavior (or
catatonia)
•Negative symptoms
Functional impairment in one
or more areas
Signs of disorder for at least 6
month

13. Schizoaffective Disorder
A mood episode and
the active-phase
symptoms of
schizophrenia occur
togetherand were
preceded or are
followed by at least 2
weeksof delusions or
hallucinations without
prominent mood
symptoms.

15. Substance/Medication-Induced
Psychotic Disorder
Essential feature: prominent delusions and/or
hallucinationsjudged to be due to the physiological
effects of a substance/medication.
Arises during or soon afterexposure to a medication
or after substance intoxication or withdrawalbut can
persist for weeks.
Psychotic symptoms may continue as long as the
substance/medication use continues.
Occur in association with intoxication or withdrawal
from the following substances: alcohol, cannabis,
hallucinogens, inhalants, sedatives, hypnotics,
anxiolytics, stimulants, and other (or unknown)
substances.
Disability is typically self-limitedand resolves upon
removal of the offending agent.

16. Psychotic Disorder Due
to Another Medical
Condition
Essential feature: delusions or hallucinationsthat are
attributable to the physiological effects another medical
condition and are not better explained by another
mental disorder.
May be a single transient state or it may be
recurrent, cycling with exacerbations and remissions of
the underlying medical condition.
Medical conditions that may cause psychotic symptoms:
neurological conditions, endocrine conditions, metabolic
conditions, fluid or electrolyte imbalances, hepatic or
renal diseases, and autoimmune disorders with central
nervous system involvement.
Functional disability is typically severebut varies by
type of condition and likely to improve with resolution
of condition.

17. Catatonia Associated with Another
Mental Disorder (Catatonia Specifier)
Catatonia -alternating immobility and
excited agitation.
Used when criteria are met for catatonia
during the course of a
neurodevelopment, psychotic, bipolar,
depressive, or other mental disorder.
Characterized by marked psychomotor
disturbanceand involves at least three
of 12diagnostic features in Criterion A.

18. Catatonia Disorder Due to Another
Medical Condition
Presence of catatonia is judged to be
attributed to the physiological effects of
another medical condition.
There must be evidencefrom the history,
physical examination, or laboratory findings
that the catatonia is attributable to another
medical condition
Diagnosis is not given if can be better
explained by another medical disorder or
occurs exclusively during the course of a
delirium.

19. Other Specified
Schizophrenia
Spectrum and
Other Psychotic
Disorder

21. Treatment
Milieu Therapy -a humanistic approach to institutional treatment based on the premise that
institutions can help patients recover by creating a climate that promotes self-respect, responsible
behavior, and meaningful activity.
The Token Economy -A behavioral program in which a person’s desirable behaviors are reinforced
systematically throughout the day by the awarding of tokens that can be changed for goods or
privileges.
Antipsychotic Drugs -revolutionized the treatment for schizophrenia as it eliminated many of its
symptoms that resulted to shorter hospitalization. Mainly helped to correct the grossly confused or
distorted thinking.
Psychotherapy
Cognitive-Behavioral Therapy -designed to help change how people view and react to their
hallucinations.
Family Therapy -provides family members with guidance, training, practical advice,
psychoeductaion about the disorder, and emotional support and empathy.
Social Therapy -clinicians offer practical advise, work with clients on problem solving, memory
enhancement, decision making, and social skills.

22. Bipolar and Related Disorders

23. What is Bipolar and Related
Disorders?

24. Bipolar and
Related Disorders
The diagnoses includes Bipolar I
disorder, Bipolar II disorder,
Cyclothymic disorder,
substance/medication-induced bipolar
and related disorder, bipolar and related
disorder due to another medical
condition, other specified bipolar and
related disorder, and unspecified
bipolar and related disorder.

25. Bipolar and Related Disorders
The bridge between Schizophrenia Spectrum and Depressive Disorders in terms in
symptomatology, family history, and genetics.
Characterized by both the lows of depression and the highs of mania, as well as changes in
activity and energy levels.
Manic symptoms are the defining feature of each of the bipolar disorders, differentiated by how
severe and long-lasting the manic symptoms are.
These disorders are labeled “bipolar” because most people who experience mania will also
experience depression during their lifetime.
An episode of depression is not required for a diagnosis of bipolar I, but it is, required for a
diagnosis of bipolar II disorder.

26. What causes Bipolar Disorders?
Neurotransmitter Activity-Studies found that the norepinephrine activity of people with mania tend to
be higher than that of the depressed. Research also found that bipolar disorder may b tied to the abnormal
activity of the neurotransmitter GABA.
Ion Activity -It is believed that irregularities in the ion transport may cause the neuron to fire easily, which
may lead to resist firing, which may lead to depression. When it comes to bipolar disorder, investigators
have found defects in the membrane in the neurons in individuals with the disorder
Brain Structure-rain imaging and postmortem studies have identified a number of abnormal brain
structures in people with bipolar disorders. For example, the basal ganglia and cerebellum of these people
tend to be smaller than those of other people, they have lower volumes of gray matter in the brain, and
their dorsal raphe nucleus, striatum, amygdala, hippocampus, and prefrontal cortex have some structural
abnormalities.
Genetic Factors-Many theorists believe that people inherit a biological pre-disposition to develop
bipolar disorders.

27. Mood Episodes
MANIC episode-a distinct period of abnormally and persistently elevated, expansive, or irritable
mood lasting at least 1 week (or any duration if hospitalization is necessary)
HYPOMANIC episode-a distinct period of persistently elevated, expansive, or irritable mood,
lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood (not
severe enough to caused marked impairment in daily routines)
MAJOR DEPRESSIVE episode -there is either a depressed mood or loss of interest in pleasure
MIXED episode-criteria for both Manic episode and for a Major Depressive episode (except for
duration) are met nearly every day during at least a 1 week period.
RAPID CYCLING-at least 4 or more episodes (manic for Bipolar 1 / hypomanic for Bipolar 2)
within a one year period.

28. Bipolar I Disorder
At least one lifetime manic episode
Alternating major depressive and manicepisodes.
Can have hypomanic episode, but is not required for
diagnosis
Experiences five (or more) depressive symptoms
during the same 2-week period. Should include at
least either depressed mood or loss of interest or
pleasure.
Recurrent
Mentend to developthe bipolar disorder at a much
earlierage, and their first episodeis usually
mania.
Symptom free for 2 months

29. Bipolar II Disorder
Alternatingmajor depressive and
hypomanic episodes
At least one major depressiveepisode
with at least one episode of
hypomania
No manicepisode
Patients are more likely to go for
treatment because of the major
depressive episode and not the
hypomania

30. Cyclothymic Disorder
Presence of recurrent hypomanic episodes and
depressive symptoms only
For at least 2 years (or 1 year in children or
adolescents)
Numerous periods with hypomanic symptoms that do
not meet criteria for hypomanic episode
Numerous periods with depressive symptoms that do
not meet criteria for major depressive episode
The symptoms do not clear for more than 2 months at a
time. Criteria for a major depressive, manic, or
hypomanic episode have never been met.
Adults: symptoms more than 2 years
Children and adolescents: symptoms more than 1 year
Less severe

32. Substance/Medic
ation-induced
Bipolar and
related disorder

33. Bipolar and related disorder due to
another medical condition

34. Other specified
Bipolar and related
disorder
Presence of symptomscharacteristic
of a bipolar and related disorder that
cause significant distressor
impairment in social, occupational, or
other important areas of functioning
predominate but do not meet the full
criteriafor any of the disorders in the
bipolar and related disorders.

35. Treatment
Lithium and other Mood Stabilizers -Drugs such as carbamazepine or
valproate have proved to be effective in the treatment of bipolar disorders,
particularly in the reduction and prevention of manic episodes. In some cases,
these drugs are combined with antidepressant drugs or certain antipsychotic
drugs. Mood stabilizers may reduce bipolar symptoms by affecting the activity
of second-messenger systems okey proteins or other chemicals in certain
neurons throughout the brain.
Adjunctive Psychotherapy -addresses medication management, social skills
and relationships, education of patients, solving the family, school, and
occupational problems caused by bipolar episodes.

36. References:
Comer, R. (2015). Abnormal Psychology, 9th ed., Worth Publishers,
United States of America
Barlow, D., Durand, V., & Hofmann, S. (2018). Abnormal Psychology: An
Integrative Approach, 8th ed., Engage Learning Asia Ptd Ltd, Singapore
American Psychiatric Association (2013). Diagnostic and Statistical
Manual of Mental Disorders, 5th ed., American Psychiatric Pub,
Washington, DC. doi:10.1176/appi.books.9780890425596