By: John Boyd

and Ti mothy
Chmi el ewski
SCHIZOPHRENIA
Observations on Madness and Melancholy by John Hasl am
(1809)
Emi l Kraepeli n (1899) catatonia, hebephrenia, paranoia
Eugen Bl euler (1908)
WHAT IS IT?
DSM- IV TR
Del usions
Hal l ucinations
Di sorgani zed speech
Di sorgani zed and catatonic behavior
Negative symptoms:
avol i tion, a=without vol i ti on=an act of choosi ng, wi l ling or
deci ding
al ogia, l ogos=words
anhedonia, hedoni c=pertaining to pl easure
fl at af fect
ITS A PSYCHOTIC DISORDER!
Interferes wi th occupations, i nterpersonal rel ationships and
sel f- care
Si gns of symptoms have to persi st for a 6 month peri od and 1
month of acti ve symptoms
Schi zoaf fective and mood di sorders have been rul ed out
Ef fects of substances rul ed out
If some sort of devel opmental di sorder i s present they must
have 1 month of promi nent del usi ons of hal l uci nati ons

CRITERIA
Paranoid Type: del usi ons, hal lucinations, paranoia
Di sorgani zed Type: di sruption i n speech and behavior
Catatonic Type: catatoni a, echol alia, echopraxia
Undi f ferentiated Type: do not fi t i nto other types
Resi dual Type: di splay l ef tover symptoms
SUBTYPES

An accumulati on of cogni tive and functi onal i mpai rments
l eading to Schi zophrenia

THE PRODROMAL PERIOD
Three Stages of The Prodrome
First, individuals will experience non-specific symptoms such as
depression, anxiety, or social isolation
Next, people will experience basic symptoms and attenuated
positive symptoms.
Finally, individuals enter the high risk period, with includes pre-
delusionary thoughts, pre-hallucinatory perceptions, and
disordered thoughts.

Stages of Prodromal
Risk factors
Age
Family history of psychosis
Symptom Scores
Ultra-High-Risk
Ages 14-29
Experienced positive symptoms in the last year
Schizotypal Personality Disorder
Family history of psychosis


ASSESSMENT OF PATIENTS
The Prodromal Peri od has been shown to have a hi gh rate of
conversion to Schi zophrenia
Study of 291 prodromal patients, 82 converted to schizophrenia after
2.5 years.
WHY IS THE PRODROME IMPORTANT?
Patients that are classified UHR have a
much higher rate of conversion to
Schizophrenia
A study of 104 UHR people, about 81% of them
converted to Schizophrenia after one year
Many variables affect UHR individuals
converting to psychosis
Poor functioning
High levels of depression
Substance Abuse
Genetic risk

ULTRA-HIGH-RISK INDIVIDUALS
People that are at ri sk for substance abuse and psychosis are
more l i kely to convert to Schi zophrenia
Study l i nki ng cannabis use to schi zophrenia
Included 54 UHR individuals
6 used cannabis during study, 3 converted
16 reported lifetime abuse, 5 converted
32 reported no lifetime use, only 1 converted
SUBSTANCE ABUSE LINKED TO
SCHIZOPHRENIA
Anti psychotic medicati on i s the standard
Antagonist to Dopamine receptors
Prol onged exposure i s associ ated wi th si de ef fects such as
EPS, and Tardive Dyski nesia
Extrapyramidal Symptoms- tremors, muscle spasms, muscle
stiffness, and pseudo-parkinsonism

PHARMACEUTICAL THERAPY
Also called second generation antipsychotic
medication
Developed in the 1990s
Associated with much less EPS, but may have
other negative side-effects
Weight gain
Metabolic Disturbances
Olanzapine, Quetiapine, Risperidone,
Ziprasidone, Clozapine, Aripiprazole, etc.
ATYPICAL ANTIPSYCHOTIC DRUGS
Cl i ni cal Anti psychoti c Tri als of Interventi on Ef fectiveness
Doubl e- bl ind, randomi zed study of 1460 parti cipants over 18
months
Compared ef fectiveness of typi cal vs. atypical anti psychotic
medications

THE CATIE STUDY
Participants were randomly placed on either
one of four atypical (2nd generation)
medications, or one typical (1st generation)
medication.
Olanzapine, Quetiapine, Risperidone, Ziprasidone
Perphenazine
The study measured how long patients
benefited from the drugs, any side effects
they created, and how well they controlled
symptoms
THE CATIE STUDY
Olanzapine was slightly better at controlling
symptoms
Associated with significant weight gain
Perphenazine performed just as well as the
other drugs
EPS were not seen more frequently
Comparing the good with the bad, the newer
medications did not have a distinct advantage
over the older medications
RESULTS OF THE CATIE STUDY
Study comparing Ol anzapine and Hal operidol
Found that Ol anzapine treated psychosis better and brai n
scans showed no changes i n grey matter
Patients on Haloperidol showed significant decreases in grey matter
Whi ch type i s better??
OTHER STUDIES
Doubl e- bl ind, randomi zed, parall el - group, pl acebo- control led
study
Thi s study examined the ef fects of Ol anzapine on symptom
severity over an ei ght week peri od
Results showed that Ol anzapine worked wel l for acute
treatment of symptoms
Long term use may be problematic
MORE STUDIES!
A continuation of the previous study looked at
conversion rates after two years.
After one year, only 5 of the 31 patients treated
with Olanzapine converted to psychosis
In the control group, 11 of the 29 patients converted to
psychosis
During the 2nd year, no treatment was given
Only 17 patients participated in this part
Conversion rates between the two groups did not differ
STUDIES CONTINUED
Group 1: Low doses of Risperidone combined
with enriched psychosocial treatment
Group 2: Standard psychosocial treatment
Results: Of the 31 patients in group 1, only 3
converted to psychosis. Of the 28 patients in
group 2, 10 converted.
These results were significant and they
suggest combination therapy helps delay the
onset of psychosis
STUDIES INVOLVING COGNITIVE BEHAVIORAL
THERAPY
Randomized, parallel -group study comparing
Amisulpride combined with needs based
treatment, to needs based treatment alone.
Needs based treatment included CBT, counseling, and
educational assistance
Results showed that the group with combined
therapies had a greater reduction in
symptoms, and improvement in functional
deficits compared to the other group.
STUDIES INVOLVING COGNITIVE BEHAVIORAL
THERAPY
Natural istic study i nvol ving 48 prodromal pati ents over 2
years
20 prescribed anti depressants
No patients converted to psychosis
28 prescribed anti psychotics
12 patients converted to psychosis
However, 11 of these 12 were non-adherent to their medication
RECENT STUDIES INVOLVING
ANTIDEPRESSANTS
Another group retrospectively l ooked at naturalistic data
Results: Of 35 pati ents prescribed anti psychotics, 10
developed psychosi s. Of 13 pati ents prescribed
anti depressants, onl y one of them developed psychosi s
RECENT STUDIES INVOLVING
ANTIDEPRESSANTS
Another naturali stic study i nvol ving 191 patients, compared
the ef fects of anti psychoti cs and anti depressants on symptom
severity
Results showed that pati ents on anti psychotic medi cation had
a greater decl ine i n symptom severity compared to those on
anti depressants.
RECENT STUDIES INVOLVING
ANTIDEPRESSANTS
Anti psychotic medicati ons have thei r ups and downs.
Combi ning anti psychotic medicati on wi th Cogni tive Behavioral
Therapy can be hel pful for many people.
Prescribing Anti depressant medi cation to prodromal pati ents
can be very benefi cial .
Earl y detection and therapy i s the key!
WHAT DOES ALL THIS MEAN?
moral treatment focus around soci al i mprovements, sel f
control s and understanding the i mportance of work and
rel i gion
Gordon Paul and Robert Lentz (1970s) and token economy
Re- teaching soci al ski l ls


TREATMENT
Independent Li vi ng Ski lls Program at UCLA
Focuses on pati ent taki ng charge of thei r own l i fe and
knowi ng the warni ng si gn of symptoms and how to deal wi th
them
Understanding medi cations
Soci al support
COMMUNITY BASED TREATMENT
Identify tri ggers
Exposure to tri ggers and exposure therapy
Experience sti l l i s not real l i fe
Si de ef fects such as si mulator si ckness
VIRTUAL REALITY
Barl ow, Davi d H. , and Vi ncent Mark. Durand. Abnormal
Psychology: An Integrative Approach. Bel mont, CA:
Wadsworth, Cengage Learni ng, 2012. Pri nt.
Freeman, D. "Studying and Treating Schi zophrenia Usi ng
Vi rtual Real ity: A New Paradigm. " Schizophrenia Bulletin 34. 4
(2007): 605- 10. Pri nt.
http: //www. youtube. com/watch?v=_vYQ6pbJt2k
REFERENCES