2 symptoms for at least 1 month, with signs of continuous disturbance for 6 months “Positive” symptoms 1. hallucinations (false perceptions) 2. Delusions (false beliefs) 3. Disorganized speech (derailment, incoherence, loose associations) 4. Disorganized behavior (e.g., disheveled appearance) “Negative” symptoms ▶ flat affect (lack of emotion) ▶ reduction in speech quality ▶ mental confusion ▶ lack of energy/initiative ▶ Diagnosis also requires significant decrease in functioning or failure to make expected gains Prevalence and Course • Rare in children less than 12 age • Increased prevalence in adolescence and early adulthood • average age onset 20-25 • COS: boys > girls, difference disappears in adolescence • Gradual onset: ~ 95% show a clear history of disturbances prior to onset of psychosis • speech language problems • poor motor development • movement abnormalities • social skills deficits
• odd behavior (suspicion/paranoia) • substance abuse • childhood onset of schizophrenia indicates a more severe form of the disorder • Chronic disorder with poor long-term prognosis • Prevalence rates of adult schizophrenia similar across cultural groups and countries • COS is distinct from transient psychotic symptoms Causes of COS • Strong genetic contribution (80% heritability) • Neurodevelopmental model – Genetic vulnerability +prenatal insult defective neural circuitry, which is vulnerable to dysfunction under stress & developmental changes • Exaggerated cortical gray matter loss during adolescence • Pattern eventually mimics that seen in adult-onset cases • temporal (attention and perception) and prefrontal lobe (organizing, planning, problem- solving) gray matter reductions. Family Influences exposure to a stressful family environment + genetic risk increases risk for developing COS Parents of children with COS are more critical parents of those with COS score higher on communication deviance = interpersonal signs of attentional and thought disturbance. Treatment of COS • Primary treatment: anti-psychotic medications (dopamine antagonists – block dopamine transmission) – reduce hallucinations and delusions
– negative symptoms often endure – predict poor quality of life – adverse effects reduce adherence to treatment and require constant monitoring • Weight gain • Metabolic changes (cholesterol, prolactin) • Sedation • Neurological side effects – Akathisia – inner restlessness inability to sit still – Other long-term motor side effects (tremor, tardive dyskinesia) • Treatment guidelines emphasize the use of antipsychotic medications combined with psychosocial treatments – family intervention – social skills training
You've reached the end of your free preview.
Want to read all 11 pages?