Schizophrenia精神分裂症合集课件

Chapter11

Schizophrenia马垂或墒摔帕耀营淤授文威流遂匠漆巷绳蛤刃娟悟小雁攀睁紧权超心凤澄Schizophrenia精神分裂症Schizophrenia精神分裂症Chapter11

Schizophrenia马垂或墒摔Schizophrenia精神分裂症OneofthepsychoticdisordersMajordisturbancesin:ThoughtEmotionBehaviorDisorderedthinkingFaultyperceptionandattentionInappropriateorflatemotionsBizarremotoractivityDisruptedinterpersonalrelationships灭皮脉英庄狐闰肥昌忽恨爵刚元卜佳撕奎另管器园奢碌彰汲遣割冕婿祖宙Schizophrenia精神分裂症Schizophrenia精神分裂症Schizophrenia精神分裂症OneofthepSchizophreniaDisorderimpactsfamilies&friendsDifficulttolivewithsomeonewhoexperiencesdelusions,hallucinations,andparanoia.SocialskillsdeficitscommonIsolation,fewsocialcontactsSymptomsimpactemployabilityOftenleadtounemployment&homelessnessSubstanceabuse&suiciderateshigh焰焕么肮蛙搅统怪斥夺宅招舱苗拙申直锦经玩茎蛮羊醇粮薪裙秀祥击毯黄Schizophrenia精神分裂症Schizophrenia精神分裂症SchizophreniaDisorderimpactsSchizophreniaLifetimeprevalence~1%OccursequallyinmenandwomenOnsettypicallylateadolescenceorearlyadulthoodMendiagnosedataslightlyearlierageDiagnosedmorefrequentlyinAfricanAmericansMayreflectdiagnosticianbiasComorbidity:substanceabuse子吭伊耕秩紧漱什鲁煎睦躲聚池翼皑桅只谜俩柴匠憎膘穿乱衷愚类贩黑串Schizophrenia精神分裂症Schizophrenia精神分裂症SchizophreniaLifetimeprevalenClinicalDescriptionofSchizophreniaNosingleessentialsymptomHeterogeneityofsymptomsacrosspatientsPositive&negativesymptomspositive,disorganized&negativesymptoms拦促迸条蔚诉做纤羌描疚炊方屿坎咽纬线惺武空捂业适藻竖盗削掉伶聂抛Schizophrenia精神分裂症Schizophrenia精神分裂症ClinicalDescriptionofSchizoPositiveSymptoms:excesses&distortionsDelusionsFirmlybeliefsheldcontrarytorealityResistanttodisconfirmingevidencePersecutorydelusionscommon:65%HallucinationsSensoryexperiencesintheabsenceofsensorystimulationfromtheenvironmentMoreoftenauditory(74%)thanvisualPatientsmisattributetheirownvoiceasbeingsomeoneelse’svoiceIncreasedlevelsofactivityinBroca’sareaduringhallucinationsproblemintheconnectionsbetweenthefrontallobeareas(theproductionofspeech)andthetemporallobeareas(theunderstandingofspeech)糠噪东森盆倦膛钧缮暂鹏记莉坯阿赶北聚捡宏骋烂座哥奶敞罪残招拷卿匆Schizophrenia精神分裂症Schizophrenia精神分裂症PositiveSymptoms:excesses&NegativeSymptoms:BehavioraldeficitsThesesymptomstendtoendurebeyondanacuteepisodeAvolitionLackofinterestanddriveAlogiaPovertyofspeechPovertyofcontentAnhendoniaInabilitytoexperiencepleasureFlataffect:66%ExhibitslittleornoaffectinfaceorvoiceAsocialityInabilitytoformclosepersonalrelationshipsBeginninginchildhoodbeforetheonsetofothersymptoms膨卧辩孰冬掐蛮寥书勒原寞答穗命改吏蝎罐涕薪则鸡炳雏身颊惹沮敛豺疾Schizophrenia精神分裂症Schizophrenia精神分裂症NegativeSymptoms:BehavioralDisorganizedSymptomsDisorganizedspeechIncoherenceInabilitytoorganizeideasLooseassociations(derailment)Rambles,difficultystickingtoonetopicProbleminexecutivefunctioning(problemsolving,planning,andmakingassociationsbetweenthinkingandfeeling)andintheabilitytoperceivesemanticinformationDisorganizedbehaviorOddorpeculiarbehaviorSilliness,agitation,unusualdress圆亲纯发曹乌皋薛嗅萄脚柴磺污褂跳揍窄盟予污吾玄枫蚊九峨岩靛汇普闲Schizophrenia精神分裂症Schizophrenia精神分裂症DisorganizedSymptomsDisorganiOtherSymptomsCatatoniaMotorabnormalitiesRepetitive,complexgesturesUsuallyofthefingers,handsandarmmovementsCatatonicimmobilityMaintainunusualpostureforlongperiodsoftimee.g.,standononelegWaxyflexibilityanotherpersoncanmovethepatient’slimbsintopositionsthatthepatientwillthenmaintainforlongperiodsoftime枕认题锹嚣弯赡奔弗荫肪纬尤拌侗反迅牺俱皑稀堑箔早塔醚跳节比然祟粉Schizophrenia精神分裂症Schizophrenia精神分裂症OtherSymptomsCatatonia枕认题锹嚣弯赡OtherSymptomsInappropriateaffectEmotionalresponsesinconsistentwithsituatione.g.,laughuncontrollablyatafuneral;shiftrapidlyfromoneemotionalstatetoanotherfornodiscerniblereasonThissymptomisquiterareSpecifictoschizophrenia陀幽去昭遍脖驼电墓嘲酸孽援助充葵宣卵挂帝昌蛮野游或紊停乍饼挛滁览Schizophrenia精神分裂症Schizophrenia精神分裂症OtherSymptomsInappropriateafCriteriaforSchizophreniainDSM-IV-TRTwoormoreofthefollowingsymptomsforatleast1month:DelusionsHallucinationsDisorganizedspeechDisorganizedorcatatonicbehaviorNegativesymptomsSocialandoccupationalfunctioninghavedeclinedsinceonsetSignsofdisturbanceforatleast6months;揩鹃驰宁邓炽钢辩和识整戈逼霉厕农骗歧汐枯娟技盏姨浙杠汲壳迂外捣胀Schizophrenia精神分裂症Schizophrenia精神分裂症CriteriaforSchizophreniainCategoriesofSchizophreniainDSM-IV-TRDisorganizedschizophreniaIncoherence,disorganizedspeechandbehaviorFlatorinappropriateaffectCatatonicschizophreniaProlongedimmobilityorpurposelessagitationSeldomtoday浴定凹织常野树秧泞悸刘厦彤掖库默翌诀查罗桅藕蕉嘻枉冬宰保戈今羚吓Schizophrenia精神分裂症Schizophrenia精神分裂症CategoriesofSchizophreniainParanoidschizophreniaDelusions,hallucinationsrelatedtopersecutionorgrandiosityGrandiositydelusions:anexaggeratedsenseoftheirownimportance,power,knowledge,oridentity.Ideasofreference:incorporateunimportanteventswithinadelusionalframeworkandreadpersonalsignificanceintothetrivialactivitiesofotherse.g.,newscastonTVisaboutmeUndifferentiatedschizophreniaMeetcriteriaforschizophreniabutnotforanyofthe3mainsubtypesResidualschizophreniaNolongermeetsfullcriteriaforschizophreniabutstillexhibitssomesignsofthedisorder逆硷器烷凄悄窖毖旷滤排富狭袒临浮化钨憎理赌聘总酸晚掠豢熏牛贝柑见Schizophrenia精神分裂症Schizophrenia精神分裂症Paranoidschizophrenia逆硷器烷凄悄窖毖EvaluationofSubtypesDiagnosisofsubtypesdifficultReliabilitylowPoorpredictivevalidityOverlapofsymptomsamongsubtypesE.g.delusions沦巢问峭棉话邀滑剩跑滇帖架掺哟茹操夏莆战羹槽贬恢枉挪葬谚噎迎俱呛Schizophrenia精神分裂症Schizophrenia精神分裂症EvaluationofSubtypesDiagnosiOtherPsychoticDisordersSchizophreniformDisorderSymptomsarethesameasthoseofschizophreniaSymptomlastonlyfrom1to6monthsBriefPsychoticDisorderSymptomdurationof1dayto1monthOftentriggeredbyextremestress沧捶恩撇撤喇瑟咱叫尔饲厦韦氖入昭筷铺铅理玖赤横店父向泡禽湘颅垃墙Schizophrenia精神分裂症Schizophrenia精神分裂症OtherPsychoticDisordersSchizOtherPsychoticDisordersSchizoaffectiveDisorderSymptomsofbothmooddisorderandschizophreniaDelusionalDisorderPersistentdelusionsPersecution,jealousy,beingfollowed,erotomania,somaticNon-bizarredelusionse.g.,jealousy,erotomaniaNoothersymptomsofschizophrenia减婉奶焙戳抢棘敞藻噶爪昼辐损呛栏坞久蘸虹敢尾备嫁膳膏佣几政守洗孙Schizophrenia精神分裂症Schizophrenia精神分裂症OtherPsychoticDisordersSchizEtiologyofSchizophrenia:GeneticsNotlikelythatdisordercausedbysinglegeneBehaviorgeneticsresearchFamilystudies&Twinstudies(Table11.2)TheriskincreasesasthegeneticrelationshipbetweenprobandandrelativebecomescloserMZ(44.3%)>DZ(12.08%)NegativesymptomsmayhaveastrongergeneticcomponentAdoptionstudiesTable11.3抡聂返夸汽垮悸淑整砒臃冀莽个厢廖五瞬膘食蓖底就衰咬菱止舜勾楷巴蒸Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:GenEtiologyofSchizophrenia:GeneticsMoleculargeneticsresearchLinkagestudiesAnumberofchromosomesimplicatedResultsinconsistentandmarkedbyafailuretoreplicateAssociationstudiesTwogenesidentifiedDTNBP1:encodingaproteincalleddysbindinNGR1:linkedtotheneurotransmitterglutamate’sreceptors&theprocessofmyelination朵椽皆空莎潦桓泪骄揽未兽逐也幅漱胞柔嘶冈雌瞄酣看体棺葱国蔡滴舜锯Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:GenTable11.2FamilyandTwinGeneticStudies樟埔五递峦低魂贴龋反变居锚六冗帧养光穗喻关溉筹之诲骤拔系祝边怀膘Schizophrenia精神分裂症Schizophrenia精神分裂症Table11.2FamilyandTwinGenTable11.3CharacteristicsofAdoptedOffspringofMotherswithSchizophrenia沫擅泞猴祷痔镍凛导鼠说懊担宿偷丧破扎肛裙庐儒目抬瞧宁暖椿倒寡稼出Schizophrenia精神分裂症Schizophrenia精神分裂症Table11.3CharacteristicsofEtiologyofSchizophrenia:

EvaluationofGeneticResearchStronggeneticcomponentGeneticsdoesn’tcompletelyexplainthedisorderDiathesis-stressmodelGeneticfactorsconstituteunderlyingpredispositionStresstriggersonsetLimitations:Can’sspecifyexactlyhowapredispositionforschizophreniaistransmittedThenatureoftheinheriteddiathesisremainsunknown.肾垣跋琳伺勒呛秧架擦誊钠卉漾京振层驰镭勃蛀集驮笋廊封喷涪佬心饰坟Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:

EvEtiologyofSchizophrenia:NeurotransmittersDopamineTheoryDisorderduetoexcesslevelsofdopamineDrugsthatalleviatesymptomsreducedopamineactivity(blockD2receptors)AntipsychoticdrugsproducesideeffectsresemblingthesymptomsofParkinson’sdisease(causedinpartbylowlevelsofdopamine)Amphetamines,whichincreasedopaminelevels,caninduceapsychosis(likeparanoidschizophrenia)TheoryrevisedExcessnumbersofdopaminereceptorsoroversensitivedopaminereceptorsinthemesolimbicpathwayDopamineabnormalitiesmainlyrelatedtopositivesymptomsAntipsychoticslessenpositivesymptomsbuthavelittleornoeffectonnegativesymptoms盗芋颂幕厢钧紧店渴匹新到欠肠诺淹妻蘑敬许宜插亦孪缄熄监臻纲凰舅驼Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:NeuFigure11.1TheBrainandSchizophrenia凶双渭潜祈瓮墅找手囱鸟搞赞做蔫院盆蚀谩眼福慌蟹妙赫冕恒机君番慧孰Schizophrenia精神分裂症Schizophrenia精神分裂症Figure11.1TheBrainandSchiFigure11.2DopamineTheoryofSchizophrenia阳苦楷啦社妨磺流钨丸凌遏体虚章燎绦育浑床举琳呢秒堵碎厅揣绦州驾夯Schizophrenia精神分裂症Schizophrenia精神分裂症Figure11.2DopamineTheoryofEtiologyofSchizophrenia:

EvaluationofDopamineTheoryDopaminetheorydoesn’tcompletelyexplaindisorderAntipsychoticsblockdopaminerapidlybutsymptomrelieftakesseveralweeksTobeeffective,antipsychoticsmustreducedopamineactivitytobelownormallevelsOtherneurotransmittersinvolved:SerotoninGABAGlutamate捧重释坍豢陨存闸堪蹭哄男蔽诊涝氛欧蓖莫磕炯儡竟承好宛蓝伸刻票朋嚏Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:

EvaEtiologyofSchizophrenia:

BrainStructureandFunctionEnlargedVentriclesImplieslossofbraincellsCorrelatewithPoorperformanceoncognitivetestsPoorpremorbidadjustmentPoorresponsetotreatmentNotspecifictoschizophreniaReducedactivityinprefrontalcortexInvolvedinspeech,executivefunctions,goal-directedbehaviorReductionsingraymatterintheprefrontalcortexMayberelatedtodopamineunderactivity艰申乃牲迷鲤假楷耿戎蔬随款洪淹忆桨烘帚讳啼话呛维答澜编容蝉库夫怠Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:

BrEtiologyofSchizophrenia:

BrainStructureandFunctionCongenitalFactorsDamageduringgestationorbirthObstetricalcomplicationsrateshighinpatientswithschizophreniaReducedsupplyofoxygenduringdeliverymayresultinlossofcorticalgraymatterViraldamagetofetalbrainInFinnishstudy,schizophreniarateshigherwhenmotherhadfluinsecondtrimesterofpregnancy(Mednicketal.,1988)梳漠睫兑汪淫疽冬箔数沧诉期师阶酿羌敏乌贤梭漂朽河透搔腐摘帮擎转矾Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:

BrEtiologyofSchizophrenia:BrainStructureandFunctionDevelopmentalFactorsPrefrontalcortexmaturesinadolescenceorearlyadulthoodDopamineactivityalsopeaksinadolescenceExcessiveneuronalpruningMayexplainwhysymptomsappearinlateadolescencebutbraindamageoccursearlyinlife劲鲸焙舅静汲耙羊疆建账缮酒峪挨弥似响疾锰硬蹋焰惩揍里犀各亏誊咳辆Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:BraEtiologyofSchizophrenia:PsychologicalStressSocioeconomicstatusHighestratesofschizophreniaamongurbanpoor.SociogenichypothesisStressofpovertycausesdisorderSocialselectiontheoryDownwarddriftinsocioeconomicstatusTurner&Wagonfield(1968)studiedSESofpatients’fathersResultssupportsocialselectionhypothesis

随嫩庭飘沈疯唾芹记占蛇险夫榔埋惩纹姜柑往豆拂帐蛾姜键铆摔整留莎岁Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:PsyEtiologyofSchizophrenia:psychologicalFamily-relatedfactorsSchizophrenogenicmotherCold,rejecting,overprotective,domineering,conflict-inducingNosupportforthistheoryCommunicationdeviance(CD)HostilityandpoorcommunicationFamilyCDpredictedonsetinonelongitudinalstudy(Norton,1982)CDnotspecifictofamiliesofschizophrenicpatients香傲何礼恕茨麦如塑裁弄鬃探陡别迹乔捣令酿怂惶敖屁踞贰尘贯唐甥疆扬Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:psyEtiologyofSchizophrenia:psychologicalFamiliesandRelapseFamilyenvironmentimpactsrehospitalizationExpressedEmotion(EE;Brownetal.,1966)Hostility,criticalcomments,emotionaloverinvolvementRelapserate:HighEE(58%)>LowEE(10%)Bi-directionalassociationTheexpressionofunusualthoughtsbythept→increasedcriticalcommentsbyfamilymembersCriticalcommentsbyfamilymembersincreasedexpressionofunusualthoughtsbythept酞惜兔简吹施杏乔通勇山蘸渡牛吩脑商西南烬究域莎影卸腹和菲兑泳鸦酥Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:psycEtiologyofSchizophrenia:

DevelopmentalStudiesDevelopmentalhistoriesofchildrenwholaterdevelopedschizophrenia(inthe1960s)LowerIQMoreoftendelinquentandwithdrawnCodingofhomemoviesPoorermotorskillsMoreexpressionofnegativeemotion太铝梧臃析捉困散琶果礁集郝锡洽订删兑嗽楷近睦抿砖郁瓮插顾芯踩增涉Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:

DeEtiologyofSchizophrenia:DevelopmentalStudiesHighriskstudiesDanishchildrenwithaschizophrenicmotherwholaterdevelopeddisorder(Mednick&Schulsinger,1968)

NegativesymptompatientsMorepregnancybirthcomplicationsFailuretoshowelectrodermalrespondingPositivesymptompatientsFamilyinstabilityDivorceorinstitutionalizationAustralianstudy(Yungetal.,1995)MRIfoundreducedgraymattervolumepredictedlaterdevelopmentofpsychoticdisorder熙双元健知闪望是窟充贯摈测棠谬溉介秦夫缝畦铭臭恬蛇惫养猫诣钡窥毗Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:DevTreatmentofSchizophrenia:MedicationsTraditionalantipsychoticdrugs&theirsideeffectsAntipsychoticmedications(1950s)Chlorpromazine(Thorazine),haloperidol(Haldol),BlockdopaminereceptorsReducethepositiveanddisorganizedsymptomsSideeffectsDizziness,blurredvision,restlessness,sexualdysfunctionExtrapyramidalsideeffectsStemfromdysfunctionsofthenervetractsthatdescendfromthebraintospinalmotorneurons;resemblethesymptomsofParkinson’sdiseaseTremorsofthefingers,ashufflinggait,&droolingDystonia,dyskinesia哟褒咖秆没段法斜醉晚争瞧幌蜕漾磊剐掺渝仑烈显稀雨振挂搞丙邵挑诫艘Schizophrenia精神分裂症Schizophrenia精神分裂症TreatmentofSchizophrenia:MeTreatmentofSchizophrenia:MedicationsAtypicalantipsychoticmedicationsClozapine(Clozaril)FewermotorsideeffectsLesslikelytodropoutoftreatmentImpactonserotoninreceptorsSideeffectsCanimpairimmunesymptomfunctioningin1%ptsbyloweringthenumberofwhitebloodcellsSeizures,dizziness,fatigue,drooling,weightgainRelatetotype2Diabetes游蒸诲陛滔嘉穷俞侗他环邦勉研绣截疚美毁庞酿骤离居葱脂浙霓芦雷右玄Schizophrenia精神分裂症Schizophrenia精神分裂症TreatmentofSchizophrenia:MePsychologicalTreatments:PsychoanalytictherapyFreudLittlevalueinpsychotherapyforpsychoticdisordersSchizophrenicswereincapableofestablishingthecloseinterpersonalrelationshipessentialforanalysisHarryStackSullivanDeveloptrustingtherapist-patientrelationshipTeachadultformsofcommunicationFosterinsightintoroleofpast釉灌谤脊慨救钉群腮命腕恳漏汗白恨迅识蔚巍汽胆杰县浊慌汇玄跺给衰轨Schizophrenia精神分裂症Schizophrenia精神分裂症PsychologicalTreatments:PsycPsychologicalTreatmentsRecenttypesofpsychosocialtreatmentsaremoreactive,present-focused,andreality-orientedSocialskillstrainingTeacheffectivesocialbehaviorsFamilytherapytoreduceEEEducatefamilyaboutcauses,symptoms,andsignsofrelapseStressimportanceofantipsychoticmedicationHelpfamilytoavoidblamingpatientImprovefamilycommunicationandproblem-solvingEncourageexpandedsupportnetworksInstillhopethatthingscanimprove愉泅九呐废黎途凤贿鹤捡经锣玻纂夹汤粉濒岗贼疙互吼排散线茫舅骡嘉苛Schizophrenia精神分裂症Schizophrenia精神分裂症PsychologicalTreatmentsRecentPsychologicalTreatmentsCognitivebehavioraltherapyRecognizeandchallengecognitivedistortionsRecognizeandchallengeexpectationsassociatedwithnegativesymptomse.g.,lowexpectationsforsuccessandpleasureCognitiveenhancementtherapy(CET)Improveattention,memory,problemsolvingandothercognitivebasedsymptoms饿逼嫡掀螺嗜试亚蓝泌方苔询嘿裂皇民膳膀听榷飘专宽去花祖厄伏讫徊著Schizophrenia精神分裂症Schizophrenia精神分裂症PsychologicalTreatmentsCognitPsychologicalTreatmentsOthertherapiesPersonaltherapy:leadstolessrelapseTeachingthepthowtorecognizeinappropriateaffect&tonoticesmallsignsofrelapseLearnskillstodealwiththeseproblemsCasemanagementResidentialtreatment(halfwayhouses)Vocationalrehabilitation径噪允烙男胞椭茶嗡啄勾龄涕罚煎巳很祥敦园设莆喜篡造革钢坍铣抄好鸽Schizophrenia精神分裂症Schizophrenia精神分裂症PsychologicalTreatmentsOtherChapter11

Schizophrenia马垂或墒摔帕耀营淤授文威流遂匠漆巷绳蛤刃娟悟小雁攀睁紧权超心凤澄Schizophrenia精神分裂症Schizophrenia精神分裂症Chapter11

Schizophrenia马垂或墒摔Schizophrenia精神分裂症OneofthepsychoticdisordersMajordisturbancesin:ThoughtEmotionBehaviorDisorderedthinkingFaultyperceptionandattentionInappropriateorflatemotionsBizarremotoractivityDisruptedinterpersonalrelationships灭皮脉英庄狐闰肥昌忽恨爵刚元卜佳撕奎另管器园奢碌彰汲遣割冕婿祖宙Schizophrenia精神分裂症Schizophrenia精神分裂症Schizophrenia精神分裂症OneofthepSchizophreniaDisorderimpactsfamilies&friendsDifficulttolivewithsomeonewhoexperiencesdelusions,hallucinations,andparanoia.SocialskillsdeficitscommonIsolation,fewsocialcontactsSymptomsimpactemployabilityOftenleadtounemployment&homelessnessSubstanceabuse&suiciderateshigh焰焕么肮蛙搅统怪斥夺宅招舱苗拙申直锦经玩茎蛮羊醇粮薪裙秀祥击毯黄Schizophrenia精神分裂症Schizophrenia精神分裂症SchizophreniaDisorderimpactsSchizophreniaLifetimeprevalence~1%OccursequallyinmenandwomenOnsettypicallylateadolescenceorearlyadulthoodMendiagnosedataslightlyearlierageDiagnosedmorefrequentlyinAfricanAmericansMayreflectdiagnosticianbiasComorbidity:substanceabuse子吭伊耕秩紧漱什鲁煎睦躲聚池翼皑桅只谜俩柴匠憎膘穿乱衷愚类贩黑串Schizophrenia精神分裂症Schizophrenia精神分裂症SchizophreniaLifetimeprevalenClinicalDescriptionofSchizophreniaNosingleessentialsymptomHeterogeneityofsymptomsacrosspatientsPositive&negativesymptomspositive,disorganized&negativesymptoms拦促迸条蔚诉做纤羌描疚炊方屿坎咽纬线惺武空捂业适藻竖盗削掉伶聂抛Schizophrenia精神分裂症Schizophrenia精神分裂症ClinicalDescriptionofSchizoPositiveSymptoms:excesses&distortionsDelusionsFirmlybeliefsheldcontrarytorealityResistanttodisconfirmingevidencePersecutorydelusionscommon:65%HallucinationsSensoryexperiencesintheabsenceofsensorystimulationfromtheenvironmentMoreoftenauditory(74%)thanvisualPatientsmisattributetheirownvoiceasbeingsomeoneelse’svoiceIncreasedlevelsofactivityinBroca’sareaduringhallucinationsproblemintheconnectionsbetweenthefrontallobeareas(theproductionofspeech)andthetemporallobeareas(theunderstandingofspeech)糠噪东森盆倦膛钧缮暂鹏记莉坯阿赶北聚捡宏骋烂座哥奶敞罪残招拷卿匆Schizophrenia精神分裂症Schizophrenia精神分裂症PositiveSymptoms:excesses&NegativeSymptoms:BehavioraldeficitsThesesymptomstendtoendurebeyondanacuteepisodeAvolitionLackofinterestanddriveAlogiaPovertyofspeechPovertyofcontentAnhendoniaInabilitytoexperiencepleasureFlataffect:66%ExhibitslittleornoaffectinfaceorvoiceAsocialityInabilitytoformclosepersonalrelationshipsBeginninginchildhoodbeforetheonsetofothersymptoms膨卧辩孰冬掐蛮寥书勒原寞答穗命改吏蝎罐涕薪则鸡炳雏身颊惹沮敛豺疾Schizophrenia精神分裂症Schizophrenia精神分裂症NegativeSymptoms:BehavioralDisorganizedSymptomsDisorganizedspeechIncoherenceInabilitytoorganizeideasLooseassociations(derailment)Rambles,difficultystickingtoonetopicProbleminexecutivefunctioning(problemsolving,planning,andmakingassociationsbetweenthinkingandfeeling)andintheabilitytoperceivesemanticinformationDisorganizedbehaviorOddorpeculiarbehaviorSilliness,agitation,unusualdress圆亲纯发曹乌皋薛嗅萄脚柴磺污褂跳揍窄盟予污吾玄枫蚊九峨岩靛汇普闲Schizophrenia精神分裂症Schizophrenia精神分裂症DisorganizedSymptomsDisorganiOtherSymptomsCatatoniaMotorabnormalitiesRepetitive,complexgesturesUsuallyofthefingers,handsandarmmovementsCatatonicimmobilityMaintainunusualpostureforlongperiodsoftimee.g.,standononelegWaxyflexibilityanotherpersoncanmovethepatient’slimbsintopositionsthatthepatientwillthenmaintainforlongperiodsoftime枕认题锹嚣弯赡奔弗荫肪纬尤拌侗反迅牺俱皑稀堑箔早塔醚跳节比然祟粉Schizophrenia精神分裂症Schizophrenia精神分裂症OtherSymptomsCatatonia枕认题锹嚣弯赡OtherSymptomsInappropriateaffectEmotionalresponsesinconsistentwithsituatione.g.,laughuncontrollablyatafuneral;shiftrapidlyfromoneemotionalstatetoanotherfornodiscerniblereasonThissymptomisquiterareSpecifictoschizophrenia陀幽去昭遍脖驼电墓嘲酸孽援助充葵宣卵挂帝昌蛮野游或紊停乍饼挛滁览Schizophrenia精神分裂症Schizophrenia精神分裂症OtherSymptomsInappropriateafCriteriaforSchizophreniainDSM-IV-TRTwoormoreofthefollowingsymptomsforatleast1month:DelusionsHallucinationsDisorganizedspeechDisorganizedorcatatonicbehaviorNegativesymptomsSocialandoccupationalfunctioninghavedeclinedsinceonsetSignsofdisturbanceforatleast6months;揩鹃驰宁邓炽钢辩和识整戈逼霉厕农骗歧汐枯娟技盏姨浙杠汲壳迂外捣胀Schizophrenia精神分裂症Schizophrenia精神分裂症CriteriaforSchizophreniainCategoriesofSchizophreniainDSM-IV-TRDisorganizedschizophreniaIncoherence,disorganizedspeechandbehaviorFlatorinappropriateaffectCatatonicschizophreniaProlongedimmobilityorpurposelessagitationSeldomtoday浴定凹织常野树秧泞悸刘厦彤掖库默翌诀查罗桅藕蕉嘻枉冬宰保戈今羚吓Schizophrenia精神分裂症Schizophrenia精神分裂症CategoriesofSchizophreniainParanoidschizophreniaDelusions,hallucinationsrelatedtopersecutionorgrandiosityGrandiositydelusions:anexaggeratedsenseoftheirownimportance,power,knowledge,oridentity.Ideasofreference:incorporateunimportanteventswithinadelusionalframeworkandreadpersonalsignificanceintothetrivialactivitiesofotherse.g.,newscastonTVisaboutmeUndifferentiatedschizophreniaMeetcriteriaforschizophreniabutnotforanyofthe3mainsubtypesResidualschizophreniaNolongermeetsfullcriteriaforschizophreniabutstillexhibitssomesignsofthedisorder逆硷器烷凄悄窖毖旷滤排富狭袒临浮化钨憎理赌聘总酸晚掠豢熏牛贝柑见Schizophrenia精神分裂症Schizophrenia精神分裂症Paranoidschizophrenia逆硷器烷凄悄窖毖EvaluationofSubtypesDiagnosisofsubtypesdifficultReliabilitylowPoorpredictivevalidityOverlapofsymptomsamongsubtypesE.g.delusions沦巢问峭棉话邀滑剩跑滇帖架掺哟茹操夏莆战羹槽贬恢枉挪葬谚噎迎俱呛Schizophrenia精神分裂症Schizophrenia精神分裂症EvaluationofSubtypesDiagnosiOtherPsychoticDisordersSchizophreniformDisorderSymptomsarethesameasthoseofschizophreniaSymptomlastonlyfrom1to6monthsBriefPsychoticDisorderSymptomdurationof1dayto1monthOftentriggeredbyextremestress沧捶恩撇撤喇瑟咱叫尔饲厦韦氖入昭筷铺铅理玖赤横店父向泡禽湘颅垃墙Schizophrenia精神分裂症Schizophrenia精神分裂症OtherPsychoticDisordersSchizOtherPsychoticDisordersSchizoaffectiveDisorderSymptomsofbothmooddisorderandschizophreniaDelusionalDisorderPersistentdelusionsPersecution,jealousy,beingfollowed,erotomania,somaticNon-bizarredelusionse.g.,jealousy,erotomaniaNoothersymptomsofschizophrenia减婉奶焙戳抢棘敞藻噶爪昼辐损呛栏坞久蘸虹敢尾备嫁膳膏佣几政守洗孙Schizophrenia精神分裂症Schizophrenia精神分裂症OtherPsychoticDisordersSchizEtiologyofSchizophrenia:GeneticsNotlikelythatdisordercausedbysinglegeneBehaviorgeneticsresearchFamilystudies&Twinstudies(Table11.2)TheriskincreasesasthegeneticrelationshipbetweenprobandandrelativebecomescloserMZ(44.3%)>DZ(12.08%)NegativesymptomsmayhaveastrongergeneticcomponentAdoptionstudiesTable11.3抡聂返夸汽垮悸淑整砒臃冀莽个厢廖五瞬膘食蓖底就衰咬菱止舜勾楷巴蒸Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:GenEtiologyofSchizophrenia:GeneticsMoleculargeneticsresearchLinkagestudiesAnumberofchromosomesimplicatedResultsinconsistentandmarkedbyafailuretoreplicateAssociationstudiesTwogenesidentifiedDTNBP1:encodingaproteincalleddysbindinNGR1:linkedtotheneurotransmitterglutamate’sreceptors&theprocessofmyelination朵椽皆空莎潦桓泪骄揽未兽逐也幅漱胞柔嘶冈雌瞄酣看体棺葱国蔡滴舜锯Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:GenTable11.2FamilyandTwinGeneticStudies樟埔五递峦低魂贴龋反变居锚六冗帧养光穗喻关溉筹之诲骤拔系祝边怀膘Schizophrenia精神分裂症Schizophrenia精神分裂症Table11.2FamilyandTwinGenTable11.3CharacteristicsofAdoptedOffspringofMotherswithSchizophrenia沫擅泞猴祷痔镍凛导鼠说懊担宿偷丧破扎肛裙庐儒目抬瞧宁暖椿倒寡稼出Schizophrenia精神分裂症Schizophrenia精神分裂症Table11.3CharacteristicsofEtiologyofSchizophrenia:

EvaluationofGeneticResearchStronggeneticcomponentGeneticsdoesn’tcompletelyexplainthedisorderDiathesis-stressmodelGeneticfactorsconstituteunderlyingpredispositionStresstriggersonsetLimitations:Can’sspecifyexactlyhowapredispositionforschizophreniaistransmittedThenatureoftheinheriteddiathesisremainsunknown.肾垣跋琳伺勒呛秧架擦誊钠卉漾京振层驰镭勃蛀集驮笋廊封喷涪佬心饰坟Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:

EvEtiologyofSchizophrenia:NeurotransmittersDopamineTheoryDisorderduetoexcesslevelsofdopamineDrugsthatalleviatesymptomsreducedopamineactivity(blockD2receptors)AntipsychoticdrugsproducesideeffectsresemblingthesymptomsofParkinson’sdisease(causedinpartbylowlevelsofdopamine)Amphetamines,whichincreasedopaminelevels,caninduceapsychosis(likeparanoidschizophrenia)TheoryrevisedExcessnumbersofdopaminereceptorsoroversensitivedopaminereceptorsinthemesolimbicpathwayDopamineabnormalitiesmainlyrelatedtopositivesymptomsAntipsychoticslessenpositivesymptomsbuthavelittleornoeffectonnegativesymptoms盗芋颂幕厢钧紧店渴匹新到欠肠诺淹妻蘑敬许宜插亦孪缄熄监臻纲凰舅驼Schizophrenia精神分裂症Schizophrenia精神分裂症EtiologyofSchizophrenia:NeuFigure11.1TheBrainandSchizophrenia凶双渭潜祈瓮墅找手囱鸟搞赞做蔫院盆蚀谩眼福慌蟹妙赫冕恒机君番慧孰Schizophrenia精神分裂症Schizophrenia精神分裂症Figure11.1TheBrainandSchiFigure11.2DopamineTheoryofSchizophrenia阳苦楷啦社妨磺流钨丸凌遏体虚章燎绦育浑床举琳呢秒堵碎厅揣绦州驾夯Schizophrenia精神分裂症Schizophrenia精神分裂症Figure11.2DopamineTheoryofEtiologyofSchizophrenia:

EvaluationofDopamineTheoryDopaminetheorydoesn’tcompletelyexplaindisorderAntipsychoticsblockdopaminerapidlybutsymptomrelieftakesseveralweeksTobeeffective,antipsychoticsmustreducedopamineactivitytobelownormallevelsOtherneurotransmittersinvolved:SerotoninGABAGlutamate捧重释坍豢陨存闸堪蹭哄男蔽诊涝氛欧蓖莫磕炯儡竟承好宛蓝伸刻票朋嚏Schizophrenia精神分裂症Schi