Schizophrenia and Substance Use Disorders
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Transcript of Schizophrenia and Substance Use Disorders
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SchizophreniaSchizophreniaand Substance Use and Substance Use
DisordersDisordersHow do Thought Disorders and
Substance Use Disorders Interact?
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Topic AreasTopic Areas
I. Description of Thought Disorders
II. Influential Factors on the Illness
III. Effect of Substance Use
IV. Implications for Recovery
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I. Description of Thought Disorders
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How is it decided if someone has a
“thought disorder?”
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Diagnostic Criteria for Schizophrenia*Diagnostic Criteria for Schizophrenia*A. Characteristic symptoms: Two (or more) of the following, each
present for a significant portion of time during a 1-month period: (1) delusions(2) hallucinations(3) disorganized speech(4) grossly disorganized or catatonic behavior(5) negative symptoms, i.e., affective flattening, alogia, or avolition
B. Social/occupational dysfunction: One or more areas of functioning such as work, interpersonal relations, or self care are markedly below the level achieved prior to the onset.
C. Duration: Continuous signs of the disturbance persist for at least 6 months.
E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 312
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Diagnostic Criteria for Diagnostic Criteria for Schizoaffective Disorder*Schizoaffective Disorder*
A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.
B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
C. The disturbance is not due to the direct physiological effects of a substance, or a general medical condition
* Diagnostic and Statistical Manual, 4 th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 323
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Diagnostic Criteria for Diagnostic Criteria for Substance-Induced Psychotic Disorder*Substance-Induced Psychotic Disorder*A. Prominent hallucinations or delusions. B. There is evidence from the history, physical examination, or
laboratory findings of either (1) or (2):(1) the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal(2) medication use is etiologically related to the disturbance
D. The disturbance is not better accounted for by a Psychotic Disorder that is not substance-induced.
* Diagnostic and Statistical Manual, 4th Ed. (2000). American Psychiatric Association. Arlington, VA. p. 342
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Terms and DefinitionsTerms and Definitions
“Positive” symptoms (“in addition to” what was experienced before the illness) include; – Delusions– Hallucinations (Auditory, Visual, etc.)– Disorganized Speech– Bizarre Behavior
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Terms and DefinitionsTerms and Definitions“Negative” symptoms (“taken away
from” what was experienced before the illness) include; – Alogia– Affective Blunting or Flattening– Avolition– Anhedonia– Attentional Impairment
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DelusionsDelusions
False beliefsAffects the “Inference” system of the
brain(ex.) “Conspiracy theories” are common
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HallucinationsHallucinations
False perceptionAffect the “Perception” system of the
brainAuditory hallucinations are most
commonAny of the 5 senses may be involved
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Disorganized SpeechDisorganized SpeechAffects the “Language” system of the
brain (ex.) Word salad is a jumble of
words/phrases that lacks comprehensible meaning;
(ex.) Tangentiality is a style of speech in which a person replies to questions in an irrelevant, “off the topic” manner).
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Bizarre BehaviorBizarre Behavior
Affects the “Behavior-inducing” systems of the brain
(ex.) Ritualistic behaviors – may represent “normal” responses to the “abnormal” stimuli of active delusions or hallucinations
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AlogiaAlogia
the inability to organize one’s thoughts and express them fluently
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Affective Blunting or Affective Blunting or FlatteningFlattening
“Flat affect”
A deficiency in the ability to express a full range of emotion
May be expressed in a monotonal voice, a “poker face,” or a “schizophrenic stare”
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AvolitionAvolition
The inability to initiate a behavior, or carry it out
(exs.) Withdrawal, apathy, decreased energy, decreased motivation
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AnhedoniaAnhedonia
The inability to experience pleasure or enjoyment
May result in the discontinuation of hobbies or recreational activities
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Attentional ImpairmentAttentional Impairment
Difficulty in focusing attention
Can lead to inability to complete tasks or activities that require focused attention
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II. Influential Factors
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Family History (Genetic) FactorsFamily History (Genetic) Factors
Individuals with schizophrenia are more likely to have relatives with psychiatric illness (or substance use disorders)
Indicates a genetic vulnerability to psychiatric illness (and substance use disorders)
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Supersensitivity ModelSupersensitivity Model
Biological vulnerability + environmental stress = precipitate the onset of the disorder or trigger relapses
Medications decrease vulnerabilitySubstance use increases vulnerability
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III. Effect of Substance Use
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Alcohol UseAlcohol Use
Combining Alcohol and antipsychotic medication can cause life-threatening oversedation
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Cocaine UseCocaine Use
Cocaine abuse can damage the brain and cause psychotic episodes to occur
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Marijuana UseMarijuana Use
Marijuana use can contribute to the frequency and intensity of psychotic episodes – More severe positive symptoms– Quicker psychiatric relapses & re-
hospitalizations– Earlier age of onset
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IV. Implications for Recovery
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Special ConsiderationsSpecial Considerations
More likely to develop addiction with recreational use.
Many clients report using substances to facilitate social interactions with peers.
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Principles of Integrated Treatment*Principles of Integrated Treatment*IntegrationComprehensivenessAssertivenessReduction of Negative ConsequencesLong-Term PerspectiveMotivation-Based TreatmentMultiple psychotherapeutic modalities
* Mueser, K.T. et al. (2003). Integrated Treatment for Dual Disorders. Guilford Press: Canada. p. 16-33