PSYB32: Schizophrenia
Schizophrenia definition
A psychotic disorder characterized by disturbances in thought, emotion and behaviour.
Lifespan of someone with schizophrenia
20 years shorter than those without
Cultural differences
Asians and immigrants have it easier because of averse life events, family differences and social disadvantage.
When do schizophrenia usually develop?
Adolescene or early adulthood.
3 types of symptoms
Positive symptoms, negative symptoms and other category symptoms
Where do treatment usually happen
In communities without hospitalisation
Cormorbidity
Common, most likely with substance use, de[ression and anxiety.
Positive symptoms
Too much of a behaviour:
Disorganized speech: including incoherence, derailment, and neologisms.
Hallucinations: not real sensory experiences.
Delusions: false beliefs even with evidence of being false
Most dramatic hallucination
perception
Types of delusions
Delusion of control: fear that they are being manipulated by external forces.
Delusion of grandeur: thinking that they are important/powerful
Delusion of percesution: delusion that others are after you.
Delusions in schizphrenia vs other disorders
They are more bizzare.
2 categories of positie symptoms
disorganized speech and bizzare behaviour vs hallucinations and delusions
Negative symptoms
Behavioural deficits.
Avolitation/apathy: lacking interest and energy and inability to continue routines.
Ahedonia: inability to feel interest and leasure.
Algoia: no speech, whether it is speech itself or content of the speech.
Flat affect: inability to express emotions, not feeling them.
Asociality: inability to form close relationships and feel intimacy.
Other symptoms
Catatonia: motor abnormalities that could either be a lot of gestures and movements or catatonic immobility. Also wavy flexibility.
Innapropriate affect: out of context emotions where there are often emotional shifts for no reason.
Innapropriate affect
Out of context emotions where there are shifts in emotion for no reason.
It is rare and exclusive to schizophrenia.
Emil Kraeplein concept of schizophrenia
2 components:
Dementia precox: incurable mental process ability decline since adolescence
Mania-depressive illness.
Eugene Bleuler's changes to schizophrenia definition
Dementia precox no longer relevant because they did not always have adolescnet onset.
Coined "schizophrenia" term.
disassociative thoughts where thoughts are cut off and unrelated from eachother.
Blocking: total loss of train of thought.
Tried to categorize/ subtype schizophrenia but did not work.
Amount of schizophrenia diagnosis
Differed depending on definition.
Broadened with: anyone with hallucination/delusion included (even if they are present in other disorder) anyone with personality disorder included, anyone even with acute and quick symptoms and recovery included.
Enclosed with: Detailed reports, people with mood disorders left out, 1 month of at least 2 symptoms for 6 months (disorganized speech, hallucinations, delusions, negative symptoms, catatonia)
Types of schizophrenia
Disorganized, catatonic, paranoid, undifferentiated, residual
Disorganized schizophrenia
Schizophrenia characterized by disorganization, incoherence, detrailment, behaiour is not goal oriented and disorganized, lacking contol with no regard for time, place and themselves.
Catatonic schizophrenia
schizophenia where people are shifting from a lot of movements to being very stiff.
Other symptoms include resisting instructions/suggestions or echoing speech back to others.
Often misdiagnosed a lethargic.
Paranoid schizophrenia
Schizophrenia with lots of hallucinations, delusions and ieas of reference. Prominent are delusions. Often accompanied by auditory hallucinations.
Undifferentiated schizophrenia
Schizophrenia not fitting into other or multiple types
Residual schizophrenia
episodes of schizophrenia with signs of disorder but no psychotic symptoms
5 schozophrenia types based on neurocognitive features
Executive, failing card tests. Executive-motor, failinng both card and motor tests. Motor, failing motor tests. Normative, intact cognition. Dementia subtype, persuasive and generalized cognitive impairment.
Etiology
diathesis stress model
Genetic etiolog
It is hereditory. The closer they are to you in genetics, the more likely they are also to have it. even if not, there;s probably going to be like an illness or something. Negative symptoms are more hereditory. seen in parent and child even if the child is adopted away.
5 things happening together with schizophrenia
depression, anxiety, adhd, autism. So they share many genes but we don't know why some have one but not the other.
Protein altering mutation
found in 40 genes in schizophenis.
schozophrenia and synapses
less synapses and connections between neurons.
Hoe does genetics influence schizophrenia
through body chemistry and biological processes
Dopmine hypothesis
schixophrenia is caused by too much dopamine in the body.
Drugs that stops schizophrenia reduces dopamin. They also induce autism like parkinson like symptoms that come from too little dopamine. Some drugs giving dopamine induces paranoid schizophrenia like states.
Is it just extra dopamine
no it is also excess amount of dopamine receptors and them being really sensitive
areas for dopemine excessive
meso cortical and mesolimbic. they go to the prefrontal cortex then into the limbic area. If there is too much dopamine/dopamine receptprs in the prefrontal cortext, posiitbe sumptoms. If too little, negative symptoms.
Other neurotransmittors
seotonin and low glutamate
Brain pathologies
large ventricles, there since birth so it does not represent deterioration. Prefrontal cortex, smaller amounts of gray matter for lack of illness awarness less activation there and slower metabolis, brain tissue deterioation ehere the brain is smaller in general
where do brain abnormailities come from
destation or birth where there is a raise in rish on those with a predisposition.
Virus and infectios
maternal influenza, genital or reproductive infection, toxoplasmosis
Brain abnormalities in childhood
infections and injuries
Emviornmental factors
SES and family
social factors
enviornmental factor where those in lower social classs have higher changes of being schizophrenic. Does not get worse as you look below classes, there is just a sharp difference in categories.
Sociogeneic hypothesis: those with lower SES have enviornments that foster schizophrenia.
Selective social theory: those with schizophrenia cause people to have lower SES.
SCHIZOPHRENIC MOTHER
type of mother that causes schizophrenia due to being mean, cold, demanding, domimemt, overprotective,etc.
Family factors
mother relatiomships
hostile enviornments are bad for all pathcologies
Percieved criticism
Percieved critcism
measured with expressed expression. important for hospital release. preidcts relapse. bizzare/dangers activits increaes it. both causal and reactive role
etilogy for negative symptoms
prenancy, birth complications, electrodermal responses
etiology for positive symptoms
family hsitory instbailit such as divorce doster home, etc.
Curing/treating
Often treated, not cured
Treatments due to lack of insight of the victim
Involuntary hospitalisation or community treatment.
Goal of treatment
Treat psychotic symptoms with medication, treat cormorbidity, use treatments that are proven to be effective.
Types of treatments
Psychosurgery
Medication
Therapy
Insulin-induced therapy
May cause coma and death
Psychosurgery
Lobotomy, lecotomy
Lobotomy
Cutting the prefrontal cortex from the rest of the brain. For violent behaviour. Makes the person pretty much a zombie with no cognitive thought/capabilities
Leucotomy
More refined version of lobotomy
Antipsychotics and it's types.
Medication for schizophrenia
2 generations
First generation antipsychotics
phenothiazine
Chlopromazine is one of them that calms schizophrenics by blocking dopamine receptors.
Clozapine is for treatment resistent schizophrenia. But it gives extrapyramidal effects.
Extrapyramidal effects
side effects like parkinson's disease
Drooling, twisted posture, chewing movements, dystonia, dyskinesia, etc
Dystonia
Side effect of chlorapine where there is muscular ridgitity
Dyskinesia
Abnormal voluntary or involuntary movement
Tardive dyskinesia
Mouth movements involuntarily suck, lip smack or chin wag.
Finding medications
One medication will not work for everyone. you need a trial-and-error process
Drugs on different types of symptoms
A lot more works on positive sympoms an psychosis but not negative symptoms
What treats side effects of clozapine?
drugs for parkinson's disease, but they are given at a maintenence dosage, just enought for it to work.
Second generation antipsychotics
Chlorzepine, olanzapine, risperidone
Second gen vs first gen anti-psychotics
Same effectiveness but second generation has less side effects.
Psychotherapies
Social skills training, family therapy and EE, Cognitive-brhavioural therapy
Effects of therapy
enhaces effects of anti-psychotics, revents rlapses
Social skills training
Helps succeed in interpersonal situations which inhances functioning.
3 things:
Better recieving skills, better processing skills, appropriate response behaviour.
Now a component for overall schizoprhenia
Family therapy and ee
Education, learn not to blame, learn to moditor the victim, learn communication and problem-solving, expanf social contacts, instill hope.
Cognitive behavioural therapy
Changes maladaptive beliefs and dysfunctional attitudes (like the defeatist attitude) and then use behaviours to further emphasize that.
Good for hallucinations and delusions and negative symptoms because delusions and hallucinations are thought to be because of cognitive styles.
Group CBT does not do the same but has other benefits.
Also good for anxiety, depression and social functioning as well.
Treatment focused on cognitive functions
Treatment enhancement therapy
Utility of scafolding
Cognitive remeditation
Treatment enhancement therapy
Computer based training for memory, attention, problem-solving and social-cognitive skills.
Utility of scafolding
Everyone has a zone of development and what you should be doing is on the same level
Cognitive remediation
improves cognitive performance and psychosocial functioning.
Modern treatment includes
Both medication and therapy.
Early interventions
You need to get on medication as soon as possible. the more time between your first psychotic episode and your medication means higher chances of relapse, more time until remission and more positive symptoms
DUP
Duration of untreated psychosis
Schizophrenia and homelessness
Large portion of the homeless are mentally ill. Over half of those that are mentally ill and homeless have a history of schizophrenia.
Schizoprhenia and jobs
People who have undergone treatment have had trouble getting jobs but getting jobs really help. 20-30 years anf they will be able to look after themselves and participate in society.
CNN effect
Sensationalised stories may overshwdow anti-stigma initiative