Lecture 8 - Schizophrenia Flashcards
(22 cards)
History of Schizophrenia
Greisinger, Morel, Kraeplin, Blearier -> Many psychoses vs. unitary psychosis -> 1850s-1900s
Schneider -> Dementia praecox, manic pressive insanity -> 1900s
DSM-1, ICD-6-7 -> Schizophrenia, secondary schizophrenias, e.g. Pellagra, encephalitis, lethargica -> 1950s
DSM-11, ICD-8 -> Broad schizophrenia concept (latent pseudo-neuortic) -> 1960s-1970s
DSM-III, ICD-9 -> very narrow schizophrenia concept -> 1970s-1980s
DSM-III-R & DSM-IV, ICD-10 -> mildly broadened schizophrenia/psychosis concept -> 1990s
DSM-5 and beyond, ICD-11 and beyond -> toward deconstructing sz or psychosis, dimensions and intermediate phenotypes -> 21st century
Schizophrenia
Psychological disorder involved severely distorted beliefs, perceptions, and thought processes
Diagnosed when two or more of characteristic symptoms
- at least one symptom must be delusions, hallucinations, or disorganised speech
- diagnosed either with or without catatonia (movement issues)
- DSM-5 diagnostic criteria -
Section A: - characteristic symptoms. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated_. At least one should include 1-3
1. delusions
2. hallucinations
3. disorganised speech (e.g. frequent derailment or incoherence)
4. grossly disorganised or cationic behaviour
5. negative symptoms (i.e. diminished emotional expression or avolitition)
Section B: - social/occupational dysfunction: for a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to onset (or when onset is in childhood or adolescence, their is a failure to achieve expected levels of interpersonal, academic, or occupational functioning)
Section C: - Duration: continuous signs of the disturbance persist for at least 6 months
- this 6 month peered must include at least 1 month of symptoms (or less if successfully treated) that meet criterion A (i.e. active-phase symptoms) and mat include periods of prodromal or residual symptoms
- during these prodigal or residual periods, the sings of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g. odd beliefs, unusual perceptual experiences)
Multilevel process for diagnosing sz:
- symptoms (postive/negative) - reduction in functioning (e.g. work, relationships, self-care)
- symptoms exists for 6 months, 1 month of positive symptoms
- rule out symptoms found in other dispersers
~ mania
~ depression
~ drug abuse
Subtypes
DSM-5 removed classification of subtypes
- paranoid subtype
- disorganised subtype
- cationic subtype
- undifferentiated subtype
- residual; subtype
Positive symptoms
Delusions (false beliefs)
- can lead to dangerous behaviours
Hallucinations (false perceptions)
- can be indistinguishable from reality
Disorganised thought processes, speech and behaviour
Delusions
Persecutory delusions
- beliefs about being followed or watched, suavely by agents of authorities such as the FBI or the government
Grandiose delusions
- beliefs about being a famous or special person (e.g. being the president or royalty)
Delusions of reference
- believing that other are talking about them
Delusions of though control
Somatic delusions
- believing you have a physical defect or physical abnormality
Hallucinations
People might see, hear, taste, smell or feel something that others don’t perceive
- hearing voices or other sounds (called auditory hallucinations) is the most common altered perception
- followed by visual hallucinations (seeing things that aren’t there)
The hallucinations may tell the person to perform certain acts or may be frightening
How coming types of hallucinations are:
- auditory - 63%
- visual - 27%
- tactical - 15%
- smell/taste - 11%
Disorganised behaviour
Disorganised speech
- lack of association between ideas and events
- “loose associations” or “word salads”
Disordered behaviour
- unusual, odd or repetitive behaviours and gestures
~ e.g. head banging, finger flapping or tracing a pattern
- childlike silliness, inappropriate sexual behaviour (such as public masturbation), or difficulty maintaining hygiene
Catatonia
Cationic stupor
- absence of motor behaviours, totally motionless and rigid
Catatonic excitement
- agitated, fidgety, shouting, swearing or moving rapidly
Either can last for hours
Negative symptoms
Deficits in behavioural or emotional functioning
Symptoms can occur in combination
- flat affect
- alogia (reduced speech)
- avolition (lack of follow through)
Flat effect
Lack of emotional expression
- passive, with immobile facial expressions
- vocal tone does not change
- does not respond to events with emotion
- speech lacks the inflection that communicates mood
How common are the different symptoms
Postive:
- delusions = 81%
- hallucinations = 58%
- disorganised thoughts = 22%
Negative:
- flat affect = 65%
- alogia/poverty of speech = 30%
- avolition/apathy = 85%
Prevalence
200,000 new cases are diagnosed in US per year
Approx 1 million Americans treated annually
- 1% of US population will expense at least one episode
- most cultures correspond very closely to the 1% rate
~ England is supposedly around 0.5% (NHS, 2016)
- Psychotic disorder in the past year (2007 and 21014 combined) -
16-24: - men = 0.2%
- women = 0.5%
25-34: - men = 0.3%
- women = 0.8%
35-44: - men = 0.99%
- women - 0.95%
45-54: - men = 0.5%
- women = 0.45%
55-64: - men = 0.65%
- women = 0.75%
65-74: - men - 0.1%
- women = 0.3%
75+: - men = 0
women = 0.19% - House hold type (all adults) -
Living alone: - men = 1.4%
- women = 0.9%
Living with children: - men = 0.55%
- women = 0.65%
Living with adults, no children: - men = 0.25%
- women = 0.5%
- Ethnic group (all adults)-
White: - men = 0.3%
- women = 0.7%
Black: - men = 3.25
- women = 0%
Asian: - men = 1.3%
- women = 0.4%
Mixed/other - both = 0%
- Employment status (16-64 year olds) -
Employed = 0.1%
Unemployed = 0.6%
Economically inactive = 2.25%
Temporary or chronic
Onset typically occurs during young adulthood
- 25% of those who experience sz recover completely
- 25% experience recurrent episodes
- 50%, sz becomes a chronic mental illness, and the ability to function may be severely impaired
Spectrum and related disorders
Schizophrenia -> as already discussed
Brief psychotic disorder -> delusions, hallucinations, disorganised thinking and speech, abnormal moot behaviours and negative symptoms lasting for less than a month
Schizophreniform disorder -> delusions, hallucinations, disorganised thinking and speech, abnormal motor behaviour and negative symptoms lasting for at least 1 months but last than 6 months
Schizoaffective disorder -> delusions, hallucinations, disorganised thinking and speech, abnormal motor behaviours and negative symptoms along with those of a major mood disorder (major depressive or manic)
Substance/Medical induced psychotic disorder -> delusions or hallucinations related to drugs or medications
Psychotic diorder due to another medical condition -> delusions or hallucinations related to a medical condition
Catatonic disorder due to another medical condition -> abnormal activity of the motor system such as stupor, holding of a posture, mutism, mannerisms or grimacing related to a medical condition
Unspecified catatonia -> as above, just not due to the medical condition
Other specified schizophrenia spectrum and other psychotic behaviour -> delusions, hallucinations, disorganised thinking and speech, abnormal motor behaviours and negative symptoms that don’t meet the criteria for other categories
Unspecific schizophrenia and other psychotic disorder -> as above
Delusion disorder -> presence of delusions for 1 month or longer without criteria for another sz spectrum disorder
Genetic factors
Family, twin and adoption studies
- 50% risk for a person whose identical twin has sz
- rate not close to 200% as might be expected
- if biological parents of an adopted individual had sz, there is a greater risk to develop sz
Sz clusters in certain families
- the more closely related a person who has sz, the greater the risk of sz
Social factors
Higher change of developing if raised in a psychologically disturbed environment
Genetic factors
Chromosomes associated with genes that influence brain development, memory, and cognition seem rated
- no specific pattern of genetics can be identified as “cause” of sz, but presence of variations increase susceptibility
- bipolar disorder and sz might share genetic origins
Other factors
Parental age
- sz caused by mutation in the sperm of fathers
- age increases the rate of mutation
- compared to fathers younger than 25 Years
~ 45-49: 2x as likely
~ 50+ years: 3x as likely
Mother’s age made no difference
Biological factors
Abnormal brain structures
- 50% of people with sz show some type of brain abnormality
- most consistent finding: enlargement of the ventricles
- loss of grey matter tissue and lower overall volume of the brain
~ gray matter = cell bodies
~ white matter = myelinated axons
Adolescents with early-onset
- severe loss of grey matter and correlated symptoms
- pattern of loss mirrored progression of neurological and cognitive deficits
Default mode network
- Parts of brain active under wakefulness; rest (e.g. daydreaming)
- normally, we switch between this and execution functioning
- people with sz tend to stay in default mode network
Sz and the brain
- suppression of default mode network absent
- weaker connections between brain areas
- hallucinations due to dysfunction of areas
Issues with neurotransmitters
- activity of dopamine neurones
- dopamine imbalance hypothesis
- Glutamate linked to psychotic-like symptoms
Biological factors not conclusive
- some people with sz do not show brain structure abnormalities
- evidence is correlated
- brain abnormalities seen in other mental disorders
Antipsychotic medications
1954 discovery of chlorpromazine (Thorazine)
- reduces agitation, hostility, aggression, hallucinations, delusions
- increases time between hospitalisations
- does not change negative symptoms and cognitive deficits
Side effects of Thorazine and other “typical” drugs
- tardive dyskinesia (movement disorder)
~ involuntary movement of lower face, limbs
~ affect dopamine neurotransmitters
- weight gain
Atypical medications
Began to be introduced around 1990
Advantages
- less likely to cause movement-related dopamine side effects
- more effective in treating the negative symptoms of sz
Disadvantages
- weight gain, diabetes, cardiac problems
- no greater improvements than with older antipsychotics
Issues with general antipsychotics:
- do not cure sz
- unwanted side effects
- “revolving door” pattern of hospitalisation discharge and rehospitalisation
Psychosocial interventions
Family interventions reduce relapse and hospitalisations
- provide practical emotional support to family members
- provide information about support served
- help family develop model of sz
~ modify unhelpful, inaccurate beliefs about sz
- enhance positive communications
- involve everyone in replace prevention plan
Cognitive behavioural therapy
- importance of individual’s interpretation of psychotic events
- understand client’s interpretation of past and present events
- normalise and reduce impact of symptoms
Early intervention
- seek out high-risk individuals
- develop cognitive skills to increase attention, memory, executive control, and other cognitive processes
