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What is schizophrenia?

Psychotic disorder characterized by major disturbances in thought, emotion, and/or behavior
Disordered thinking in which ideas are not logically related
Faulty perception and attention
Flat or inappropriate affect
Bizarre disturbances in motor activity


How is schizophrenia diagnosed?

No essential symptom must be present for a diagnosis of schizophrenia.
People with schizophrenia can differ from each other more than do people with other disorders.
There is heterogeneity at the empirical and conceptual levels.


What are some of the ways that schizophrenia varies?

People with schizophrenia typically have a number of acute episodes of their symptoms. Some may only have one.
Between episodes, they can have less severe symptoms but still may be very debilitating. Some may develop the symptoms which runs a chronic course.
Most people with schizophrenia are treated in the community; however, hospitalization is sometimes necessary.


What are the different types of schizophrenic symptoms?

Positive - excess
Disorganized – thought disorder
Negative – absence or decrease
Catatonic – excessive motor activity to immobility


What are positive symptoms?

the presence of too much of a behaviour or experience that is not apparent in most people
Defines an acute episode of schizophrenia.


What are delusions? What is the prevalence of delusions among people with schizophrenia? What is the difference between the delusions of schizophrenic people and people with other disorders?

Erroneous beliefs despite clear contradictory evidence.
Abnormal thought content.
Usually involves misinterpretation of perceptions and experience.
Delusions are found among more than half of people with schizophrenia,
Delusions are also found among people with other diagnoses: Notably mania and delusional depression.
The delusions of people with schizophrenia are generally more bizarre. They are highly implausible.


What are 4 common types of delusions?

Belief that one is being tormented, followed, tricked, spied on, subjected to ridicule.
Belief that environmental cues are specifically directed at the individual.
Body Control:
Belief that body or actions are manipulated by outside force.
Delusions of Grandeur:
Belief that individual is famous or important.


What are hallucinations?

The most dramatic distortions of perception
Sensory experiences in the absence of any stimulation from the environment.
Visual, gustatory, olfactory, tactile, or auditory (most frequent)
Like delusions, hallucinations can be very frightening experiences.
Some people report hearing their own thoughts spoken by another voice, voices arguing, voices commenting on their behaviour.


What are disorganized symptoms?

Inappropriate affect
Disorganized speech
Evidence indicates that the speech of many people with schizophrenia is not disorganized and that the presence of disorganized speech does not discriminate well between schizophrenia and other psychoses, such as some mood disorders.
Some clinicians include Catatonic symptoms


What is inappropriate affect?

The emotional responses of these individuals are out of context
These clients are likely to shift rapidly from one emotional state to another for no discernible reason.
This symptom is quite rare, but its appearance is of considerable diagnostic importance because it is relatively specific to schizophrenia.


What is disorganized speech?

Formal Thought Disorder – (form of thought is disorganized) Many different symptoms
Loose associations or derailment
Incoherence or “word salad”


What is catatonia?

Several motor abnormalities; can gesture repeatedly, using peculiar and sometimes complex sequences that often seem to be purposeful, odd as they may be.
An unusual increase in overall level of activity, which might include much excitement, and great expenditure of energy similar to that seen in mania.
Catatonic immobility: clients adopt unusual postures and maintain them for very long periods of time.
waxy flexibility , whereby another person can move the persons ’ limbs into strange positions that they maintain for extended periods.


What are negative symptoms?

Behavioural deficits
Avolition - Lack of energy, will
Alogia - Poverty of speech or content.
Anhedonia - Lack of interest in recreational activities, relationships with others, and sex
Flat affect - a lack of emotional expressiveness
Asociality - Few friends, poor social skills, and little interest in being with others


What is Avolition?

refers to a lack of energy and a seeming absence of interest in or an inability to persist in what are usually routine activities.
may become inattentive to grooming and personal hygiene, with uncombed hair, dirty nails, and disheveled clothes.
have difficulty persisting at work, school, or household chores and may spend much of their time sitting around doing nothing.


What is Alogia?

A negative thought disorder, can take several forms.
In poverty of speech, the sheer amount of speech is greatly reduced.
In poverty of content of speech, the amount of discourse is adequate, but it conveys little information and tends to be vague and repetitive.


What is Anhedonia?

An inability to experience pleasure manifested as a lack of interest in recreational activities, failure to develop close relationships with other people, and lack of interest in sex.
Clients are aware of this symptom and report that normally pleasurable activities are not enjoyable for them.


What is Flat affect?

Virtually no stimulus can elicit an emotional response.
The client may stare vacantly, the muscles of the face flaccid, the eyes lifeless.
flat and toneless voice.
Flat affect is found in many people with schizophrenia.
The concept refers only to the outward expression of emotion and not to the person ’s inner experience, which may not be impoverished at all.


What is Asociality?

severely impaired social relationships
few friends, poor social skills, and little interest in being with other people.
A study of clients from the Hamilton (Ontario) Program for Schizophrenia showed that people diagnosed with schizophrenia have lower sociability and greater shyness
People with schizophrenia also reported more childhood “social troubles.”


What characterizes paranoid schizophrenia?

Delusions or frequent auditory hallucinations.
Delusions are typically persecutory and/or grandiose.
Hallucinations are often related to the delusion.
Usually organized around a theme.
No disorganized speech, disorganized or catatonic behavior, or flat affect.
40% of cases
Good prognosis


What characterizes disorganized schizophrenia? (Hebephrenic)

Disorganized speech, disorganized behavior, and flat or inappropriate affect.
Catatonia is not present.
Hallucinations/delusions do not have a theme.
Poor premorbid personality, early and gradual onset, poor prognosis.


What characterizes catatonic schizophrenia?

Marked psychomotor disturbance:
motoric immobility (stupor or waxy flexibility)
excessive motor activity
extreme negativism or mutism
echolalia or echopraxia

Rare diagnosis in industrialized countries


What characterizes undifferentiated schizophrenia?

Presence of Symptoms but criteria are not met for Paranoid, Disorganized, or Catatonic Type.

Most of the remaining 60% of cases
Catchall category


What characterizes residual schizophrenia?

Used when there has been at least one episode of schizophrenia, but there are no longer prominent positive/disorganized symptoms.

Continued negative symptoms or attenuated positive symptoms.


How did the diagnosis of schizophrenia change in the DSM-5?

DSM-5 includes a dimensional rating of symptoms that enables clinicians to consider the heterogeneity in symptom expression.
Categories were rarely used diagnostically, with the exception of paranoid schizophrenia.


What is Heinrichs and Awad (1993) cluster analysis?

identified subtypes of schizophrenia based on performances on a battery of neuropsychological tests ( included, Wisconsin Card Sorting Test (a test of executive functioning), the Wechsler Adult Intelligence Scale (WAIS), and measures of motor function and verbal memory).
Five subtypes:
normative, intact cognition.
executive subtype, which was distinguished by impairment on the Wisconsin Card Sorting Test;
executive-motor subtype, which had deficits in card sorting and motor functioning
motor subtype, which had deficits only in motor functioning
dementia subtype, which had pervasive and generalized cognitive impairment.

Subtypes differed on other variables, such as duration of symptoms and extent of hospitalization.
A continuing focus on neuropsychological differences may provide important insights into the heterogeneity of schizophrenia.


What are biological theories of Schizophrenia?

Heritability - Neurobiological abnormalities:
Enlarged ventricles (loss of brain cells)
Hypofrontality (Reduced resting metabolism in PFC)
Executive functions and working memory deficits
Lack or pruning or it doesn't occur properly
Prenatal and perinatal stressors:
Viral infection – no real evidence
Nutritional deficiency
Birth complications
Gene-environment interaction
Physical stressors could cause brain abnormalities that lie dormant until late adolescence/early adulthood.


What is the dopamine hypothesis of schizophrenia?

Excessive dopamine activity
Supporting evidence:
L-DOPA can induce psychotic symptoms.
Amphetamines can induce psychotic symptoms.
Antipsychotic drugs are dopamine antagonists.
More likely: increased number of D2 receptors


What is the glutamate hypothesis of schizophrenia?

Reduced glutamate transmission
PCP and ketamine (glutamate antagonists) can induce psychotic symptoms.
Reduced activity of glutamate receptors (NMDA) could lead to neuronal death in some areas.


What is the combined hypothesis of schizophrenia?

Increased D2 receptors => Reduced Glutamate => Reduced NMDA activity
Serotonin has also been implicated


How does contemporary research understand schizophrenia?

research has moved away from trying to find some highly specific “lesion” and is examining neural systems and the way different areas of the brain interact with one another.


What are psychosocial risk factors for schizophrenia?

High stress sensitivity
Urban living and immigration
Schizophrenia is more common in people with low socioeconomic status (SES).
Sociogenic hypothesis (stress causes disorder)
Social drift hypothesis (disorder causes stress and keeps you in a low SES bracket)
Communication Deviance:
Vague, confusing and unclear
Gene-environment interaction
Expressed Emotion (EE):
Criticism, Hostility, Emotional overinvolvement
Relapse (1st year)


What kinds of antipsychotic medications have been used to treat schizophrenia?

First-generation (neuroleptics)
Dopamine antagonists (D2 receptors)
E.g., Chlopromazine (Thorazine), haloperidol (Haldol)
Mainly effective on positive symptoms
Extrapyramidal side effects, tardive dyskinesia

Block broader range of receptors
Ex: Clozapine, Risperidone
Effective on positive and negative symptoms
Less side effects (better compliance)


How is family therapy used to treat schizophrenia?

Goal is to reduce EE in households to which patients return, to calm their home life.
Provides families with communication skills
Education on illness and proper medication.
Encouraged to lower expectations to reduce their criticism toward patient.


How is social skills training used to treat schizophrenia?

Learn skills in specific domains: employment, relationship, self-care (incl. medication), conversation, etc.
Break down tasks to make them less overwhelming for the patient.
Does not necessarily improve global functioning.


What are some other forms of treatment for schizophrenia?

Psychodynamic therapy
Required patient to gain insight into the role that the past played in current problems.
Long term therapy. Often not feasible

Cognitive-behavioral therapy (CBT)
Goal is to decrease symptom intensity, relapse, and social difficulties through “reality checks”
Helpful in reducing positive symptoms

Supportive counselling


What are some common delusions about one’s own thoughts?

Belief that thoughts are controlled.
Capgras syndrome:
Belief that someone a person knows has been replaced by an imposter. May also see himself as his own double.


What is Cotard's syndrome?

A delusion characterized by the belief that one has lost body parts (e.g., blood, internal organs) or even that one has died.