Week 11 Lecture 11 - Schizophrenia (DN) Flashcards Preview

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What did an article in 1988 Nature Journal say about Schizophrenia?

arguably the worst disease affecting mankind

1

How did Louis......make a name for himself.....????

anthropomorphising cats in his paintings - represented his progression of schizophrenia

2

How does ALex describe the experience.....

being bombarded by stimuli in the world around them

3

History -
Behaviours referred to as madness - generally charcterise what we refer today as schizophrenic behaviours....
how did ancients treat madness?

if someone displayed these symptoms - possessed by evil spirits
Trephination - drill hole in skull - let evil spirits fly out....

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Trephination

hole drilled in skull

5

Who was Emil Kraepelin?

swiss psychiatrist
first to describe dementia praecox
tried to find patterns in how symptoms cluster together
People he saw generally has early on-set & always deteriorated

6

How did Kraeplin describe dementia praecox?

dementia (deterioration of mental function)
praecox (young people)
- peculiar destruction of internal connections of psychic personality
- course is regular progression
- common form is idiocy
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What was required for a diagnosis of dementia praecox?

early onset
deteriorating course

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8

Who was Yergan Bleuler?

Coined the name Schizophrenia
Shizen - split
phren - mind
thought name dementia praecox was in appropriate
he said - not all patients have deteriorating course
not all patients same but splitting was always present
Coined four A's to define disorder
- Loosening of Associations
- Ambivalence
- Autism (subtle social difficulties)
- Affective disturbance
plus accessory symptoms
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9

what may have coloured the perceptions of Kraeplin at the time?

many of patients they were seeing may have actually had
encephalitis lethargica

10

What was Kurt Schneider's approach to diagnosis of Schizophrenia?

Atherioretic diagnosis of actual symptoms (in contrast to the emerging psychoanalytic theoretical approach of Freud, Jung etc)
First-rank symptoms
Second-rate symptoms

11

What were Schneider's first rate symptoms?

The core features of Schizophrenia or psychosis
1. Auditory hallucinations (hearing voices not really there)
2. Passivity experiences (not in control of own bodily functions)
3. Thought echo (if I think something others will hear it)
4. Thought withdrawal (something is sucking thoughts out of my brain)
5. Thought insertion (some external agent is beaming thoughts into my brain)
6. Thought broadcasting (lots of different people can hear my thoughts)
7. Delusional perception (believing strange things that dont have a basis in reality)

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What were Schneiders 'Second-rank symptoms'?

1. Other disorders of perception
2. Sudden delusional ideas
3. Perplexity
4. Depressive/euphoric mood changes
5. Emotional impoverishment

13

Which study in the 70's examined how diagnostic processes differed between New York & London?
What were the findings?

US UK Cross-National Project 1974
Diagnosed as either Schizophrenia or an Affective Disorder
Project diagnosis was similar in both cities
Clinical (Hospital diagnoses)
- Strong bias to diagnose Schizophrenia in New York
- London clinical diagnoses were similar to project
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14

What did John Feighner et al., propose with regard to diagnostic criteria for Schizophrenia in 1972?

Core features of "definite" schizophrenia
- Delusions, hallucinations or disorganised speach
- Unmarried
- Poor premorbid social/work history
- Family history
- Absence of drugs
- Onset before 40yrs
- Illness must be present for 6+ months

he also had criteria for probable schizophrenia
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15

Why is Robert Spitzer significant in the diagnoses of Schizophrenia?

Research Diagnostic Criteria for Psychosis 1973
Looked at Reliability (inter & intra rater reliability between diagnosticians
IMPT as it became basis for DSM-3
reformed diagnosis as a checklist of symptoms
Spitzer headed task force to develop DSM-3

16

Briefly outline the key people in the development of diagnostic criteria for Schizophrenia.

Kraeplin - emphasised course of illness

Bleuler - started to look at certain core symptoms - 4 A's

Schneider - focussed on symptoms in an atheoretical way (1st rank/2nd rank)

Feighner - focussed on symptoms in an atheoretical way (definite/probable)

Spitzer - RDC (Research Diagnostic Criteria for Psychosis)
& DSM-3 - a menu of symptoms for diagnosis

17

DSM

DSM-3
DSM-4 1994 & DSM-4-TR 2000 (dominated for past 20 years)
DSM-5 2013
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DSM-4 Criteria

DSM-V
2 or more symptoms for 1mnth ( 1 must be 1, 2, or 3) i.e., (primary) 1st ranked symptoms
1. Delusions
2. Hallucinations
3. Disorganised thinking/speech (formal thought disorder)
4. Disorganised/catatonic behaviour
5. Negative Symptoms

Qualifiers
Only 1 required if delusions are BIZARRE or hallucinations give RUNNING COMMENTARY or >1 voice
Symptoms have to cause social/occupational dysfunction
Continuous disturbance >6 mnths (otherwise diagnose as schizophreniform (1mth)
Cannot be explained by drug use


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19

Why is there am arbitrary 6 month time frame for symptoms in order to get a diagnosis of schizophrenia?

Diagnosis can be quite unstable in early stages

20

What is the main difference between DSM-4-TR & DSM-5 classifications of Schizophrenia?

Pretty much the same except:
DSM-4-TR included Paranoid, Catatonic, Undifferentiated and Residual sub-types - these have been removed from DSM-5

21

What is the difference between diagnoses in an individual having experienced symptoms for >1month and an individual >6months

>1 month - Schizophreniform
>6 months - Schizophrenia

22

How are the symptoms of Schizophrenia split in the DSM?
Are both symptom types required for a diagnoses?

Positive Symptoms
Negative Symptoms

No both are not required.
Positive & Negative symptoms = Diagnosis
Positive but no negative symptoms = Diagnosis
Negative but no positive symptoms = No diagnosis

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Positive Symptoms

Symptoms in excess or normal experience
- Delusions
- Hallucinations

24

Delusions

Persecutory
- others are trying to harm (most common)
Referential
- belief that external stimuli are directed to oneself
Grandiose
- belief in ones own exceptionality
Erotomanic
- false belief that another is in love with him/her
Nihilistic
- belief that a major catastrophy will occur
Somatic
- preoccupations with health/organ function
Bizarre - implausible e.g., thought withdrawal. insertion & delusions of control (e.g., alien control over hand)

25

Hallucinations

Most commonly Auditory
but can occur in any modality Visual, Olfactory, Auditory, Somatosensory

Own voice spoken by another
Multiple voices arguing or keeping running commentary
Command hallucinations
Most often derogatory
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What type of auditory hallucinations most commonly come to clinical attention?

Derogatory

27

What is the DSM-4 & 5 criteria for
Disorganised Symptoms?

Disorganised thinking (revealed through speech content)
- Derailment or loose topic switching
- Tangentiality (irrelevant answers)
- Incoherence

Disorganised behaviour - silliness, agitation, difficulty with goal-directed behaviour

Catatonia (rarer) - unresponsive

Above combined are Psychosis defines Shizophrenia
These may be features of other disorders
It is particular combination leads to diagnosis of Schizophrenia

28

What is an important point when considering Psychosis & Schizophrenia?

If one is Psychotic they do not necessarily have Schizophrenia
but
If one has Schizophrenia, they have to have had a Psychotic episode

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Negative symptoms

Deficits of normal experiences or behaviour
account for the most burden
family find these most troubling - WITHDRAWAL
Common features
- Diminished emotional expression: reduction in facial exp., eye contact, prosody, mvts
- Avolition: decrease in self initiated activities
- Alogia: diminished speech output
- Anhedonia: decreased ability to feel pleasure from positive stimuli
- Associality: lack of interest in social activities

Specifiers
based on Chronicity & Acuteness
i.e., first episode, multiple episodes, continuous
Acute, partial, partial remission, remission

specify if with Catatonia

Severity - 4pt scale

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