1. Schizophrenia Flashcards
positive symptoms
hallucinations, experiences of influence, passivity or control (though withdrawal, insertion broadcasting), Delusions (grandeur, persecution)
weaker verions of the core symptoms
prodromal symptoms
negative
do not experience typical emotional highs and lows
flat effect
negative
not able to carry out a goal directed behaviour
avolition
negative
lack of spoken language
alogia
negative
inability to experience pleasure
anhedonia
age of onset
earlier for males: early to mid 20s
females: late 20s
late onset (more common in females): 40s
persecutory ideation – freeman
The belief (without any evidence) that other people are being hostile towards you, or that they have negative feelings towards you.
It can lead to complete social withdrawal and an inability to maintain usual activities due to the fear of hostility from others.
Interpersonal Sensitivity - freeman
A tendency to focus on feelings of personal inadequacy or inferiority and a feeling of marked discomfort during interpersonal interactions
freeman aim
Whether neutral, non-threatening avatars could provoke persecutory thoughts in people with no previous clinical diagnosis
Whether this was more common in people with higher levels of paranoia and emotional distress
methodology — freeman
Correlational study
Based on quantitative data gathered via questionnaires
Qualitative data was collected in semi-structured interviews, and scored later to provide further quantitative data
sample – freeman
12 male and 12 female
Paid volunteers
Mean age=26
Recruited from University College, London, UK
All mentally well
21 students and 3 administrative staff
freeman questionaires
Brief Symptom Inventory (BSI)
a 53-item questionnaire to assess mood, anxiety and psychotic symptoms in the last 7 days
two 20-item self-reports which measures ideas of persecution and reference:
The Spielberger State Anxiety Questionnaire (scale on 1 not at all to 4 very much so)
The Paranoia Scale
15-item VR-Paranoia Questionnaire, which measured persecutory thoughts, ideas of reference and positive beliefs about the avatars.
conclusions – freeman
Emotional processes linked to anxiety and interpersonal sensitivity contribute directly to the development of persecutory ideation
VR holds ‘great promise’ as a way of helping individuals evaluate and reduce persecutory ideation and delusions
data gathered for ICD-11
The ICD-11 encourages both idiographic and nomothetic approaches; data about symptoms is gathered through:
A clinical interview regarding the individual’s experiences (idiographic)
The clinician also rates each of the six-dimensional descriptors on a four-point scale (nomothetic)
Concordance Rate (MZ and DZ) - Genetic Explanation - Classic Research
the probability of two people with the same genes getting the same disease:
monozygotic (MZ) twins - 42%
dizygotic (DZ) twins - 9%
genes that come in different forms
also. GWAS
polymorphic
schizo is a polygenic disorder
Genome-Wide Association Studies
COMT gene
During cell division a whole strands of DNA can become duplicated/even deleted
e.g. in DiGeorge syndrome, a strand of DNA is deleted from a chromosome
This has been linked to the deletion of a specific gene called COMT
COMT codes for an enzyme which breaks down neurotransmitters (such as dopamine)
the absence of COMT could be partially responsible for the complex neurochemical imbalances that seem to underpin the symptoms of schizophrenia
DISC1 gene and evidence
the ‘disrupted in schizophrenia’ increases the risk of schizophrenia due to its association with the neurotransmitter GABA
GABA is an inhibitory neurotransmitter which helps to regulate activity in neural circuits that communicate via dopamine and glutamate
An abnormality of this gene could increase vulnerability to excess dopaminergic activity and subsequent symptoms of schizophrenia
Eg: In a large Scottish family with an unusually high rate of schizophrenia, 34 family members carried the DISC1 gene
The Dopamine Hypothesis: two mechanisms in which we could have excessive amounts of dopamine
excess L-Dopa (the substance that dopamine is made from)
synapses that use dopamine may also be overactive due to differences in the number of receptors on the postsynaptic cell
cognitive explanations
Errors in self-monitoring Patients fail to recognise that their perceived hallucinations are in fact just inner speech. They attribute what they are hearing to someone else (a voice speaking to them from an external source)
Difficulties with mentalising (believe that others have the same opinion of them as they have of themselves, neutral behaviour may be misinterpreted as hostility)
Thinking errors and biases (tend to draw conclusions based on insufficient evidence and show a bias against counter-evidence)
Typical antipsychotics - what and side effects
Biochemical treatments
The first of these drugs was called chlorpromazine - blocks dopamine receptors on the postsynaptic cell, without activating them → less dopamine activity
dopamine antagonists - effective in reducing positive symptoms of schizophrenia
side effects:
can be unpleasant, debilitating and even fatal, Dizziness, drowsiness and restlessness are common, as well as nausea, constipation and excessive weight gain
uncontrollable blinking, jerking and twitching of the face and body)
Atypical Antipsychotics what and side effects
Biochemical treatments
These drugs block both dopamine and serotonin (an inhibitory neurotransmitter ) receptors.
Ex: clozapine and risperidone
Effective in reducing both negative and positive symptoms of schizophrenia
The rapid dissociation allows for normal dopamine transmission to take place → fewer side effects
side effects:
Clozapine can cause agranulocytosis (a potentially fatal blood condition, although the risk is minimised through regular blood counts)
The Texas Medication Algorithm Project (TMAP)
Designed to assist doctors in the prescription of antipsychotics.
- using an atypical drug, such as risperidone
- if this does not work to move onto a typical drug, such as haloperidol, or olanzapine
- if the person still does not find any relief, clozapine may be trailed.
- final stages of the TMAP include combining antipsychotics with other types of medication, such as mood stabilisers like lithium.
- Once doctors have exhausted their options with medications, they may move onto the use of electroconvulsive therapy
Randomised control trials (RCTs)
a study where the participants are randomly assigned to either the treatment or the control condition
Used to research the use of antipsychotic drugs
These trials are often double-blind placebo controlled
ECT - What it does, anasthesic
Involves delivering electrical pulses (70-150 volts, up to 1 second) to one or both sides of the brain via electrodes placed on the scalp, with the intention to induce a controlled seizure of up to one minute. It is used in addition to medication, for people who are treatment-resistant.
it is believed the shocks trigger the release of neurotransmitters like dopamine and serotonin
administered under general anaesthetic using muscle relaxants (the person cannot be injured during the seizure and has no recollection of the procedure)
Applied unilaterally to the non-dominant hemisphere only, to reduce memory loss
Cognitive-Behavioural Therapy
Psychological Treatment
a therapeutic alliance.
Thoughts - Physical Sensations- Emotions - behaviours
aims to develop coping skills, including stress management, and helps identify early warning signs (prodromal symptoms)
Psychoeducation
Focusing very much on present issues, as opposed to past life events, the therapist helps the person to explore how thoughts are interlinked
decompensation
remission
decompensation - breakdown in an individual’s defence mechanisms resulting in progressive loss of functioning or worsening of psychiatric symptoms
Remission: a reduction in symptoms to the point where the person no longer meets the threshold for diagnosis
sensky conclusion
CBT was more effective than befriending
Patients continued to improve post-treatment to follow-up, unlike befriending, where initial improvements were no longer at follow-up
The dopamine deficiency hypothesis
The brain compensates for low levels of dopamine by increasing the number of receptors on the postsynaptic cell (upregulation)
