9: Schizophrenia & Disorders of Self Flashcards
How did Emil Kraepelin (1856-1926) classified severe mental health problems?
Affective + non-affective categories
What does the category “dementia praercox”, devised by Emil Kraepelin mean?
Senility of the young
- assumed to be a tangible morbid process in the brain = accounting for slide into dementia
- but symptoms assumed unintelligible
What type of behaviours so sufferers of dementia praecox exhibit?
- intellectual impairment
- problems with attention + memory
- hallucinations
- delusions
Who is Eugen Bleuler (1857-1939?
Coined term SZ
- Schizen = slip
- Phren = mind
How did Eugen Bleuler explain SZ?
- Primary disorder
- affect, ambivalence, autism - Secondary disorders
- response to primary disorder
- delusions, hallucinations
What is the diagnostic criteria for SZ?
- need 2 or more of the following (Psychosis)
- delusions
- hallucinations
- disorganised speech
- grossly disorganised or catatonic behaviour
- negative symptoms - emotional flattening + apathy - deterioration of work, relations/ self-care
- continues for at least 6 months
Psychotic xp are key features of what other diagnoses within DSM V and how are they different from SZ?
- Schizoaffective Disorder
- prominent psychotic xp + less mood disturbance - Bipolar affective disorder
- greater emphasis on affect + activity levels
- the manic predominance
- less disturbances of social functioning - Severe depression w/ psychotic symptoms
- greater emphasis on depression
What are the Neo Kraeplinian assumptions of mental illness?
- Boundary clear between sick + normal
- Discrete mental illnesses - not one but many
- Primary focus of psychiatric physicians should be biological underpinnings
What are some positive symptoms?
GAIN
- delusions
- Hallucinations
- Disorganised thinking
- Misperceptions
What are some negative symptoms?
LOSE
- Blunted affect
- Poor initiation + planning w/ task
- Poverty of speech
- Anhedonia
What are some different ways symptoms can be categories?
- Positive
- Negative
- Mood
- Manic
- Anxiety
What is a general problem with diagnosis?
SZ fq = 1%
Chronicity
- SZ patients die younger
-
= people present certain symptoms but they can vary thought time
What is the frequency of SZ?
1% pop
What is the chronicity f SZ?
- SZ patients die younger
- males 5.1 greater mortality
- higher suicide rates
- More physical disease + homelessness
What is the management of SZ with medication like?
- 80/30% relapse rate after 1 yr
- greater affect on acute psychotic symptoms of SZ
What is thought to be the etiology of SZ?
- Convergence of different problems = syndrome, not just a single disease
- Brain abnormalities, although only 1/2 show it
- Stress diathesis Model
- Dopamine Hyp
What support is there for the genetic component of SZ?
1 SZ parent = 10%
2 SZ parents = 45%
= familia presentation
What is there to challenge the genetic component of SZ?
- not 100%
- only 11% cases of SZ have 1/+ parents with same diagnosis
- 37% of all SZ cases = not first/ second degree relative with same diagnosis
(Gottesman + Erlenmeyer- Minling, 2001) - family = genetic + social component
- TWINS
What % of SZ cases have one or more parents with the same diagnosis?
11%
Gottesman + Erlenmeyer- Minling, 2001
What % of SZ cases do not have a first/ second degree relative with same diagnosis?
37%
Gottesman + Erlenmeyer- Minling, 2001
What is the age of onset SZ like?
- build up at adolescent, but does show onset at all ages
- gives clues about what it is about development = higher onset of age
What are the courses + outcome of SZ treatment like?
- Only 15% make 100% social, symptomatic recovery
- ranges from 60/50%
- have to consider treatment method
previous treatment = avoid school/ stressful situations
VS NOW = go back and stay the same
What factors are related to a good prognosis in SZ?
disease process ? or the chronicity emerging before onset of psychosis?
- Late onset
- Obvious precipitating factors
- Acute onset
- Good premorbid social, sexual + work history
- Married
- Family/ personal history of mood disorders
- Good support systems
- positive symptoms
What factors are related to poor prognosis in SZ?
- Young + insidious onset
- No precipitating factors
- Poor premorbid social, sexual + work history
- Withdrawn, autistic behaviour; assultative history
- Single, divorced/ widowed
- Neurological signs + symptoms/ prenatal trauma
- Family history of SZ
- No remission in 3 years; many relapses
Was psychosis thought to be continuous/ discontinuous?
discontinuous esp positive og thought
BUT Hearing voices - a continuum with anomalies of normal xp
= 11% of gen pop xp hallucinations (Tien, 1991)
What did Posey + Losch (1983) find when they asked students if they had any auditory hallucinations?
- most = heard someone call name
- whilst falling asleep
- conversation with dead relative
What is the causal connundrum with SZ (Gilmore (2010)?
- SZ = result of complex interaction between thousands of genes + multiple environmental risk factors
- high comorbidity
not a single disease process
= Stress- vulnerability (Diathesis) Model
(Zubin + Spring, 1977)
SZ has high comorbidity with what other disorders?
- 91% accompanied w/ substance abuse/ mental heal disorders (Judd, 1989)
- Strongest relationship with mood disorder!
Although twin studies do support the genetic factor of SZ, what is its limitation?
MZ
w/ diagnosis = 16.8%
W/OUT diagnosis = 17.4%
What is the new understanding of phenotypes in severe mental illness (eg Ronald et al)?
- Paranoia, hallucinations, anomalous xp all on a continua with normality
- Genetic vulnerability to psychosis + depression shared
- Environmental influences are also common across disorders + play an important role independently + dependently
What is a criticism of the DSM even though there is value in having a label (help/ benefits) Frances + Widiger, 2012?
result of a practical necessity
- not based on causes
- influenced by pharmaceutical industry
- worry more about false negatives than false positives
What are the 2 different types of error?
- False positives (type 1)
- receive a positive result for a test, when you should have received a negative results - False negatives (type 2)
- opposite
What are alternative diagnostic approaches?
- Dimensional
- bipolar, SZ + Schizoaffective disorder explained by 5 dimensions - Trans-diagnostic approach
- Return to all-encompassing psychosis syndrome ( First, Carpenter et al, 2009)
- focus on the specific symptom = no SZ/ bipolar disorder left to explain
What is the advantage of the dimension approach vs categorical?
= continuum of the different aspects eg
ad = people go up and down = explains this
What is a problem with the trans- diagnostic approach?
- people hear not just the symptom investigated but other symptoms
suggestion for why catatonis a common symtom of most SZ patients?
Reposne to thetraditoinal trateent
= institutionaism
What are some traditional treatments for SZ?
- Institutionalism
- Neuroleptic medication
Why do up to 74% of people who take medication for SZ discontinue?
BAD side effects
OLD = movement disorders
NEW = weight
Even though medication can have bad side effects, why is medication still given to SZ patients?
Actually effective for managing symptoms of SZ + relapse
What has been found about the effectiveness of the psychological treatment CBT for SZ in the 2014 NICE meta-analysis?
= small but robust effects on:
- Total + positive symptoms up to 12 months post treatment
- Depression
- Social functioning - some
- Hallucinations - on specific measures
- At risk mental health
Although treatment is available, what big obstacle is there?
difficult to deliver for all those whose need it
What are some current research on CBT in people with psychosis in the UK?
- CBT for psychotic symptoms
- alt to medication + focus on voices - Low intensity targeted intervention for psychotic symptoms
- paranoia = worry, social anxiety - At risk mental states:
- CBT for youth at high risk - Improving social recovery
- can you directly target?
What is the Symptom- disability Gap in early Psychosis?
Medication given when social disability high + symptoms are present
- but later, when symptoms decrease, social disability continues to persist
= need to focus on helping social disability too
What are the advantages of early intervention?
- reduces admissions
- has LT health + economic + social benefits
Before Early Intervention, what was the social recovery at 2 years like (Fowler et al, 2010: Cocchi et al, 2012)?
15% then
NOW = >50%
What are some ongoing studies on early intervention?
- GETUP (Mirella Ruggerie, 2012)
- effectiveness of multicomponent psychosocial intervention VS TAU pragmatic cluster - SUPERDEN (Birchwood, owler, Jones, Singh et al)
- national evaluation of early psychosis - SUPERDEN3 (Fowler et al)
- Trail of social recovery CBT
What is suggested to be a key indicator of social disability across disorders?
Co-morbidity + non-specific psychopathology
= depression + social anxiety
