Problem 3

Question 1

Schizophrenia

Answer 1

Refers to a psychotic disorder that involves a breakdown in the relation between

a) thought

b) emotion

c) behaviour

–> that leads to faulty perception + inappropriate actions and feelings and a withdrawal from reality + personal relationships

Question 2

Prevalence of schizophrenia ?

Answer 2

1. 0.5-2% general pop. prevalence

2. Develops in late adolescence/ early adulthood

3. Slight ethnic differences may occur due to differences in socioeconomic status

Question 3

There are 3 types of schizophrenic symptoms.

Name them.

Answer 3

1. Positive symptoms/adding qualities

a) Delusions
b) Hallucinations
c) Disorganized thought or speech
d) Catatonic behavior

2. Negative symptoms/ loosing qualities

a) affective flattening
b) alogia
c) avolition

3. Cognitive deficits

a) attention
b) WM
c) abstract thinking

Question 4

Gender differences surrounding schizophrenia ?

Answer 4

1. Men have an earlier age of onset than women

2. Men experience a more serious form of it with more negative symptoms, women are hospitalized less

–> differences are not yet understood

Question 5

Men with schizophrenia tend to show more severe deficits in language than women.

Why ?

Answer 5

Language is controlled more bilaterally in women

–> as it is more localized in men their deficits are larger

Question 6

People with schizophrenia show deficits in basic cognitive processes.

Name them.

Answer 6

1. WM

–> holding + manipulating info, thus more difficult to ignore irrelevant info and making connections between relevant ones

2. Attention span

–> early marker of the risk for schizophrenia

Question 7

Prodromal vs residual symptoms

Answer 7

Prodromal

–> present before people go into acute phase of schizophrenia

Residual

–> present after they emerge from acute phase

=> during these phases people may have unusual but not delusional beliefs, milder version

Question 8

Are environmental factors important when it comes to schizophrenia ?

Answer 8

Yes,

1. Obstetric complications e.g. premature birth, low birth weight, etc may have an effect on brain development

2. Social Isolation

3. Migrant status

4. Urban life

–> patients with supportive parents do much better than those with hostile ones

Question 9

Can drug abuse cause schizophrenia ?

Answer 9

Yes,

evidence suggests that patients with established schizophrenia smoke more cannabis than the general population

Question 10

Is early recognition of the onset of schizophrenia important ?

Answer 10

Yes,

the longer the period of untreated psychosis, the worse the outcome

Question 11

How does longterm management work in primary care ?

Answer 11

1. A GP will exclusively look after 6 patients
2. Once recovered from an acute episode of schizophrenia, he should remain on prophylactic (vorbeugend) doses of antipsychotic for 1-2 years

3. When symptom free, the drug dose can be gradually reduced

4. When there are signs of relapse the dose has to be increased again

Question 12

Which psychological treatments can help ameliorate schizophrenia symptoms ?

Answer 12

1. Cognitive behavioral therapy

–> should be provided for at least 10 sessions over 3 months

2. Family therapy

–> improves communication between family members

3. Psychoeducation

–> can reduce relapse

Question 13

What is the prognosis for schizophrenia ?

Answer 13

1. 50-80% of people who have previously been hospitalized, will be so again

2. Life expectancy is 10 years shorter

3. Suffer from infectious diseases for unclear reasons

4. No progressive detoriation

–> stabilization within 5-10 years with no relapse

Question 14

Structural + functional brain abnormalities of schizophrenic patients.

Answer 14

1. Enlarged ventricles

–> suggests deterioration in other brain tissue

2. Lower volume density of neurons in

a) PFC

–> less active, connects to the other regions mentioned

b) temporal lobe
c) basal ganglia
d) limbic area

3. Hippocampus

Question 15

Cognitive factors contributing to schizophrenia

Answer 15

Schizophrenic people try to conserve their already limited cognitive resources, by using biases/schemas to understand the load of info they receive

–> delusions arise as a consequence of trying to explain different phenomena

Question 16

Delusion (Positive symptom)

Answer 16

Refer to ideas that an individual believes are true but are highly unlikely

–> often impossible

Question 17

Hallucinations (Positive symptom)

Answer 17

Refer to unreal perceptual experiences

–> may be consistency with delusions

Question 18

Where do the cognitive deficits stem from in schizophrenic patients ?

Answer 18

The reorganization of both structural and functional brain networks, starting off by the production of synoptic connections that spans out from early neurodevelopment into adolescence are disrupted

–> this leads to widespread impairments in neural communication + cognitive deficits

Question 19

Gamma oscillations

Answer 19

Play a major role in determining the architecture of functional brain networks and are linked with a wide range of cognitive abilities in healthy individuals

–> disrupted synchronization in schizophrenic patients

Question 20

Which neuronal processes/abnormalities contribute to the cognitive and negative symptoms of schizophrenia ?

Answer 20

1. Loss of pyramidal cells leads to reduced excitatory activity
2. Reduced excitatory input to GABAergic interneurons leads to reduced inhibition of pyramidal cells
3. Thus there is aberrant gamma activity + dysfunction of functional NWs

Question 21

Dopamine theory

Answer 21

1. Excessive dopamine activity in mesolimbic pathway

–> positive symptoms

2. Usually low dopamine activity in PFC

–> thus negative symptoms

3. Other neurotransmitters also play a role

–> interaction between serotonin + dopamine may be crucial

4. Abnormalities in GABA levels

Question 22

Among persons with schizophrenia who engage in aggressive behavior there are 2 distinct types.

Name them.

Answer 22

1. Those who additionally suffer from conduct disorder (CD)

2. Those who begin engaging in aggressive behavior as the illness onsets

Question 23

Some individuals with no childhood/adolescent history of antisocial behavior engage in physical aggression toward others as the illness onsets.

How can this be explained ?

Answer 23

AGB is a response to increased positive symptoms which reflects an increase in dopamine production that leads to stress dysregulation

Question 24

How can current clinical practices be modified to reduce AGB among people with schizophrenia ?

Answer 24

1. Validated assessments of the risk of violence should be used in FEP clinics once acute symptoms are reduced

2. A past history of AGB along with other risks should lead to a program of treatment to effectively treat schizophrenia

3. Schizophrenic patients need to be encouraged to always report victimization as victimization increases the risk of AGB

4. Patients require

a) housing that keeps them safe

b) programs that teach them how to resolve interpersonal conflicts

Question 25

What is the relation between schizophrenia and violence ?

Answer 25

Schizophrenic patients are more likely than others to engage in AGB

–> they have an even higher risk to kill compared to the general population