Psychosis (Week 10 / Chapter 14) Flashcards
Early Figures in Diagnosing Schizophrenia
Emil Kraepelin (1899)
Eugen Bleuler (1908)
Earliest categorization of schizophrenia
▪ He combined previously distinct disorders of insanity:
– Catatonia
– Hebephrenia
– Paranoia
- Into Dementia praecox: used to capture this cluster of symptoms;
thought that had the same underlying cause; later added
hallucinations, delusions, negativism, and stereotyped behavior - Manic Depressive Illness
Emil Kraepelin (1899)
Swiss psychiatrist, introduces the term
Schizophrenia form “split (skhizen) mind (phren)”
– They can’t connect one idea/experience/perception to the next
– “Associative splitting” of personality functions – there is a
disconnection/ a “breaking of associative threads”
– Associations allow us to think and function efficiently, if there is a
breakdown, there is a breakdown of thought and other processes
Eugen Bleuler (1908)
Bleuler agrees Schizophrenia is heterogenous
but…
Remember Kraeplin was someone who focused on early adverse
experiences
▪ Bleuler: this is a thought disorder that connects all the symptoms into a
heterogeneous presentation
▪ Several behaviours or symptoms not shared by all people given
diagnosis of schizophrenia
▪ Clusters of symptoms identified: Positive symptoms (include
delusions and hallucinations); negative symptoms (deficits e.g.,
diminished emotional expression), disorganized symptoms or
catatonia (rambling speech, erratic behavior).
– So much variability in presentation
▪ Is schizophrenia really a thing? Construct validity?
▪ Is it best used an umbrella term, e.g., schizophrenia spectrum
disorder?
Polythetic disorder
▪ Group of diagnoses related to schizophrenia
▪ DSM‐5 includes a dimensional assessment of symptoms on a 0–4 scale
– 0 indicated no symptoms
▪ The symptoms of schizophrenia can be divided into “positive,”
“negative,” and “disorganized.”
▪ Positive symptoms: are active manifestations of abnormal behaviour, or
an excess or distortion of normal behaviour, and include delusions and
hallucinations.
▪ Negative symptoms: involve deficits in normal behaviour, in such areas as
speech, affect, and motivation.
▪ Disorganized symptoms: include rambling speech, erratic behaviour, and
inappropriate affect.
Schizophrenia spectrum disorder
50%–70% people with schizophrenia experience ________
symptoms: hallucinations, delusions, or both
Positive Symptoms
Delusions
▪ A disorder of thought content
– Delusion of grandeur
– Delusions of persecution
– Cotard’s syndrome
– Capgras syndrome
Hallucinations
▪ Experience of sensory events
without input from
surrounding environment
▪ Auditory hallucinations:
hearing things that aren’t
there
– Associated with listening to
own thoughts
– Abnormal activation of primary
cortex
– Increased metabolic activity in
left auditory cortex (C
Negative Symptoms of Schizophrenia
▪ Absence or insufficiency of normal behaviour
▪ Seen in approximately 25% with schizophrenia
▪ Avolition
▪ Alogia
▪ Anhedonia
▪ Asociality
▪ Affective flattening
inability to initiate/persist in activities
Avolition
absence of speech; brief replies
Alogia
lack of pleasure experienced
Anhedonia
lack of interest in social interactions
Asociality
no open reaction to emotional
situations
Affective flattening
Disorganized Symptoms
– Disorganized speech
– Inappropriate affect and Disorganized behaviour (ie; laughing or crying at inappropriate times)
- Catatonic immobility
keeping body and limbs in
the position they are put in by someone else
Catatonic immobility
communication problems in schizophrenia
Disorganized speech
DSM5TR Schizophrenia
Text / Slide
STUDY SCHIZOPHRENIFORM/SHIZOAFFECTIVE/DELUSIONAL DISORDER DSM-5
TEXT / SLIDE!
Prevalence and Causes of Schizophrenia
Statistics
– 0.2% to 1.5% in general population
– less than average life expectancy
– Men and women affected at same rate
Development
– Age of onset: Onset of schizophrenia is greatest in early
adulthood and declines with age for males, whereas the
reverse is true for females.
– Early brain damage cause?
Natural History of Schizophrenia
SEE SLIDE / TEXTBOOK
Prevalence and Causes of Schizophrenia: Cultural Factors
– Cultural norms
– Cultural variations
– Stereotypes and bias: misdiagnoses
– Treatment outcomes are better in poorer countries
Prevalence and Causes of Schizophrenia: Genetic Factors
Genetic Influences
▪ Multiple gene variances combine to produce vulnerability
Family Studies
▪ Children of schizophrenic parents likely to have it too
▪ Seen within families
▪ Predisposition may be inherited
Twin Studies
– Genain quadruplets
– All four of the identical quadruplets developed
schizophrenia (same genes, same environment)
– Time of schizophrenia onset, symptoms, diagnoses,
course, outcomes differed from sister to sister
Adoption Studies
▪ Gene‐environment interaction observed
Offspring of Twins
▪ 1.7% of children with nonschizophrenic parents develop
schizophrenia
Gene‐Environment Interaction
▪ Genes may act as vulnerability factors
▪ Interact with specific environmental pathogens at crucial
developmental stages
▪ Leading to development of schizophrenia
Linkage and Association Studies
▪ Genetic risk may arise from a large number of
common genes
▪ Each has a small effect that might be detected by
genome‐wide association studies
The Search for Markers
▪ Eye‐tracking deficit may be a marker for
schizophrenia
Evidence for Multiple Genes
▪ Schizophrenia involves more than one gene; located
at different sites throughout chromosomes
▪ This is referred to as quantitative trait loci
a region of DNA associated with a specific phenotype or trait that varies within a population. “different sites within chromosomes”
quantitative trait loci
Prevalence and Causes of Schizophrenia: Neurobiological Influences
Dopamine
▪ Clues to the role of dopamine in schizophrenia:
– Neuroleptics (dopamine antagonists) effective in treating
– Neuroleptics produce negative side effects
– L‐dopa (agonist) produces schizophrenia‐like symptoms
– Amphetamines, which activate dopamine, can worsen some
symptoms in schizophrenia
Brain Structure
▪ Abnormally large lateral and third ventricles in people
with schizophrenia
▪ Hypofrontality (less active frontal lobe)
– Associated with negative symptoms
▪ Brain damage
Viral infection
▪ In utero events may be associated with schizophrenia
▪ Prenatal brain damage
Prevalence and Causes of Schizophrenia: Psychological and Social Influences
Stress
▪ Retrospective and prospective approaches to
examine impact of stress
▪ Tendency for people with schizophrenia to be
found in lower social classes
▪ Sociogenic hypothesis
▪ Social selection hypothesis
Families and Relapse
▪ Schizophrenogenic: mothers with cold, dominant,
rejecting nature
▪ Double bind: conflicting messages
▪ Expressed emotion (EE): disapproval, animosity,
intrusiveness
– Predictor of relapse
Causal Model of Schizophrenia
SEE TEXT VERY IMPORTANT!!!
Treatment For Schizophrenia: Biological Interventions
Neuroleptics: dopamine antagonists
▪ When effective, neuroleptics help people think more
clearly
▪ Reduce or eliminate delusions and hallucinations
▪ Effective for 60%–70% persons who try them
▪ Newer antipsychotics have fewer side effects (TD)
▪ Help in improving cognitive functioning
▪ Transcranial magnetic stimulation (TMS) depolarize
neurons depolarize, generating action potentials
▪ Some support negative symptoms treated with TMS to
the left dorsolateral prefrontal cortex, and positive
symptoms treated with TMS to left temporoparietal
cortex (Cole et al., 2015) but mixed findings too especially
for positive symptoms (Marzouck et al., 2020)
▪ Effect is brief
NICE Treatment Guidelines (2014): after
an acute episode of psychosis or schizophrenia
▪ Offer oral antipsychotic medication in conjunction with a psychological
intervention (which can be started either during the acute phase or later)
▪ Cognitive behavioural therapy offered to all people with psychosis or
schizophrenia
– CBT‐S: across 40 studies (Bighelli et al., 2018) CBT reduced positive symptoms in moderately ill
patients more than inactive control, treatment as usual and supportive therapy with effect
sizes from low to medium range
▪ Family intervention offered to families of people with psychosis or
schizophrenia who live with or are in close contact with the service user.
▪ Psychosocial intervention for medication‐taking compliance
Prevention of Schizophrenia / Psychosis
▪ Identify and treat children who may at risk for
developing schizophrenia
▪ Identify instability in early family‐rearing
environment
▪ NICE Guidelines (2014): those at increased risk of
developing psychosis ‐ offer individual cognitive
behavioural therapy, with or without family
intervention
