Schizophrenia 1

Question 1

What are the systems level challenges of Schizophrenia?

Answer 1

Psychosis difficult to understand at the level of brain

Evidence that activity in large brain systems (such as auditory) leads to conscious experience

Evidence that SZ associated with auditory cortex abnormalities

Unclear mechanisms

Question 2

ICD10 and DSMV criteria for SZ are heavily influenced by who’s descriptions?

Answer 2

Schneider

‘First rank symptoms’

Question 3

Describe Schneider’s first rank symptoms for ‘delusion’

Answer 3

Delusional percept

Question 4

Describe Schneider’s first rank symptoms for ‘auditory hallucination’

Answer 4

Audible thoughts

Voices arguing or discussin

Voices commenting on the patient’s action

Question 5

Describe Schneider’s first rank symptoms for ‘thought disorder - pssivity of thought’

Answer 5

Thought withdrawal

Thought insertion

Thought broadcasting (diffusion of thought)

Question 6

Describe Schneider’s first rank symptoms for ‘ passivity experiences - delusion of control’

Answer 6

Passivity of affect (‘made’ feelings)

Passivity of impluse (‘made’ drives)

Passivity of volition (‘made’ volitional acts)

Somatic passivity (influence playing on the body, eg. alien penetration)

Question 7

What are Hallucinations?

Answer 7

In SZ very commonly auditory

Not an auditory misperception - sounds like real speech in external space

Question 8

What are Delusions?

Answer 8

Fixed rigidly held belief

Not understandable on basis of patient’s background

• dominates thinking
• often bizarre
• usually has a reason for importantce
• Not eccentric ideas or suspicion

Question 9

What are negative symptoms?

Answer 9

Persistent loss of usual activities, interests

-apathy, speech reduction

Social withdrawal, impaired attention, anhedonia, lethargy

Can be very disabling and non-responsive to therapy

Not due to modd disorder or drug side-effects

Question 10

What are Passivitiy Phenomena?

Answer 10

Patient’s belief that they are not in control of heir actions, feelings, thoughts

External agent controlling them to act, feel or think

Relatively rare in actual patients with SZ

Question 11

Decribe the arguments for explaining the experiential abnormalities of SZ (2)

Answer 11

Hallucinations and delusions - Salience (Kapur)

passivity phenomena - Agency (Voss)

Question 12

The concepts of brain abnormalities and abnormal sailence and agency can be presneted though what theory?

Answer 12

Whitford’s theory

2012

Question 13

Summarise Whitford’s theory 2012

Answer 13

(1) SZ arises from incompletely undestood genetic trigger
(2) Myelin structural abnormality
(3) Functional disconnection leads to corollary discharge mechanisms
(4) Self-generated APs not ‘tagged’ as internally generated

Leading to 1st rank symptoms with abnormal sense of agency

(5) Brains response to constantly experiencing unexpected internally generated events is to increase dopamine ‘noise’: hyperdopaminergia

Treatable with DA blockers

(6) A factor influencing axon survival through adolesent pruning is synchroniciity. Abnormal myelination could lead to synapse loss: GM abnormalities