Schizophrenia Flashcards
What can explain why the voices heard by a patient with schizophrenia often know exactly what to say to hurt him/her?
Voices become a misinterpretation of patient’s inner feelings
- a worrying thought becomes a negative voice
What is the earliest and most famous ‘mad house’ in England?
Bethlem (Bedlam)
- founded in 1247
What happened in psychiatry with the industrialisation?
Psychiatric hospitals were built across Europe and USA
What were the key aspects of asylums during the institutionalisation in the 1800s?
Asylums
- should provide good accomodation
- built in green areas, outside cities
- provide healthier lifestyle to patients
- allow patients to recover away from poor living conditions of Victorian cities
What was the reality of asylums during the institutionalisation in the 1800s?
Terrible conditions in the original ‘Mad houses’
What was the context of the building of asylums in the first half of the 19th century (1808-1845) in England?
- Most major cities decided to build asylums
- Movement to try and do the best for those with mental disease
- Often, quite beautiful buildings
- Initially good conditions and people were well looked after
What was the main difficulty in the asylums during the first half of the 19th century in England?
Lack of patient recovery
- remote location of asylums -> hard for relatives to visit patients
What characterised the deterioration of asylum conditions in the 19th and 20th century?
- Lack of patient discharge
- Mental hospitals began to get overwhelmed with numbers
- > conditions deteriorated
- By 1900s, idea of moral therapy had declined
- The mentally ill were segregated from rest of population
- > patients were forgotten by society
What promoted a better understanding of the differences between patients in mental hospitals in the 1800s?
Mental hospitals allowed doctors to be exposed to different types of patients with a wide spectrum of disorders
-> alienists (now psychiatrists) realised there was different types of people with different types of diseases
What were common mental diseases identified by alienists in the 1800s?
- General paralysis of the insane (illness secondary to chronic syphilis, which caused brain damage)
- Mental handicap
- Alzheimer’s disease
How were Emil Kraepelin and Alois Alzheimer connected?
Alois Alzheimer was in Kraepelin’s department in Germany
What was Dementia praecox?
Disease considered by Emil Kraepelin, currently known as schizophrenia
- he compared it to Alzheimer’s disease
- key difference was its earlier onset
- it differentiated from ‘Manic depressive insanity/psychosis’, with a fluctuating course of frequent relapses, but better prognosis
- worse outcome
Who coined the term schizophrenia in 1911?
Eugen Bleuler
What was Eugen Bleuler’s view on schizophrenia?
- Existence of more than one type of schizophrenia
- More psychological than organic: a neuropathological degenerating disorder
- 4 A’s: autism, ambivalence, loose associations, blunting or incongruity of affect
- more optimistic outcome than Kraepelin
What were the four ‘A’s of schizophrenia defined by Eugen Bleuler?
- Autism: difficulties in social communication
- Ambivalence: uncertainty
- Loose associations: unusual forms of thought
- Blunting or incongruity of affect: in the display of emotions
What the issue with Bleuler’s diagnostic criteria of schizophrenia?
- It was hard to distinguish what the 4 ‘A’s were
- > in the US, there was an emerging over diagnosis of schizophrenia
How is the Kraepelinian view of psychosis, modified by Eugen Bleuler, still used nowadays?
- Dementia praecox -> Schizophrenia
- Manic depressive insanity/psychosis -> Bipolar disorder
What were Schneider’s first rank symptoms as indicators of schizophrenia?
- Auditory hallucinations
- thought echo
- third-person hallucinations
- running commentaries - Thought insertion or withdrawal
- Thought broadcasting
- ‘Made’ acts, thoughts or feelings (via external force that takes over control of the person)
- seen in acute episodes - Delusional perception
- delusional meaning given to a perceived thing
What was Schneider’s view on Bleuler’s characterisation of schizophrenia?
Bleuler’s ideas were too complex for the average psychiatrist to detect reliably
What are positive symptoms in schizophrenia?
Presence of abnormal phenomena
- Delusions: fixed false idea, unshakeable, not shared amongst people from same culture
- Hallucinations: perception when there is lack of stimulus
- Formal thought disorder: disorganised thinking
What are negative symptoms in schizophrenia?
Absence of normal behaviour
- Flat or blunt affect: lack of emotional response
- Cognitive difficulties
- Poverty of speech
- Loss of initiative: lack of motivation for everyday activities (e.g. eating)
- Self-neglect: lack of care for one’s appearance
- Social disinhibition: embarrassing or rude behaviour
What are the rates variations of schizophrenia according to age and gender?
- Tends to affect young people
- Unlikely to occur in older people or children
- Men are most likely to develop psychosis in early 20s
- Women are most likely to develop psychosis later in life
What does the oestrogen theory of later onset of psychosis in women propose?
Oestrogen is protective, hence it is unlikely for women to develop psychosis during their reproductive period
What did Manfred Bleuler propose on the long-term course of schizophrenic psychoses (1973)?
- “Large number of long-standing schizophrenic illnesses”
- “On average, schizophrenia showed no further change for the worse after a duration of 5 years, but rather a tendency to improve”
- > not necessarily a deteriorating disorder
- > different from Alzheimer’s disease
Who was Manfred Bleuler?
- Son of Eugen Bleuler
- he would stay with his dad an play with some of the patients
- after graduating, he went on to medical school to become a doctor and psychiatrist
- he worked and lived at Burgholzli psychiatric clinic in Switzerland
What are the five possible outcomes of schizophrenia?
- One episode only in the lifetime
- One episode every 2 to 3 years (no symptoms in-between)
- One episode every 2 years (no symptoms in-between)
- Several episodes and symptoms continue (no worsening)
- Several episodes and symptoms continue, accumulate and get worse
- accumulation of negative symptoms
In a 10 years follow-up of people with schizophrenia, what was observed about the course and prognosis?
- About 40% will have no psychotic symptoms at 10 years (half will be taking medication)
- About 40% will have relapses (potential degradation of social/work relationships)
- About 20% will go into a chronic form: treatment-resistant
What is the traditional Kraepelinian dichotomy?
Psychosis
- ‘Dementia praecox’: true schizophrenia
- ‘Manic depressive psychosis’: true bipolar disorder
What is usually observed in real life on the traditional Kraepelinian dichotomy?
Often difficult to tell apart schizophrenia from bipolar disorder
- misdiagnosis
- schizoaffective disorder in-between the schizophrenia and bipolar
What is the issue with diagnosing people with schizophrenia?
It is not welcomed by patients
- they often find bipolar diagnosis more positive, with the existence of more available treatment for BD
- stigma around schizophrenia due to generalised perception of those diagnosed being dangerous or violent
- even though vast majority of people with schizophrenia are not dangerous or violent (concerns mostly those with substance misuse)
Why was a dimensional view of psychosis suggested by psychiatrists?
In recent years, dissatisfaction with the diagnosis of schizophrenia
- stigma
- lack of explanation for its onset and outcome
What does the multidimensional approach to the diagnosis of psychosis consist of?
5 factors
- Negative symptoms (loss of motivation, cognitive difficulties, self-neglect)
- Positive symptoms (delusions, hallucinations)
- Manic
- Depressive
- Disorganisation (thought disorder)
What did the SCAN interview study of Demjaha and colleagues (2009) show about psychotic patients?
- 536 first-episode psychotic patients interview with SCAN
- Usual five factors identified (negative, positive, manic, depressed, disorganisation), better when describing people and their responses to different treatments
- Patient’s responses weren’t positive enough to justify abolishing previous diagnoses of schizophrenia and bipolar disorder
- > Best approach: mix of categorical diagnosis with description of the factors
What was the traditional view of schizophrenia?
Discrete categorical disease entity
- ‘sane’ vs ‘insane’
What is the emerging view on schizophrenia and psychosis?
Continuum of psychosis
- in general population up to 15% might have psychotic symptoms
- psychosis is similar to anxiety or depression, in that people experience it at some point in their lives
- schizophrenia is severe psychosis
- some people are not prone to paranoia
- some are in the middle
- some have many psychotic symptoms and need treatment
What does the psychiatric literature suggest on the view of psychosis?
Psychosis as fluctuating matter, such as weight
- in the dimensions, there’s a threshold (cut-off point) that makes the diagnosis of schizophrenia
- factors that induce psychosis and schizophrenia also induce temporary paranoia or other psychotic symptoms in gen pop
- > look at factors within our society that push people into developing psychosis and schizophrenia
