Schizophrenia

Question 1

Definition of schizophrenia

Answer 1

A collection of signs and symptoms of unknown aetiology, predominantly defined by observed signs of psychosis. Complex mental health disorder charactised by an array of symptoms inc: delusions, hallucinations, disorganised speech or behaviour, impaired cognitive ability, hard to take the perspective of another person

Question 2

Schizophrenia - a look back:

Answer 2

Century ago there was large public institutions for serious mental illnesses, tuberculosis and leprosy, of the three only SZ remains unchanged in prevalence, could be due to: stigma, challenges treating a mental illness compared to physical and not having a full understanding of the brain and it’s mental processes

Question 3

Schizophrenia: statistics

Answer 3

Sustained recovery occurs in less than 14% within 5 years of the psychotic episode
Longer term outcomes may be marginally better- a 25 year old follow up study reported an additional 16% with late-phase recovery
In EU less than 20% with SZ are employed
US nearly 20% homeless
Lifetime prevalence of 1%
Annual associated costs in US estimated to be more than $150 billion
Life expectancy 15 years less and 5-10% lifetime suicide risk

Question 4

Positive symptoms:

Answer 4

hallucinations, delusions, disorganized speech and thoughts

Question 5

Negative symptoms

Answer 5

anhedonia, avolition, blunted affect

Question 6

Cognitive symptoms

Answer 6

Memory issues, inability to process social cues, impaired sensory perception

Question 7

DSM-V on SZ

Answer 7

Two or more of following symptoms must be present for one month or longer, at least q must be from items 1,2,3
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catanoic behaviour
5. Negative symptoms, such as diminished emotional response
Impairment in 1 of the major areas of functioning

Question 8

ICD-10 On schizophrenia

Answer 8

also says symptoms need to be present for one month, delusions must be culturally inappropriate e.g., talking to the dead is normal in China but in the UK would be seen as a symptom of Schizophrenia

Question 9

Factors affecting susceptibility: biological

Answer 9

• Twin and other studies showed the large genetic component with heritability about 80%
  Increased rates in utero adversity, such as maternal infections and starvation during pregnancy, and obstetric complications e.g., preterm birth and preeclampsia

Question 10

Factors affecting susceptibility: social and environmental

Answer 10

Childhood trauma, minority ethnicity, residence in an urban area, social isolation.
Social stressors: discrimination or economic adversity, may predispose individuals to delusional or paranoid thinking

Question 11

Age when schizophrenia is most likely to develop

Answer 11

Develops early adulthood, rare before 16
highlighting other factors as well as genetics lead to the disorder

Question 12

Stage 1 of schizophrenia development

Answer 12

Genetic vulnerability and environmental exposure
Diagnosed through genetics/family history
Experience none/mild cognitive defect
It would be unknown at this point

Question 13

Stage 2 of schizophrenia development

Answer 13

Cognitive, behavioural and social deficits, help seeking
Diagnosed through SIPS, cognitive assessment
Experience change in school/social function
Intervention: cognitive training, polyunsaturated fatty acids
Family support

Question 14

Stage 3 schizophrenia diagnosis

Answer 14

Abnormal thought and behaviour, relapsing-remitting course
Diagnosed through clinical interview and loss of insight
Experience acute loss of function and acute family distress
Intervention: medication and psychosocial interventions

Question 15

Stage 4/5 development schizophrenia

Answer 15

Loss of function, medical complications, incarceration
Diagnosed through clinical intervention or loss of function
Experience chronic disability, unemployment, homelessness
Intervention: medication, psychosocial interventions and rehabilitation services

Question 16

Key points on delusions

Answer 16

Can be recurring making the hard to refute
Persecutory delusions are most common
Auditory hallucinations are the most common type of sensory delusion
Many experience multiple types at the same time (multimodal)
2016 study with 750 SZ patients found 53% have multimodal hallucinations
Can change overtime in approximately 1/3 of cases

Question 17

5 types of delusions

Answer 17

Delusion of control
Delusion of thought insertion or thought broadcasting
Delusion of persecution
Religious delusion
Nihilistic delusion

Question 18

History of schizophrenia late 19th century

Answer 18

Bleuler, coined the term schizophrenia and less convinced of it’s deteriorating course but emphasised the notion of a fundamental disorder of thoughts and feeling
Decades psychiatrists learned this as 4 a’s: Assertion, Affect, Ambivalence, Autistic isolation
Fist half 20th century considered a psychotic reaction, a fragmented ego due to an ambivalent mother
Treatment including remothering

Question 19

History of schizophrenia first half 20th century

Answer 19

considered a psychotic reaction, a fragmented ego due to an ambivalent mother
Treatment including remothering

Question 20

History of schizophrenia second half 20th century

Answer 20

condition was medicalized and medication was used as treatment
- Both conventional and atypical antipsychotics reduce delusions and hallucinations they have not enhanced functional recovery (e.g., employment) for people with SZ
- One reason is due to SZ being largely due to cognitive deficits, such as problems with attention and working memory which these drugs fail to improve

Question 21

Schizophrenia and culture: Bauer et al., (2011)

Answer 21

Researchers from 7 different countries showed that hallucinations vary greatly in incidence and in type across cultures. Conducted a comparative study of the incidence of hallucinations in adult schizophrenic patients (1080) across various countries
Auditory hallucinations most common in all countries, infrequent in Austria and Georgia
Visual hallucinations most reported in West Africa. But only 3.9% Pakistani and 9..5% Georgian Patients experienced them
Cenesthetic hallucinations most common in Ghana

Question 22

Schizophrenia and culture Bauer et al., 2011; Suhail and Coch, 2002

Answer 22

Westerners pay more attention to salient objects in an image and tend to have a perceptual orientation in vision, East Asians pay more attention to background and have a conceptual orientation in vision
Visual hallucinations reported frequently in traditional cultures, may lead to lower threshold for the experience of visual hallucinations or increased willingness to report

Question 23

Schizophrenia and Gender Crimson et al., 2014

Answer 23

Equal prevalence in males and females but onset of symptoms is at an earlier age for men, first episode early 20’s women’s first episode late 20’s early 30’s
May be due to early research conducted on hospitalised men women the symptoms just seen as hormones

Question 24

Schizophrenia and gender Li et al., 2016

Answer 24

Men have , higher prosperity to negative symptoms lower social functioning and co-morbid substance abuse
Women have more affective symptoms, also have a peak in first episode at 45-50 and larger dosage which could be due to the onset of the menopause.
Females better treatment response 50% less hospitalisations
Men need greater dosages of antipsychotics
oestrogen therapy may be effective as treatment

Question 25

Acceptance of mental illness East and West divide: (Krendl and Pescosolido, 2020)

Answer 25

Stigma related to the types of attributions make about the etiology of mental illnesses, also to an individuals bad character or lack of self control
Eastern countries more likely to make moral attributions about the etiology of mental illness, even reporting having a mental illness was shameful. need to conceal their illness for how it would effect friends and family

Question 26

Acceptance of mental illness East and West divide: (Krendl and Pescosolido, 2020) study

Answer 26

Explored stigma in 11k people between 4 eastern and 7 western countries using data from a survey. Focusing on discrimination to not interact with those with a mental illness
East found to be more prejudice, have higher discriminative potential, moral attributes and biological attributes in both depression and schizophrenia

Question 27

Schizophrenia and personality

Answer 27

• SZ patients show abnormalities on basic dimensions of personality
• These personality disorders may be a manifestation of liability to schizophrenia
• Personality disturbance resulted from the interaction of a neural integrative deficit, termed schizotaxia, with social learning during development
• The schizophrenia spectrum personality disorder Include schizotypal personality disorder, paranoid personality disorder, and schizoid personality disorder termed “Cluster A” in the DSM-IV diagnostic schema, reflect phenotypic expression of a liability for SZ

Question 28

Interventions for SZ

Answer 28

• Antipsychotics have been available for almost 70 years and greatly improved outcomes for SZ patients
• All currently available options derive their efficacy from the blockade of dopaminergic receptors
• Issue with side effects
• Treatment-resistant schizophrenia represents a major challenge

Question 29

Types of behavioural therapy

Answer 29

• CBT
• DBT
• Group Counselling
• (Burlingame et al., 2020) meta-analysis found that group therapy for schizophrenia patients compared to controls explained 16% of schizophrenia symptom and 44% general functioning improvement.