SCHIZOPHRENIA Flashcards
neurosis is less severe=
anxiety and mood disorder
-symptoms of stress but not a radical loss of touch with reality
psychosis is more severe=
a loss of contact with reality
*can be psychotic but also experience symptoms of neurosis
History
Dementia Praecox- Biological = Kraepelin, 1893
Schizophrenia- Freudian = Eugene Bleuler, 1911
Epidemiology
- 0.7% of people
- higher prevalence un inner cities/ lower socioeconomic
- 20% of psychiatric hospitals
- 20% attempted suicide admissions
- 2/3 of ‘insanity pleas’ in legal cases
Onset
- usually between late teens and mid 30s
- only if symptoms persist for 6 months
- three episodes: prodromal, active and residual
DSM-5
NO LONGER SUBTYPES
2 or more for at least a month/signs of disturbance for 6 months or more:
- delusions (+)
- hallucinations(+)
- disorganised speech(+)
- disorganised behaviour
- negative symptoms
- diminished level of functioning in work, relationships or self care
Positive symptoms (also includes motor and thought disturbances)= generally more responsive t treatment than negative symptoms
Thought broadcasting
one’s own thoughts are being broadcast or transmitted to others
Thought withdrawal
ones thoughts are being removed from ones own mind
Delusions of grandeur
one is famous or powerful person from past or present
Delusions of control
some external force is trying to take control of one’s thoughts
Delusions of reference
all happenings revolve around oneself/ centre of attention
Delusions of persecution
one is the target of others’ mistreatment, evolution plots, murderous intent
Delusions of jealousy
that everyone is jealous of them
Hallucinations- sensory perception is not perceived by others
- auditory= sounds and voices outside
- visual= clear or vague
- tactile- tingling, burning, electric shock
- somatic-insects crawling under skin
Disorganised thinking and speech
Illogical, disconnected thought and speech patterns
-thought alienation derailment neologisms -perseveration -clang and rhyming -word salad
loose associations (cognitive slippage)
repeatedly shifting from topics without apparent or logical connection
neologisms
new, seemingly meaningless words formed by combining words
disorganised motor disturbances
extreme activity levels, peculiar body movements or postures, strange gestures and grimaces
Negative symptoms examples
- flat affect- show no emotion at all
- anhedonia- lack of pleasure or enjoyment
- alogia- reduction in amount and meaningful content of speech
- avolition- feeling drained of energy and unable to initiate course of action
- inability to engage in routine or goal-directed activities
- inability to feel pleasure; lack of interest or enjoyment in activities or relationships
The prodromal phase
- changed occur in weeks, months, years before
- irritability
- fragmentary psychotic symptoms
- avoidance of work and social functioning
- “attenuated general functioning”
The active phase
- “Florid” psychotic symptoms (distortions in thinking, delusions, hallucinations(
- anxiety, depressions and fear
- difficult to distinguish between manic episode
- dangerous with presence of paranoid elements
The residual phase
- symptoms ease a bit
- same symptoms may persist
*not a DSM term
Schizoaffective disorders
- presence of schizophrenia and bipolar
* some clinicians think schizophrenia is a group of disorders- different symptoms = different treatments
Genetics
- 80% heritability (17% fraternal-prenatal and 48% identical twins)
- adoption studies
- epigenetics- changing of expression of genes to be coded
- mutations are rare
The dopamine hypothesis
excessive levels of dopamine or sensitivity to dopamine (uptake)
*antipsychotic drugs lower dopamine amounts
Enlarged ventricles
- CT scene and MRI
- deteriorations or atrophy of brain- increased blood flow
- increased compared to twin or sibling
substance abuse
- biological vulnerability
- may not be first exposure, may be fourth or fifth
- ecstatcy, alcohol, cocaine, marijuana, crystal meth
Stress
of life events and trauma -in combination with biological vulnerability
- hallucinations often be meaningfullly linked to earlier trauma or stress
- high rates of reports of child abuse and trauma (childhood risk factors)
Smoking
- correlation
- cigarettes used a a from of self-medication, not that cigarettes trigger psychosis
Social causation hypothesis
different standards of healthcare, poorer living conditions which increase stress
Social drift hypothesis
clinical features of psychotic disorder contribute to gradual downward socioeconomic trajectory
Conventional antipsychotic drugs
- reduce positive symptoms of schizophrenia in around 65% of cases
- unwanted Parkinson’s disease side effects:muscle tremors, muscle rigidity, taking, shuffling feet, lack of facial expression
Atypical antipsychotic drugs
- act of both dopamine and serotonin systems
- more effective: help 85% of schizophrenics
- help negative and positive symptoms
*major danger in side-effects e.e.g agranulocytosis
Group Therapy
Hearing Voices Network
-bring people who suffer from hallucinations together to talk about their experiences and to find their voices
Prognosis
- after 5 years, one quarter recover completely
- gradually improves, only deterioration in 10%
- better prognosis for this diagnosed in adulthood than childhood
- 20% of people attempt suicide
Recurrence
- 20%have only one episode
- 35% go on to have several episodes with no impairment between
- about 10% have multiple episode with a static level of functional and personality impairment. between
- 35% have multiple episodes with increasing levels of impairment
Subclinical symptoms
Experiences associated with schizophrenia- such as paranoid delusional thinking and auditory hallucinations- are observes in an attenuated for in 5-8& of healthy people.
Unusual belief in the general population
- 45% beloved in telepathy
- 45% believed in the ability to predict the future
- 31% believed in ghosts
- 21% said there had been ties over the past year when they’d felt that people were against them
- 9% said they had believed that they thoughts were being controlled or interfered with by some outside force or person
- 1.5% said there had been ties when they’d felt people were plotting to cause them serious harm.
