Schizophrenia

Question 1

Topics

Answer 1

1) Epidemiology - Affected people
2) Description of schizophrenia
3) Commonality among schizophrenias
4) 3 main symptoms
5) Positive symptoms description
6) Delusions
7) Martha Mitchell effect
8) Hallucinations
9) Disorganized speech, behaviour, and catatonic behaviour
10) Negative symptoms
11) Avolition, alogia, anhedonia, flat affect
12) Cognitive symptoms
13) Criteria for diagnosis
14) Phases
15) Problems with diagnosis
16) Example with problems with diagnosis
17) Causes of schizophrenia
18) Neurological causes
19) Genetic causes
20) Environmental factors
21) Gender differences
22) Treatment

Question 2

Names and Years

Answer 2

1) Laroi et al (14) - Lairon
2) Skodlar et al (08) - Skoda
3) Bracha et al (89) - Barack Obama
4) Upthegroove et al (16) - Upgroove
5) Kessler et al (05) - Keiser
6) Kulage et al (14) - Collage
7) Rosenhan (73) - Rose’s hand
8) Borstein and Emler (01) - Torstein & Elmo
9) Callard et al (13) - Caller

A Lairon was eating a Skoda, then Barack Obama came all upgroovy mood accompanied by the Nazi Kaiser to take a collage picture for Ruby Rose’s hand to get Torstein and Elmo to Call them.

Question 3

Who are the ones most affected?

Answer 3

It is a chronic illness that typically begins in early adulthood

Question 4

What is Schizo?

Answer 4

It is characterized by a broad collection of symptoms akin to:
incoherent or illogical thoughts,
bizarre behaviour and speech,
delusions and hallucinations such as hearing voices

Question 5

What are the Commonality among schizophrenias?

Answer 5

There are other several variants such as delusional disorder, brief psychotic disorder, and schizophreniform disorder.
Commonality: extreme distortion of sufferer’s reality

Question 6

What are the 3 main symptoms?

Answer 6

A Positive symptoms
B Negative Symptoms
C Cognitive Symptoms

Question 7

Can you describe the Positive symptoms?

Answer 7

Delusions, hallucinations, disorganized speech, disorganized behaviour, and catatonic behaviour.

Question 8

Describe the delusions

Answer 8

Delusion: extreme distortion of reality where patient has difficulties identifying reality. Delusions often grounded in actual facts (Laroi et al, 14). Studies by Skodlar et al (08), strong correlation b/ delusions and current ideologies or affairs of current time. E.g. paranoid and persecutory delusions during 20th century when there were repressions of political dissidents.

Question 9

What is the Martha Mitchell effect?

Answer 9

Due to the fact that some delusions are somewhat grounded in reality, it can be difficult to diagnose. Clinicians not concerned with objective truth/falsehood of delusion, but the immunity to reality testing (willingness to shift beliefs to new compelling info).
Marth Mitchel effect: patient’s accurate perception of real events may be labelled as delusional

Question 10

What are hallucinations?

Answer 10

Usually auditory up to 98% (Bracha et al, 89). 52% suffer from visual. Can also b olfactory or tactile.
Auditory hallucinations often make sense and usually voices, rather than sounds (Upthegroove et al., 16)

Question 11

What are disorganized speech, disorganized behaviours, and catatonic behaviour?

Answer 11

Disorganized speech = word salad - irrational speech patterns
Disorganized behaviours = inappropriate behaviours, e.g. laughing at a funeral
Catatonic behaviour = grossly abnormal psychomotor behaviour, e.g. muscle tension and rigidity, immobility, repetitive movements

Question 12

What are negative behaviours?

Answer 12

Symptoms that should be there, but are not:
Avolition,
Alogia,
Anhedonia

Question 13

What are avolition, alogia, anhedonia, and flat affect?

Answer 13

Avolition = inability to persists in daily tasks such as eating or hygene
Alogia = absence of speech or slow verbalisation
Anhedonia = lack of pleasure and indifference to enjoyable activities
Flat affect = no visible signs of emotions, even though in some cases they may feel it

Question 14

What are cognitive symptoms?

Answer 14

Much more subtle. They affect memory, learning, and understanding.
These can only be noticed if very specific tests are done

Question 15

What characteristics need to be met to be diagnosed with schizophrenia?

Answer 15

According to DSM 5, must have 2 of symptoms mentioned before, and at least one of the two must be delusions, hallucinations, or disorganized speech. Other one can be from negative e.g. disorganized/catatonic behaviour

Also, none of the symptoms must be attributable to other conditions, e.g. substance abuse.

Question 16

What are the phases of schizophrenia?

Answer 16

Prodromal phase = patient is withdrawn
Active phase = patient displays severe symptoms
residual phase = patient is more calm and may show cognitive symptoms before potentially going back to phase one and repeat the cycle

The symptoms must be ongoing for at least 6 months and 1 of the 6 must be the active phase (these being delusions, hallucinations, disorganized speech, behaviour, or catatonic behaviour).

Question 17

What are the problems with diagnosing?

Answer 17

Diagnostic tools are not quite optimal, and in their infancy, semantics are an issue, and diagnosing can be subjective, as well as circumstantial.

DSM 5 definitions are constantly being updated, and further research into causes and actual symptoms are substantially being required.

Question 18

Can you give an example where diagnosing can become problematic?

Answer 18

A) 50% of people with one diagnosis also qualify for another disorder (Kessler et al., 05). To rectify this, the DSM is being continuously updated. –> 25-68% reduction is ASD diagnosis (Kulage et al., 2014).

B) Rosenhan (73): healthy people (pseudopatients) been diagnosed with mental health issue when infiltrated psychiatry ward, then after being told this. Ward pointed out that there were psedo again, when there were none. Same fundings by Borstein and Emler (01)

C) Callard et al (13)= Misdiagnosing a healthy person can have serious consequences. The LABEL can mould their identity and they may take over their lives.

Question 19

What are the causes of schizophrenia?

Answer 19

The causes are somewhat unknown. Seems like signs of symptoms only unique to humans, or at least hard to detect in other animals, such as mice.

Question 20

What do we know about the causes based on neurological findings?

Answer 20

One clue is that majority of medications that improve schizophrenia symptoms block the dopamine receptor D2, which reduces dopamine levels in neurons. This suggests that maybe has something to do with increased dopamine levels.

However, these are neither universal nor always effective.

One of the most effective psychotic drugs, CLOZAPINE, is a weak D2 receptor antagonist. Suggesting that other neurotransmitter systems like norepinephrine, serotonin, and GABA are involved.

Question 21

What can we learn from twin studies for schizophrenia?

Answer 21

Twin studies have shown support for a genetic basis as well, even though no specific genes have been conclusively linked to schizophrenia yet.

Question 22

What can we learn from environmental causes?

Answer 22

Environmental factors, like prenatal exposure to infection, and certain autoimmune disorders like Celiac disease have been linked to schizophrenia.

Question 23

Are there gender differences?

Answer 23

Epidemiology: men slightly more susceptible than women and having earlier onset than women - suggests that the estrogen regulation of dopamine system plays a role. There seems to be no difference among race.

Question 24

How can schizophrenia be treated?

Answer 24

Usually involves different disciplines and approaches to have the most efficient treatment. Disciplines include therapy, medicine, and psychopharmacology. Antipsychotics can be very effective at reducing symptoms, but may be very costly and result in unwanted side effects.