Week 3 Schizophrenia Flashcards
History of Schizophrenia
Emil Kraepelin (1899) - Dementia Praecox - believed that the brains of individuals who developed schizophrenia had begun to deteriorate prematurely.
Eugene Bleuler (1911) - “Schizophrenia”
Four core disturbances:
*Affect
*Ambivalence
*Associations
*Preference for fantasy over reality
Myths about schizophrenia
People with schizophrenia, dangerois or split personlity.
Epidemiology
“Schizophrenia”
Four core disturbances:
*Affect
*Ambivalence
*Associations
*Preference for fantasy over reality
Epidemiology Continued
Described in all cultures & SES groups
* Industrial nations: disproportionate % are lower SES
* The most expensive of all mental disorders:
- Direct treatment costs - Loss of productivity
* Public assistance costs
* Shorter average lifespan
DSM-5-TR Criteria
A. Characteristic Symptoms Two or more of the following each present for a
significant portion of time during a 1-month period. At least one must be
(1), (2), or (3)
1. Delusions
2. Hallucinations
3. Disorganised speech (frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms
p Affect flattening
p Alogia
p Avolition
DSM-5-TR Continued
B. Social Occupational Dysfunction
For a significant portion of the time since the onset of the disturbance, level of functioning in one
or more major areas, such as work, interpersonal relations, or self-care, is markedly below the
level achieved prior to the onset (or when the onset is in childhood or adolescence, there is
failure to achieve expected level of interpersonal, academic, or occupational functioning)
C. Duration continuous signs for 6 months
This 6-month period must include at least 1 month of symptoms (or less if successfully treated)
that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or
residual symptoms.
D. Exclusion: Schizoaffective & Mood Disorder
E. Exclusion: Substance/general Medical Condition
F. Relationship to Autism Spectrum Disorder or a communication
disorder
Characteristic Symptoms - POSITIVE Symptoms
Positive symptoms. “Excess” behaviours such as:
* Delusions
* Hallucinations
* Loose associations
* Disorganised behaviour
Characteristic symptoms - NEGATIVE symptoms
- Flat affect
- Apathy
- Social withdrawal
- Poor attention
Characteristic symptoms - Disturbance of Perception
- Hallucinations - Percept like experience occurring in the
absence of appropriate stimulus and not under voluntary control
Auditory
Visual
Olfactory
Gustatory
Tactile
Characteristic Symptoms - Disturbances in form of thought
- Disturbances in production and organisation of thought -
revealed by peculiarities/disorganisation of speech: - Loosening of Associations
Neologism
Perseveration
Word salad
Circumstantiality
Tangentiality
Characteristic symptoms - Disturbances in Affect
Expression of outward emotion
- restricted affect
- Blunted affect
- Flat affect
Characteristic symptoms - Disturbances in social behaviour
- Avolition – decreased self initiated purposeful activities
- Anhedonia – decreased ability to experience pleasure
- Asociality – decreased interest in social interactions
Do individuals with Schizophrenia experience challenges across many domains, if so, what are they?
This can include structure of thought, the experience of emotions and in perception.
Schizophrenia Specifics - Duration
- First episode, currently in acute episode
- First episode, currently in partial remission
- First episode, currently in full remission
- Multiple episode, currently in acute episode
- Multiple episode, currently in partial remission
- Multiple episode, currently in full remission
- Continuous
- Unspecified - people diagnosed as schizophrenic who don’t fall neatly into
one category
Schizophrenia Specifics - Catatonia
Disturbances in psychomotor behaviour
- Collectively called Catatonia
Catatonic Stupor
Cataonic rigidity
Catatonic excitement
Schizophrenia specifiers: Severity
- Severity based on assessment of primary symptoms of
psychosis
Delusions
Hallucinations
Disorganised speech
Abnormal psychomotor behaviour
Negative symptoms
Rated on a 5 point scale (most severe in the last 7 days) from 0
(not present) to 4 (present and severe)
Why can symptom profiles be diverse?
No single symptom is pathognomonic of schizophrenia
* Diagnosis relies on recognition of a constellation of symptoms
associated with impaired social or occupational functioning
* Individuals with the disorder will vary on most features
* Severity of symptoms an important additional consideration
Cognitive impairments in Schizophrenia
- Many individuals with schizophrenia experience cognitive
impairments across a range of domains - Declarative memory
- Working memory
- Language function
- Executive/attention function
- Sensory processing
- Predict functional outcome
- Persist during symptom recovery
What are the phases of schizophrenia
Episodic, Residual phase, active phase, predromal phase
What is Prognosis in schizophrenia ?
~ 20-30% experience minimal impact on overall social/work
functioning
~ 20-30% experience moderate symptoms
~ 40-60% remain significantly impaired
What are the outcome predictors of schizophrenia?
Good Outcome
* Good premorbid adjustment
* No family history of schizophrenia
* Sudden onset
* Precipitating stress
* Good response to medication
* Positive symptoms
* Later age of onset
* Female gender
Poorer Outcome
* Poor premorbid adjustment
* Family history of schizophrenia
* Slow onset
* No precipitating stress
* Poor response to medication
* Negative symptoms
* Early age of onset
* Male gender
Schizophreniform Disorder
Duration at least 1 month but less than 6 months
- Impaired social/occupational functioning not required
Schizoaffective Disorder
- Symptoms fall on the boundary between schizophrenia and mood
disorders - Prominent episode of mood disturbance concurrent with Criterion A
schizophrenia symptoms - Delusions/hallucinations for at least 2 weeks in absence of prominent mood disturbance
Delusional Disorder
One or more delusions and has neber met criteria A for schizophrenia
Brief psychotic Disorder
Sudden onset of at least one: delusions, hallucinations, disorganised
speech, disorganised/catatonic behaviour
- Lasts at least one day but less than month and full return to premorbid
functioning
The Biological view of schizophrenia
Genetics
Twin adoption and family studies,
There are genetic linage studies
Hetergeneous disorder, with a likelyhood of their being a polygenic influence.
What are some biochemical abnormality theories?
Dopamine hypothesis - Dopamine hyperactivity linked to positive symptoms of schiz
D2 receptors target antipsychotic medication
Problems in the dopamine hypothesis
*Problems with the dopamine hypothesis
- Many of the drugs used to treat schizophrenia are effective in
treating other disorders.
- Clozapine primarily blocks serotonin receptors
*Current research focuses on many neurotransmitters:
-Serotonin pathways
-GABA and glutamate
The biological view - alterations in brain structure and function
- Differences in structure and function of multiple brain regions between
individuals with and without schizophrenia (based on neuroimaging) - Differences also evidence in cellular architecture, and white matter
connectivity - Likely changes in broad neural connectivity
- No evidence for a single pathological process identifiable on an
individual basis
Limitations of biological view
- Difficult to determine whether the abnormality is related to the
disease process or to treatment - A single pathological process in the brain can cause a wide range
of phenomena in different individuals
Psychosocial factors - behaviour view
- Limited value in understanding aetiology:
- Failure to attend to relevant social cues results in bizarre responses to environment
- Acquisition of bizarre behaviours through operant conditioning
- Unable to fully account for the origins of the various symptoms of schizophrenia
- More successful in modifying problematic behaviours:
- Appropriate verbal responses and social behaviours can be learned with systematic
ignoring of bizarre behaviours and reinforcement of appropriate responses
What are the psychosocial factors, in theoretical frameworks that focuses on family views for schiz?
Schizophrenogenic mother (Fromm-Reichmann, 1948)
* Double-bind communication (Bateson, 1956)
* Family structure (Lidz, 1973)
* Communication deviance (Wynne & Singer, 1963)
* Expressed emotion (Vaughn & Leff, 1976)
Psychosocial factors - Express emotions (Vaughn & Leff, 1976)
Expressed emotion
*Family stress may precipitate relapses
*Family stress = expressed emotion
- Criticism
- Hostility
- Emotional over-involvement
*Person with schizophrenia is 3.7 times more likely to relapse if
living in a High vs. a Low EE family
*Low specificity – but highlighted the family environment as a target
for intervention
What are the limitations of the family views theories?
Earlier views were not based on empirical evidence
* Many of the findings are correlational
* These family patterns also occur in families of patients with other
disorders
* Reciprocal relationship between patient and family members not
taken into account
* The impact of living with a family member with schizophrenia
neglected
What is the Diathesis-Stress theory?
When the Diatheses: * Genetic factors
* Physical trauma
prenatally or during birth
* Brain or neurotransmitter
abnormalities
* Psychosis-prone
personality
And the Stressors: * Physical trauma,
prenatally or during birth
* Psychological and
social stressors and
environmental hazards
associated with urban living
and poverty
* Family environment with
high EE
Come together and screate Schizophrenia
What are some treatements for schiz?
Cognitive Behavioural Therapy
* Psychoeducation
* Social skills training
* Coping strategies enhancement training
- Problem solving
- Strategies for maximising medication compliance
- Identification of relapse warning signals
- Stress management strategies
Broad rehabilitation approach
* Focuses on broader practical difficulties
Family interventions
* Supplementing drug treatment with family intervention reduces relapse
Anti-psychotics
* Positive symptoms respond better than negative symptoms.
* About 25% do not improve on classical antipsychoticsrugs.
* Unwanted effects of traditional anti-psychotic drugs, eg.
tardive dyskinesia
More treatments..
The community approach
* Deinstitutionalisation
* Effective community care
* Coordinated services
* Short-term hospitalisation * Partial hospitalisation
* Community house/halfway houses
- Advocacy
