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Schizophrenia

Schizophrenia. Nature of Schizophrenia and Psychosis : overview. Schizophrenia vs. Psychosis: Psychosis is a broad term (e.g. hallucination, delusions) Schizophrenia is a type of psychosis Psychosis and schizophrenia are heterogeneous Disturbed thoughts, emotions, behavior.

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Schizophrenia

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  1. Schizophrenia

  2. Nature of Schizophrenia and Psychosis : overview Schizophrenia vs. Psychosis: • Psychosis is a broad term (e.g. hallucination, delusions) • Schizophrenia is a type of psychosis • Psychosis and schizophrenia are heterogeneous • Disturbed thoughts, emotions, behavior

  3. Early Figures in The History of Schizophrenia John Haslam (1764 – 1844) • Superintendent of a British hospital • In “observation on madness and melancholy” He outlined a description of the symptoms.

  4. Psychosis • Involves a “loss of touch” with reality. • Unable to determine what is real and what is not. • Perceptions fail to “map on” to reality. • Schizophrenia is a psychotic illness. • One can be said to be suffering from psychosis, and this could mean that they have schizophrenia.

  5. General Diagnostic Considerations • At least one month of acute symptoms of: • Delusions • Hallucinations • Disorganized thought and speech • Disorganized behavior • Negative symptoms • Some symptoms must be present for at least 6 months.

  6. Prevalence • Worldwide (lifetime) : 0.2% to 1.5% • The disorder will affect about 1% of the general population in some time.

  7. Group 1: one episode only – no impairment, 22% . • Group 2: several episodes with minimal or no impairment, 35%. • Group 3: impairment after the first episode with subsequent exacerbation an no return to normality, 8%. • Group 4: impairment increasing with each of several episodes and no return to normal, 35%.

  8. Symptoms • Positive/type 1: exaggerations of normal phenomenon • Hallucinations (auditory/ visual) • Delusions • Disorganized thoughts and speech • Disorganized / Catatonic behavior

  9. Delusions Ideas that are believed to be true. • Persecutory • “I am being followed by MOI” • Delusion of reference • “secret messages about me are broadcaster On TV” • Delusions of being controlled • Thought broadcasting “my thoughts are being played on the radio” • Thought insertion “my father is transmitting terrible thoughts into my brain.”

  10. Delusions • Thought withdrawal • “when I study, my thoughts are being stolen by people around me” • Delusion of guilt or sin • “I am a murderer” • Somatic delusions • “I have a demon growing inside of my stomach”

  11. Hallucinations • Unreal sensory/ perceptual experiences • Verbal/ visual • Not just a psychotic experience • Delusion of auditory hallucinations : • Hearing voices, music, etc…. • Most common type • Voices maybe accusatory • May ask to harm selves or others • People with schizophrenia may talk back to the voices • Auditory hallucinations are experiences by 60% of people with schizophrenia

  12. Hallucinations • Visual hallucinations : • Seeing a friend’s face “melting away” • Tactile hallucination • “bugs are crawling on my body” • Somatic hallucinations • “bugs are crawling under my skin”

  13. Disorganized Thought and Speech • Sometimes called formal thought disorder • Tendency to move from one topic to another • Loosing of association • The person may see connections, but they are not apparent to observers • Tendency to answer questions with unrelated information • Incoherent speech: “word salad”

  14. Disorganized / Catatonic Behavior • Behavior can be unpredictable • Agitated • Shouting, swearing, etc…. • Self care is often compromised. • Catatonia: an extreme lack of responsiveness to the outside world. • Excessive behavior • Lack of behavior

  15. Negative/ Type II Symptoms • Involves losses or deficts in certain domains • Not as note worthy as positive symptoms • When people think about schizophrenia, negative symptoms are often not considered • However negative symptoms are very common in schizophrenia

  16. Affective flattening: a severe reduction emotional responses to the environment. • Facial features remain unchanged • Reactions seem very understated • Alogia: poverty of speech; reduction in speaking • Very brief, empty replies • Avolition: an inability to persist at common goal directed activities.

  17. Other symptoms: • Inappropriate affect • Anhedonia: a pervasive loss of interest in all activities in life • Impaired social skills

  18. Biological Theories • Genetics • Family, twin, adoption studies suggest a genetic component. • Probably a cluster of genes • Structural brain abnormalities • Enlarged ventricles • Fluid-filled spaces in the brain • Ventricle enlargement could be related to the deterioration of other brain areas • Prefrontal cortex seems to be smaller and shows less activity • Smaller prefrontal cortex found in people at risk for schizophrenia

  19. Biological Theories • Birth complications • Prenatal and birth complications more common in people with schizophrenia. • 30% of people with schizophrenia have a history of hypoxia • Prospective studies indicates that the risk of schizophrenia increase with degree of hypoxia • Majority do not develop schizophrenia • Genetic predisposition might be required

  20. Biological Theories • Prenatal viral exposure • High rates of schizophrenia among persons who’s mothers were exposed to influenza virus while pregnant • Especially during second trimester

  21. Biological Theories • Dopamine hypothesis of schizophrenia • Substance that decrease DA levels, also decreases symptoms of schizophrenia • Reserpine affects vesicles- reduces schizophrenia • Substances that block access to DA receptors effective in schizophrenia • High correlation between blocking and effective treatment • Compounds that increase DA formation (L-Dopa) worsen. • This, amphetamine and cocaine can lead to psychotic behaviors.

  22. Biological Theories • Neurotransmitters • Thought that too much dopamine leads to schizophrenia • Later dopamine theories • Increases DA activity in mesolimbic pathway account for positive symptoms • Decreased DA activity in prefrontal cortex account for negative symptoms

  23. Psychosocial Perspectives • Social drift/ urban birth • Schizophrenia makes it more difficult to obtain an education/ good job (people drift downward in social status) • People with schizophrenia more likely to be born in large urban/ metropolitan area • Possibly related to stress • Overcrowding, exposure to toxins

  24. Psychosocial Perspectives Stress and relapse Expressed emotion • Not very good evidence that EE causes schizophrenia but • It does seem to lead to more frequent relapse • Very difficult to ascertain “what is causing what?”

  25.  Good Luck To You All 

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