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emil kraepelin (1898)

emil kraepelin (1898). dementia praecox “premature dementia”. paranoia (all delusions). hebephrenia. catatonia. eugene bleuler (1908). schizophrenia. “split mind”. schizophrenia. 1 month of at least two of the following:. delusions. positive/psychosis. hallucinations.

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emil kraepelin (1898)

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  1. emil kraepelin (1898) dementia praecox “premature dementia” • paranoia (all delusions) • hebephrenia • catatonia eugene bleuler (1908) schizophrenia • “split mind”

  2. schizophrenia 1 month of at least two of the following: • delusions positive/psychosis • hallucinations • disorganized speech disorganized • disorganized behavior • negative symptoms negative 6 mo course includes prodromal or residual period

  3. prodromal symptoms schizophrenia symptoms residual symptoms 5 MO 1 MO 5 MO 6 mo course includes prodromal or residual period

  4. delusions What types of schizophrenic delusions have you heard of? persecution grandeur control reference

  5. hallucinations What kinds of schizophrenic hallucinations have you heard of?

  6. disorganized speech A.K.A. THOUGHT DISORDER • tangentiality • derailment • neologisms • clanging

  7. disorganization DISORGANIZED BEHAVIOR inappropriate affect bizarre behavior

  8. negative symptoms alogia (few words) affective flattening avolition (lack of motivation) social withdrawal

  9. stats • 1% prevalence • equal sex ratio • course: better for women age of onset

  10. brain abnormalities • STRUCTURAL • enlarged ventricles • cytoarchitecture of frontal lobe • FUNCTIONAL • “hypofrontality” • cognitive deficits of frontal lobe

  11. cognitive deficits working memory perseveration disinhibiton executive functions endophenotypes biological markers for disease genes e.g. eye tracking

  12. genetics disease risk in family & twin (also, equal risk in offspring of discordant MZ twins)

  13. neurodevelopmental hypothesis prenatal brain defect environmental stressor in early adulthood SZ + =

  14. 2nd trimester Flu Epidemics 1957 Kochi Japan 1949-1981 France 40 yr study Finland & Denmark Starvation 1944-1945 WWII Dutch Winter 1959-1961 famine in China

  15. DA pathways nigrostriatal substantia nigra > striatum mesocortical VTA > all cortical areas mesolimbic VTA > limbic system

  16. medication ANTIPSYCHOTICS (A.K.A. neuroleptics) TYPICAL ATYPICAL treats + & - symptoms? treats + symptoms side effect: tardive dyskinesia less side effects? 10x price • 74% noncompliance w/in 18 mo • extrapyramidal side effects Parkinsonian symptoms tardive dyskinesia

  17. therapy • “token economy” – operant conditioning • teach social skills & give insight • manage medication • identify signs of impending relapse

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