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chap 11

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Biology (Sci)
BIOL 101
Sonya Laszlo

Ch 11: Schizophrenia Schizophrenia is a psychotic disorder characterized by major disturbances in thought, emotion, and behaviour: disordered thinking in which ideas are not logically related, faulty perception and attention, flat or inappropriate affect, and bizarre disturbances in motor activity Patients with schizophrenia withdraw from ppl and reality often into a fantasy life of delusions and hallucinations Schizophrenia is one of the most severe psychopathologies; however its life time prevalence is generally accepted to be about 1% Concluded that there may be real variation in schitzo across geographical regions around the world with Asian populations having the lowest prevalence rates Higher in males than in females (male- female = 1:4) Although schitzo sometimes begins in childhood it usually appears in late adolescence or early adulthood or early adulthood somewhat earlier for men than for women Ppl with schitzo typically have a # of acute episodes of their symptoms. Between episodes they often have less severe but still very deliberating symptoms. Most ppl with schiotzo are treated in the community however hospitalization is sometimes necessary Concluded that almost one half (46%) do not require inpatient services. However ppl who were 1 diagnosed while inpatstnts and those residing in rural areas were most likely to require additional inpatient services in the 1 year of treatment In Canada hospitalization rates are typically much higher among young men relative to young women accounting for 19.9% of separations from general hospitals. Scitzo accounts for 30.9% of separations from psyiatric hospitals About 10% of ppl with scitzo commit suicide Many ppl with scitzo remain chronically disabled. The disability can be attributed to symptoms inherent to schitzo as well as the comorbid disorders from which approx 50% of those with shcitzo suffer In 2004 there were an estimated 234,305 ppl in Canada with schozto. Overall 374 deaths that year were attributed to schizto. The illness total costs were $6.85 billon 70% of which was the cost of lost productivity Schizophrenia and comorbidity Comorid conditions appear to play a role in the development, severity and course of schito. Comorbid substance abuse is a major problem for patients with schizto occurring in as many as 70% of them 37% of the sample of ppl with schizto showed current evidence of substance us disorders. The relationship was especially common among men and analyses suggested that childhood conduct disorder problems are potent risk factors for substance use disorders in shcizto about 40% of the participants were depressed at the outset. Over the next three years those diagnosed with shcizto who were also depressed relative to the non depressed group were more likely to use relapse related mental health services to be a safety concern, to have substance related problems and report poorer life satisfaction, quality of life, mental functioning, family relationships and medication adherence. Comorbid anxiety disorders are also common and can impose an additional burden on ppl with schizo and results in further decline in their perceived quality of life. Comobidity with obsessive compulsive disorder is also related to a previous history of suicidal ideation and suicide attempts Post traumatic stress disorder is highly prevalent and under diagnosed among military veterans with shizto Developing( prodromal) phase of schito. Found that prodomol patients experience a wide variety of comorbid psychiatric syndrome especially major depressive disorder and cannabis dependence CLINICAL SYMPTOMS OF SCHIZOPHRENIA The symptoms of patients with shcizto involve disturbances in several major areas: thought, perception, and attention; motor beh; affect or emotion; and life functioning Although only some of these problems may be present at any given time The duration of the disorder is also imp in diagnosis Unlike most of the diagnostic categories we have considered no essential symptom must be present for a diagnosis of schizo Thus patients with schizto can differ from each other more than do patients with other disorders The key to understanding shcito is to recognize its heterogeneity The presentation, course and outcome of shcito are variable and diverse Currently evidence indicates that it is hard to find specific traits or characteristics that are shared by all persons with a diagnosis or schizo Positive symptoms Comprise excesses or distortions such as disorganized speech, hallucinations and delusions. They are what define for the most part an acute episode of schiz Positive symp are the present of too much of a beh that is not apparent in most ppl while the negative symp are the absence of a beh that should be evident in most ppl Disorganized speech----also known as formal though disorder, disorganized speech refers to problems in organizing ideas and in speaking so that a listener can understand Theres incoherence found in conversations of indivb with S. although the patient may make repeated references to central ideas or a them the images and fragments of thought are not connected; it is difficult to understand what theyre saying Disturbances in speech were at one time regarded as the principal clinical symp of s ad they remain one of the criteria for the diagnosis. But evidence indicates that the speech of many patients with s is not disorganized and that the presence of disorganized speech does not discriminate well between s and other psychoses such ass some mood dis. Patients in manic episode exhibit loos associations as much as those with s Delusions--- beliefs held contrary to reality are common positive symp of s. persecutory delusions like these were found in 65% of a larger cross national sample Delusions make take several other forms as well: The patient may be the unwilling recipient of bodily sensations or thoughts imposed by an external agency Patients may believe that their thoughts are broadcast or transmitted so that others know what they are thinking Patients may think their thoughts are being stolen from them suddenly and unexpectedly by an external force Some patients believe that their feelings are controlled by an external force. Some patients believe that their beh is controlled by an external force Some patients believe that impulses to behave in certain ways are imposed on them by some external force Although delusions are found among more than half pf ppl with schizto as with speech disorganization they are also found among patients with other diagnosesex: mania and delusional depression. The delusions of patients with s are often more bizarre though than patients in other diagnostic categories. They are also highly implausible Hallucinations and other disorders of perception Patients with s often report that the world seems somehow diff or even unreal to them. A patient may mention changes in how his or her body feels or the patients body may become so depersonalized Some ppl report having difficulty in attending to what is happening around them The most dramatic distortions of perception are hallucinations, sensory experiences in the absence of any stimulation from the environment. They are often more auditory than visual 74% sample had auditory hallucinations Some hallucinations occur more often in patients with s than in other psychotic patients. They types of hallucinations include the following: some patients with s report hearing their own thought spoken by another voice, or hear voices arguing, or they hear voices commenting on their beh Negative symptoms Consist of behavioural deficits, such as avolition, alogia, anhedonia, flat affect, and asociliaty These symptoms tend to endure beyond an acute episode and have profound effects on the lives of patients with s. they are also imp as the presence of many negative symp is a strong predictor of a poor quality of life two years following hospitalization Some evidence that negative symp are associated with earlier onset brain damage (enlarged ventricles) and progressive loss of cognitive skills (IQ decline) Ex; flat effect (lack of emotional expressiveness) can be a side effect of antipsychotic medication Observing patients over extended periods of time negative symp such as flat affect and anhedonia are difficult to distinguish from aspects of depression so specifity becomes an issue Avolition apathy or avoliytion referred to lack of energy and a seeming absence of interest in or an inability to persist in what are usually routine activities. Patients may become inattentive to grooming and personal hygiene They have difficulty persisting at work, school or household chores and may spend much of their time sitting around doing noting Alogia A negative thought disorder, alogia can take several forms. In poverty of speech, the sheer amount of speech is greaydly reduced. In poverty of content of speech the amount if discourse is adequate but it conveys little info and tends to be vague and repetitive Anhedonia An inability to experience pleasure. its manifested as a lack of inte
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