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Lecture

Schizophrenia and Other Psychotic Disorders Lecture and text notes (chapter 13) detailing schizophrenia and the clinical description, causes and treatment.

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Department
Psychology
Course
PSYCH 257
Professor
Uzma Rehman
Semester
Winter

Description
Schizophrenia and Other Psychotic Disorders March-09-11 3:35 PM Schizophrenia: involves characteristic disturbances in thinking (delusions), perception (hallucinations), speech, emotions and behaviour Majority of people with schizophrenia in Canada are unemployed and living in poverty Affects one out of 100 people Perspectives on the concept of Schizophrenia Early figures in diagnosing o Emil Kraepelin provided most enduring description and categorisation of schizophrenia o He combined several symptoms of insanity usually viewed as reflecting separate and distinct disorders Catatonia: alternating immobility and excited agitation Hebephrenia: silly and immature emotionality Paranoia: delusions of grandeur or persecution o Considered features under dementia praecox: early label of schizophrenia, emphasising disorder's frequent appearance during adolescence o Also distinguished dementia praecox from manic depressive illness. Early onset and poor outcome were characteristic which were not essential to manic depression o Eugen Bleuler; introduced the term schizophrenia. Believed that underlying all unusual behaviours shown by people with disorder as an associative splitting: separation among basic functions of human personality (cognition, emotion, perception), that is seen by some as the defining characteristic of schizophrenia. o Also believed that difficulty keeping a consistent train of thought led to many symptoms Identifying Symptoms o Schizophrenia is a number of behaviours that aren't necessarily shared by all people who are given the diagnosis Class notes Symptoms: o Delusions o Hallucinations - usually auditory o Nonsensical speech o Sometimes paranoid o Breakdown of reality Lots of variability in the disorder; some have well developed delusions, some are disorganised Distinguishes between two types of symptoms o Positive: active manifestations of abnormal behaviour, distortions of normal behaviour. Delusions (misrepresentation of reality, grandeur or persecutions), hallucinations (sensory events without sensory input), disorganised speech. Easier to treat than negative symptoms. Drugs usually affect positive symptoms o Negative symptoms: absence or insufficiency of normal behaviour. Emotional/social withdrawal, apathy, poverty of thought/speech Avolition (apathy): inability to initiate and persist in activities Alogia: relative absence of speech Anhedonia: lack of pleasure Affective flattening: show little expressed emotion, but still feel emotion Subtypes o Paranoid: intact cognitive skills and affect, do not show disorganised behaviour Hallucinations and delusions center around a theme (grandeur or persecution) Best prognosis of all types of schizophrenia o Disorganised Marked disruptions in speech and behaviour, flat or inappropriate affect Hallucination and delusions have a theme, but tend to be fragmented Develops early, tends to be chronic, lacks period of remission Early age of onset associated with more severity, less responsiveness to treatment and more chronic. Earlier onset is more problematic o Catatonic Show unusual motor responses and odd mannerisms Tends to be severe and quite rare o Undifferentiated Wastebasket category, dont meet criteria for any other subtypes o Residual One past episode of schizophrenia Continue to display less extreme residual symptoms (ex. Odd beliefs) Schizophreniform Disorder o Schizophrenic symptoms for a few months Schizoaffective disorder Facts and stats o 0.2-1.5% of prevalence across countries. On average 1% o Usually develops in early adulthood, but can emerge at any time o After mid 30s, risk for developing schizophrenia really low o Tends to be a chronic disorder o Traditional neuroleptics developed in 1950s targeted dopamine pathways had awful side effects o Most suffer with moderate to severe impairment throughout their lives o Life expectancy is slightly less than average o No gender difference o Female tend to have better long term prognosis o Not often violent or dangerous, very rare o Medication adherence a problem Causes o One of the most heritable disorders o Family studies show that a tendency for schizophrenia is inherited, but not a specific form of schizophrenia. Other family members at an increased risko Twin studies show that the risk in monozygotic twins is 48% and drops to 17% for dizygotic twins o Adoption studies shows risk of schizophrenia remains high if a biological parent suffers from schizophrenia o Risk of schizophrenia increases as a function of genetic relatedness o Dont need to show symptoms to pass on relevant genes. May not have phenotype, but have genotype o Strong genetic component, but not enough (twin studies) o Searches for genetic markers: still inconclusive, likely to involve multiple genes Neurobiology and neurochemistry: dopamine hypothesis o Saw that drugs that increase dopamine (agonists), result in schizophrenic like behaviour, and drugs that decrease dopamine (antagonists), reduce schizophrenic like behaviour o Neuroleptics and L-dopa for Parkinson's disorder o Dopamine hypothesis proved problematic and overly simplistic. Not everyone gets better on dopamine antagonists o Current theories emphasise several neurotransmitters and their interaction Other neurobiological influences o Structural and functional abnormalities in the brain. Enlarged ventricles and reduced tissue volume; hypofrontality - less active frontal lobes (major dopamine pathway) o Viral infections during early prenatal development. Inconclusive o Conclusions
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