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Lecture

PSYCH257 Lecture Notes - Dementia Praecox, Schizophreniform Disorder, Schizoaffective Disorder


Department
Psychology
Course Code
PSYCH257
Professor
Uzma Rehman

Page:
of 12
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, don’t 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 risk
o 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 Don’t 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: schizophrenia is associated with diffuse Neurobiological Dysregulation. Structural
and functional abnormalities in the brain are not unique to schizophrenia
Psychological and social influences
o Role of stress may activate underlying vulnerability and/or increased risk of relapse
o Family interaction: families tend to show ineffective communication patterns, high expressed
emotion in the family is associated with relapse
o Role of psychological factors, likely exert only a minimal effect in producing schizophrenia
Medical treatment
o Antipsychotic/neuroleptic medications
Often first line of treatment
Began in 50s
Most reduce or eliminate positive symptoms, can’t handle negative symptoms well
Acute and permanent Parkinson like side effects are common - more common in classic
neuroleptics, atypical antipsychotic have better side effect profiles
Compliance with meds often a problem
o Transcranial magnetic stimulation relatively untested treatment for hallucinations
Clinical Description
March-12-11
5:00 PM
Psychotic: characterises many unusual behaviours, which usually involves hallucinations and
delusions
Schizophrenia involves psychotic behaviour
Can affect all functioning
Not really a violent disorder
Positive, negative and disorganised symptoms: