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33.Schizophrenia 1. Definitions. Clinical Picture.doc

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Mac Burnham

SCHIZOPHRENIA 1. DEFINITIONS, CLINICAL PICTURE Sources: Lectures (Burnham –Schizophrenia 1-4, Carlson (p. 556-571, p. 553-569), Book of Readings – Mamo, Kapur and Seeman 1. CLINICAL PICTURE Definitions A psychosis is loss of contact with reality. Unlike OCD, the patient does not realize that they have lost touch with reality and believe their perception is correct. • not “neurosis” – this is anxiety • not multiple personality A “functional” psychosis is “primarily a disorder of cognition” (not an affect disorder, like depression) and there is nothing obviously wrong with the brain. • Although behavior and emotion may be affected • Distinguished from organic psychosis where there’s clearly something wrong with the brain (e.g., Alzeihmers) Depression is a disorder of “affect”. (Anxiety syndromes should be given that title.) Lifetime Prevalence: About 1/100 or (0.3 - 0.7%) -Carlson says 1-2%. -Men slightly more than women (1.4 X) -Found in many cultures and from earliest times (unlike Huntington’s chorea, which we can trace to an abnormality a few hundred years ago in Europe) Co-Morbidities: major depression, anxiety, substance abuse (abuse: about 50%) Onset: often around 20 years of age (dementia praecox – early name) -Rarely childhood, rarely middle age -Carlson’s figure shows a wide range of onsets -Negative onset or positive onset: both possible • Carlson however stresses negative onset (onset always starts with negative symptoms -Men slightly earlier than women (early vs. late 20s) Prognosis: Poor prognosis if untreated -- disabling, long lasting -Leads to unemployment, poverty homelessness Duration: often for life (it seems that the negative symptoms grow more prominent as life progresses) Types: Traditionally several types were recognized, although there has been debate about whether they really exist. - Types may be cut from DSM V, Carlson doesn’t mention them - All respond to the same drugs, unlike epilepsy - Among the traditional types are: Paranoid (Common) -The most common -Hallucinations and delusions -Thought disorder when they have hallucinations and delusions, but it is not prominent. Carlson says that ALL schizophrenics have a thought disorder, that they’re essentially brain damaged. But Burnham doesn’t agree. Catatonic (Rare) - immobile -Bizarre behaviour Hebeprenic/Disorganized (Rare) -Prominent thought disorder (flight of thoughts, loose associations, word salad) with flat affect. -Hallucinations and delusions not important here Symptoms in Detail (Paranoid Schizophrenia): Its thought that the positive vs negative abnormalities relate to different parts of the brain: • Positive relate to the nucleus accumbens • Negative relate to the frefrontal cortex Positive (helped by “typical” and “atypical” drugs) – The old antipsychotics (the typical) psychotics work on the positive symptoms. The atypical drugs works on both the positive and negative symptoms. Delusions: fixed false beliefs • Persecution (plotting against you), grandeur, controlling your mind Hallucinations: false perceptions (Alzheimers and extreme depressives have this) • Often voices, sometimes olfactory, tactile or other • Seem real to the person: part of brain involved in hallucinations active o Carlson: “any sensory mode” Negative (helped by “atypicals” ? not by standard (typical) drugs) -Apathy, withdrawal, economic deterioration -Anhedonia: lack of pleasure -Problems with thought and m
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