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PSY396 JUNE 10.docx

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PSY396 JUNE 10, 2013 Psychosis and schizophrenia most common disorder with psychosis part of diagnoses Psyhcosis - Not the same - Shi disorder - Psych – is set of or syndrome and can be part of many disorders - Not perfect overalap of the two - Misused term - What it is is set of symptoms that involve delusions and hallucination - Syndrome – present in multiple disorderd - Can be defiing feature of disorder like shcizop or drug induced - Pyshcosis can appear as an associative feature with alz or major depression pysh can appear and not defining feature it is ass feat - Two most sig symptoms is hallacuation and delusion - Disorganized speech and thought and behavior irregularities - Appear as a symptom of sch or induced by drugs - Can induce pyshosis after prolonged use or acute after high dose - Drugs change function of dop release in nuc acumbens - State of psychosis may relate to same da dys in nuc accumbens Schizo - Full blown disorder - Psychosis as defining feature - Heavily studied - Not affect large number of people say depression put 1 percent sig still and schizophrenia is debilitating disease - Lose most functions to live in todays society - Another reason is ass with suicide - 25 – 50 diagnosed attempt it and 10 percent will succeed - Not lethal does produce negative personal experience and hardlives and commit suicide Next - Disease or disorder heavily researched - People needing full or permanent hospitalization - Need lengthy and expensive therapy - Starts early late teens or early twenties - Some ideas some symptoms or markers of it appear earlier - After onset patient go through cycling of different symtoms - Overall prognosis is negative and prognosis cog abilities to intergrate or stay decrease as disease progresses Course - 4 stages st - 1 - Premorbid - 1 phase observable symptoms - Some markers – some bio markers present even earlier not over behavioural - What happens in phase 1 - Possible who develop schzi bc start treatment earlier corr better outcome later on - Asymtopmictatic - 2 - Symtoms start appearing - Some oddness in behavour - And personal hygiene go down and lack of social life - 3 rd - Full psychosis kicks in - Active phase exhibiting positive and some extent negative cog symptoms - Longest phase and shcizo go through periods of remission or good health dispersed with lost of function - 4 - Latter on in progression - Defined by negative and cog symtoms bc strees brain go under lose some cog functions and abilities and people exhibit neg symptoms Life course - Premorbid phase - Late teens early 20s disease progressing to have obsrervable symtoms - Longest phase 3 – healthy and negative - And positive symptoms decrease have static phase and cog and negative symptoms of sch Dsm - 1 month 2 or more of symtoms Next - Three main clusters - Positive – most memeroable – delusions or hall - Negative – relate to emotional disturbances or falttening - And cogn – relate to lose of cog function attention memeory etc - Other classifications divide into pos and neg and positive spread out among the two Positive symoms - Most memorable - Hall – perception of things not there - Delusions – belief no ground in reality - Dis speech and thought – making own words, mimicking people Hall - Can occur in all senses - Visual are rare and appear early in disease - Auditory are most common and perciveve auditory stimuli not really there – voice tells them to do things Delusions - Delusions of persecution – someone after them - Referential – may think remote events relate to himself - Somatic – something going on with body – part of hall thin line - Religious - Grandiose – son of god - Defining feature – out of keepings with patients social culture background Negative symptoms - Compared to positive have some behaviurs present that should be there in negative lacking or missing that should be present - Usually these relate to emotions or emotional control and one isn flattening of affect - Loss of will to eintiate gfoal directed behavior - Or reduced expereicne of pleasure - And alogia – related to disorganized speech - Asociality Cog imairmnents Attnetional problems - Seen in healthy population who are under some stress such lack of sleep – lose focus or ability to ocnentrate - Difference have sleep good to go - Attentional haze state unable to focus full on env in sch - Lack of attention affect large number of activities Rt - Distractability or lack of attnetional focus can be exhbitive as slower rxn times - With targets long prep interval - Inability to detect targetes in large array of distracters – comp span - Detect t in three letters 2 distractors as increase distracters unable to deterct - Problems with smooth pursuit of eye movement - Target move across screen normal follow well with some deviations from path - Sch patients jagged and irregular - Attential deficitis are detecabel in the lab Core symptom cluster - Some disturbances in mood lead to severe consequences comes to social intergration in society Etiology - Studied heavily - No theory explains why schizophrenic patients get schizophrenia - Things may relate but no clear idea of what causes it - Research points to genes in developing sch - No straightforward thing no shc gene - Role of gene diathesis strees – gene predispose but some env factors need to play out shizo be triggered - Other – env – prenatal and env or events related to birth - Peranatal complications - Correlates to schzzio that are anatomical - Strucutal abnormalities - More correlate not what causing it - Other corr and neurbichemical changes in nt glut and dop and mediate some or most of symotms of sch Genetics - Found - Genes contribute to it to a degree - Among people who share high proportion of genetic materal concordance rate Is higher - Not just one gene but possible a set a large set - Particular set of alleles for sch to develeopemnt - Share higher porportiion of genes higher concordance rate of identical twins - Share only 50% - 4 share same porpotrtion of genes but concordance is very different – points to contribution of env and genes – fraternal share env and placenta as well maybe exposed to same chem. And nutrients from mother – prenatal env may increase likelihood in delveoping sch compared to normal siblings born some time about not share env to such an extent Nongentic - Compliations occur during pregnancy - Chemical and viruses or physical damagae or injury during labor itself - Brain most development – or cell proliferenation migration and diferential in prenatal - See how prenatal growth Is sensitive period - Harmful factors affect sens period of dvelopementn – exposure of vurises and vit d deficiincey Seasonal effect - Born during season and incidence of shc early spring higher then different time periods - Not time of birth but first and decond trimester when brain growing thogu development not getting vit d from mothers - No real explanation however Flu - Start of flu epidemic - 5 months after epidemic – born 5 months after higher chance schziio - What happening in second trimester where brain devleopemnt is occurring and sensitivce brain development is occurign – broken down bc exposed to virus - Ass with schiz not tell us cause of disease may be indicator or what questions to ask Hypo - May be precursor of disease but not initiate the disease – happenes in adol or adulthood where see first symptoms of schizophrenia - Synaptic pruning all cells formed early and conections during early devlepoment getting sleected or deleated or inefficient – from puberty to later adolescents - Synaptic pruning happen in puberty – injuries not come to forfront until after occurred - Some abnormailities - Increase ventricles - Loss of brain mass – brain matter – mainly in prefrontal cortex and lose of volume in termparal lobe Ct scan - Control vs schz – largement of lateral ventricles - Size – data x and y is volume - Not defining feature of many fall between normal range Sudden cell loss - Loss of useless cells in puberty and adol exagertaed in sch patients - Not increase rate of cell death but loss of dendrtitic branches which may result decrease in brain matter - Frontal cortex consistent decrease in brain matter – consistent for sch Brain scan - Early stage of disease - And some loss of gray matter in parietal occicptal lobe - As diseae progresses more widespread loss thoughout Pfc - Appears loss of brain matter here consisitenly ass with sch - Pfc – last to develop and take over higher cog functions and last to develop - Injury to this brain then sch ass with cog deficitis - Pfc control things like exec function planning attention learning and memeroy all cog functions to some degree lost in sch patients - Wcst – card sorting – test of
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