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PSY346H5 (21)
Chapter 10

PSY346-Chapter 10.doc

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Gary Kraemer

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Chapter 10-Schizophrenia -prevalence rates from 0.5%-1.5% -generally diagnosed between ages of 15-35, estimated to afflict 24 million people worldwide -Kraepelin came up with symptoms: 1) auditory and visual hallucinations-an internal perception of a realistic sensory event in the absence of any external stimuli 2) motor tics 3) poor regulations of speech or disordered thought 4) catatonia, an absence of movement often observed in the schizophrenic patient, coupled with hebephrenia, an inappropriate and uncontrollable laughter dementia pracecox: older term for schizophrenia, early dementia schizophrenia: Bleuler, mental disorder characterized by disordered thoughts, delusions, hallucinations and other bizarre behaviours schizo-“splitting” phrene-“psychic functions” -Bleuler split the symptoms into fundamental and accessory fundamental or core symptoms-ambivalence, affective disturbances and alterations in association accessory symptoms-hallucinations, delusions and speech and behaviour abnormalities -DMS has three broad categories of schizophrenic symptoms: 1. Hallucinations and delusions are positive symptoms, in the sense of adding a new symptom to the repertoire 2. Behaviours that are “taken away” from the patient’s normal functionining (lack of appropriate emotional expression, reductions of speech and thoughts) are referred to as negative symptoms 3. Disorganized symptoms (ex: disorganized speech and thought patterns) Genetic Factors -Frank Kallmann-conducted an elaborate study of the relative roles of heritability and environmental influences in schizophrenia -examined medical records of New York State mental hospitals concordance rate of 86% in identical twins and 15% in fraternal twins -appears to cluster in families -case of identical sisters, known as the Genain quadruplets, all of whom were diagnosed with schizophrenia -twin suffering from birth complications likely to have it -genetic links reside on chromosomes 1, 6, 8, 10, 13, 15, 18 and 22 and the X chromosome -Silbersweig-excess neural activity in the temporal lobes of the individuals experiencing auditory hallucinations -during auditory hallucinations thalamus, striatum, and hippocampus in the cingulate, orbiofrontal and auditory cortices -poor neuronal organization in schizophrenic brain -increased density of neurons in the prefrontal and occipital cortex -early onset, grey matter loss occurred at about 5%, normal adolescence 1% -neurons are smaller in the schizophrenic hippocampus -have less synaptophysin-immunoreactive tissue in the prefrontal cortex -one of the earliest discoveries-ventricles are larger in schizophrenic patients -sulci are enlarged -the total volume of the mid-portion of the cerebellum is smaller -frontal lobe involvement -antihistamine drug chlorpromazine (Thorazine) could mollify delusional patients -DA hypothesis of schizophrenia-observation that he clinical efficacy of the early drugs correlated with their ability to block DA in vitro as opposed to in vivo -schizophrenic DA present in the synapse or excess DA could not be cleared quickly enough -the mesolimbic system arises from cell bodies in the ventral tegmental area with projections that run into many limbic structures, mesocortical system arises from cell bodies in the VTA but the projections run to the neocortex -conflicting evidence described by Robert Freedman: 1) when DA transmission is blocked, the symptoms of schizophrenia are
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