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Chapter 11

PSYB32H3 Chapter Notes - Chapter 11: Disorganized Schizophrenia, Endophenotype, Hepatotoxicity

Course Code
Konstantine Zakzanis

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Ch 11: Schizophrenia
Schizophrenia is a psychotic disorder characterized by major disturbances in thought, emotion,
and behaviour: disordered thinking in which ideas are not logically related, faulty perception and
attention, flat or inappropriate affect, and bizarre disturbances in motor activity
Patients with schizophrenia withdraw from ppl and reality often into a fantasy life of delusions and
Schizophrenia is one of the most severe psychopathologies; however its life time prevalence is
generally accepted to be about 1%
Concluded that there may be real variation in schitzo across geographical regions around the
world with Asian populations having the lowest prevalence rates
Higher in males than in females (male- female = 1:4)
Although schitzo sometimes begins in childhood it usually appears in late adolescence or early
adulthood or early adulthood somewhat earlier for men than for women
Ppl with schitzo typically have a # of acute episodes of their symptoms.
Between episodes they often have less severe but still very deliberating symptoms.
Most ppl with schiotzo are treated in the community however hospitalization is sometimes
Concluded that almost one half (46%) do not require inpatient services. However ppl who were 1st
diagnosed while inpatients and those residing in rural areas were most likely to require additional
inpatient services in the 1st year of treatment
In Canada hospitalization rates are typically much higher among young men relative to young
women accounting for 19.9% of separations from general hospitals. Scitzo accounts for 30.9% of
separations from psyiatric hospitals
About 10% of ppl with scitzo commit suicide
Many ppl with scitzo remain chronically disabled. The disability can be attributed to symptoms
inherent to schitzo as well as the comorbid disorders from which approx 50% of those with shcitzo
In 2004 there were an estimated 234,305 ppl in Canada with schozto. Overall 374 deaths that year
were attributed to schizto. The illness total costs were $6.85 billon 70% of which was the cost of
lost productivity
Schizophrenia and comorbidity
Comorid conditions appear to play a role in the development, severity and course of schito.
Comorbid substance abuse is a major problem for patients with schizto occurring in as many as
70% of them
37% of the sample of ppl with schizto showed current evidence of substance us disorders. The
relationship was especially common among men and analyses suggested that childhood conduct
disorder problems are potent risk factors for substance use disorders in shcizto
about 40% of the participants were depressed at the outset. Over the next three years those
diagnosed with shcizto who were also depressed relative to the non depressed group were more
likely to use relapse related mental health services to be a safety concern, to have substance related
problems and report poorer life satisfaction, quality of life, mental functioning, family
relationships and medication adherence.
Comorbid anxiety disorders are also common and can impose an additional burden on ppl with
schizo and results in further decline in their perceived quality of life.
Comobidity with obsessive compulsive disorder is also related to a previous history of suicidal
ideation and suicide attempts
Post traumatic stress disorder is highly prevalent and under diagnosed among military veterans
with shizto
Developing( prodromal) phase of schito. Found that prodomol patients experience a wide variety
of comorbid psychiatric syndrome especially major depressive disorder and cannabis dependence

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The symptoms of patients with shcizto involve disturbances in several major areas: thought,
perception, and attention; motor beh; affect or emotion; and life functioning
Although only some of these problems may be present at any given time
The duration of the disorder is also imp in diagnosis
Unlike most of the diagnostic categories we have considered no essential symptom must be
present for a diagnosis of schizo
Thus patients with schizto can differ from each other more than do patients with other disorders
The key to understanding shcito is to recognize its heterogeneity
The presentation, course and outcome of shcito are variable and diverse
Currently evidence indicates that it is hard to find specific traits or characteristics that are shared
by all persons with a diagnosis or schizo
Positive symptoms
Comprise excesses or distortions such as disorganized speech, hallucinations and delusions.
They are what define for the most part an acute episode of schiz
Positive symp are the present of too much of a beh that is not apparent in most ppl while the
negative symp are the absence of a beh that should be evident in most ppl
Disorganized speech----also known as formal though disorder, disorganized speech refers to
problems in organizing ideas and in speaking so that a listener can understand
There’s incoherence found in conversations of indivb with S. although the patient may make
repeated references to central ideas or a them the images and fragments of thought are not
connected; it is difficult to understand what they’re saying
Disturbances in speech were at one time regarded as the principal clinical symp of s ad they
remain one of the criteria for the diagnosis. But evidence indicates that the speech of many
patients with s is not disorganized and that the presence of disorganized speech does not
discriminate well between s and other psychoses such ass some mood dis. Patients in manic
episode exhibit loos associations as much as those with s
Delusions--- beliefs held contrary to reality are common positive symp of s. persecutory delusions
like these were found in 65% of a larger cross national sample
Delusions make take several other forms as well:
The patient may be the unwilling recipient of bodily sensations or thoughts imposed by an external
Patients may believe that their thoughts are broadcast or transmitted so that others know what they
are thinking
Patients may think their thoughts are being stolen from them suddenly and unexpectedly by an
external force
Some patients believe that their feelings are controlled by an external force.
Some patients believe that their beh is controlled by an external force
Some patients believe that impulses to behave in certain ways are imposed on them by some
external force
Although delusions are found among more than half pf ppl with schizto as with speech
disorganization they are also found among patients with other diagnoses—ex: mania and
delusional depression. The delusions of patients with s are often more bizarre though than patients
in other diagnostic categories. They are also highly implausible
Hallucinations and other disorders of perception
Patients with s often report that the world seems somehow diff or even unreal to them. A patient
may mention changes in how his or her body feels or the patients body may become so
Some ppl report having difficulty in attending to what is happening around them
The most dramatic distortions of perception are hallucinations, sensory experiences in the absence
of any stimulation from the environment. They are often more auditory than visual 74% sample
had auditory hallucinations
Some hallucinations occur more often in patients with s than in other psychotic patients. They
types of hallucinations include the following: some patients with s report hearing their own

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thought spoken by another voice, or hear voices arguing, or they hear voices commenting on their
Negative symptoms
Consist of behavioural deficits, such as avolition, alogia, anhedonia, flat affect, and asociliaty
These symptoms tend to endure beyond an acute episode and have profound effects on the lives of
patients with s. they are also imp as the presence of many negative symp is a strong predictor of a
poor quality of life two years following hospitalization
Some evidence that negative symp are associated with earlier onset brain damage (enlarged
ventricles) and progressive loss of cognitive skills (IQ decline)
Ex; flat effect (lack of emotional expressiveness) can be a side effect of antipsychotic medication
Observing patients over extended periods of time negative symp such as flat affect and anhedonia
are difficult to distinguish from aspects of depression so specifity becomes an issue
apathy or avoliytion referred to lack of energy and a seeming absence of interest in or an inability
to persist in what are usually routine activities.
Patients may become inattentive to grooming and personal hygiene
They have difficulty persisting at work, school or household chores and may spend much of their
time sitting around doing noting
A negative thought disorder, alogia can take several forms. In poverty of speech, the sheer amount
of speech is greaydly reduced.
In poverty of content of speech the amount if discourse is adequate but it conveys little info and
tends to be vague and repetitive
An inability to experience pleasure. its manifested as a lack of interest in recreational activities,
failure to develop close relationships with other ppl and lack of interest in sex. Patents are aware
of this symp and report that normally pleasurable activities are not enjoyable for them
Flat affect
Virtually no stimulus can elicit an emotional response. The patient may stare vacantly, the muscles
of the face flaccid, the eyes lifeless
When spoken to the patient answers in a flat and toneless voice.
Flat affect was found in 66% of a large sample of patients with s
The concept of flat affect refers only to the outward expression of emotion and not to the patients
inner experience which may not be improvishered at all
While the patients were much less facially expressive than were the non patients they reported
about the same amount of emotion and were even more physiologically aroused
Some have severely impaired social relationships
They have few friends, poor social skills, and little interest in being with other ppl
Ppl diagnosed with s have lower socialability and greater shyness
Ppl with s also reported more childhood social troubles
These manifestations of s are often the first to appear beginning in childhood before the onset of
more psychotic symp
Confirmed that ppl with s did less well on facial affect recognition and facial recognition tasks
These deficits persisted and were evident when the patients were reassessed three moths later even
though there were substantial improvements in the # of both positive and negative symp since
initial hospitalization
Other symptoms
One problem is that the positive and negative symp do not necessarily reflect exclusive subtypes
cyz they are dimensions that often coexist within the same patient.
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