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Chapter 10

Psychology 2030A/B Chapter Notes - Chapter 10: Dementia Praecox, Psychosis, Neurodevelopmental Disorder

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David Vollick

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Chapter 10
Schizophrenia Spectrum and Other Psychotic disorders
Psychotic Disorders
- unusual thinking (illogical), distorted perceptions (inaccurate), odd behaviour (dysfunctional)
- psychosis = loss of contact with reality (delusion and/or hallucination)
- delusions = a false belief
- hallucination = a false sensory perception
note: hallucinations or delusions alone do not indicate psychotic disorder
- bipolar, major depressive, PTSD, substance-related disorders also show psychotic symptoms
- even with physical illnesses like brain tumours, alzheimer's, parkinsons, injuries, toxic exposure
- healthy adults may face psychotic symptoms once in a while
What is Schizophrenia?
- severe psych disorder
- not the same as split/multiple personalities (DID)
- Emil Kraeplin first looked at it
- described it as "dementia praecox" (lit. dementia early-onset)
- he defined dementia as pervasive disturbances in perceptual and cognitive facilities
- Bleurer called it schizophrenia (lit. split mind))
Schizophrenia in Depth:
3 categories of symptoms:
- Positive Symptoms
- unusual thoughts, feelings, perceptions, behaviours
- delusions
- persecutory
- influence (eg: someone else is manipulating their thoughts directly)
- others: eg. grandiose
- hallucinations (perception-like experience without external stimulus)
- verbal (someone else said something)
- auditory - most common, in schiz characterised by a running commentary
- visual - usually in more severe cases
- olfactory
- somatic/tactile (eg: bugs crawling)
- gustatory (having to do with taste)
- loose associations (no link between ideas)
- thought blocking (very long pause in speech/thought)
- clang associations (eg: compulsion to rhyme even though nonsensical)
- catatonia (non-responsive to stimuli) - hypothesized to reduce stimulation; waxy flexibility
- Negative Symptoms
- blunted affect (flat emotions) / diminished emotional expression
- anhedonia (lack of excitement, pleasure)
- avolition (apathy; decrease motivation to initiate activities)
- alogia (decreased quality and quantity of speech)
- psychomotor retardation - slow mental or physical activities (eg: very slow speech)
- negative symptoms are difficult to fix even with medication and are often function-impairing
- Cognitive Impairment
- social cognition (inability to understand social cues), visual, verbal, abstract learning
- echolalia (repeating what other people say)
- decrease in information processing speed
- one of the earliest signs of schizophrenia
- absent in some people with schizophrenia
- similar to negative symptoms, difficult to treat and function-impairing
-> Diagnosis of schizophrenia requires presence of symptoms from each of the categories
- Functional impairment in schizophrenia
- symptom severity equals the level of impairment
- significant human toll on the individual and the family (quality of life)
- higher risk of being victims and perpetrators of violence
Epidemiology of Schizophrenia
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- prevalence rate averages 1% of the general population
- Large % of schizophrenics have depression, attempted suicides, anxiety, PTSD, substance abuse
- either acute (sudden) or gradual onset
- in gradual onset, starts with deterioration of functions:
- prodromal phase (social withdrawal or deterioration of hygiene)
- acute phase (starts to exhibit positive symptoms)
- nb: acute onset and acute phase are different things
- residual phase (psychotic symptoms no longer present, negative symptoms remain)
Sex, Race, Ethnicity
- women develop at later age and have milder forms
- hypotheses for why milder in women:
- later onset more time for brain to develop, life to settle (education, job)
- estrogen may have protective effect on brain
- women have better social networks
- symptoms consistent across racial and ethnic groups
- some hypothesize schiz to be a kind of PTSD, control issue
Developmental Factors
- as children, adults who develop schiz are anxious, depressed, face psychotic episodes, magical thinking (thinking makes things happen), referential ideas /
delusions of reference (casual events directed at you like random people laughing)
- study showed adults who developed schiz were much less social when they were 11 to 13 years old
- earlier the treatment is started, the better it is
- early-onset schiz = develops before the age of 18 / [textbook says 19]
- lose more cortical gray matter over 5 years
- only 8 to 20% achieve full remission
- outcome extremely poor when disorder begins before 14
Ethics and Responsibility
- diagnosis based solely on symptoms without knowing the culture is bad
- clinicians generally have little cultural competence
- schizophrenia not especially associated with violence compared to other disorders, despite the misconception
- poorer socioeconomic status means they live in crime-laden neighbourhoods, leading to violence
- watch for language barriers
- these things may lead to inaccurate diagnosis
- Biological
- generally understood to be a neurodevelopmental disorder, with genetic predisposition and leading to alterations in brain structure and function
- neurotransmitters
- hypothesis: too much dopamine (DA) in the neural synapses
- causality not established:
- maybe schiz causes brain changes leading to excess dopamine
- maybe schiz and dopamine result from a third cause
- high dopamine implicated in positive symptoms
- paradoxically, low dopamine and serotonin (resembling depression) associated are with negative symptoms
- low GABA and glutamate levels associated with cognitive deficits (problems learning)
- Neuroanatomy
- macro: increased size of ventricles; decreased (cortical) gray matter amount
- present at time of onset, also present in relatives
- micro: cellular disorganization that could have only occurred prenatally
- Genetics and Environment
- risk of developing schiz is 15% if one parent has it; 50% if both parents have it
- twin studies show that monozygotic (identiical) twins have a higher change of concordance
- Viral theories and other prenatal stressors
- established that neuroanatomical alterations do exist, but genetic link is not definite
- therefore prenatal factors have been studied extensively
- maternal exposure to influenza virus of high interest
- hypothetical mechanism: influenza antibodies cross placenta and react with antigens in baby's brain, disrupting development; in mice leads to
lower number of cells
- Neurodevelopment model of schizophrenia
- a combination of effects including genetic predisposition and prenatal environment
- synaptic pruning occurs faster
- in normal development during adolescence, some synapses get pruned. in schiz, this happens faster, perhaps brain doesn't have a chance to
develop certain neural functions
- Family influences
- expressed emotion (describes the level of emotional involvement and critical atittudes that exist within a family of a patient)
- higher expressed emotion families correlate to higher incidence of schiz relapse
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