Chapter 11 Schizophrenia

Presence of too much behaviour found in schizophrenics but not found in most people.

Disorganized speech Hallucinations Delusions

The absence of behaviours most people have. A sign of schizophrenia.

Flat Affect Anhedonia Avolition Alogia Asociality

Incoherence, loose associations or derailment

Difficulty sticking to one topic. Drift off on a train of associations evoked by an idea from the past.

Beliefs held contrary to reality. Common positive symptom of schizophrenia.

German psychologist proposed particular forms of hallucinations and delusions (first-rank symptoms) as central to schizophrenia.

1 Unwilling recipient of bodily sensations/thoughts 2 Thought are broadcast or transmitted so others know what they're thinking 3 Thought being stolen from them 4 Feelings are controlled by an external force 5 Behaviour is controlled by an external force

1 Hearing their own thoughts spoken by another voice 2 Hearing voices arguing 3 Hearing voices commenting on their behaviour

Lack of energy and interest/ability to do normal routine activities such as grooming and personal hygiene. May spend a lot of time sitting and doing nothing. Negative symptom of schizophrenia.

Poverty of speech. Content and amount of speech is reduced. What they're saying does not convey much info. Negative symptom of schizophrenia.

No stimulus elicits emotional response. Answers in toneless voice. Eyes lifeless.

Catatonia Inappropriate Affect

Motor abnormalities, such as gesturing repeatedly, using peculiar sequence of finger, hand, arm.

Adopting unusual postures that are maintained for long periods of time

Another person can move the person's limbs into strange positions

Emotional responses are out of context. Rare, but relatively specific to schizophrenia.

Dementia paranoides Catatonia Hebephrenia

"mental enfeeblement" (Emil Kraeplin)

Greek: "schizein" meaning "to split" and "phren" meaning "mind". Term developed by Eugen Bleuler in 1908.

Another term for disorganized subtype of schizophrenia (proposed by Kraeplin initially)

Woman who was arrested at SkyDome for plotting to kill Blue Jay Roberto Alomar. She had delusional disorder and was frustrated that she couldn't contact Alomar even though she didn't know him.

1 Critieria were more detailed 2 Mood disorder symptoms were excluded 3 At least six months of disturbance was required 4 milder forms of schizophrenia were made into personality disorders (schizotypal personality disorder) 5 differentiation between paranoid schizophrenia and delusional disorder

Classic subtypes of schizophrenia were removed. Schizoaffective disorder was dropped.

Incorporating unimportant ideas into a delusional framework, reading significance into them. Eg. Overheard segments of conversation are thought to be about them.

People who meet criteria for schizophrenia, but do not meet criteria for a subtype (DSM IV-TR)

Person no longer meets full criteria for schizophrenia, but still shows signs of the disorder (DSM IV-TR)

All four developed schizophrenia, which is extremely unlikely. But they all had different life outcomes. Some were higher functioning than others. Demonstrates that the course of the disorder can be variable and both genetic and environmental factors need to be considered.

Amphetamines can induce a state resembling paranoid schizophrenia. This is probably a result of the increased dopamine. This led researchers to believe that schizophrenia was caused by excessive dopamine.

It is more likely that an increase in dopamine receptors and not dopamine is a cause of some (positive) symptoms (but not all) of schizophrenia. Antipsychotics reduce positive symptoms, while amphetamines worsen positive symptoms and lessen negative ones.

Low levels of glutamate have been found in the spinal fluid of schizophrenics. PCP can induce psychotic state by interfering with one of glutamate's receptors.

Came up with term "Dementia Praecox" to describe schizophrenia in 1988. It included dementia paranoides, hebephrenia and catatonia.

In 1908 he proposed changing the name "Dementia Praecox" to schizophrenia. He differed from Kraeplin on two aspects: the disorder didn't necessarily have an early onset and progressing towards dementia wasn't inevitable.

Evidence shows people with schizophrenia have enlarged ventricles. This is linked with poor cognitive performance, poor adjustment prior to the onset of the disorder and poor response to drug treatment. It is also found in patients with other psychoses such as bipolar disorder.

- Plays a role in behaviours. - Lack of awareness in schizophrenics maybe be related to defective frontal-love functioning. - Evidence shows reduction in grey matter int he prefontal cortex in schizophrenics. - Schizophrenics show low metabolic rates in the prefontal cortex during psychological tasks. - Schizophrenics show less frontal activation - Frontal hypoactivation is less pronounced in the non-scizophrenic twin of a MZ pair - Violent people with schizophrenia and a history with anti-social and/or substance abuse manifest neural dysfuntion affecting basal or obital parts of the prefontal cortex.

- presence of craniofacial/midline anomalies and/or early impairments of central nervous system anomoly double the risk - higher rates of S. in babies born with delivery complications (genetic predisposition). - Virus during pregnancy that invades the brain of the fetus (influenza, toxoplasmosis and genital/reproductive infections)

Stressors associated with class may cause or contribute to the development of schizophrenia. The degrading treatment a person receives from others, the low level of education, and the lack of opportunities make membership in the lower socio-economic class a stressful experience that may predispose individuals to develop the disorder. Could also be biological: children whose mothers are malnourished during pregnancy are are increased risk.

A reversal of causal factors of schizophrenia from sociogenic hypothesis. People with schizophrenia may drift into poverty-ridden areas or choose to move to areas with little social pressure so they can escape intense social relations or they may not be able to earn a living due to disability and discrimination. There is more evidence for this theory over the sociogenic theory.

Term was coined to describe a cold, dominant, conflict-inducing parent who was said to produce schizophrenia in her children. These mothers were rejecting, overprotective, self-sacrificing, impervious to the feelings of others, rigidly moralistic about sex and fearful of intimacy. There is no supporting evidence of this theory.

Negative symptoms

Surgical procedure introduced in 1935 that destroys parts of the brain connecting frontal lobes to lower centres fo the brain used to treat schizophrenia. 1950s it was stopped due to introductions of antipsychotic medications.

More circumscribed and specific procedure to a lobotomy.

Portugese psychiatrist who introduced the prefontal lobotomy in 1935.

By blocking dopamine receptors in the brain.

First to introduce /publish an article on chlorpromazine as a treatment for schizophrenia in North America. He was a physician in Montreal who escaped the nazis.

A supportive therapy that includes educational and supportive aspects of therapy. It focuses on computer-based training in attention, memory and problem solving as well as cognitive skills and initiating conversations. It is a therapy focused on basic cognitive functioning.

- family interventions - psychoeducation and social skills training - cognitive behavioural therapy - assertive community treatment - support employment

- Calming down the family environment and reducing critical comments from family members. (reducing expressed emotion) - Encourages family members not to blame themselves. - Encourages clients and families to expand their social support networks

Designed to teach people with schizophrenia behaviours that can help them succeed in various areas of life.

Effective in reducing negative symptoms of schizophrenia. Addresses delusions and hallucinations and can facilitation motivation and encouragement in social and vocational activities.

Forms of Assertive Community Treatment models/Case Management. They entail a multidisciplinary team that provides services ranging from medication, treatment for substance abuse, help with daily stressors, psychotherapy, vocational training, housing and employment.

First episode psychosis clinic for people with schizophrenia and their families manage the initial episode. The goal is to intervene in the prodormal phase to prevent onset of active phase symptoms and the decline in cognitive social and occupational functioning.

A term that refers to antipsychotic drugs because they produce side effects similar to symptoms of neurological diseases

Most frequently prescribed anti-psychotic drug in the past 50 years.

Schizophrenia appears earlier in men than women.

Disorganized

A. teachers described pre-schizophrenic boys as disagreeable in childhood. B. teachers described pre-schizophrenic girls as passive. C. men and women were described as delinquent and withdrawn in childhood. D. pre-schizophrenic children showed poorer motor skills.

receiving skills processing skills behavioural responses

the "breaking of the associative threads"

Delusions of persecution

schizophrenia causes poverty.