Schizophrenia

1. Positive symptoms
   1. Delusions

      Nota:

      • Delusions - Highly implausible thoughts that you believe are the activities of those who plot against you/use you
   2. Hallucinations

      Nota:

      • Hallucinations - Perceptions in any sensory modality without relevant and adequate external stimuli
2. Negative symptoms
   1. Avolition

      Nota:

      • Patients lack energy and have no interest or ability to go through routine activities
   2. Alogia

      Nota:

      • Symptom where poverty of speech and poverty of content can be seen
   3. Anhedonia

      Nota:

      • An inability to experience pleasure
   4. Asociality

      Nota:

      • Having severe impairments in social relationships - few friends, poor social skills, and little interest in socializing
   5. Flat/Blunted Affect

      Nota:

      • No emotional can be elicited from a stimulus
3. Disorganization
   1. Disorganized speech

      Nota:

      • Disorganized speech - Speech found in schizophrenics that is marked by problems in the organization of ideas and in speaking so that others can understand
4. Other (Catatonic)
   1. Catatonia

      Nota:

      • Patients gesture repeatedly with no reason or sometimes just uncontrollably.  In catatonic immobility, patients stay in one position for a long time
   2. Waxy flexibility

      Nota:

      • Another person ca move the patients limbs and the patient remains that way for a long time

1. Paranoid schizophrenia

   Nota:

   • - Characterized by positive symptoms - Typically experience delusions of persecution or grandeur that are detailed and complex - No disorganization or flat affect
2. Disorganized schizophrenia

   Nota:

   • - Characterized by silly and incoherent behavior - Disorganized speech (loose associations and derailment) - Disorganized behavior (not goal-directed, neglecting appearance) - Flat or inappropriate affect
3. Catatonic schizophrenia

   Nota:

   • -Characterized by impairment of body movement - Wild and uncontrolled movement - Immobility or catalepsy (possibly 'waxy flexibility') - Peculiar voluntary movement (bizarre postures or repeated gestures) - Extreme negativism or mutilism - Often echo speech of others
4. Undifferentiated

   Nota:

   • - Characteristic symptoms of schizophrenia are present, but criteria are not met for any of the other sub types
5. Residual

   Nota:

   • -Absence of positive symptoms ,symptoms of disorganized schizophrenia, or catatonic behavior - Presence of negative symptoms or presence of other schizophrenia symptoms in lesser form
6. Limitations of categorizing into types

   Nota:

   • - Lacks precision/reliability - People don't fit neatly into one stubtype - Categorizing people gives little or no indication of:   - Cause   - How it might develop   - Effective treatment

1. Biochemical
   1. Dopamine hypothesis

      Nota:

      • Dopamine hypothesis: the brains of schizophrenic patients are more sensitive to dopamine than the brains of non-schizophrenics
      1. Studies with drugs

         Nota:

         • - Amphetamines and cocaine increase the level of dopamine in the brain and produces schizophrenic (paranoid) symptoms - When schizophrenics take amphetamines or cocaine, the symptoms worsen - Chlorpromazine (anti-psychotic drug) can reduce symptoms by blocking D2 receptors, but can produce side effects similar to symptoms of Parkinson's disease.
         1. Parkinson's disease

            Nota:

            • - Parkinson's patients have low levels of dopamine - L-dopa can raise dopamine activity - But if too much L-dopa is taken, schizophrenic symptoms can be developed.
      2. Post mortem studies

         Nota:

         • - Autopsies show that schizophrenics have 6 times more the number of dopamine receptors than normal - Excess of dopamine receptor sites is the same as having high levels of dopamine since the same message is sent too much in both
      3. PET scans

         Nota:

         • - Radioactive L-Dopa was tracked when absorbed by subject's brain. - L-Dopa taken up quicker in schizophrenics - Suggests that schizophrenics have more receptor sites or have hypersensitive receptors
   2. Genetic
      1. Gottesman & Shields

         Nota:

         • - Examined records of 57 schizophrenics with 40% being monozygotic and 60% being dizygotic. - If pair was discordant, the non-schizophrenic was followed for 13 years - MZ concordance rate was 42% - DZ concordance rate was 9%
         1. Limitations

            Nota:

            • - Since MZ twins probably lived in similar conditions, environmental factors may have had a larger role - MZ twins most likely had similar parenting hence the similarity - Genetic link is shown, but it doesn't explain schizophrenia

Nota:

• - Disturbed thinking processes are the cause of schizophrenia - Physiological abnormalities lead to cognitive malfunctioning - Hallucinations are the most dramatic perception distortions. - They are mostly (74%) auditory - Can be very frightening

1. Cognitive malfunctionins

   Nota:

   • In a normal brain there is a mechanism that filters incoming stimuli.  A schizophrenic brain's mechanism malfunctions and lets in too much stimuli - cannot focus - unable to interpret information correctly - world is very different
2. Frith's study

   Nota:

   • -In schizophrenics, there is a disconnection between the pre-frontal cortex that control action and the posterior areas that control perception -PET scans were done during cognitive test to trace radioactive glucose -In schizophrenics, the prefrontal cortex showed low activation -Schizophrenics performed poorly on the cognitive tests
   1. Frith's model of psychosis

      Nota:

      • Because of the disconnection, patients experience: - Inability to generate willed action - Inability to monitor willed action - Inability to monitor the beliefs and intentions of others
3. Limitations

   Nota:

   • - Cannot explain the cause of schizophrenia. The symptoms can be explained, but no cause is given - Too deterministic. cognitive impairments = mental disorders

1. Antipsychotics
   1. Typical

      Nota:

      • - The first generation of antipsychotics developed in the 1950s - Block dopamine receptors - Positive symptoms are treated, but negative symptoms are not - Many side effects - 30% don't respond
   2. Atypical

      Nota:

      • - Newer generation of antipsychotics developed during the 1990s - Atypicals attach to specific dopamine receptors - Effective for positive symptoms and has some effect on negative symptoms  - Fewer side effects
2. Electro Convulsive Therapy (ECT)

   Nota:

   • - Electric shocks are used to cause  seizure where a 'rush' of chemical neurotransmitters is released and temporarily alters function. - 3-4 times  week for max. 12 treatments - Sleep is induced  - Muscle relaxant used - Only for catatonic symptoms and only when drug treatments have failed - Side effects of temporary short term memory loss, confusion, paranoia, nausea, muscle aches and headache.

1. Cognitive Behavioral Therapy (CBT)

   Nota:

   • Based on the idea that most unwanted thinking patterns, and emotional and behavioral reactions are learnt over a long period of time - Restructures patient's perception to a more normal view - Usually done alongside drug treatment - Changes patient's faulty way of thinking - Teaches patients recognize inapproproate affect and test delusional beliefs -Treats symptoms and not the cause
2. Behavioral Therapy

   Nota:

   • Based on operant conditioning (learning through reinforcement)
   1. Token Economies

      Nota:

      • - Helps people in psychiatric institutions to perform socially desirable behaviors
      1. Paul and Lentz

         Nota:

         • Paul and Lentz used token economies and behavior modification to reinforce socially acceptable behavior