Schizophrenia

Schizophrenia

Symptoms:DelusionsGrandiose DelusionsHallucinations                          Ideas of reference                                 AlogiaAsocialityAnhedoniaAvolitionFlat affectCatatoniaWaxy flexibilitySpeech disturbances         These symptoms are characterized as either positive or negative symptoms or disorganization. Positive symptoms are a distortions of normal functions or an excess of normal functions. Negative symptoms are a lack or a deficit of normal function.

Subtypes:1. Paranoid    - characterized by positive symptoms2. Disorganized    -  Characterized by disorganized speech, disorganized behavior, flat or inappropriate affect3. Catatonic    - Largely characterized by impairments of body movement4. Undifferentiated    -  Characteristic symptoms of schizophrenia present but criteria are not met for the other subtypes5. Residual

Genetic explanations of schizophrenia     Gottesman and Shields StudyStudied 57 pairs of schizophrenic twins. If pair were discordant then the non-schizophrenic twin was studied for 13 years. 40% were MZ, 60% DZ Results= Concordance Rates          MZ= 42%          DZ= 9%Therefore the  genetic link through this study argues that there is a genetic link to schizophrenia. However, genetics are not the sole reason for schizophrenia as concordance rates between MZ twins was not 100%.

Biochemical explanationDopamine hypothesis- states that the brains of schizophrenic patients are more sensitive to dopamine than the brains of non schizophrenics.A. Role of drugs  

B. Post mortem evidence    Brains of people with schizophrenia have 6 times more dopamine receptors than normal brains. Therefore, the increased level of dopamine receptors indicate excess levels of dopamine being transmitted into the brain.

C. PET scans    L- dopa taken up quicker with schizophrenic brains. this suggests more receptor sites in the brain or hypersensitivity to dopamine

Cognitive explanation    Disturbed thinking processes are the cause rather than consequence of schizophrenia   Cognitive psychologists believe that there are physiological abnormalities associated with schizophrenia that lead to cognitive malfunctioning.    * Agrees with biological view in explaining hallucinationsCognitive Malfunctions   In a normal brain there is a mechanism that filters incoming stimuli. However in a schizophrenic brain the mechanism malfunctions and lets in too much stimuli = hallucinationsThe brain and schizophrenia   * Prefontal Cortex and PosteriorFrith's Model : Most symptoms can be explained in terms of deficits in 3 cognitive processes     a. inability to generate willed action     b. inability to monitor beliefs and intentions of others     c. inability to monitor willed action  (meta- representation)Faulty operation of this mechanism is due to functional disconnection between the frontal areas of the brain concerned with action and more posterior areas of the brain concerned with perception    Results: Frith detected low activation of the PC in schizophrenic patients who also performed poorly on cognitive tests

Treatments for schizophrenia1. Biological Therapies : Anti-psychotic drugs      a. Typical anti psychotics. The first generation of anti-psychotics developed during the 1950's     Effectiveness       - able to reduce (+) symptoms but has little effect on (-)       - 30% of patients don't respond     Appropriateness       -  Patients who respond well to them+ May result in many side effects such as weight gain, may affect blood pressure, produces confusion     b. Atypical anti-psychoticsA newer generation of anti-psychotics developed during the 1900's      Effectiveness      - produces greater therapeutic gains      - a greater reduction in side effects as only focuses on blocking D2 receptors      - reduces (+) symptoms largely      - improves working memory and social skills        Appropriateness      - anyone who does not respond well to typical drugs     2. ECT  ECT is not considered a first line of treatment but may be prescribed in cases where other treatments have failed. it is only measurably effective where symptoms of catatonia are present and in terms of treatment for drug resistant catatonic schizophrenia        Effectiveness      - does work but minimally effective      - only in cases of catatonia      - not a recommended treatment        Appropriateness       - Catatonic schizophrenic patients       - in cases where drug treatments have failed

Psychological Therapies1. CBTThe aim of CBT is to identify faulty thinking patterns that are causing unwanted feelings or behavior and to learn to replace this thinking with more realistic and useful thoughts a. Personal therapy Aims to ameliorate a full spectrum of problems of patients who have been discharged from the hospital  Helps patients to avoid turning frustrations into catastrophies to reduce stress levels        Effectiveness      - improves social and emotional lives of schizophrenics      - reduces rates of relapse since it reduces stress      - unable to work without drug treatments       - helps patients test delusional beliefs         Appropriateness       - helps both positive and negative symptoms       - only works for people released from hospital       - re-attribution therapy works for paranoid schizophrenicsBehavioral Therapies  Behavioral treatment focuses on operant conditioning- learning through reinforcement   a. Token EconomiesHelp encourage people in psychiatric institutions to perform socially desirable behaviors    Paul and Lentz   Show how they treated schizophrenic patients by giving reinforcement for socially acceptable behaviors which reduced their psychotic behaviors    They used behavior modification techniques to help learn new ways to behave         Evaluation      - Superficiality      - Reductionist      - Low ecological validity      - Ethical issues

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