Schizophrenia

Define: Schizophrenia

A type of psychotic illness, a disorder where people lose touch with reality. Sufferers tend to have irrational beliefs, hear voices, see things which are not true or even there.

Define: Classification

Taking a set of symptoms and putting them into a category.

Define: Diagnosis

The clinical judgement that an individual is suffering from a disorder.

Define: Psychosis

A severe mental health problem where the individual loses contact with reality, they are unaware there is a problem.

Define: Positive Symptoms

Any change in behaviour which is excitatory, the addition of something.

Define: Negative Symptoms

Any change in behaviour which is a reduction or deficit of functions.

Define: Hallucinations

Sensory experiences such as hearing voices, visual distortions, seeing people or animals which are not real.

Define: Delusions

Irrational beliefs such as grandeur or paranoia, can concern the body such as belief of being under control of someone else.

Define: Alogia

Speech poverty. Characterised by changes in amount of speech or its quality. Some may have delays in verbal responses.

Define: Avolition

More commonly apathy. The loss of motivation to carry out tasks and results in lower activity levels.

Define: Co-Morbidity

When two or more medical conditions occur at the same time, or the tendency for this to happen.

Define: Symptom Overlap

The way symptoms extend between different disorders, leading to unreliable diagnosis.

Define: Blunted Affect

The inability to express emotions and negative feelings, expressions don’t show outwardly.

Define: Experiences of Control

The irrational belief that thoughts are being controlled by someone else, they are not one’s own, or thoughts are being planted.

Define: Disordered Thinking

A thought process is disjointed, there is a collapse or suddenly stops. Words may be randomly spoken or generally incoherent.

Define: Asociality

The lack of motivation to engage in social interaction.

Define: Echolalia

The pathological repletion of the words of others.

Define: Anhedonia

The lack of pleasure or the inability to feel pleasure from enjoyable activities.

Define: Delusions of grandeur

A false impression one’s own importance, can involve irrational belief of being an important historical, political, or religious figure.

Define: Delusions of persecution

Irrational belief that harm is going to occur, that they are being targeted by a particular group, eg the government, a superpower, or an individual.

Define: Prodromal Symptoms

An early symptom indicating the onset of a disorder, only seen in hindsight.

Define: Paranoia Type

The extreme feeling of suspicion or grandeur. Strong delusions and hallucinations.

Define: Catatonic Type

A person is withdrawn, mute, negative and may be either very immobile or very mobile.

Define: Hebephrenic Type

Primarily negative symptoms: apathy, lack of motivation.

Define: ICD

The International Classification of Diseases published by the World Health Organisation which classifies many disorders.

Define: DSM

The Diagnostic Statistical Manual of Mental Disorders published by the American Psychiatric Association which classifies many disorders.

Define: Genetics

The study of heredity through genes and DNA.

Define: Concordance Rate

A statistical measure that describes the proportion of pairs that share an attribute given that one already possesses the trait.

Define: Dopamine

A neurotransmitter which plays a role in pleasure and reward, attention, movement and more.

Define: HypERdopaminergia

Excessive levels in the subcortex and Broca’s area.

Define: HypOdopaminergia

Low levels in the prefrontal cortex.

Define: Neural Correlates

An association between a physical occurrence in the nervous system (mainly the brain) and a mental state/event.

Define: Agonist

An antipsychotic drug that initiates a physiological response when combine with a receptor.

Define: Antagonist

Depresses the effect of an agonist.

Cheniaux et al (2009)

Two psychiatrists independently diagnosed 100 patients using ICD and DSM

Cheniaux et al (2009) Results

Low inter-clinician reliability: Diagnosis of 26 compared to 13.

Poor validity: DSM diagnosed 26 ICD diagnosed 44.

Osório et al (2019)

Reported excellent inter-rater reliability using DSM-5 by WHO (0.97) and APA (0.92)

Lakeman (2019)

Stated that the voices are not recognised as hallucinations, thus Matakites are not diagnosed.

Cultural Bias examples

Psychedelic used in South America for hallucinations, recognised by government of Peru.

Matakites in New Zealand hear voices of ancestors for knowledge and wisdom.

Leo and Cartagena (1999)

Most studies exclude women as hormonal fluctuations act as confounding variables.

Fischer and Buchanan (2007)

Women may not be diagnosed, 1.4:1 (M:F)

Gottesman and Shields (1991)

Evidence supporting genetic basis, MZ concordance rate of 48%

Falkai et al (1988)

Increased dopamine in left amygdala in post-mortems

Seidman (1990)

Larger dopamine receptors in post-mortems

Berry et al (2008) - support for all family dysfunction.

Adults with insecure attachments were more likely to develop schizophrenia

Stirling et al (2006)

Showed how schizophrenics scored lower on cognitive tasks (Stroop test)

Genain Quadruplets

All developed Schizophrenia showing a genetic basis

Lobos (2010)

Compared Clozapine to a number of other atypical drugs, found it faired very favourably in reducing positive symptoms.

Valenstein et al (2004)

Found that 40% of over 63000 cases adherence rate was poor. Only drug where this was not an issue was clozapine which had 4.6% poor adherence.

Moncrieff (2006)

Found that withdrawal from atypical antipsychotics can cause psychosis even in patients without psychosis history.

Szasz (1960)

Drugs are like a chemical straightjacket trying to make patients normal.

Pontillo et al (2016)

Found that CBTp reduced frequency and severity of auditory hallucinations

Jauher et al (2014)

Found clear evidence for small but significant reduction in both positive and negative symptoms.

McFarlane (2016)

Concluded that family therapy was one of the most consistently effective treatments available.

The National Collaborating Centre for MH (2009)

Meta-analysis of 32 studies with 2500 patients found relapse rates from family therapy significantly lower (26%) than standard care (50%)

NCCMH (2006) cont.

Family therapy lead to reduction in hospital readmission and reduction in severity of symptoms during and 24 months after treatment.

Matson et al (2016)

Identified three categories which can be addressed through token economies. (Poor hygiene, illness-related behaviours, social behaviours)

Ayllon and Azrin (1968)

Token Economy in women’s ward in US increased desirable behaviours significantly, but decreased when withdrawn.

Corrigan (1991)

Found that token economies only work in hospitals.

Dickerson et al (2005)

Meta-analysis found that 11/13 studies found the system was effective.

Comer (2013)

Studies tend to be uncontrolled

Tienari et al (2001)

Longitudinal study of 1900 Finnish adoptees found that only the adoptees with genetic vulnerability AND adopted family with high levels of criticism developed SZ.

Read et al (2001)

Proposed neurodevelopmental issues alter the brain leading to vulnerability.

Tarrier et al (2000)

Found support for an interactionist approach to treatment, CBT and drug therapy, counselling with drugs, were more effective than drugs alone.