schizophrenia

what is schizophrenia ?

mental disorder characterised by hallucinations, delusions, disorganised thinking and behaviour and flat or inappropriate effect

Dr Emile Kraeplin 1887

first diagnosed schizophrenia as “dementia praecox” - early onset dementia

Eugen Bleuler 1911

coined term schizophrenia - means split mind in greek

approx. what % of the population develop schizophrenia ?

1

what individuals are at higher risk of developing schizophrenia ?

men and those with fathers ages 45+ at time of birth

what is the average age of onset for schizophrenia ?

18 - 30yrs Tandon et al. 2009

how does schizophrenia differ in its presentation between genders ?

5-7yrs later onset in women, more severe affective symptoms, less severe negative symptoms and cognitive impairment, lower suicide rates, respond better to treatment

list the common signs and symptoms of schizophrenia

characteristic distortions of thinking and perception

cognitive impairments

motor abnormalities

avolition and apathy

difficulties in communication

restricted affective expression

avolition

total lack of motivation

apathy

lack of feeling or emotion

positive vs negative symptoms

positive - additional experiences eg. hallucinations

negative - take away eg. loss of speech

symptoms can be classified into what 6 groups ?

positive, negative, cognitive, disorganisation, mood, motor

what are the 3 primary diagnosis symptoms

delusions, hallucinations or disorganised speech - must have 1 for diagnosis

what are the 5 DSM-5 diagnosis criteria ?

delusions

hallucinations

disorganised speech

disorganised / catatonic behaviour

negative symptoms

delusions

false beliefs resistant to the truth

hallucinations

disturbances of perception - sensory

catatonia

awake but not responsive

delusions usually focus on…

those close to the person

what is the most common type of hallucination ?

auditory - hearing things

what are the 5 sensory forms ?

auditory, visual, tactile, gustatory, olfactory

what are the 3 types of schizophrenia ?

disorganised

paranoid

catatonic

characteristics of disorganised/hebephrenic schizophrenia

disorganised speech, flat or inappropriate effect, short-lasting delusions and hallucinations, requires ongoing treatment

characteristics of disorganised/hebephrenic schizophrenia

most common, paranoid delusions, auditory hallucinations, catatonic symptoms not prominent

characteristics of catatonic schizophrenia

psychomotor disturbances

prolonged periods of stillness

alternate with hyperkinesis - excessive activity

“wavy flexibility”

vivid hallucinations

what is the concordance rate in MZ twins vs DZ ?

40 to 50% vs 10 - 15

4 biologically based explanations for schizophrenia

genetics, viral infections, complications during pregnancy and birth, excess levels of dopamine in brain

psychosocial explanation for schizophrenia

schizophrenogenic mother - certain mothering style can lead to development of disorder

characteristics of a schizophrenogenic mothering type

cold, over-protective, domineering and rejecting towards children

Freud’s psychodynamic explanation for schizophrenia

anxiety motivated regression

person gives in to overwhelming anxiety

regresses back to early oral stage - between development of ID and ego

Sullivan (1962) psychodynamic explanation

cause of anxiety is damaging mother- child relationship

gradual withdrawal from other people that begins in early childhood

final withdrawal = schizophrenic break

cons of the psychodynamic explanation

lack of evidence

speculative - not empirically testable

unfalsifiable - cannot be proven

individualistic

cognitive explanation

most people able to focus selectively

if not sensory overload experienced - schizophrenia

Frith (1979)

attention deficit theory - believed faulty attention systems to be cause

Bentall’s suggestion that schizophrenics have trouble processing info can be tested using…

Stroop tests - takes longer for schizophrenics

Meyer-Lindenberg et al. (2002)

suggested link between faulty processing and high dopamine

biological treatment

antipsychotics - effective in treating hallucinations and delusions

psychosocial treatment

targets lack of psychological, social and occupational skills

rehabilitation

social and vocational training

self help groups

what was Freud’s opinion on treating schizophrenia ?

cannot be treated

incapable of establishing close interpersonal relationships during adulthood

Sullivans psychodynamic treatment

return to early forms of childhood communication so therapy requires pts to learn adult forms

key is to develop trusting relationship with therapist

evaluation of Sullivan’s treatment

lack of success (Stone 1986)

too intense

Sullivans early pts only had mild forms of the disorder

cognitive treatment

stress management and belief modification

Gould (2001)

statistically significant decrease in positive symptoms after CBT treatment

Kirschen (2006)

of 142 pts most not suitable for CBT - would not engage

what % of schizophrenics commit suicide or attempt

10 and 40