SCHIZOPHRENIA

PROTYPE PRESENTATION

young (late teens/20s)

persecutory delusions

auditory hallucinations

cataonic & negative Sx

onset gradual & fast builds to misery & chaos

FEATURES

psychosis presence = not hard to determine

Sx = obvious changes

causes & maintaining factorrs = HARD

FACTS

come from happy or bad childhood

core issue = hard to see/know reality

danger to self

not a hopeless situation!

HISTORY DEMENTIA PRAECOX

EMIL KRAEPLIN

dementia = loss of mind

praecox = young

HISTORY EUGEN BLEULER

disease that wax & wanes

schiz = lack of mental functions

DIGNOSIS CRITERIA

need 2 of 5 for 6 months

1 months consistent active phase Sx

1 must be delusion, hallucination or disorganized speech

POSITIVE SYMPTOMS

delusions

hallucinations

DISORGANIZED SYMPTOMS

disorganized speech (word salad)

catatonic behavior

NEGATIVE (ABSENT) SYMPTOMS

deficits in affect, speech, motivation

STAGES

back & forth w/ active & residual

prodromal = start deteriation (isolating, self talk, delusions)

active = full blown disorder most intense Sx

residual = less severe/frequent Sx

more in touch w/reality

COMMON DELUSIONS

persecutory = hounded/followed/intefered w

70% of 1st episode

grandoise = special status

body/mind control

FUNCTION OF DELUSIONS

their way of making sense of confusing world

BELIEF FEATURE

hold thought

truly believe it

thought guides behavior

angry if ppl say untrue/disagree

delusiosn & overvalued ideas = beliefs differing in how false/rigid

HALLUCINATIONS

5-28% gen. pop exp. in less degree

absences of sensory stimulation

70% ppl auditory

visual

tactile (bug crawling on skin)

HALLUCINATIONS & THE BRAIN

brain creates ind own speech but its distorted broca area = speech

wernickes = hearing

HALLUCINATIONS CULTURE IMPACT

US west = dark. cruel, scary

india & africa = kind, relaxed, playful

DISORGANIZED SPEECH

rhymes, puns, word salad

cant get a point across (tangentiality)

DISORGANIZED BEHAVIOR

lacks purpose, not goal oriented

disrobing in public

staying in uncomfy strange posture

CATATONIC SPECIFIERS

abnormal immobility /movement, behavior & withdrawal

NEGATIVE ABSENT SX

flat affect = no natural expression

avolition = no motivation

alogia = mising speech / 1 word answers

anhedonia = loss of pleasure in activities

WHY WERE SUBTYPES REMOVED

didnt help in or predict treatment

disorder morphs & changes

IMPACT

short life

raised risk of suicide

largest stigma

more hospital beds used than other MIs

females have 2nd peak in 40s

CONSEQUENCES

not married bc severe isolation

dont work or its below their education/training

PROGNOSIS

after 10 & 30 years 25% recovered

EPIDEMIOLOGY

range: kids to 50s/60s

M= teens to mid 20s

F= early/late 20s (2nd peak 40s)

FACTORS LINKED W/RECOVERY

onset = acute or late age

brief active stage Sx

good insight & functioning between episodes

PREICTING: EARLY RISK FACTORS

mom w/severe form

exposure to toxins

birth complications (hypoxia, low weight)

fam stress, trauma & fall outs

live in big pop (city)

prenantal exposure to hunger

TOO MUCH DOPAMINE D2/D4 RECEPTOR

help explain paranoia & hallucinations

like taking amphetamine OD all the time

POOR COORDINAITION OF NEURAL FIRING IN FRONTAL LOBE

impairs judgement & self control

THALAMUS

fires during hallucinations AS IF real sensations occurring

ABNORMAL RAIN FUNCTION GENREAL SHRINKING OF

mnay brain areas & connections between them

ROLE OF DOPAMINE

low levels = Parkinson disorder

excess levels = psychotic Sx

reduce too much = parkinson’s Sx

ABHERRENT SALIENCE IS WHAT

something is interesting noticable

linked w/ reward & punishment

brain automatically filter out unesecarry info

ABHERRENT SALIENCE + DISORDER

everything has a life changing importance

greater awareness of world (enhance senses)

thought disorgnization (hard to comprhend info)

causes confusion & distracted easily

PSYCHOSOCIAL CAUSES (common)

family stress, trauma

deal w/ fam member who has it

family that yells & fights linked w/ relapse & worse Sx

CULTURAL COMMON FACTORS

have low SES

immigrants

twice likely to smoke weed as a kid

does it cause? or is ind self-medicating prodromal Sx?

EARLY FORMS OF TREATMENTS

INEFFECTIVE

insulin coma therpay

ECT

psychosurgery

ANTIPSYCHOTIC MEDS

neuroleptics

reduce production of dopamine

brain adjust & reduce dopamine productions

trail & error to target positive Sx

zombie like side effects

ANTIPSYCHOTIC MEDS EXTRAPYRAMIDAL SIDE EFFECTS

tardive dyskinesia = uncontrolled movement

akinesia =difficult to move

akathisia = uncomoft restlessness

weight gain, diabetes, sleepy, slower

PSYCHOTHERAPY

ACCEPTENCE & COMMITMENT THERAPY (ACT)

thoughts are just thoughts (not real)

perspective taking

lower rate of rehospitalization

less distress about Sx

MEDS VS PLACEBO

placebo have better longer

have to recover from disorder then meds