PSYC 2161 Chapter 11: Schizophrenia

Schizophrenia definition

Psychotic disorder characterized by major disturbances in thought, emotion, and behaviour

• Disordered thinking in which ideas are not logically related

• Faulty perception and attention

• Flat or inappropriate affect

• Bizarre disturbances in motor activity

Schizophrenia in Canada

1) Onset

2) Appears earlier for men or women? (Same for incidence)

3) Higher rates among which ethnic groups

4) Lowest rates among which ethnic groups

5) Life expectancy that is ___ years shorter from the general population

6) MOST PREVALENT comorbid condition

1) Late adolescence or early adulthood

2) Earlier for men

3) Caribbean, Bermuda, Africa

4) Asian

5) 20 years shorter

6) Social anxiety disorder (14.9%)

Hospitalization

1) Accounts for ___% of hospitalizations in psychiatric hospitals

2) Around __ in _ people have symptom remission

1) 35.6%

2) 1 in 3

Positive symptoms of schizophrenia

1) What is it

2) Symptoms

3) Early cues

The presence of TOO MUCH of a behavior that is not apparent in most people

• Disorganized speech

• Problems organizing ideas and in speaking so that a listener can understand

• Loose associations

• Derailment

• Delusions

• Hallucinations

__________

3) Linked to environmental stressors and social disruptions during childhood (ex: family instability)

Negative symptoms of schizophrenia

—> ** Endures beyond acute episodes

1) What is it

2) Symptoms

3) Early cues

The absence of a behaviour that should be evident in most people

• Avoliation (Lack of Energy)

• Alogia (Poverty of speech, amount of speech)

• Anhedonia (Lack of interest; no pleasure)

• Flat affect (Lack of emotional expressiveness)

• Asociality (Few friends , poor social skills, little interest ni being with others)

________

3) Stronger connection to biological/neurological factors from early development (ex: pregnancy/low birth weight, failure to show electrodermal responses)

Catatonia

1) Defined by what

Catatonic immobility

2) What is it

3) What is “waxy flexibility” under catatonic immobility

1. Several motor abnormalities; often includes an unusual increase in their overall level of activity; wild flailing of limbs

2. Clients adopt unusual postures and maintain them for a very long period of time

3. hereby another person can move the person’s limbs into strange positions and that they maintain for extended periods

Inappropriate affect

Emotional responses which are out of context

• Rapid shifts from one emotional state to another for no discernible reason

• QUITE RARE but specific to schizophrenia

1) Kraepelin differentiated two groups of endogenous psychoses

2) Common subtypes: (DSM4 based on Kraepelin)

3) Kraepelin believed that they shared a common core: an ____ (__) and a deteriorating course marked by a progressive intellectual deterioration (____)

1)

• Manic depressive illness

• Dementia praecox

2)

• Disorganized (hebephrenic)

• Catatonic

• Paranoid

3)

• An early onset (praecox)

• Dementia

Bleuler came up with the word schizophrenia

1) What does schizein mean

2) What does phren mean

1) To split

2) Mind

Disorganized Speech (Hebephrenic) DSM-4

1) What it is

2) May have a ____ effect or experience constant shifts of emotion (fits of laughter —> crying)

3) Is this behaviour goal oriented??

4) Sometimes clients deteriorate to the point of ___

• Speech is disorganized and difficult for a listener to follow

• Clients may speak incoherently

  • Stringing together similar sounding words, inventing new words

• ACCOMPANIED BY LAUGHTER

_____

2) flat effect

3) No

4) incontinence

Catatonic Schizophrenia (DSM-4)

• Clients typically alternate between catatonic immobility and wild excitement (but one of these symptoms may predominate)

• Clients often resist instructions + echo the speech of others

Paranoid Schizophrenia DSM-4

1) Key to diagnosis is the presence of prominent ____

2) Delusions of ____ are most common

3) Define grandiose delusions

4) Define delusional jealousy

5) What may accompany delusions?

6) Define ideas of reference

1. Delusions

2. Persecution

3. An exaggerated sense of their own importance, power, knowledge, or identity

4. The unsubstantiated belief that their partner is unfaithful

5. Vivid auditory hallucinations

6. They incorporate unimportant events within a delusional framework and read personal significance into the trivial activities of others

Neuropsychology Subtypes of Schizophrenia: Heinrichs & Awad

1. Instead of grouping by symptoms, heinrichs and Awad grouping them based on how ___ ____ ____ in cognitive testing

2. How did they do this

3. Five subtypes found

4. Why it matters: Follow up study showed that motor and function differences ____ ___ ____ over time; symptom severity ___ differ muchbetween the subtypes

1. Their brain functions

2. Cluster analysis

   • Wisconsin Card Sorting Test (WCST)

   • WAIT (Wechsler Adult Intelligence Scale)

   • Motor function tests

   • Verbal memory tests

3. Five subtypes:

   • Normative

   • Executive subtype

   • Executive motor subtype

   • Motor subtype

   • Dementia subtype

4. Stayed the same overtime; symptom severity did not differ

Heinrichs & Awad’s 5 Subtypes of Schizophrenia

1) Normative

2) Executive subtype

3) Executive-Motor subtype

4) Motor subtype

5) Dementia subtype

1. Cognition basically normal/intact

2. Struggled mainly with executive functioning (bad WCST performance)

3. Problems in both executive functioning (WCST) AND motor skills

4. Only motor skills impaired

5. Widespread cognitive impairment in multiple areas

Schizophrenia + Genetics

2) Positive or negative symptoms have a stronger genetic component?

3) Is there a single gene that we look for that causes schizophrenia

4) What is endophenotypic strategy

5) Possible genetic contributors:

Genes do play a role; genetic link; runs in families

• HOWEVER, most cases aren’t directly inherited

• BUT, higher risk the more closely geneticly related you are to someone (twins > sibling > cousin)

2) Negative has a greater genetic component

3) No single gene

4) Researchers now look at endophenotypes; measureable traits linked to genetic risk, even when the person doesn’t have schizophrenia symptoms

5)

• Serotonin 2A, Dopamine D3

Etiology: Molecular Genetics

1) Researchers found that 5 major psychaitric disorders share certain generic risk factors (Schizo, depression, bipolar, ASD, ADHD). The shared genetic variations include:

2) What are sporadic cases ; what causes this

3) Researchers at Salk Institute found out what about neurons

1) Regions on chromocomes 3p21, 10q24, and two calcium channel subunit genes CACNA1C and CAMb2

2) People who develop schizophrenia without a family history —> rare protein altering gene mutations

3) Ppl w/ schizophrenia’s neurons had fewer synapses —> fewer connections between nerve cells

DOPAMINE HYPOTHESIS

1) Most recent theory for dopamine hypothesis

2) Positive symptoms

3) Negative symptoms

1. Excess or oversensitive dopamine receptors rather than a high level of dopamine

2. Release of mesolimbic dopamine neurons from inhibitory control

3. Dopamine neuron under active in prefrontal cortex

1) High or low levels of glutamate usually found

2) Enlarged ventricles implies a loss of what

3) Reduction in cortical __ matter in temporal + frontal regions

1) Low levels of glutamate

2) Loss of subcortical brain cells (structural problems in hippocampus, basal ganglia, nd in prefrontal/temportal cortex)

3) Grey matter reduction

Prefrontal cortex

1) What is it known to play a role in

2) How is it affected in schizophrenia

1) Behaviour such as speech, decision making, and willed action

2) Reduction in grey matter, low metabolic rates

Congential and Developmental Considerations

1) Low birth rate is only a risk factor when combined with what

2) Childhood infectinos of the CNS ___x risk of adult schizophrenia

1) Influenza or hypoxia

2) Doubles 2x

Sociogenic hypothesis

Stressors associated with being in a low social class may cause or contribute to the development of schizophrenia

• However, biological factors associated with poverty and low social class may also contribute

Social selection theory

During the course of developing psychosis, people with schizophrenia may drift into the poverty ridden areas of the city

Schizophrenogenic mother

Outdated theory that once blamed schizophrenia on cold controlling and emotionally distant parent(s)

—> No evidence to support this

1) What is Expressed Emotion EE

2) High EE

3) Low EE

4) People living in ___ EE families have been found to be at higher risk of relapse

1. Describes the emotional climate in a family, especially how family members talk about and behave towards the person with schizophrenia

2. Criticism, emotional overinvolvement, hostility, low warmth

3. More warmth, acceptance, supportive communication

4. High EE families = worse

Biological treatments: Insulin coma therapy

Inducing coma with large doses of insulin

Claimed ¾ treated showed improvement

Actually was bad… has been abandoned

Biological treatments: Electroconvulsive therapy ECT

Only minimally effective

Biological treatments: Prefrontal lobotomy

Surgical procedure that destroys the tracts connecting the frontal lobes to the lower centres of the brain

• Many clients become dull/listless and suffered serious losses in cognitive capacities

Biological treatments: Repetitive transcranial magnetic stimulation

Modern and non-invasive approach

• effective in relieving the symptoms especially auditory and hallucinations

First generation (conventional) antipsychotic drugs

1) Thought to reduce ___ symptoms of schizophrenia

2) About ___-___% of people do not respond favourably

3) Common side effects

4) What are extrapyramidal side effects

5) Do a lot of people quit? Why?

1) Positive

2) 30-50%

3) Dizziness, blurred vision, restlessness, sexual dysfunction

4) Dysfunctions of the nerve tracts; resemble symptoms of Parkinsons Disease

5) Yes up to 50% in first year and 75% after 2 years b/c of side effects

Neuroleptic malignant syndrome

Severe muscular rigidity develops accompanied by fever

• Heart rates, BP increases, client may lapse into coma

** Vary rare side effect of antipsychotics <1%

2nd generation ATYPICAL antipsychotics

1) Why use

2) What neutrotransmitter receptor does it impact

3) Name 3

1) Less side effects

2) Serotonin

3) Clozapine, Olanzapine, Risperidone

PSYCHOLOGICAL TREATMENTS

1) Come in what two forms

2) What does it aid in

3) What did Freud believe

1. Psychosocial treatments AND Cognitive-Behavioural Interventions

2. Plays an important role in increasing the effectiveness of medication treatment and decreasing relapse rate

3. That people with schizophrenia were incapable of establishing the close interpersonal relationship essential for diagnosis

Social Skills Training

1. Receiving skills (social cognition)

2. Processing skills

3. Behavioural responses in social interactions

Command hallucinations

Person believes that they’re being commanded to do something (super scary)

—> Treat with CBT

Cognitive Enhancement Therapy

Computer based training in attention, memory, and problem solving, as well as social cognitive skills

• Evidence that it protects against grey matter loss in the brain

Scaffolded Instruction

requires instructors to select tasks that reflect the clients’ current capabilities so that eventually they are able to solve problems for themselves.