Schizophrenia
Patient interpret reality abnormally. Positive symptoms (hallucination) and negative symptoms (social withdrawal)
Prodromal symptoms: Weak symptoms that can develop into real ones
Symptoms that should not be there in a healthy person but they are
False belief (idea of reference, persecutory thoughts)
e.g: Believing that aliens are watching, police following you,…
False perceptual experience, occur naturally, patients have no control over this
Visual + audio + touch
Symptoms that should be present in a normal person but they are not
Patients mixing up words, jump from one sentence to another, saying nonsense
If this becomes too intense then it is classified as positive symptoms
Lack of motivation, fail to take care of self-hygiene
Flat effect, no feeling high or low emotions
How to collect data?
Self report questions. 0-4
Show at least 2 symptoms over 1 month
At least 1 core symptoms (delusion, hallucination)
What does it measure?
Judge symptoms severity
Categorize symptoms into 6 dimensional description (4 scale, not present, severe)
Judge symptoms in 1 month, the DSM-5 takes 6 months. ICD-11 is faster
Doctor rate symptoms based on severity, better treatment
Diagnose for children under 13 is hard cause Similar symptoms, delusion same with depression and OCD. OCD patient can’t differentiate between intrusive and real thoughts (delusion)
Culture differences, in Maori, hearing voices (Schizophrenia) is respected.
Aim: To investigate whether neutral VR avatars can provoke persecutory thoughts in healthy people, and whether this depends on interpersonal sensitivity of anxiety and stress
Persecutory thoughts: believe everyone harm them
Idea of reference: believe everything happen because of them
Correlational study
Volunteer, 24 paid ppt students from University College London
(Use healthy ppt cause this is a test study to see the effectiveness of VR, use healthy people to report accurately)
Before VR:
Half PPT did BSI, assess mood + psychotic symptoms over the last week
Spielberger State Anxiety Questionnaire + Paranoia Scale (persecutory ideation and reference)
(To see whether doing questionnaire before primed ppt to form persecutory thoughts during VR)
VR:
5 mins
Library setting
5 avatars in groups of 2-3. Smilling talking to each other
Ppt told "explore the room, form impression about people in the room"
After VR:
All ppt do questionnaires above (twice for half people)
Complete VR-Paranoia Questionnaire. Measure persecutory thoughts + idea of reference. Made for this study
Interviewed about their experience, psychologist watched interview and rate ppt out of 6 on persecutory ideation.
Most people have positive belief about avatars
Persecutory thoughts correlated with idea of reference and negatively correlated with positive thoughts
Persecutory thoughts ratings the same between questionnaire and interview (both accurate)
VR persecutory ideation linked to interpersonal sensitivity and anxiety.
Presence rating (how real vr feels) is low 2.3/6
+ Half PPT did questionnaire before, to see if this will primed ppt to form more persecutory thoughts, but this was not true
+Lots of test and interview watched by psychologist = valid data analysis
Idiographic vs monothetic:
Monothetic cause quantitative data from questionnaire => generalisable
Idiographic cause interview
- PPT: Low generalizability, demand characteristics
- Lack ecological validity, average presence rating were 2.3/6, ppt did not feel real => not act naturally
Individual vs situational:
Individual cause interpersonal sensitivity unique to individuals
Situational cause there are some situational variable that provoke persecutory thoughts
Ethics:
Anxiety level stays the same before after the test
Deception, but no psychological harm so justifiable
If one parent has schizophrenia there is 12% their child develop it, 40% if two parents have it
SCZ is polygenic: lots of genes contributed to SCZ. 100+ different genetic associated with vulnerability to SCZ
MZ twins who share 100% of genes more likely to both have SCZ (higher concordance rate), compared to DZ twins who only share 50% genes
DiGeorge syndrome: when 40 genes are deleted from chromosome 22. 1-4 people develop SCZ with DiGeorge, while 1-100 healthy people develop SCZ.
DiGeorge deletes COMT gene (break down dopamine neurotransmitter). So neurochemical imbalance cause SCZ
Supported by research. Val allele (a version of COMT) associated with decreased dopamine in prefrontal cortex. Support dopamine deficiency
Ignore nuture role: MZ Twins (share 100% DNA) but concordance rate was not 100%, suggest nurture affect likelihood of SCZ
Excess dopamine / receptor in mesolimbic pathway + in Broca’s area cause poverty of speech and auditory hallucinations.
Lack of dopamine:
Low levels of dopamine in the prefrontal cortex cause negative symptoms (disorganized thinking) cause dopamine responsible for attention
Excess serotonin:
Serotonin slows down activity so we can sleep. Excess serotonin can stop postsynaptic firing, hence lead to lack of dopamine → negative symptoms
However, upregulation increase dopamine receptor, so this theory is not 100% accurate
Nature vs nurture:
Supported by studies, rats injected with dopamine agonist, show social withdrawal, but cured with drugs to block D1 receptor.
However, another study, inject dopamine agonist into human, but no symptoms in SCZ and healthy people. Therefore nature is not 100% the cause, but also nurture.
Too reductionist: SCZ is not caused by a single neurotransmitter. Lots of genes associated to SCZ we don’t know yet. Our lifestyle affect neurochemistry, need holistic approach.
Deterministic: Working of brain affect SCZ, not free will.
SCZ can’t differentiate between internal monologue and voice from outside.
Linked to delusion (hear voices, believe it’s from the alien)
SCZ can’t understand mental state/intention of others, see neutral behavior as hostile.
Undeveloped theory of mind, if SCZ think of themselves as a bad person, other people will think the same => social withdrawal
Biased
SCZ draw conclusion on insufficient evidence, and ignore info saying they are wrong.
That’s why SCZ holds false belief for a long time
Too reductionist: Does not explain how faulty thinking begin + the process is unique to individual
Too nomothetic: Studies only compare SCZ group with control group. Doesn’t take individual differences, even though SCZ differ per patient
Individual + situational: SCZ process info differently and stress endurance level differ (individual), but external factor affect stress level and cognitive load determine severity of symptoms (situational)
Typical Drugs | Atypical Drug |
|---|---|
First gen drugs | Second gen |
Chlorpromazine | Clozapine |
Fused D-2 dopamine receptor, prevent absorbing dopamine | Block dopamine + serotonin receptor |
Only treat positive symptoms | More effective, both positive + negative symptoms |
Twitching muscle, nausea | Blood disease |
Ineffective for 30-70% patient
Move to ECT if meds don’t work
Patient are put into anesthesia and muscle are relaxed
Deliver 70-100 volts shock on side of head => cause neurons to fire and cause seizure. Help gene expression and connectivity in hippocampus
Applicable = highly effective
Ethical issues, some countries do ECT without anesthesia.
Cultural differences: ECT works in China because patient trust doctor more in China => they feel more positive about treatment (placebo effect)
Talk therapy, change how patient think
Identify troubled past, how negative event affects emotion and thoughts
Identify faulty thinking
Reshape that wrong thinking (include homework like journaling to track emotion)
Stress management.
Stress inoculation training (like getting a vaccine, deal with stress overtime)
Use of imagery and relaxation
Psychoeducation. Teach patient family about SCZ, encourage patient to join social activities
Therapy requires patient’s effort, develop self-efficacy + confidence. Believe their self-worth
However, if patient doesn’t put effort CBT will not work
SCZ patient might have trouble speaking to psychologist (impaired speech), make therapy harder
90 ppt, 19 sessions for 9 months
1st group therapist discuss the cause of symptoms and how to treat them
2nd group therapist be a friend, talk about hobbies, non-directive
CBT has longer-term efficacy than befriending
Patient interpret reality abnormally. Positive symptoms (hallucination) and negative symptoms (social withdrawal)
Prodromal symptoms: Weak symptoms that can develop into real ones
Symptoms that should not be there in a healthy person but they are
False belief (idea of reference, persecutory thoughts)
e.g: Believing that aliens are watching, police following you,…
False perceptual experience, occur naturally, patients have no control over this
Visual + audio + touch
Symptoms that should be present in a normal person but they are not
Patients mixing up words, jump from one sentence to another, saying nonsense
If this becomes too intense then it is classified as positive symptoms
Lack of motivation, fail to take care of self-hygiene
Flat effect, no feeling high or low emotions
How to collect data?
Self report questions. 0-4
Show at least 2 symptoms over 1 month
At least 1 core symptoms (delusion, hallucination)
What does it measure?
Judge symptoms severity
Categorize symptoms into 6 dimensional description (4 scale, not present, severe)
Judge symptoms in 1 month, the DSM-5 takes 6 months. ICD-11 is faster
Doctor rate symptoms based on severity, better treatment
Diagnose for children under 13 is hard cause Similar symptoms, delusion same with depression and OCD. OCD patient can’t differentiate between intrusive and real thoughts (delusion)
Culture differences, in Maori, hearing voices (Schizophrenia) is respected.
Aim: To investigate whether neutral VR avatars can provoke persecutory thoughts in healthy people, and whether this depends on interpersonal sensitivity of anxiety and stress
Persecutory thoughts: believe everyone harm them
Idea of reference: believe everything happen because of them
Correlational study
Volunteer, 24 paid ppt students from University College London
(Use healthy ppt cause this is a test study to see the effectiveness of VR, use healthy people to report accurately)
Before VR:
Half PPT did BSI, assess mood + psychotic symptoms over the last week
Spielberger State Anxiety Questionnaire + Paranoia Scale (persecutory ideation and reference)
(To see whether doing questionnaire before primed ppt to form persecutory thoughts during VR)
VR:
5 mins
Library setting
5 avatars in groups of 2-3. Smilling talking to each other
Ppt told "explore the room, form impression about people in the room"
After VR:
All ppt do questionnaires above (twice for half people)
Complete VR-Paranoia Questionnaire. Measure persecutory thoughts + idea of reference. Made for this study
Interviewed about their experience, psychologist watched interview and rate ppt out of 6 on persecutory ideation.
Most people have positive belief about avatars
Persecutory thoughts correlated with idea of reference and negatively correlated with positive thoughts
Persecutory thoughts ratings the same between questionnaire and interview (both accurate)
VR persecutory ideation linked to interpersonal sensitivity and anxiety.
Presence rating (how real vr feels) is low 2.3/6
+ Half PPT did questionnaire before, to see if this will primed ppt to form more persecutory thoughts, but this was not true
+Lots of test and interview watched by psychologist = valid data analysis
Idiographic vs monothetic:
Monothetic cause quantitative data from questionnaire => generalisable
Idiographic cause interview
- PPT: Low generalizability, demand characteristics
- Lack ecological validity, average presence rating were 2.3/6, ppt did not feel real => not act naturally
Individual vs situational:
Individual cause interpersonal sensitivity unique to individuals
Situational cause there are some situational variable that provoke persecutory thoughts
Ethics:
Anxiety level stays the same before after the test
Deception, but no psychological harm so justifiable
If one parent has schizophrenia there is 12% their child develop it, 40% if two parents have it
SCZ is polygenic: lots of genes contributed to SCZ. 100+ different genetic associated with vulnerability to SCZ
MZ twins who share 100% of genes more likely to both have SCZ (higher concordance rate), compared to DZ twins who only share 50% genes
DiGeorge syndrome: when 40 genes are deleted from chromosome 22. 1-4 people develop SCZ with DiGeorge, while 1-100 healthy people develop SCZ.
DiGeorge deletes COMT gene (break down dopamine neurotransmitter). So neurochemical imbalance cause SCZ
Supported by research. Val allele (a version of COMT) associated with decreased dopamine in prefrontal cortex. Support dopamine deficiency
Ignore nuture role: MZ Twins (share 100% DNA) but concordance rate was not 100%, suggest nurture affect likelihood of SCZ
Excess dopamine / receptor in mesolimbic pathway + in Broca’s area cause poverty of speech and auditory hallucinations.
Lack of dopamine:
Low levels of dopamine in the prefrontal cortex cause negative symptoms (disorganized thinking) cause dopamine responsible for attention
Excess serotonin:
Serotonin slows down activity so we can sleep. Excess serotonin can stop postsynaptic firing, hence lead to lack of dopamine → negative symptoms
However, upregulation increase dopamine receptor, so this theory is not 100% accurate
Nature vs nurture:
Supported by studies, rats injected with dopamine agonist, show social withdrawal, but cured with drugs to block D1 receptor.
However, another study, inject dopamine agonist into human, but no symptoms in SCZ and healthy people. Therefore nature is not 100% the cause, but also nurture.
Too reductionist: SCZ is not caused by a single neurotransmitter. Lots of genes associated to SCZ we don’t know yet. Our lifestyle affect neurochemistry, need holistic approach.
Deterministic: Working of brain affect SCZ, not free will.
SCZ can’t differentiate between internal monologue and voice from outside.
Linked to delusion (hear voices, believe it’s from the alien)
SCZ can’t understand mental state/intention of others, see neutral behavior as hostile.
Undeveloped theory of mind, if SCZ think of themselves as a bad person, other people will think the same => social withdrawal
Biased
SCZ draw conclusion on insufficient evidence, and ignore info saying they are wrong.
That’s why SCZ holds false belief for a long time
Too reductionist: Does not explain how faulty thinking begin + the process is unique to individual
Too nomothetic: Studies only compare SCZ group with control group. Doesn’t take individual differences, even though SCZ differ per patient
Individual + situational: SCZ process info differently and stress endurance level differ (individual), but external factor affect stress level and cognitive load determine severity of symptoms (situational)
Typical Drugs | Atypical Drug |
|---|---|
First gen drugs | Second gen |
Chlorpromazine | Clozapine |
Fused D-2 dopamine receptor, prevent absorbing dopamine | Block dopamine + serotonin receptor |
Only treat positive symptoms | More effective, both positive + negative symptoms |
Twitching muscle, nausea | Blood disease |
Ineffective for 30-70% patient
Move to ECT if meds don’t work
Patient are put into anesthesia and muscle are relaxed
Deliver 70-100 volts shock on side of head => cause neurons to fire and cause seizure. Help gene expression and connectivity in hippocampus
Applicable = highly effective
Ethical issues, some countries do ECT without anesthesia.
Cultural differences: ECT works in China because patient trust doctor more in China => they feel more positive about treatment (placebo effect)
Talk therapy, change how patient think
Identify troubled past, how negative event affects emotion and thoughts
Identify faulty thinking
Reshape that wrong thinking (include homework like journaling to track emotion)
Stress management.
Stress inoculation training (like getting a vaccine, deal with stress overtime)
Use of imagery and relaxation
Psychoeducation. Teach patient family about SCZ, encourage patient to join social activities
Therapy requires patient’s effort, develop self-efficacy + confidence. Believe their self-worth
However, if patient doesn’t put effort CBT will not work
SCZ patient might have trouble speaking to psychologist (impaired speech), make therapy harder
90 ppt, 19 sessions for 9 months
1st group therapist discuss the cause of symptoms and how to treat them
2nd group therapist be a friend, talk about hobbies, non-directive
CBT has longer-term efficacy than befriending
