Schizophrenia

Definition: Initially referred to as ‘dementia praecox’, schizophrenia affects thoughts, emotions, and behaviours.

• SIMPLE: Gradual withdrawal from reality.

• PARANOID: Presence of delusions and hallucinations.

• CATATONIC: Involves disturbances in motor activity.

Diagnostic Criteria (ICD-11)

• Symptoms must persist for at least one month and cannot be attributed to other health conditions.

• Symptoms categorised as either:

  • Positive Symptoms: e.g. persistent delusions, hallucinations, thought disorder, experiences of influence.

  • Negative Symptoms: e.g. avolition, flattened affect, impaired cognitive function, catatonia.

Aneja et al (2018)

• Aim: To investigate early-onset schizophrenia through case studies.

• Procedure: A case study of a boy who showed significant behavioural changes post-divorce, leading to schizophrenia diagnosed at age 12.

• Findings: The boy experienced auditory hallucinations and aggressive behaviour despite medication.

• Conclusion: Highlighted the complexities of early-onset schizophrenia.

• Evaluation: Emphasises the use of case studies but limits generalisability.

Freeman et al (2003) – Key Study

• Context: Explores the use of virtual reality (VR) to investigate persecutory ideation in healthy individuals.

• Aim:

  • To see if individuals without a mental illness experience persecutory thoughts in a VR setting.

  • To identify cognitive or emotional predictors of such ideation.

• Procedure:

  • 24 participants (12 male, 12 female) from University College London without mental illness history.

  • Participants used VR to explore a library scene with avatars showing ambiguous behaviour.

  • Measured paranoia levels before and after VR using a series of questionnaires, including the Brief Symptom Inventory (BSI) and VR-Paranoia questionnaire.

• Findings: Significant correlation between scores on the paranoia questionnaire and interview. Increased interpersonal sensitivity and anxiety correlated with persecutory thoughts.

• Conclusion: Individuals attribute mental states to VR characters, allowing for the investigation of persecutory ideation.

• Evaluation: Highlights VR as a standardised approach to assess behaviours and brings insights on interpersonal sensitivity influencing thoughts.

Treatment and Management of Schizophrenia

• Schizophrenia tends to develop in adolescence or early adulthood.

• Affects men and women equally, but men suffer more severely.

• 1/3 of diagnosed individuals improve with treatment, 1/3 worsen, 1/3 have long-term institutionalisation.

Onset and Prognosis

• Before the dopamine hypothesis, treatment options were limited, often resulting in hospitalisation.

• Antipsychotics emerged in the 1950s, targeting dopamine activity.

Dopamine Explanation

• Antipsychotics reduce symptoms by blocking dopamine receptors (especially D2 receptors).

• Typical antipsychotics: Phenothiazines like Haloperidol and Chlorpromazine.

Antipsychotic Medications

• Typical (1st Generation): Block D2 receptors, effective on positive symptoms (delusions, hallucinations).

  • Side effects: Tardive Dyskinesia, extrapyramidal symptoms (EPS), sedation, weight gain.

• Atypical (2nd Generation): Bind less to D2, more to D1 and D4 receptors.

  • Examples: Risperidone, Olanzapine, Clozapine.

  • Side effects: Weight gain, drowsiness.

Randomised Controlled Trials (RCTs)

• Provide evidence for the effectiveness of antipsychotics, comparing treatment and control groups.

Sarkar and Grover (2013)

• Aim: Assess effectiveness of antipsychotics in children/adolescents with schizophrenia.

• Procedure: Meta-analysis of 15 studies comparing first- and second-generation.

• Findings: Both generations superior to placebo; clozapine was most effective.

• Conclusion: Extrapyramidal side effects more common in 1st generation drugs.

Third Generation Antipsychotics

• Includes Lurasidone and Aripiprazole with fewer side effects.

ECT (Electroconvulsive Therapy)

• Definition: Induction of seizures via electrical stimulation; used for severe cases.

• Procedure: 6-12 sessions, monitors for memory loss, rarely causes lasting damage.

Zervas, Theleritis, and Soldatos (2012)

• Aim: Review ECT’s effectiveness in schizophrenia.

• Findings: Effective in treating catatonic schizophrenia and improving medication response.

• Conclusion: More effective in conjunction with medication, especially for catatonia.

Cognitive Behaviour Therapy (CBT)

• Definition: Cognitive treatment with behavioural elements focused on modifying thoughts and beliefs.

  • Models: Thoughts influence feelings and behaviours; improving coping skills is key.

Example Study: Senksy et al. (2000)

• Aim: Test CBT effectiveness against a control group (befriending).

• Procedure: 90 patients with distressing symptoms over 6 months; random assignment to treatments.

• Findings: Both groups showed significant improvement, but CBT group maintained improvements at follow-up.

• Conclusion: CBT positively impacts both positive and negative symptoms.

Strengths and Weaknesses of Treatments

Antipsychotic Medications

• Strengths: Effective for positive symptoms, reduce relapse rates.

• Weaknesses: Side effects, limited efficacy for negative symptoms, non-adherence issues.

ECT

• Strengths: Rapid symptom relief for treatment-resistant cases, effective for severe agitation.

• Weaknesses: Temporary effects, potential ethical concerns.

CBT

• Strengths: Non-chemical; addresses cognitive distortions and coping mechanisms.

• Weaknesses: Limited efficacy during acute episodes; access and cost issues.

Issues and Debates

• Idiographic vs Nomothetic Approaches: Research generally aims for broad generalisations of effective treatments through robust data sets.