Test 3

13.0 Define psychosis
13.1 Describe the prevalence of schizophrenia and who is most affected
13.2 Identify and explain the symptoms of schizophrenia as described in DSM-5
13.3 List four different types of psychotic disorders and state one way in which each is different from schizophrenia
13.4 Explain the genetic and biological risk and causal factors associated with schizophrenia
13.5 Discuss how the brain is affected in schizophrenia
13.6 Explain the psychosocial and cultural factors associated with schizophrenia
13.7 Describe the clinical outcome of schizophrenia and how it is treated, noting the advantages and disadvantages associated with the use of antipsychotic medications

Definition:
- Significant loss of contact with reality; the individual has lost insight into "reality testing."
- Psychosis characterizes disorders detailed in the Psychotic Disorders chapter of the DSM-5.
- It is a hallmark symptom of schizophrenia but can also occur in other psychological disorders including:
- Bipolar disorder
- Severe major depressive disorder
- Psychotic disorders caused by medical conditions
- Substance intoxication/withdrawal
- Dementia-related psychosis.

Selected Stats:
- Lifetime prevalence of schizophrenia: 1%
- Gender/Sex Differences:
- Onset typically in Men (20's) and Women (peaks in the 20's, 40's, and 60's).
- Severity tends to be greater in males than females (M > F).
- Rates of diagnosis typically follows a ratio: M:F = 1.4:1.
- Potential protective effects of estrogen are noted.

Hallmark symptoms for DSM-5 Diagnosis:
- A diagnosis requires 2+ symptoms occurring over at least a month, with significant disturbance persisting for 6+ months.
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative symptoms (e.g., lack of emotion or motivation).

Delusions:
- False beliefs that are strongly held despite contradictory evidence.
Hallucinations:
- Sensory experiences that occur without an external stimulus; often auditory (voices) but can involve other senses.
Disorganized Speech:
- Speech that fails to make logical sense; characterized by difficulty organizing thoughts which impacts verbal communication.
- The disturbance is not merely a mix-up of words; grammar and syntax may appear fine.
Disorganized or Catatonic Behavior:
- Impairment of goal-directed activity affecting daily functions including work, social relations, and self-care (e.g., hygiene, safety, appearance).
- Catatonia involves minimal movement or response to stimuli, sometimes maintaining unusual postures.
Negative Symptoms:
- Represent an absence or deficit of normal emotional or cognitive functions.
- Examples include:
  - Flat or blunted emotional expressiveness
  - Alogia (poverty of speech)
  - Avolition (lack of motivation).
- Negative symptoms are generally associated with poorer clinical outcomes compared to other symptoms (1-4), and are harder to treat.

Genetic Contribution:
- A person’s risk of developing schizophrenia significantly increases if they have a close relative with the disorder.
- Reliability of data regarding genetic relationship to risk of development illustrated in Figure 13.2.

Schizophrenia is influenced by:
1. Rare genes that have a large effect.
2. Common genes that have a small effect.
3. Environmental factors and gene-environment interactions which confer risk.

Viral Infection: Elevates risk when mothers are infected during the second trimester of pregnancy.
Oxygen Deprivation (Hypoxia): Complications during pregnancy or delivery may lead to increased risk.
Early Nutritional Deficiency: Environmental events such as poor nutrition can trigger or cause schizophrenia.
Extreme Maternal Stress: Elevated stress levels during pregnancy can be a potential risk factor.

Neurocognitive deficits are often observed which may include:
- Attention and working memory deficits
- Eye-tracking dysfunctions.
Brain Volume Changes:
- Loss of brain volume, enlarged brain ventricles, gray matter loss, and reduced white matter volume often reported.
- Impaired social cognition includes difficulties in recognizing emotions in facial expressions or speech, which impacts social interactions.

An understanding of neurochemistry suggests that:
- Dopamine receptors and glutamate pathways play critical roles in the presentation of symptoms.
- Dopamine Hypothesis: This theory posits that dysregulation of dopamine pathways contribute significantly to the symptoms of schizophrenia.

Factors influencing schizophrenia outcomes include:
- Family dynamics and their relation to relapse rates.
- Urban living conditions and socioeconomic status (SES).
- Migration and changing geographical locations.
- Substance use and abuse (individuals with schizophrenia are twice as likely to use cannabis).

Antipsychotic Medications:
- Dopamine Antagonists: Decrease the effects of dopamine.
- First-Generation Antipsychotics: Historically the primary treatment.
- Second-Generation Antipsychotics: Typically associated with fewer motor side effects and deliver better overall outcomes.
Side Effects:
- Attention must be paid to the side effects associated with these medications.

Questions remain as to:
- Why are recovery rates for schizophrenia not improving?
- Do long-term benefits exist for patients remaining on antipsychotic medications?
- Should the poor clinical outcomes experienced by some medicated patients be attributed to the continued use of antipsychotics?