Schizophrenia

Prevalence of Mental Illness

• Western nations = 1 in 5 people will have a mental illness across their lifespan, the type depending on ages, gender, culture, etc

Schizophrenia

Key Facts

• Prevalence = 0.5 - 1 %

• Similar prevalence between males and females, but difference in the age range for onset — common between ages 15 and 35. Late onset is considering 40+

• The Lifetime risk for suicide in people living with schizophrenia is 5%. Risk factors associated with suicide including being male, being younger, and having a high level of education, as does a history of suicide and substance abuse

• People with schizophrenia die much earlier than expected with up to 40% of premature mortality attributed to suicide and unnatural death

• Referred to as the prototypical psychotic disorder as it one of the most common and covers the main 5 symptoms

• One of the highest impact disorders, having the most impact on the individual and the people around them, as well as the economic cost

The Costs Associated with Schizophrenia

• 2012 London report found the societal cost of schizophrenia in England is 11.8 billion pounds (20 billion AUD)

• Direct costs = resources used to treat or support an individual with an illness.

  • Health sectors costs, such as GP visits and hospital admissions

  • Medication

  • Accomodation (crisis care and supported care)

  • Involvement of services or agencies such as employment support services

• Indirect costs = value of the production that people with schizophrenia and their carers are unable to produce as a function of either their illness and/or early mortality as a consequence of an illness

  • Productivity losses, as people diagnosed find it difficult to remain employed. ‘Lost production’ is the expected earnings forgone when they are unable to earn

  • Informal carer who also can’t work

  • Lost revenue through income tax forgone due to a lack of productivity

  • Cost of transfer payments (income support and pensions)

  • Costs associated with absenteeism

  • DALYs

• Disability Adjusted Life Years (DALYs) = sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability

Diagnostic Criteria

DSM-5

• Within the Schizophrenia Spectrum and Other Psychotic Disorders category

• Not all symptoms have to be demonstrated, only two or more

• Criterion A

  • symptoms must be present for a six-month period or longer, with at least one month of active symptoms

  • Delusions

  • Hallucinations

  • Disorganised speech

  • Grossly disorganised or catatonic behaviour

  • Negative symptoms

• Positive symptoms = the fact that the behaviours or experiences that make up these symptoms are happening too much

• Negative symptoms = behaviours that are in a deficit

Delusions

• Positive symptom

• A false belief, so the content of their thought is inaccurate or false. Are not explained by religious or cultural beliefs.

• Are believed despite all the evidence to the contrary; it is pointless to try and persuade someone that they are inncorrect

• Delusions of Persecution = paranoid flavour with a theme of others being out to get you. May think that they are being followed everywhere

• Delusions of Grandeur = someone believes that they possess qualities or attributes that make them superior to other people — money, fame, talent, intelligence, special relationship with someone in power. May think they’re Taylor Swift’s best friend

Disorganised Speech

• Positive symptom

• Reflects a disturbance in the form of thought as opposed to the content of though

• When somebody’s thoughts, the form and the process of them, are disorganised, their speech will also be affected

• Speech disturbance involves prolonged patterns of disorganised speech that are much more extreme

• Neologism = when a person makes up a word. The word has no meaning and is often a combination of two words

• Word Salad = words tossed together that makes no sense, has no meaning

• Tangential speech = changes topic from a specific trigger, and never returns to the original topic of conversation and lacks insight into this behaviour

Hallucinations

• Disturbances of perception, a false sensory experience

• Any hallucinations could be a product of organic brain disease and this must be ruled out very early on (MRIs, etc)

• Believe they are experiencing something through one of the five senses when they are not

• Very distressing as it feels real and they fully believe it so

• Most common are auditory hallucinations = hearing voices, ones that are usually derogatory and negative. May be more than one voice.

• Visual hallucinations = the experience of seeing something that is not actually there.

• Olfactory hallucinations = smelling something that isn’t there

• Gustatory hallucinations = tasting something that theyre not actually tasting

• Tactile Hallucination = false sensory experience in relation to sense of touc

Disorganised or Abnormal Motor Behaviour

• Can manifest in many different ways, such as:

  • Psychomotor agitation, such as restlessness and inability to stay still

  • Behaviour may be characterised by childish silliness or a complete lack of focus

  • Excessive purposeless activity that is unrelated to anything going on in the environment going on in the environment

  • Self-initiated bizarre postures, such as standing bent at the waist with one arm in the air

  • Complete lack of response to all stimuli, like not responding when someone talks to you, prods you, and os on

• Catatonia = neurogenic motor immobility, or behavioural abnormality manifested as stupor; where some can become rigid and immobile. Not very common

Negative Symptoms

• Reflects normal behaviours that are in deficit

• Expression of affect or emotion, speech, and motivation

• Affect or expression of emotion

  • ‘flat affect’, where the expression of emotion through tone of voice and facial expression is significantly reduce

• Speech

  • alogia = poverty of speech, involves a lack of spontaneous speech, reflects impoverish thought processes

• Motivation

  • avolition = inability to initiate or engage in goal-directed behaviours

  • depression

  • lack of self-care around personal hygiene

Course of Schizophrenia

• Is an episodic illness, with majority of people experiencing more than one psychotic episode

• Three phases

  • Prodromal phase = decline in functioning. Negative symptoms such as motivation, social withdrawal, and a decline in self-care appear

  • Active phase = positive symptoms appear.

  • Residual phase = positive symptoms have remitted, usually with help of medication, but some negative symptoms remain.

Aetiology of Schizophrenia

• Genetics and biology are extremely important — the prevalence wherein you have a biological relative goes up to 10% from 1%. For monozygotic twins, this goes up to 50%

• People with schizophrenia have been found to have structural brain abnormalities and biochemical abnormalities (neurotransmitter dopamine)

• Being exposed to pregnancy and birth complications that may have caused structural damage to the brain is another factor

• Social factors, particularly low socioeconomic status (SES), is associated with schizophrenia.

  • More common but not restricted to

  • Some potential harmful characteristics associated with lower SES include stress, social isolation, poor nutrition, lack of access to medical services

• Social dislocation is another social factor linked to schizophrenia

  • higher rates are found in people who have migrated to a new country

• Expression emotion is a psychological factor

  • refers to the level of criticism, hostility, and emotional over-involvement that exists within a family

  • people who live in a family with a high level of negative emotion expressed are significantly more likely to relapse into schizophrenia than those not

  • With family though — no do not fall into the trap of blaming family members. Have empathy for those who have to live with someone with this disorder

Diathesis-stress model of Schizophrenia

• Proposes that, with schizophrenia, there is an underlying vulnerability that is most likely related to a genetic predisposition

• However, this vulnerability may only convert into an illness in the context of the environmental stressors

• Hypothesised diatheses for schizophrenia include

  • genetic factors

  • physical trauma prenatally or during birth

  • structural abnormalities of the brain

  • abnormalities in the neurotransmitter

• Environmental stressors may include

  • chronic psychological and social stressors, such as poverty

  • living in a family environment with a high level of negative expressed emotion

  • drug use, especially marijuana

Treatment of Schizophrenia

• Medication = anti-psychotics (good responses in positive symptoms)

• Anti-psychotics don’t work with one quarter of people however, and have many negative side effects such as weight gain and tardive dyskinesia (involuntary neurological movement disorder affecting lower face)

• Psych-education = done with the schizophrenic person and their family members to educate them about the signs of relapse and what to do if it happens

• Behavioural strategies = help people with schizophrenia to develop their social skills, with a view to promote the development and maintenance of social relationships and friendships

• CBT = recommended to those with well-managed or stable schizophrenia, but treats symptoms in the small range

• Support to families is imperative