Schizophrenia Lecture Notes
Schizophrenia Overview
Definition: Schizophrenia is characterized as a formal thought disorder, affecting an individual's way of thinking. It is classified as a severe psychotic disorder.
Key Age Range for First Break
Age Range: Most common symptoms first appear between 18 to 25 years old.
Likelihood: Unlikely for schizophrenia to occur before age 18 or after age 25.
Associated Demographic: Often observed in 2nd year college students.
First Break: Symptoms can manifest as extreme behavior, such as screaming and a complete loss of touch with reality, often requiring complete silence to avoid overwhelming stimuli.
Triggers: A bad trip from marijuana can potentially trigger the onset of symptoms.
Symptoms of Schizophrenia
Categories/Domains of Symptoms
Positive Symptoms: These symptoms are characterized by an addition to a person’s personality and experience.
Hallucinations: Perceptions without any external stimuli.
Auditory Hallucinations: The most common type, often involving hearing voices.
Command Hallucinations: Specific voices instructing the person to perform certain actions.
Tactile Hallucinations: Feeling sensations that are not present.
Visual Hallucinations: Seeing things that do not exist in reality.
Olfactory Hallucinations: Smelling things that are typically unpleasant.
Delusions: Firmly held beliefs that are not grounded in reality, not indicative of lying.
Grandiose Delusions: Believing one has extraordinary powers or is on a divine mission, often involving figures like God or the CIA.
Referential Delusions: Assuming insignificant events are personally significant, often involving media like TV or radio.
Paranoid Delusions: The belief that others are conspiring against them.
Response to Internal Stimuli: Individuals may pause to respond to hallucinations or delusions, indicating they are processing these internal stimuli as reality.
Disorganized Speech/Loose Associations: Incoherent speech that jumps between topics without logical connections. This may include:
Clanging: Rhyming in speech.
Perseveration: Repeating words or thoughts cyclically.
Negative Symptoms: These symptoms reflect a reduction or loss of normal functions.
Loss of Speech/Thought: Significant reduction in verbal communication.
Psychomotor Retardation: Marked physical slowness, resembling extreme lethargy, with observable behaviors like shuffling feet.
Trauma Relation: While trauma does not cause schizophrenia, it can precipitate the first break, often resulting in more intense initial symptoms.
Leading Theory: Schizophrenia is not traditionally viewed as a genetic disorder but may exhibit familial patterns.
Understanding Psychosis
Definition of Psychotic: When a person is not in touch with reality.
Diagnosis Criteria: A diagnosis of schizophrenia requires the presence of at least two psychotic symptoms (hallucinations and delusions).
Cognitive Implications: Individuals often struggle to follow conversations and may exhibit unpredictable agitation, which can impact social interactions.
Treatment Options
Anti-Psychotic Medications
Purpose: These medications are primarily used to alleviate symptoms of schizophrenia by reducing dopamine overload.
Types:
First Generation (Neuroleptics):
Common side effects include metabolic syndrome (weight gain, high cholesterol), sedation, and symptoms resembling neurological disorders.
Notable Examples:
Haloperidol (Haldol): Considered a life changer for many patients.
Thorazine: Often a last resort due to significant side effects.
Second Generation Antipsychotics:
More effective with fewer side effects than the first generation but may still cause mild weight gain.
Advantages include less sedation and longer-lasting effects (up to 30 days), though symptoms may return toward the end of the cycle.
Notable Examples:
Abilify, Zyprexa, Geodon, Risperdal (first successful second-generation drug).
Side Effects Consideration: Anti-psychotic medications can lead to serious side effects, including:
Metabolic syndrome, including type 2 diabetes, high triglycerides and blood sugar levels, extreme weight gain (potentially +100 lbs), and tardive dyskinesia (severe, involuntary muscle movement disorders).
Pregnancy Risks: Pregnant women should avoid anti-psychotic medications as they may significantly impact fetal development or lead to severe health consequences for the child.
Treatment Approach:
Emphasis on symptom management rather than psychotherapeutic interventions, as individuals are frequently not lucid enough to comprehend therapeutic talk.
Unique Considerations Related to Schizophrenia
Catatonia: A negative symptom previously classified as its own diagnosis but is now seen as a symptom of schizophrenia. It involves maintaining an immobile or uncomfortable posture for prolonged periods with waxy flexibility (the individual can be repositioned without resistance).
Activities of Daily Living: Individuals may stop or reduce normal self-care activities.
Choice of Medication: Individuals may choose whether or not to take medication for their psychosis, which includes the possibility of remaining untreated and psychotic.
Sociocultural Implications: Inappropriate dressing and hygiene concerns are noted, as the person may not register environmental cues regarding temperature (e.g., inappropriate clothing for weather conditions).
Drug-Induced Psychosis: Occurs from adverse effects of drug use leading to a psychotic state from which the individual may not fully recover.
General Challenges in Treatment: Schizophrenia is labeled as the most serious mental health condition because of the challenges in treatment, particularly due to the need for patient consent, which can be complicated by their mental state.
Summary
Schizophrenia's treatment primarily revolves around the use of anti-psychotic drugs, with careful consideration of side effects, individual patient responses, and unique cases that may require tailored treatment strategies.