Chapter 11 Schizophrenia

Common hallucinations proposed as significant in schizophrenia:

1 Hearing their own thoughts spoken by another voice 2 Hearing voices arguing 3 Hearing voices commenting on their behaviour

Kurt Schneider

German psychologist proposed particular forms of hallucinations and delusions (first-rank symptoms) as central to schizophrenia.

Changes to diagnosis of schizophrenia from DSM III to IV-TR

1 Critieria were more detailed 2 Mood disorder symptoms were excluded 3 At least six months of disturbance was required 4 milder forms of schizophrenia were made into personality disorders (schizotypal personality disorder) 5 differentiation between paranoid schizophrenia and delusional disorder

"Dementia" in Dementia Praecox referred to:

"mental enfeeblement" (Emil Kraeplin)

Family therapy for schizophrenia

- Calming down the family environment and reducing critical comments from family members. (reducing expressed emotion) - Encourages family members not to blame themselves. - Encourages clients and families to expand their social support networks

Importance of prefrontal cortex in schizophrenia:

- Plays a role in behaviours. - Lack of awareness in schizophrenics maybe be related to defective frontal-love functioning. - Evidence shows reduction in grey matter int he prefontal cortex in schizophrenics. - Schizophrenics show low metabolic rates in the prefontal cortex during psychological tasks. - Schizophrenics show less frontal activation - Frontal hypoactivation is less pronounced in the non-scizophrenic twin of a MZ pair - Violent people with schizophrenia and a history with anti-social and/or substance abuse manifest neural dysfuntion affecting basal or obital parts of the prefontal cortex.

Treatment strategies for schizophrenia supported by APA

- family interventions - psychoeducation and social skills training - cognitive behavioural therapy - assertive community treatment - support employment

Congential/developmental considerations in causes of schizophrenia

- presence of craniofacial/midline anomalies and/or early impairments of central nervous system anomoly double the risk - higher rates of S. in babies born with delivery complications (genetic predisposition). - Virus during pregnancy that invades the brain of the fetus (influenza, toxoplasmosis and genital/reproductive infections)

Common delusions proposed by Schneider:

1 Unwilling recipient of bodily sensations/thoughts 2 Thought are broadcast or transmitted so others know what they're thinking 3 Thought being stolen from them 4 Feelings are controlled by an external force 5 Behaviour is controlled by an external force

Social-Selection Theory

A reversal of causal factors of schizophrenia from sociogenic hypothesis. People with schizophrenia may drift into poverty-ridden areas or choose to move to areas with little social pressure so they can escape intense social relations or they may not be able to earn a living due to disability and discrimination. There is more evidence for this theory over the sociogenic theory.

Cognitive enhancement therapy

A supportive therapy that includes educational and supportive aspects of therapy. It focuses on computer-based training in attention, memory and problem solving as well as cognitive skills and initiating conversations. It is a therapy focused on basic cognitive functioning.

Neuroleptics

A term that refers to antipsychotic drugs because they produce side effects similar to symptoms of neurological diseases

Catatonic Immobility

Adopting unusual postures that are maintained for long periods of time

In the developmental data of schizophrenia, all of the following was noted:

A. teachers described pre-schizophrenic boys as disagreeable in childhood. B. teachers described pre-schizophrenic girls as passive. C. men and women were described as delinquent and withdrawn in childhood. D. pre-schizophrenic children showed poorer motor skills.

Significance of Genain Quadruplets

All four developed schizophrenia, which is extremely unlikely. But they all had different life outcomes. Some were higher functioning than others. Demonstrates that the course of the disorder can be variable and both genetic and environmental factors need to be considered.

Dopamine theory

Amphetamines can induce a state resembling paranoid schizophrenia. This is probably a result of the increased dopamine. This led researchers to believe that schizophrenia was caused by excessive dopamine.

Waxy flexibility

Another person can move the person's limbs into strange positions

Hebephrenic

Another term for disorganized subtype of schizophrenia (proposed by Kraeplin initially)

How do antipsychotics work?

By blocking dopamine receptors in the brain.

Delusions

Beliefs held contrary to reality. Common positive symptom of schizophrenia.

Emil Kraeplin

Came up with term "Dementia Praecox" to describe schizophrenia in 1988. It included dementia paranoides, hebephrenia and catatonia.

Other symptoms of schizophrenia (not positive or negative)

Catatonia Inappropriate Affect

Changes to DSM V diagnosis for schizophrenia

Classic subtypes of schizophrenia were removed. Schizoaffective disorder was dropped.

What is thought to be the most common type of delusions in schizophrenia?

Delusions of persecution

Diagnostic categories of Dementia Praecox

Dementia paranoides Catatonia Hebephrenia

CBT Social skills therapy for schizophrenia

Designed to teach people with schizophrenia behaviours that can help them succeed in various areas of life.

Loose associations

Difficulty sticking to one topic. Drift off on a train of associations evoked by an idea from the past.

Incontinence is a symptom of which subtype of schizophrenia?

Disorganized

Positive symptoms of schizophrenia include the following:

Disorganized speech Hallucinations Delusions

CBT for schizophrenia

Effective in reducing negative symptoms of schizophrenia. Addresses delusions and hallucinations and can facilitation motivation and encouragement in social and vocational activities.

Inappropriate Affect

Emotional responses are out of context. Rare, but relatively specific to schizophrenia.

Large ventricles in relation to schizophrenia

Evidence shows people with schizophrenia have enlarged ventricles. This is linked with poor cognitive performance, poor adjustment prior to the onset of the disorder and poor response to drug treatment. It is also found in patients with other psychoses such as bipolar disorder.

PRIME clinic (CAMH)

First episode psychosis clinic for people with schizophrenia and their families manage the initial episode. The goal is to intervene in the prodormal phase to prevent onset of active phase symptoms and the decline in cognitive social and occupational functioning.

Heinz Lehrmann

First to introduce /publish an article on chlorpromazine as a treatment for schizophrenia in North America. He was a physician in Montreal who escaped the nazis.

Negative symptoms of schizophrenia include the following:

Flat Affect Anhedonia Avolition Alogia Asociality

Mobile Crisis Intervention Team, ACT, PACT

Forms of Assertive Community Treatment models/Case Management. They entail a multidisciplinary team that provides services ranging from medication, treatment for substance abuse, help with daily stressors, psychotherapy, vocational training, housing and employment.

Etymology of term "schizophrenia"

Greek: "schizein" meaning "to split" and "phren" meaning "mind". Term developed by Eugen Bleuler in 1908.

Eugen Bleuler

In 1908 he proposed changing the name "Dementia Praecox" to schizophrenia. He differed from Kraeplin on two aspects: the disorder didn't necessarily have an early onset and progressing towards dementia wasn't inevitable.

Disorganized speech involves:

Incoherence, loose associations or derailment

Ideas of reference

Incorporating unimportant ideas into a delusional framework, reading significance into them. Eg. Overheard segments of conversation are thought to be about them.

Problem with dopamine theory

It is more likely that an increase in dopamine receptors and not dopamine is a cause of some (positive) symptoms (but not all) of schizophrenia. Antipsychotics reduce positive symptoms, while amphetamines worsen positive symptoms and lessen negative ones.

Avolition

Lack of energy and interest/ability to do normal routine activities such as grooming and personal hygiene. May spend a lot of time sitting and doing nothing. Negative symptom of schizophrenia.

Glutamate in relation to schizophrenia

Low levels of glutamate have been found in the spinal fluid of schizophrenics. PCP can induce psychotic state by interfering with one of glutamate's receptors.

Leucotomy

More circumscribed and specific procedure to a lobotomy.

Phenotiazine

Most frequently prescribed anti-psychotic drug in the past 50 years.

Catatonia

Motor abnormalities, such as gesturing repeatedly, using peculiar sequence of finger, hand, arm.

Symptoms most likely to produce critical comments from relatives of patients with schizophrenia

Negative symptoms

Flat affect

No stimulus elicits emotional response. Answers in toneless voice. Eyes lifeless.

Undifferentiated schizophrenia

People who meet criteria for schizophrenia, but do not meet criteria for a subtype (DSM IV-TR)

Residual Schizophrenia

Person no longer meets full criteria for schizophrenia, but still shows signs of the disorder (DSM IV-TR)

Egas Moniz

Portugese psychiatrist who introduced the prefontal lobotomy in 1935.

Alogia

Poverty of speech. Content and amount of speech is reduced. What they're saying does not convey much info. Negative symptom of schizophrenia.

Positive symptoms (definition):

Presence of too much behaviour found in schizophrenics but not found in most people.

Difference in age of onset between men and women

Schizophrenia appears earlier in men than women.

Sociogenic hypothesis

Stressors associated with class may cause or contribute to the development of schizophrenia. The degrading treatment a person receives from others, the low level of education, and the lack of opportunities make membership in the lower socio-economic class a stressful experience that may predispose individuals to develop the disorder. Could also be biological: children whose mothers are malnourished during pregnancy are are increased risk.

Prefontal lobotomy

Surgical procedure introduced in 1935 that destroys parts of the brain connecting frontal lobes to lower centres fo the brain used to treat schizophrenia. 1950s it was stopped due to introductions of antipsychotic medications.

Schizophrenogenic mother

Term was coined to describe a cold, dominant, conflict-inducing parent who was said to produce schizophrenia in her children. These mothers were rejecting, overprotective, self-sacrificing, impervious to the feelings of others, rigidly moralistic about sex and fearful of intimacy. There is no supporting evidence of this theory.

Negative symptoms (defnition):

The absence of behaviours most people have. A sign of schizophrenia.

Tricia Miller

Woman who was arrested at SkyDome for plotting to kill Blue Jay Roberto Alomar. She had delusional disorder and was frustrated that she couldn't contact Alomar even though she didn't know him.

Social skills training in schizophrenia focuses on these three key elements

receiving skills processing skills behavioural responses

The social-selection theory proposes that

schizophrenia causes poverty.

The metaphorical concept Bleuler adopted to explain schizophrenia was:

the "breaking of the associative threads"