Presentation is loading. Please wait.

Presentation is loading. Please wait.

SchizophreniaSchizophrenia Onset 18-35 year Prevalence 0.6% Positive, negative and disorganisation symptoms Cognitive disorder Multifactorial genetic and.

Similar presentations


Presentation on theme: "SchizophreniaSchizophrenia Onset 18-35 year Prevalence 0.6% Positive, negative and disorganisation symptoms Cognitive disorder Multifactorial genetic and."— Presentation transcript:

1 SchizophreniaSchizophrenia Onset year Prevalence 0.6% Positive, negative and disorganisation symptoms Cognitive disorder Multifactorial genetic and non-genetic aetiology Developmental origin 20% life-span reduction Cost $200 billion/year worldwide

2 Dopamine Hypothesis Mesolimbic pathway Nigrostratial pathway (part of EP system) Tuberoinfundibular pathway (inhibits prolactin release) Mesocortical pathway Hypoactivity: negative symptoms Hyperactivity: positive symptoms

3 Haloperidol and D 2 Occupancy 11 C-Raclopride PET Scan Coregistered MRI Scan Before Treatment Haloperidol 2 mg/d (74% Occ.) 11 C-Raclopride PET Scan

4 Medication side effects Parkinsonism Acathisia Dystonia

5 Hallucinations

6

7 Psychological models Lower level intrusions Appraisal of experience as external Symptoms Emotional changes Cognitive attributions

8 Mood and psychosis

9 Disturbed source monitoring Voice distorter Frith et al, 1995

10 Auditory hallucinations

11

12

13

14

15 Delusions

16 Threatning/adverse events delusionsnegative self concept Need to readjust self concept Positive self perception at the expense of others having a negative view of the person Bentall et al., 1994 Kinderman & Bentall, 1996 External attribution of negative events: “others are to blame for the negative things that happen to me” actual self ideal self Attribution self-representation cycle

17 Cumulative effect of LE OnsetPsychosis Hirsch et al, 1996

18 A B

19

20 Theory of mind Frith & Corcoran, 1996 First order false belief John has five cigarettes left in his packet. He puts his packet on the table and goes out of the room. Meanwhile, Janet comes in and takes one of John’s cigarettes and leaves the room without John knowing. ToM question: When John comes back for his cigarettes, how many does he think he has left? Memory question: How many cigarettes are really left in John’s packet?

21 Cascade model of psychotic symptoms Jones, 1994 Theory of mind difficulties Difficulties making inferences about other children’s mental states Increasingly unsure of self, social withdrawal Decreasing opportunities for social interaction and reality testing Social isolation Paranoid attributions

22 CBTCBT Delusions: guided discovery, socratic questioning Hallucinations: attributions, coping mechanisms Thought disorder: “thought linking” Negative symptoms: paced activity schedules, mastery diary Delusions: guided discovery, socratic questioning Hallucinations: attributions, coping mechanisms Thought disorder: “thought linking” Negative symptoms: paced activity schedules, mastery diary

23 Prodromal phase of symptoms Häfner et al, 1999 n73% had prodromal symptoms nonset social disabilities 2-4 years before first admission

24 Outcome of childhood psychotic experiences N=761 – CIDI interviews Poulton et al Arch Gen Psych, 2000

25 Transition model Psychotic experience (pre-) First episode of disorder (post-) Time

26 The process of need Psychotic experience Attributions Need for care Emotional change Coping

27 Are voices more likely to result in need for care in the presence of delusions? Voices No delusional ideation Delusional ideation Schizophrenia T1 T2 T3 De Clérambault, 1947; Maher & Ross, 1974

28 Cannabis No pre-existing psychosis Pre-existing psychosis Psychosis outcome Interaction with pre-existing psychosis T1 T3 2.2%54.7% American Journal of Epidemiology, 2002

29 Lack of motivation

30 Blunting of affect

31 Ventricular enlargement

32 Fetal programming and morbidity accumulation

33 Verbal learning: remembering verbal information Immediate or working memory: keeping in mind limited information for a short-term Problem solving: planning and sequencing actions Sustained attention: target from noise discrimination over time Cognitive Constructs

34 Cognitive Constructs - Verbal Learning Definition: ability to acquire, store, and retrieve verbal information for more than a few minutes Example: California Verbal Learning Test Activities of daily living: remembering information from a rehabilitation program, class, vocational setting, clinic visit drillplumsvestparsleygrapespaprikasweaterwrenchchivestangerineschiseljacketnutmegapricotspliersslacks

35 Definition: ability to hold information “on line” in a temporary store and/or to manipulate the information Example: Letter Number Sequencing Test Activities of daily living: carrying on a social conversation, switching between different tasks K3B4_ _ _ _ R8C3G5_ _ _ _ _ _ Cognitive Constructs – Working Memory

36 Definition: ability to plan, sequence, self-monitor, comprehend, and implement rules Example: Wisconsin Card Sorting Test Activities of daily living: planning a meal, using public transportation, following steps for a job task Cognitive Constructs – Problem Solving

37 100 ms Definition: ability to respond to targets, not respond to nontargets, over a period of time Example: Continuous Performance Test Activities of daily living: identifying relevant information in a social interaction, discussions with a doctor “Press when you see a 7 preceded by a 3” Stimulus Response 1 second hold presshold Time Cognitive Constructs – Sustained Attention

38 Cochrane cognitive rehabilitation

39 Family Guidelines (examples) Go slow Solve problems step-by-step Keep it simple Keep it cool Give each other space Lower expectations McFarlane, 2002

40 Disorganised speech

41 Pro generale continuatie en in particuliere explicatie op uw singuliere interrogatie onze affirmamentatie. Ontelbaarheid van levensverhalen zijn aan deze bladzee gesneefd, frêle als flikflokjes, zooisel van boven, als een wjoengand waaigat vol dwaereldriften.

42 ” “One of the most elusive diseases known to man and unknown to medicine” Joyce, 1936

43

44 CatatoniaCatatonia

45 Fin

46

47 Definition: a composite score representing memory, attention, visuospatial skills, language, etc Example: Repeatable Battery for Assessment of Neuropsychological Status Activities of daily living: large associations with most types of community adaptation including social, vocational, and rehabilitation success Brief (25-min) paper and pencil test with 2 alternate forms Subtests:- Immediate memory - Visuospatial/constructional - Language (naming and fluency) - Attention - Delayed memory - Total score Summary Score From Screening Test

48 PsychotherapyPsychotherapy

49 Psychological models Lower level intrusions Appraisal of experience as external Symptoms  Reasoning biases  Attribution biases  Dysfunctional schemata  Isolation  Adverse environments Emotional changes Garety, Kuipers, Fowler, Freeman & Bebbington, 2001; Bentall et al, 2002; Chadwick & Birchwood, 1994; Morrison et al, 1995; Hemsley et al, 1993

50 CBTCBT n Tarrier et al, 1993 n Drury et al, 1996 n Kuypers et al, 1997 n Tarrier et al, 1998 n Sensky et al, 2000 n Lewis et al, 2000 n Turkington et al, 2000 First episode Befriending Supp. counselling “Real life” “TAU”

51 PsychotherapyPsychotherapy  Theory of mind  Self-monitoring AuditoryAuditory MotorMotor MemoryMemory  Probabilistic reasoning bias  Dysfunctional attributions/ self-esteem  Theory of mind  Self-monitoring AuditoryAuditory MotorMotor MemoryMemory  Probabilistic reasoning bias  Dysfunctional attributions/ self-esteem

52 Sandy en Ivan gaan samen met de trein naar huis. Sally woont in Weert maar de trein stopt niet in Weert. Sandy moet in Roermond uitstappen en met de bus verder gaan. Als Sandy eventjes weg is om een tijdschrift te kopen wordt er omgeroepen dat de trein wel in Weert stopt. Een conducteur vertelt Ivan dat de trein wel doorgaat naar Weert en Ivan gaat Sandy zoeken om het nieuws te vertellen. Nog voor Ivan haar gevonden heeft is ook Sandy reeds op de hoogte van de verandering. Uiteindelijk komt Ivan haar weer tegen net nadat ze haar ticket gekocht heeft. Vraag: voor welk station denkt Ivan dat Sandy een ticket gekocht heeft?

53

54 CBTCBT n Engagement n Identiying antecedents n Normalising rationale n Diagnosing comorbid depression/anxiety n Agreement on working plan n Engagement n Identiying antecedents n Normalising rationale n Diagnosing comorbid depression/anxiety n Agreement on working plan

55 The process of need Psychotic experience Attributions Need for care Emotional change

56 The process of need Psychotic experience Need for care Coping

57 Pathways to care Filter 1 Filter 2 Filter 3 Filter 4 Psychiatric hospital Psychiatric out patient GP recognised General population GP practice

58 Population intervention Level of risk Frequency

59 Population intervention Filter 1 Filter 2 Filter 3 Filter 4 Psychiatric hospital General population

60 Schizophrenia is rare N=10,000 Age 20 years Age 21 years N=2

61 Life course epidemiology of psychosis age 2 25 premorbid level of functioning First sign secondaryprevention Treatment First episode 1.1 year 0.9 year

62 The Finnish adoption study Genetic risk Risk adult schizophrenia Dysfunctional adoptive family Tienari et al, 1996 Non-dysfuntional adoptive family

63 Low EE High EE < 35 hrs. > 35 hrs. On med. No med. On med. No med. On med. Total 13% 51% 69% 28% 92% 53% 42% 15% 15% 12% N= 128 Low EE = 71 High EE = 57 Vaughn & Leff, 1976


Download ppt "SchizophreniaSchizophrenia Onset 18-35 year Prevalence 0.6% Positive, negative and disorganisation symptoms Cognitive disorder Multifactorial genetic and."

Similar presentations


Ads by Google