Schizophrenia

Psychotic Disorders Describes a group of disorders that are characterised by difficulties with thinking, distorted perceptions and a loss of contact with reality. Common symptoms -Cannot think clearly -Cannot reason -Cannot make good judgements & communicate effectively -Cannot tell the difference between real perceptions & those that are generated that are not present -Want to withdraw from the outside world -Lack of energy and emotions are affected -Feelings of depression, irritability

DSM-IV-TR Category Schizophrenia & other psychotic disorders There are nine disorders in the category See Box 16.1 pg 777 Prodomal Phase – individuals may start to experience changes in their thoughts, feelings and/or behaviour but not necessarily have clearly distinguishable symptoms of a specific psychotic disorder e.g. early signs/symptoms that precede the full onset of the disorder

Prevalence of schizophrenia Approximately 3% of the population will experience a psychotic disorder at some time in their life. In Australia, incidence is 1 in 5 people in 1,000. Schizophrenia and schizoaffective disorder account for more than 60% of people with a psychotic disorder Schizophrenia affects about I in 100 (1%) people across all countries Males are slightly more likely to develop schizophrenia than females. Majority of psychotic disorders begin in late adolescence or early adulthood. Age of onset for males is earlier than females. Although more females than males are affected between ages of years Reasons for these age related differences is unclear

Symptoms of Schizophrenia Positive symptoms Are experiences that happen in addition to normal experience e.g hallucinations, delusions, disorganised thoughts Negative symptoms Incorporate a loss or decrease in normal functioning. e.g. loss of pleasure or interest in normal activities, loss of motivation, loss of interest in socialisation

Diagnosis: DSM-IV-TR A person must experience at least two of the following five symptoms: -Delusions -Hallucinations -Disorganized speech -Grossly disorganised or catatonic behaviour -Negative symptoms 1.The symptoms must have been experienced for more than six months. 2.The symptoms must have a significant impact on the person’s ability to work, study or perform daily tasks. 3.Other possible causes for symptoms other than schizophrenia must have been considered and excluded.

Symptoms summary  Delusions – misinterpretation of actual information or experience. -Delusions of persecution -Delusions of reference -Delusions of control -Delusions of grandeur -Thought broadcasting -Thought insertion

Symptoms summary  Hallucinations – perceptual distortions of sensory information. The sensory information is interpreted as real but does not exist in reality. Most common is ‘hearing voices’. - critical hallucination -command hallucination What difficulties can someone have when experiencing hallucinations

Symptoms summary  Disorganised speech Characterisics include; Derailment Perseveration Neologisms Clang

Symptoms summary  Grossly disorganised or catatonic behaviour -Behaviour is fragmented, inappropriate, unusual, unpredictable, purposeless and erratic. -Can result in a decline in overall daily functioning - dishevelled, unkempt appearance or dressing in an unusual manner -Catatonic behaviour – highly disturbed movements (agitated state) or lack of movement (catatonic stupor/posturing)

Symptoms summary Negative symptoms – loss or absence of normal thought processes, emotions, behaviours typically experienced by mentally healthy individuals. These commonly start in the prodromal phase of schizophrenia. -Affective flattening -Avolition -Alogia

Biopsychosocial causes of Schizophrenia Bio – Genetic predisposition, drug induced onset, changes in brain activity Psycho – Impaired reasoning, impaired memory Social – risk factors (social disadvantage, trauma, psycho-social stress)

Biopsychosocial management of schizophrenia Bio – use of medication Psycho – CBT, cognitive remediation, stress management Social – psycho education, family support, social support, removal of social stigma

Genetic predisposition What does this mean? - having an increased risk for developing a mental or physical disorder due to factors associated with genetic inheritance. Importantly………… -Having a predisposition to schizophrenia doesn’t mean that a person will develop schizophrenia. The risk of developing schizophrenia depends on the degree of biological relationship and genetic predisposition alone does not ‘cause’ schizophrenia. -There is no single gene for schizophrenia. A number of different genes are likely to contribute to the expression of this disorder What implications are there from twin studies and adoption studies in understanding about the causes of schizophrenia?

Drug-induced onset Drugs that stimulate increased production of dopamine can ‘trigger’ psychotic symptoms similar to those that are experienced by a person with schizophrenia. Hallucinogens e.g LSD Stimulants e.g amphetamines, cocaine, ecstacy Cannabis e.g marijuana, skunk, hashish Drug induced psychosis – disorder characterised by delusions and hallucinations that are judged to be due to the direct physiological effects of a drug. How long can these effects last?

Changes in brain activity Research studies have shown a reduced level of brain activity in the prefrontal cortex (Ingvar & Franzen, 1974) Hypofrontality can contribute to reduced cognitive activity Progressive loss of grey matter in the parietal, motor and temporal cortices Information processing is slowed in the cortex

Dopamine hypothesis Dopamine – is a neurotransmitter involved in pleasure, motivation, emotional arousal and control of voluntary movements. Positive symptoms of schizophrenia are related to the excessive activity of dopamine normally found in the brain. This evidence has been found by 1)observing the role of anti-psychotic drugs which block or reduce dopamine activity and also drugs and 2)Observing that drugs like amphetamines, cocaine, cannabis etc can produce psychotic symptoms like those of paranoid schizophrenia in people without schizophrenia or worsen symptoms in people who already have schizophrenia.

Anti-psychotic medications When anti-psychotics are released into the synapse, they block the uptake of dopamine by the post-synaptic neuron, thereby inhibiting the effects of dopamine. Anti-psychotic drugs relieve the symptoms of psychosis – paranoia, confused thinking, delusions and hallucinations. They can only be prescribed by medical practitioners and psychiatrists and are commonly used alongside psychotherapy Limitations for the use of anti-psychotic drugs include;  side effects  these drugs do not cure schizophrenia and  psychotic symptoms often return if the person stops taking the medication.

Cognitive impairment Impaired reasoning -Probabilistic reasoning – affects how a person may interpret social situations. Link with the development of delusions (belief inflexibility & impaired working memory) -Another common impairment is cognitive bias or ‘jumping to conclusions’. Impaired memory -Impairments in short-term (working) memory and long term memory. Free recall and cued recall can be affected. -Studies have shown that episodic memory is affected. This may contribute to the symptom of disorganised behaviour and impairments in day-to day functioning. -Other cognitive impairment may include attention, planning ability, learning and visual perception.

CBT Cognitive Behavioural Therapy – combines cognitive and behavioural therapies to help people overcome or more effectively manage psychological problems and mental disorders. Cognitive component – the patient is helped to become aware of faulty conclusions which occur in particular situations. They analyse their thought processes and try to replace irrational conclusions with alternate, more logical ones. Behavioural component – the patient is asked to test out their faulty assumptions in a real life experimental situation, to show for example that their belief that they will come to harm in a situation can be proven wrong. Other strategies might include use of an iPod and headphones to drown out the voices in their head.

Cognitive remediation therapy A problem solving therapy which uses practical training exercises to improve cognitive functions such as memory skills, language abilities, problem solving skills or attention span. Cognitive remediation therapy can be used in-conjunction with medical treatments or psychotherapy.

Stress Management Techniques can include; - Biofeedback -Meditation & relaxation -Physical exercise -Social support Reducing stress can prevent relapse and rehospitalisation.

Socio-cultural risk factors Social disadvantage -social causation hypothesis -social drift hypothesis Trauma Psycho-social stress

Stress vulnerability model 1.Vulnerability of stress is mainly biological 2.Different individuals have differing degrees of vulnerability 3.Vulnerability is influenced by both genetic and environmental influences 4.Risk factors such as exposure to poor parenting, a high stress environment or inadequate coping skills may influence the course of schizophrenia and the likelihood of relapse 5.Protective factors such as social support and taking medication prescribed may also influence the course of the disorder and the likelihood of relapse.

Support factors Psychoeducation Supportive social environments – family, social networks, Removal of social stigma/ protest to stigma e.g StigmaWatch Community Education Interpersonal contact

Schizophrenia: the horror movie d