1. Differentiate psychotic behaviours and schizophrenia.
    • Psychotic behaviours: clusters of disorders characterised by hallucinations and/or loss of contact with reality.
    • Schizophrenia: a type of psychosis with disturbed thought, perception, language, emotion and behaviour.
  2. What are the types of symptoms in schizophrenia?
    • Positive symptoms: active manifestations of abnormal behaviour:
    • ~ Delusions: gross misrepresentations of reality. Include delusions of grandeur and persecution.
    • ~ Hallucinations (auditory and/or visual): experience sensory events without environmental input. Broca's area (speech production) more active than Wernicke's area (language comprehension) during hallucinations - can't recognise that it's their own voices.

    • Negative symptoms: deficits in normal behaviour.
    • ~ Avolition (or apathy): lack of initiation and persistence in activities
    • ~ Alogia: relative absence of speech
    • ~ Anhedonia: lack of pleasure or indifference
    • ~ Affective flattening: little expressed emotion

    • Disorganised symptoms: severe and excessive disruptions.
    • ~ Disorganised speech: cognitive slippage, tangentiality, loos associations.
    • ~ Disorganised affect: inappropriate emotional behaviour
    • ~ Disorganised behaviour: catatonia, wild agitation, waxy flexibility, immobility.

    • Motivational view: attempts to deal with anxiety/stress.
    • Deficit view: resulting from brain dysfunction.
  3. What is schizophrenia?
    • DSM:
    • ~ 2 or more of: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms.
    • ~ Social/occupational dysfunction
    • ~ Continuous signs of disturbance persist for at least 6 months, including 1 month of positive/disorganised symptoms
    • ~ Not due to schizoaffective disorder, mood disorder, medical condition, or substance abuse.

    Some suggest schizophrenia is just a label for those who don't conform with society's standards, BUT many diverse cultures have symptoms of it.

    • ~ Generally a chronic disorder.
    • ~ High risk of suicide.
    • ~ Affects all racial and cultural groups, but course and outcome vary.
  4. What are the subtypes of schizophrenia?
    • Paranoid: intact cognitive skills and affect, hallucinations and delusions (have a theme, e.g. grandeur, persecution)
    • Disorganised: marked disruptions in speech and behaviour, flat/inappropriate affect, fragmented hallucinations and delusions.
    • Catatonic: unusual motor responses and odd manerisms (e.g. echolalia, echopraxia). Severe and quite rare.
    • Undifferentiated: wastebasket category. Major symptoms of schizophrenia but fail to meet another subtype.
    • Residual: one past episode of schizophrenia, continue to display less extreme residual symptoms.
  5. What are other disorders with psychotic symptoms?
    • Schizophreniform disorder: schizophrenic symptoms for a few months.
    • Schizoaffective disorder: schizophrenia and a mood disorder
    • Delusional disorder: delusions but no other positive/negative symptoms.
    • Brief psychotic disorder: one or more positive symptoms of schizophrenia that remits after a short period of time.
    • Share psychotic disorder: delusions from one person manifest in another
    • Schizotypal personality disorder: may reflect a less severe form of schizophrenia.
  6. Treatment for schizophrenia?
    • Antipsychotic (neuroleptic) medication:
    • ~ Interfere with the dopamine neurotransmitter system.
    • ~ Most reduce or eliminate positive symptoms.
    • ~ Acute and permanent side effects are common.
    • ~ Compliance is often a problem - negative doctor patient relationship, cost, poor social support, side-effects.

    • TMS:
    • ~ Early evidence for reduction in hallucinations.
    • ~ Carry over effects - over time the benefits become longer lasting.

    • Psychosocial approaches:
    • ~ Nowadays few people believe schizophrenia is caused by psychological factors, but it is still an important part of treatment.
    • ~ Delay/avoid relapse from drug therapy.
    • ~ Family therapy - education, communication, problem solving.
    • ~ Community care programs
    • ~ Social and living skills training

    Successful treatment rarely involves complete recovery. Most have a pattern of relapse and recovery.
  7. Causes of schizophrenia?
    It seems several bio-psycho-social factors are involved.

    • Structural and functional abnormalities in the brain:
    • ~ Enlarged ventricles and reduced tissue volume.
    • ~ Hypofrontality (less active frontal lobes).
    • ~ Diffuse neurobiological disregulation.

    Schizophrenia has been characterised in part by debilitating cognitive impairments - attention, working memory and executive function.

    • Dopamine hypothesis:
    • ~ Drugs that increase dopamine result in schizophrenic-like behaviour (e.g. amphetamines, L-dopa - a Parkinson's treatment)
    • ~ Drugs that reduce dopamine reduce schizophrenia-like behaviour (neuroleptics produce Parkinson's-like effects - insufficient dopamine)
    • ~ Problematic and overly simplistic: many not helped by neuroleptics, symptoms subside more slowly than anticipated, neuroleptics only really affect positive symptoms.
    • ~ Current theory emphasises at least 3 neurochemical abnormalities (see next).

    • 3 specific neurochemical abnormalities:
    • ~ Excessive stimulation of striatal dopamine (movement, balance)
    • ~ Deficient stimulation of prefrontal dopamine (thinking and reasoning)
    • ~ Deficit in glutamate or blocking of NMDA sites.

    Stress may activate underlying vulnerability and increase risk of relapse.

    Families show ineffective communication. High expressed emotion --> relapse.

    Healthy, supportive homes may be a protective factor.
Card Set
Schizophrenia and other psychotic disorders