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.
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.
What is schizophrenia?
- ~ 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.
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.
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.
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.
- ~ 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.
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.