Schizophrenia Schizein (to split), Phren (mind)

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SchizophreniaSchizein (to split), Phren (mind)

• By Elise Stine

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• Schizophrenia A group of psychotic disorders
  characterized by major disturbances in thought,
  emotion,and behavior disordered thinking in
  which ideas are not logically related faulty
  perception and attention bizarre disturbances in
  motor activity flat or inappropriate emotions
  and reduced tolerance for stress of interpersonal
  relations. The patient withdraws from people and
  reality, often into a fantasy life of delusions
  and hallucinations.

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• Positive Symptoms behavioral excesses, such as
  hallucinations and bizarre behavior
• Negative Symptoms deficits, such as flat affect
  and apathy

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Positive Symptoms

• Disorganized Speech speech found in
  schizophrenics that is marked by problems in the
  organization of ideas and in speaking so that
  others can understand.
• Delusions beliefs contrary to reality, firmly
  held in spite of contradictory evidence .
• Loose associations the patient has difficulty
  sticking to one topic and drifts off on a train
  of associations evoked by an idea from the past
• Hallucinations perceptions in any sensory
  modality without relevant and adequate external
  stimuli

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Negative Symptoms

• Avolition individual lacks interest and drive
• Flat Affect a deviation in emotional response
  wherein virtually no emotion is expressed,
  whatever the stimulus
• Catatonic immobility a fixity of posture ,
  sometimes grotesque, maintained for long periods,
  with accompanying muscular rigidity, trancelike
  states of consequences and waxy flexibility.
• Waxy Flexibility patients limbs can be moved
  into a variety of positions maintained thereafter
  for unusually long periods of time.
• Inappropriate Affect emotional respronses that
  are out of context such as laughter when hearing
  sad news

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History

• Emil Kraepelin and Eugen Bleuler European
  psychologists who developed early theories on
  schizophrenia, then called dementia praecox.
• Dementia Praecox an older term for
  schizophrenia, chosen to describe what was
  believed to be an incurable and progressive
  deterioration of mental functioning beginning in
  adolescence.
• Kraepelin defined dementia praecox into 36 major
  categories, assigning hundreds of symptoms to
  each. He emphasized prognosis and definition
• Bleuler wanted to define the disorder. He
  believed that the disorder did not necessarily
  have an early onset and did not progress toward
  dementia.

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• Bleuler disagreed with Kraepelin and renamed the
  disorder schizophrenia, to not include altered
  personality states or contradictory opinions.
  Instead he used this term to signify what he
  considered the common core of the disorder, the
  metaphorical concept of the breaking of
  associative threads (which join words and
  thoughts). Goal- directed, efficient thinking and
  communication were possible only when these
  hypothetical structures were intact.
• The attentional difficulties of schizophrenics
  were viewed by Bleuler as resulting from a loss
  of purposeful direction in thought which caused
  passive responding to thoughts and people
• His conceptions led to a broader concept of
  schizophrenia and a more theoretical emphasis.

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• Diagnosis in the United States for schizophrenics
  reached 80 in 1940, showing an obvious problem
  in over diagnosing. These problems came from
  difficulty defining schizophrenia as well as
  identifying it.
• Up until the 1960s the label for a schizophrenic
  was loosely someone who for whatever reason,
  behaves in an eccentric manner, which would
  often shape a persons perception of the patient
  as well as encourage eccentric patient behavior.

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Changes From the DSM 3

• The definition of schizophrenia was pruned down
  in to a more finite definition in four ways.
• 1) The diagnostic criteria are presented in
  explicit and considerable detail
• 2) Patients with symptoms of a mood disorder are
  excluded
• 3) The DSM 4 requires at least six months of
  disturbance for the diagnosis, including at least
  one month of an active phase which can include
  two or more of the following delusions,
  hallucinations, disorganized speech, catatonic
  behavior, as well as one negative symptoms. Only
  one positive symptom is needed to diagnose a
  schizophrenic if they are experiencing a bizarre
  delusion, running commentary in which two or more
  voices in their head talk to each other. This
  eliminates patients that have a brief, often
  stress related, psychotic episode who then
  recover quickly.
• 4)Mild forms of schizophrenia are now diagnosed
  as personality disorders (schizotypal personality
  disorders).

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Current Schizophrenia Subtypes

• Disorganized Schizophrenia in which a person has
  rather diffuse and repressive symptoms the
  individualist given to silliness, facial
  grimaces, and inconsequential rituals and has
  constantly changeable moods and poor hygiene.
• Extremely disorganized behavior, flat affect,
  constant mood changes, frequent deteriorationon
  into incontinence, neglect of appearance

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Catatonic Schizophrenia

• Catatonic Schizophrenia schizophrenia in which
  the primary symptoms alternate between stuporous
  immobility and excited agitation.
• Motor disturbances, echo speech of others,
  previous withdrawal from reality, catatonic
  behavior (either highly excited or lethargica)

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Paranoid Schizophrenia

• Paranoid schizophrenia in which the patient has
  numerous systematized delusions such as grandiose
  delusions, delusional jealousy as well as
  hallucinations and ideas of reference.
• Agitated, angry, argumentative, sometimes
  violent.
• Grandiose delusions an exaggerated sense of
  ones importance
• Delusional jealousy the unfounded conviction
  that ones mate is unfaithful. They often collect
  evidence
• Ideas of reference reading personal significance
  into trivial remarks and activities of other and
  to unrelated events.

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Theories on The Causes of Schizophrenia

• Biological genetics (family and twin studies),
  biochemistry (antipsychotics block dopamine
  receptors, problem in dopamine system),
  microanatomy (brain abnormalities)
• Vulnerability- Stress prenatal virus exposures,
  lower class living can trigger schizophrenia,
  schizophrenics are downwardly mobile
• Family Interactions schizophrenic mother (no
  longer credible), households high in expressed
  emotion worsen schizophrenic condition.

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Biological Perspective

• Evidence suggests a strong genetic component. It
  is through the bodys chemistry and biology that
  shows how heredity can have an effect.
• Family studies risk for schizophrenia for the
  general population is less than one percent but
  the risk for a child with two schizophrenic
  parents is greater than nine percent, and a risk
  of forty-four percent when a subjects identical
  twin has schizophrenia. We must keep in mind the
  shared environments for these related subjects
  and how that may also play a role.
• In controlled studies, children were raised by
  their schizophrenic mothers or raised separately
  by their birth mothers. The group raised by
  adoptive mothers reached higher rates of
  schizophrenia than those with the schizophrenic
  mother.
• Negative symptoms are more likely than positive
  symptoms to be passed down to offspring.

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• Dopamine Theory schizophrenia may result from
  excess activity in dopamine nerve tracts.
  Dopamine receptors appear to have increased in
  number or have been hyperactive as seen in
  postmortem studies.
• The effect of amphetamines (which have highly
  similar chemical structure) has shown to both
  exacerbate and lessen the symptoms of
  schizophrenia.
• Dopamine neurons in the prefrontal cortex may be
  under active and fail to inhibit the neurons in
  the limbic system adequately (which may be the
  cause of schizophrenic symptoms)

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• Microanatomy the search for similarities within
  the schizophrenic brain.
• Many men have larger ventricles which suggests
  impaired performance on neuropsychological tests,
  poor premorbid adjustment and poor response to
  drug treatment.
• The prefrontal cortex is often the site of decay
  (Doran et all). Schizophrenics show low metabolic
  rates in the prefrontal cortex and perform poorly
  in tests related to cortex activity.

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Vulnerability- Stress Perspectives

• We know genetics plays a role, but that it is not
  the deciding factor or both monozygotic twins
  would always have schizophrenia when one had it.
• General life stressors predispose a person to
  schizophrenia. These factors are
• 1) Prenatal virus exposure
• 2) Social class
• 3) Family interaction styles.

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• Prenatal Exposure to a Virus during the second
  trimester, a fetus develops cortical abilities.
  Exposure to a virus during this time period that
  invades the brain and damages it has been linked
  with later risk for schizophrenia.
• Weinburger (1987) hypothesized that schizophrenia
  that the brain injury interacts with normal brain
  development and that the prefrontal cortex is a
  brain structure that matures late, typically like
  adolescence like schizophrenia.

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• Low Socioeconomic Status the highest rates of
  schizophrenia are found in urban areas inhabited
  by the lowest socioeconomic statuses.
• Sociogenic Hypothesis the relation between low
  social class and schizophrenia is due to being
  from a low social class itself. The degrading
  treatment, low level of education, unavailability
  of opportunity, can cause such a stressful
  experience that it causes the individual to
  develop schizophrenia.
• Social- Selection Theory an attempt to explain
  the correlation between social class and
  schizophrenia by proposing that schizophrenics
  move downward in social status.

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• Problematic Family Interactions family
  relationships are crucial in the development of
  schizophrenia.
• Schizophrenic Mother a cold dominant,
  conflict-inducing mother once believed to cause
  schizophrenia.
• Double- Blind Theory an interpersonal situation
  in which an individual is confronted over long
  periods of time by mutually inconsistent messages
  to which she or he must respond, which is
  formally believed to cause schizophrenia.
• Support for these theories is inadequate because
  the control does not support these claims.

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Treatments

• Historic Treatments Prefrontal lobotomy
• Medication Antipsychotic medications can
  alleviate the positive symptoms of schizophrenia
  but can have serious side effects that mirror
  neurological disease.
• Psychological Therapies Family therapy can
  provide support and understanding. Behavioral
  therapy can reduce behaviors that might elicit
  hostility.

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• Prefrontal Lobotomy a surgical procedure that
  destroys the tracts connecting the frontal lobes
  to lower centers of the brain, once believed to
  ban effective treatment for schizophrenia.

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• Medications Chlorpromazine was first used
  therapeutically in the USA in 1954 to treat
  schizophrenics. Now use of butyrophenones and
  thiozanthenes are also available to treat
  positive symptoms of schizophrenia.
• Side effects patients reported the drug to cause
  blurred vision, low blood pressure, jaundice and
  constipation. Also dysfunctional nerve tracts
  that descend from the brain into the spine,
  including muscular disturbances.
• Risperidone blocks both serotonin and dopamine
  receptors which helps with both positive and
  negative symptoms. This drug also has fewer side
  effects.
• When kept on the medication, levels must be
  continually monitored and reevaluated. Many
  patients do not stay on the medication

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Psychological Treatments

• Psychodynamic Therapy Freud believed that
  schizophrenics were incapable of establishing
  close interpersonal relationships and were
  therefore not suited for therapy. The
  schizophrenic ego was weak and unable to handle
  the extreme stressors of life, so it regresses.
• Encouragement of interpersonal relationships is
  focused on.

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• Behavioral Therapy Therapy techniques such as
  the token economy are used to lessen behaviors.
  This therapy style is very successful and can
  improve the functioning levels of patients to the
  extent of releasing them from hospitals.

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• Family Therapy Focused on keeping discharged
  patients living in a home setting. Lowering the
  emotional intensity of a household and
  experimenting with family treatment have been
  shown to improve schizophrenic functioning,
  allowing many more individuals to maintain at
  home instead of returning to a hospital.

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• Exploring Abnormal Psychology by John M. Neale,
  Gerald C. Davison, David A. F. Haaga - J. Wiley
  (1996) - hardback - 505 pages
• Abnormal Psychology by Kring, Sheri L. Johnson,
  Gerald C. Davison, John M. Neale - John Wiley
  Sons (2009.02.17) - hardback - 672 pages
• A Diagnostic Interview The Schedule for Affective
  Disorders and Schizophrenia Jean Endicott, PhD
  Robert L. Spitzer, MD Arch Gen Psychiatry. 197835
  (7)837-844.