Schizophrenia: An introduction

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Schizophrenia An introduction

• Dr James Cruickshank
• GLB 103
• cruickj_at_hope.ac.uk

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Intro

• Disorder that best corresponds to pop conceptions
  of lunacy
• Strips the mind of assoc between thoughts
  emotions.
• Distorted perceptions, fals ideas, illogical
  conceptions
• Acute episodes hallucinations, delusions,
  speech, and behaviour
• Between acute episodes unable to think clearly,
  may lack emotion
• S not only disorder where P experiences a break
  in reality

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Emil Kraeplin (1856-1926)

• Dementia Praecox
• Caused by specific, unknown, pathology
• DP involves loss of the inner unity of though,
  feeling and acting
• Early onset, gradual deterioration
• Results on complete disintegration of the
  personality (Kraeplin, 1909)

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Eugen Bleuler (1857-1939)

• Replaced DP with schizophrenia (1911)
• Focus on major characteristics, the splitting of
  Br Fn that give rise to cognition, feelings and
  Br.
• Shouldnt be confused with dissociative disorder
• Little agreement between thoughts emotions,
  perceptions of reality and what is really going
  on (cleaved/split mind)

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• Accepted Ks description of symptoms, but not
  early onset and gradual deterioration.
• Believed S has variable course and should be
  identified on basis of four primary features
• Associations/ thought disorder
• Affect/ flattened-inappropriate
• Ambivelance
• Autism
• Hallucinations and delusions secondary features
  of S
• Others dont agree, but gt DSM classification

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Kurt Schneider (1887-1967)

• Believed 4 As too vague for diagnosis and dont
  distinction S from other disorders
• Discriminate between features specific to S and
  those that arent
• First rank symptoms if present and not due to
  other factors diagnosis of S warranted.
• Hallucinations and delusions seen as prominent
• Now know in other disorders

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Contemporary diagnosis

• Contributions of all three expressed in DSM-4
  criteria
• S doesnt need to follow downhill course (USDHSS,
  1999a)
• 50-75 of patients improve over lifetime (ibid)
• Tighter diagnostic codes/separation in
  disturbance of mood combined with psychotic Br
  (schizoaffective D), and those with S-like
  thinking and no psychotic br (schizotypal PD)

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DSM-4 criteria

• A) two or more of the following present for sig
  portion of time over 1-month
• delusions
• Hallucinations
• Speech incoherent or insecure associations
• Disorganised or catatonic Br
• Negative features (eg flat affect)
• B) Functioning in areas such as
  social/work/self-care/family markedly below level
  achieved prior to onset
• C) Signs of the disorder occur continuously for 6
  months. Must include active phase lasting at
  least 1 month with psychotic symptoms
• D) Disorder cannot be attributed to effects of a
  substance or other medical condition

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Dev of S

• Typically develops in late adol/early adulthood
• P become increasingly disengaged from society,
  fail to function in expected roles
• 75 of cases dev by 25yrs
• Onset can be both acute and gradual
• It make take years before psychotic Brs emerge
• Prodomal phase lt socially active, gtdifficulty in
  meeting social responsibilities, cleanliness
  issues, eccentric Br, speech vague and rambling
• Acute phase hording food, collecting rubbish.
  Real psychotic symptoms (H, Delusions)
• Residual phase

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Prevalence of S

• 1 of US pop (2 million)
• WHO rate of S similar in developed/developing
  countries
• Affects 24 million worldwide
• Annual cost treatment 30billion
• Accounts for 75 of MH spending in US
• Men gt likelihood than women
• Later onset (18-25 vs 25-35). Implications?
• Whilst occurrence of S universal, patterns of
  symptoms are not.
• Visual H more common in non-western cultures.
• African, Asian, Jamaican 2X likely to experience
  vis H than Europeans (Ndetei Vadher, 1984)

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Major features of S

• Pervasive - affects cognitive/emotion/Br
• People also exhibit delusions, H, problems with
  assoc thinking, lang defects
• Diff types of S characterised by diff patterns of
  symptoms
• Perhaps gender diff actually a difference in type
  of S?
• Possible that diff S effects different parts of
  brain and this is why there is a gender diff.

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Disturbed content of thought

• Most prominent disturbance. Involves
  delusions/false beliefs that remain fixed.
• Most common are
• Persecution
• Reference
• Being controlled
• grandeur
• Other types include
• Thought broadcasting
• Thought insertion
• Thought Withdrawl

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Disturbed form of thought

• Unless daydreaming, thoughts tightly knit
  together
• Connection are logical and coherent
• In S this is not so thought disorder
• Common signs include
• Looseness of associations
• Neologisms
• Perseveration
• Clanging
• blocking
• Many, not all, S show evidence of TD
• Some speak coherently but dont thin in this
  fashion
• Occurs most during the acute phase

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Attentional deficiencies

• K B suggested S is a breakdown in attention
• Difficulty filtering out irrelevant info
• Find it impossible to focus their attention and
  organise their thoughts (Arsanow et al., 1991)
• Genetic defect in sub-cortical regions may
  account for this (Grady, 1997a). Particularly in
  the basal ganglia (Cornblatt Kelip, 1994).
• People with S also appear to be hyper-vigilant,
  especially in early stages of disorder
• This has been demonstrated as a filtration
  problem in a number of eeg studies (see Guttner
  et al., 1996)

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Perceptual disturbances

• Hallucinations images percieved in absence of
  external stimuli
• In order of importance auditory, tactile,
  somatic, visual and olfactory
• Auditory in 70 of cases. Problem with command
  hallucinations
• Not unique to S
• Not always due to psychosis (religion, stress,
  grief, drugs)
• What separates S from norm is lack of ability to
  distinguish between whats real and whats not
  (Bentall, 1990)

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• Causes of Personality disturbances unknown, but a
  number of theories
• Could be misattribution of source of inner
  monologue activity in Brocas area supports
  this (McGure et al., 1993 Bentall et al., 1994)
• Disturbances in brain chemistry the dopamine
  hypothesis

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Emotional disturbances

• of emotional problems noted in S
• Include
• Flat affect
• Inappropriate affect
• Monotony or lack of expression
• Lab evidence shows that S exp gtintense ve
  emotions, lt intense ve emotions (Myin-Germeys et
  al., 2000).
• Why? Inability to express emotions adequately.
  Can experience them.

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Tips for the exam

• Exam will focus on the causes and treatment of
  Schizophrenia, rather than identification,
  diagnosis and sub-types
• Students will be expected to compare and contrast
  psychological and medical attempts to account for
  schizophrenia.
• Also, how successful are psychological and
  medical therapies at treating this for of mental
  illness?