Schizophrenia Outline - Psychology
Schizophrenia Outline
Carolyn R. Fallahi, Ph. D.
What is Schizophrenia?
Who does it affect?
Age of onset younger in males (21) versus females (27).
Prevalence = 1%. 2 million affected by the disorder; 200,000 new cases/yr.
1/100 individual = SX.
Huge costs.
1988 Kaplan & Sadock.
History: ancient Egypt & Europe in the middle ages; homeless; need to understand pathophysiology.
History: Emil Kraepelin & dementia praecox different from euphoria & depression. Viewed as a physiological disease.
Eugene Bleuler: added simple SX for patients who did not display deteriorative course.
What does Schizophrenia mean?
Bleuler adopted a more “psychological” view.
Contemporary clinical views.
• Heterogeneous mix of disorders
• Issues with classification
• Positive versus negative symptoms (Hughlings-Jackson, 1931) & Bartko (1974)
• Crow (1980) – type I versus type II
• Types of delusions: delusions of grandeur; delusions of persecution; Capgras Syndrome; Cotard’s syndrome.
• Hallucinations & study using single photo emission tomography (SPECT)
• Negative symptoms: affective blunting, anhedonia, avolition-apathy, alogia, affective flattening.
• Some issues surrounding flat affect
• Disorganized symptoms
• Disorganized speech: cognitive slippage, tangentiality, loose associations, derailment.
• Miller & Flaum (1995): positive symptoms subdivide into 2 dimensions – psychotic factor & disorganization factor.
• Research into negative symptoms or “deficit” symptoms. These include flattened or restricted affect, anhedonia, poverty of speech, lack of a sense of purpose, and diminished social drive. Secondary symptoms due to meds?
• Hallucinations & delusions.
• Types of delusions: persecutory, grandiose, somatic.
• Type I versus Type II symptoms.
• Schizophrenia subtypes: paranoid type; catatonic type (echolalia, echopraxia); disorganized type (hebephrenia); undifferentiated type; residual type.
• Schizophreniform disorder.
• Schizoaffective disorder.
• Delusional disorder: the erotomanic type; grandiose type; persecutory type; somatic type.
• Brief psychotic disorder.
• Shared psychotic disorder (folie a deux).
• Schizotypal P. D.
Etiology of Schizophrenia: a disease of the brain.
• History: the psychoanalytic tradition, e.g. schizophrenogenic mother (Fromm-Reichmann, 1948).
• Prenatal environmental risk factors: viral infection.
• Mednick & Colleagues (1988)
• Studies of starvation using the Dutch Hunger Winter between Oct 1944 & May 1945.
• Genetic Factors: “trigger”; diathesis-stress theory of illness.
• Family Studies: 40 family studies between 1920 & 1987. Risk for the general population = 1%; risk for spouses 2%; second degree relatives 2 to 6%; first degree relatives 9 to 40%; MZ twins 50%. But….risk for MZ rate is below 100% which means…..
• The issue of schizotypal & paranoid P.D.
• Twin Studies: Gottesman (1991) concordance rate of 48% for MZ twins & 17% for DZ twins.
• Adoption studies: Heston (1966) 10.4%.
• Model of transmission? Single gene model versus Multifactorial/polygenic model.
• Gottesman (1991) 6 criteria that distinguish polygenic from Mendelian illnesses.
• Linkage & association studies focus on chromosomes 6 and 11.
• Clinical neuropsychology or brain pathology.
• Neurochemical studies: DA hypothesis based on the effects of drugs that are either agonists or antagonists.
• Support for the DA hypothesis.
• Multiple subtypes of DA receptors, specifically D1 and D2.
• PET technology show elevated D2 receptor densities; but inconsistent finding.
• Ratio of DA receptor subtypes?
• DA and its link to attention and memory.
• Neurological damage theories. Positive symptoms; negative symptoms; frontal lobes, e.g. hypofrontality & deficits that are in the dorsolateral prefrontal cortex of the frontal lobes.
• Psychological & social influences.
• Family interactions.
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