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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