schizophrenia

Descripción

Abnormal Psychology 338 Mapa Mental sobre schizophrenia, creado por cassandra el 09/03/2014.
cassandra
Mapa Mental por cassandra, actualizado hace más de 1 año
cassandra
Creado por cassandra hace casi 12 años
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Resumen del Recurso

schizophrenia
  1. some stats...
    1. prevalence LESS THAN 1%
      1. 60-70% do not marry
        1. 80% will abuse drugs
          1. 6% commit suicide, within 5 years of diagnosis
            1. life expectancy in SZ is reduced by 20%
            2. clinical presentation
              1. positive symptoms
                1. delusions
                  1. thought insertion
                    1. delusions of reference
                    2. hallucinations
                      1. auditory (most common)
                        1. STUDY: FMRI, AUDITORY HALLUCINATION VS AUDITORY STIMULATION

                          Nota:

                          • They took patients with BRIEF AUDITORY HALLUCINATIONS -then looked at BLOOD OXYGENATION ACTIVITY in the brain only 3 patients -pressed button when the hallucinations began and then when they ended -scanned them while experiencing their hallucinations -also scanned them when they were listening to a tone RESULT: -Similar areas in the brain were activated for BOTH CONDITIONS!!
                          1. STUDY: non-clinical hallucinations vs. hearing voices in healthy individuals

                            Nota:

                            • did FMRI with these individuals -they looked at TIMING of brain activity RESULT: STS: activated when we hear human voices IFG: aka BROCA'S area, involved in language production and comprehension SMA: controls INTERNALLY generated motor movements and speech people imagining: first SMA activated, then other areas kicked in 1-3 seconds later healthy individuals with non-clinical hallucinations: SMA LIGHTS AT SAME TIME AS OTHER AREAS ==> *basically, the SMA doesn't warn you that "hey, this is coming from you"
                            1. SMA
                              1. "this action is coming from me!"
                                1. TICKLING STUDY
                                  1. SZ can tickle themselves
                        2. disorganized symptoms
                          1. disorganized speech
                            1. ex. neologisms
                            2. disorganized + catatonic behaviour
                              1. catatonia
                                1. unusual and uncomfortable position for long period of time
                            3. negative symptoms
                              1. flat, blunted affect
                                1. alogia
                                  1. avolition
                                    1. more negative symptoms= WORSE PROGNOSIS
                                  2. EPIDEMIOLOGY
                                    1. older father >45-50
                                      1. certain ethnic groups
                                        1. sex differences
                                          1. men= EARLIER ONSET
                                            1. av age men 25, women 29
                                              1. ESTROGEN
                                                1. women's negative symptoms get worse after menopause
                                        2. related disorders
                                          1. schizoaffective disorder
                                            1. features of BOTH schizophrenia + severe mood disorder
                                            2. schizophreniform disorder
                                              1. same criteria as SZ but SHORTER DURATION of symptoms
                                            3. neurodevelopmental disorder
                                              1. STUDY: Walker et al, CHILDHOOD HOME MOVIES OF PPL WITH SZ
                                                1. participants: SZ or Major Affective Disorder
                                                  1. 6 groups

                                                    Nota:

                                                    • 1. patients with SZ 2. healthy siblings of SZ 3. patients with affective 4. affective siblings 5. healthy controls 
                                                    1. result: MORE MOTOR ABNORMALITIES + MORE NEGATIVE FACIAL EMOTION IN SZ PATIENTS
                                                      1. *specifier: facial abnormalities on LEFT SIDE
                                                  2. take-home: there are abnormalities present since birth
                                                2. GENETICS
                                                  1. DANISH ADOPTION STUDY, Kety et al
                                                    1. 5500 adoptees, interviewed their families
                                                      1. blindly interviewed them and gave diaagnoses
                                                        1. SZ related diagnoses found in biological relatives not adoptive
                                                    2. phenotype
                                                      1. focus on PSYCHOTIC SYMPTOMS
                                                      2. endophenotype
                                                        1. intermediate phenotype, marks risk
                                                          1. examples of deficits
                                                            1. deficit in smooth pursuit eye movements
                                                              1. verbal memory
                                                                1. sensory gating
                                                                  1. reduced hippocampal volume
                                                              2. DIATHESIS-STRESS MODEL
                                                                1. diathesis: DOPAMINE DYSFUNCTION
                                                                  1. all meds for SZ block dopamine in STRIATUM (dopamine antagonists)
                                                                    1. effective dose depends onto how well it binds with dopamine receptor
                                                                      1. give healthy controls DOPAMINE AGONISTS= PSYCHOSIS
                                                                        1. give sz patients dopamine agonists= worsens their symptoms
                                                                          1. STUDY: Breir et al, DOPAMINE AGONIST

                                                                            Nota:

                                                                            • Gave healthy controls and SZ patients AMPHETAMINE (dopamine agonist) amphetamine: increases availability of dopamine patients: MORE DOPAMINE RELEASE relative to controls
                                                                            1. STUDY: dopamine depletion

                                                                              Nota:

                                                                              • depleted dopamine in healthy controls and SZ patients -this exposes receptors -compare binding of radio ligand at BASELINE and after depletion -estimate proportion of D2 receptors masked at baseline **ENDOGENOUS levels of dopamine have been reduced after depletion  -increased binding, increased number of RECEPTORS
                                                                              1. Unmedicated patients had more dopamine receptors available in STRIATUM compared to health controls
                                                                                1. binding of radio-ligand HIGHER in DLPFC OF SZ
                                                                              2. PROSPECTIVE LONGITUDINAL STUDY
                                                                                1. 5 X INCREASE in psychotic symptoms for methamphetamine users
                                                                                  1. ex. suspiciousness, hallucinations
                                                                            2. GLUTAMATE
                                                                              1. Antagonists of NMDA receptor of glutamate (GLU)
                                                                                1. given to healthy controls
                                                                                  1. produces symptoms similar to SZ patients
                                                                                2. PCP
                                                                                  1. another antagonist of NMDA receptor subtype of glutamate
                                                                                  2. KETAMINE
                                                                                    1. similar to PCP, less potent
                                                                                      1. emotional withdrawal, blunted affect
                                                                                      2. STUDY: effects of ketamine + amphetamine
                                                                                        1. HEALTHY CONTROLS ONLY!
                                                                                          1. tested them over 4 days
                                                                                            1. positive symptoms: 2 drugs produced greater effects COMBINED
                                                                                              1. negative symptoms: KETAMINE INCREASED THEM, not amphetamine
                                                                                                1. cognitive symptoms: each had effect, but NO EFFECT WHEN COMBINED
                                                                                              2. amphetamine
                                                                                                1. grandiosity and suspiciousness
                                                                                          2. SEROTONIN
                                                                                            1. antipsychotic-naive patients and healthy controls
                                                                                              1. NEG.CORRELATION between serotonin binding and positive symptoms
                                                                                                1. ONLY FOUND THIS IN MALES
                                                                                                  1. FRONTAL CORTEX, lower serotonin binding
                                                                                                    1. more positive symptoms
                                                                                            2. ENLARGED LATERAL and 3RD ventricles
                                                                                              1. SMALLER THALAMUS
                                                                                                1. Low dopaminergic activity in PFC
                                                                                                  1. Neurocognitive deficits
                                                                                                    1. attention
                                                                                                      1. eye-tracking deficits
                                                                                                        1. smooth pursuit deficits, saccadic
                                                                                                        2. sensorimotor gating
                                                                                                          1. working memory + executive function
                                                                                                          2. STUDY: birth complications
                                                                                                            1. swedish national birth register
                                                                                                              1. 238 cases of SZ
                                                                                                              2. complications like preeclampsia, vacuum extraction, malfromations
                                                                                                                1. increased risk of SZ
                                                                                                              3. PROJECT ICE STORM
                                                                                                                1. LONGTERM PROSPECTIVE STUDY
                                                                                                                  1. objective + subjective stress
                                                                                                                    1. objective: how many days did you not have power?
                                                                                                                      1. lower MDI SCORES
                                                                                                                        1. OBJECTIVE STRESSORS 1ST + 2ND TRIMESTER
                                                                                                                      2. subjective: how stressed did you feel
                                                                                                                      3. followed kids from 6 months to 2 yrs and looked at their IQ (MDI cuz they too young)
                                                                                                                    2. LOW SES
                                                                                                                      1. SOCIOGENIC HYPOTHESIS
                                                                                                                        1. being in LOW SES can cause SZ
                                                                                                                        2. SOCIAL DRIFT HYPOTHESIS
                                                                                                                          1. the illness itself can cause a downward shift in SES
                                                                                                                            1. STUDY: dad's occupation
                                                                                                                              1. 45% of SZ never achieved status of dad
                                                                                                                                1. 13% did better
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