Schizophrenia

Schizophrenia

Classification.
1. Disorganised
  1. Disorganised speech, bizarre behaviour, flat effect, social withdrawal, avolition
2. Catatonic
  1. Excessive motor activity or rigid posture for hours.
3. Residual
  1. Recovering - mild symptoms.
4. Paranoid
  1. Hallucinations and delusions of grandeur or persecution.
5. Undifferentiated
  1. A mixture of symptoms
Symptoms.
1. Positive - extra characteristics.
  1. Hallucinations, delusions
  2. Thought and speech disturbances.
    1. Jump from topics to topic - worse in men than women - Goldstein
2. Negative - minus normal characteristics.
  1. Avolition - lack of interest in daily life
  2. Absence of emotion
  3. Absence of social function
    1. People with negative symptoms dont succeed in education, social situations - Eaton
Diagnosis
1. DSMiv - core symptoms (hallucinations, delusions) must be present for at least one month. Other symptoms such as poor social function must be present for 6 months.
2. Due to unspecific criteria misdiagnosis may occur.
  1. Leads to wrong treatment.
3. Subjective - may lie to get a certain treatment, embarrassment.
4. Labelling
  1. Poor validity in diagnosis.
  2. Scheff - Label influences behaviour.
    1. Patients' behaviour and people who know the patient
  3. Rosenhan - 8 healthy people make appointments in hospitals using the words 'thud' , 'hollow' , 'empty'. Acted normal inside.
    1. All were diagnosed as schizophrenic.
      1. Left with diagnosis in remission
        Hard to get rid of the label
      2. Shows normal behaviour was seen as abnormal
    2. All were ignored by staff
      1. Shows change in behaviour
    3. Average stay was 17 days
    4. Unethical
  4. If you deny the existence of sch' you cannot treat it.
  5. Doesn't explain where the label comes from in the first place. Explains the maintenance but not the cause of symptoms.
  6. Szasz - anti-labeller. Sch' is a way of coping with problems in their lives.
Biological
1. Genetic predisposition.
  1. Twin study.
    1. Gottesman and Shields. - MZ = 48% .... DZ=17%
      1. 100% criticism. If entirely genetic then should be 100% for MZs.
        Environmental triggers - alcohol, drugs, trauma etc
      2. The link could be due to twins being treated more similarly than DZ twins.
  2. Adoption study.
    1. Heston. 47 mothers had schizophrenia. Their children were adopted straight away. 16% of these children got schizophrenia. normal chance level is 1%
      1. Small sample
2. Neurochemical.
  1. Dopamine hypothesis. Excess dopamine causes excessive neural activity. Causes positive symptoms.
    1. Cocaine (which increases dopamine activity) causes + symptoms.
    2. Post mortems have shown excess of dopamine.
      1. Could have occurred after death
    3. Not clear whether excess dopamine is a cause or a result of schizophrenia.
    4. Antipsychotic drugs (chlorpromazine) reduce dopamine and positive symptoms.
3. Abnormal brain structures, complications at birth and exposure of mother to virus' whilst pregnant
  1. Weyandt - enlarged ventricles correlate with negative symptoms.
Family dysfunction
1. Patterns of communication and relationships have been identified as stress factors causing Sch'- Shiffman
2. Double bind - a no win situation in which parents put their children. - Bateson
  1. Verbally given one message but non verbally given another.
    1. Negative symptoms such as flat effect are a logical response.
    2. If they find a way out of the double bind they can experience emotional growth.
3. Expressed emotion
  1. EE is a qualitative measure of the amount of emotion displayed within a family.
  2. high EE = high hostility and disapproval.
    1. Family members think they are being useful
    2. Causality issues - High EE = sch or sch = high EE
  3. Nomura - if a recovering schizophrenic returns home to a family with high EE they are more likey to relapse to a highly active phase
    1. Butzlaff and Holey - 70% of people with sch' from such families relapsed within a year. Only 30% relapsed from low EE families.
Biological Treatments
1. The most effective treatment is a combination of drug therapy, psychotherapy and social or community
2. Antipsychotic drug
  1. Conventional
    1. Major tranquilisers
    2. Neuroleptic drugs
    3. Chlorpromazine
      1. Reduce levels of dopemine activity
      2. Must be taken regularly or you relapse
      3. Must continue to take drug even if symptoms are gone
      4. Drug therapy reduces long term hospilisaton
      5. Severe muscle tremors, slow movement, involuntary movement
    4. Treat positive symptoms
  2. Atypical
    1. Treat both + and - symptoms.
    2. Reduce dopamine activity a little less and change serotonin
    3. Weight gain, nausea, salivation
  3. Cole et al - after 6 weeks 75% showed much improvement compared to 25% on the placebo
  4. 25% don't respond to conventional drugs, often do respond to atypical
3. Medication in an institution
  1. pro
    1. Can monitor dosage
    2. Safe environment
  2. contra
    1. Artificial environment doesn't help them learn to cope with real world
    2. Institutions cause self-fulfilling prophecy
Psychological treatment
1. Coping strategy enhancement
  1. Tarrier -investigating use of coping strategies during psychotic episodes
    1. 25 patients suffering + symptoms asked when and where they occurred and their coping strategies.
      1. 1/3 identified triggers such as anxiety. 75% disclosed their use of coping strategies.
        Coping strategies - Distraction, Positive self talk, Withdrawal, Relaxation
  2. Teaches strategies to reduce and handle psychotic episodes.
    1. Identify type of content
      1. Identify emotional response
        Identify thoughts
        Identify triggers
        Identify strategies.
2. Tarrier - 49 ps taking antipsychotic drugs but had + symptoms. 50% improvement in C strategies compared to control group
  1. In this study 47% dropped out.
Family Therapy.
1. Aims to reduce expressed emotion.
  1. Family members told to be less critical
    1. Family help groups provide support for families.
2. Hogart et al - Families who continued with new communication patterns had lower relapse rates.
Community Care
1. Aim to reduce hospitalisation.
  1. Sheltered living = monitored mediction
  2. Home care, day care = independent residences with psychotherapy
  3. Stein found community care for 14 months reduced the need to hospitalise
2. encourages social skills
3. Prejudice makes integration difficult

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	Created by mary threl almost 8 years ago