SCHIZOPHRENIA

Anotações:

• -It is a psychotic disorder which means the individual loses contact with reality. -It has many different manifestations with a few shared features meaning it can look different from one person to another.

1. Symptoms
   1. Positive

      Anotações:

      • INCREASE OF NORMAL BEHAVIOR -Delusions, Hallucinations Evaluation; -Content can be affected by cultural differences -Hard to measure objectively
   2. Negative

      Anotações:

      • SHORTAGES IN SPEECH AND MOTIVATION -Avolition -No emotion -Flat effect -Social withdrawal -Alogia
   3. Disorganization

      Anotações:

      • -Loss of association. Not comprehensive. "word salad" -Start before positive ones -Less affected by cultural factors -More objectively measured
2. Types
   1. Paranoid

      Anotações:

      • -Positive symptoms -Patient experiences delusions of persecution and believes they have some special power/mission that no one else does =grandeur -There is no organization or flat effect which makes their delusions almost like they makes sense/organized and are detailed and complex
   2. Disorganized

      Anotações:

      • Includes; -Illogical behaviour (talking about a senseless topic for hours and hours) -Disorganized speech so listener can't understand -Disorganized behaviour (no reason for specific behaviour)
   3. Catatonic

      Anotações:

      • IMPAIRMENT OF BODY MOVEMENT -Purposeless movement -weird postures and repeated gestures -Lacking ability of speech -Doesn't produce own speech/thoughts/, instead just echoes/repeats back what was heard.
   4. Undifferentiated

      Anotações:

      • Symptoms of Schizophrenia are present but none fit into one specific subtypes.
   5. Residual

      Anotações:

      • -Absence of positive symptoms and all the additional behaviours such as catatonic behaviour -Presence of negative symptoms or other symptoms which causes reduction of some behaviours.
3. Explanations
   1. Biological
      1. Genetic (Gottesman&Shields)

         Anotações:

         • -Examined 57 schizophrenics -40%=MZ -60%=DZ RESULTS; -MZ=42% of 40% developed schizophrenia -DZ=9% of 60% developed schizophrenia There is a genetic link but only to some extent because concordance rate would have to be 100% if it was entirely genetic.
         • -Environmental factors might have played a role
      2. Biochemical (Dopamine hypothesis)

         Anotações:

         • Suggests that schizophrenic brains are more sensitive to dopamine. -Could be because they have more dopamine receptors. -Not good at explaining NEG symptoms so suggests that there are some other abnormalities like maybe brain structure that may be causing it too., -Maybe social and environment factors play a role too.
         • DRUGS -Amphetamines increases level of dopamine and dopamine increases symptoms of schizophrenia. -Chlopeomazine reduces level of  schizophrenia by blocking D2 receptors. If this is taken excessively, patient might get Parkinson's disease and heal from schizophrenia. *L-dopa is used to increase DA activity*
         • POST MORTEM evidence -Schizophrenics have 6x more dopamine receptors than normal people.
         • PET scans; -Inject patients with a radioactive chemical, L-Dopa. -We know L-Dopa is taken more quicker with schizophrenics because of the many dopamine receptors. -After being injected, patients are given a cognitive test in order to activate the brain. Wherever it is most active, the more the chemical. 
   2. Psychological
      1. Cognitive

         Anotações:

         • Focuses on faulty processing of information or inappropriate  perceptions of ourselves. -The way we think is the cause -Physiological abnormalities along side with schizophrenia causes cognitive malfunctioning. ->Agrees with biological view that there is some sort of abnormal physiological activity in the brain which produces unusual sensations. -It becomes worse when the patient tries to understand the sensory experiences. Leads to misperception/misinterpreting sensations.
         1. Frith's model

            Anotações:

            • -Tries to explain positive symptoms;4 *Verbal hallucinations *Delusions of control *Thought insertion -Schizophrenics can't tell the difference between actions that they thought of (internal thoughts) or actions that were influenced by whatever that is around them (external forces)
            • COGNITIVE DEFICITS: 1] Inability to generate willed action. 2] Inability to monitor willed action. 3] Inability to monitor the beliefs and intensions of others(lack of ToM)
            • EVALUATION -Fails to explain actual cause of schizophrenia -Deterministic -Reductionist -Holistic
            1. Prefrontal cortex

               Anotações:

               • Problems in the meta representation is caused by this. [Plays a role in speech, decision making, and willed action]
               • -The frontal areas are responsible for our actions. -The posterior areas are responsible for our perceptions. -If there is a problem in the frontal areas, it will affect the messages that go to the posterior thus creating a problem too in the posterior areas.
               1. PET scan

                  Anotações:

                  • -Patient injected with glucose. Areas with most glucose means it's the area of the brain which is the most active. -There was low activation of the prefrontal cortex in schizophrenic patients, who also performed poorly on the cognitive tests.
4. Treatments
   1. Antipsychotics

      Anotações:

      • TYPICAL Has many side effects; -Reduces DA too much resulting to parkinson's symptoms. -Low blood pressure -Weight loss -Not effective for negative symptoms ATYPICAL have less effects; -Involuntary movement of lips and tongue -Good for both symptoms -Fewer side effects.
   2. ECT

      Anotações:

      • Works by using using an electrical shock to cause a seizure which will make neurotransmitters temporarily alter their function. -It is always the last option (where other treatments have failed) because of its side effects; *temporary short-term ,memory loss *muscle and headache *paranoia Some may have longer-lasting or even permanent problems with memory, paranoia, and depression.
   3. CBT

      Anotações:

      • The aim is to find the the thoughts which makes you have unwanted feelings and behaviour  and replace those with better thoughts. -Restructures a person's perception to a more normal view. -The good thing about it is that it deals with the symptoms and the cause.
   4. Treatment economy

      Anotações:

      • -Helps the patients perform the appropriate behaviour and is rewarded for it. -Makes patient want to do it all the time in order to be rewarded. - This can turn into a problem if no token is awarded because the patient did the good thing only to receive the token