Chapter 11 - Schizophrenia Schizophrenia - psychotic disorder ...

PREFRONTAL LOBOTOMY: surgical interruption of nerve tracts to and from the frontal lobe of the brain; often results in marked cognitive and personality ...

Chapter 11 - Schizophrenia Schizophrenia - psychotic disorder characterized by major disturbances in thought, emotion and behaviour - Disordered thinking in which ideas are not logically related, faulty perception and attention, flat or inappropriate affect, and bizarre disturbances in motor activity • 1% will suffer from schizophrenia (higher in men) • rare, but can start in childhood/late teens • men have it earlier than female • acute episodes = early onset of the disorder -> positive/psychotic symptoms - brings the patient’s attention to the doctors -> heterogeneous (functional outcome can differ greatly) -> 50% or more have a commorbit disorder (typically a personality disorder (paranoid,avoidance)) • not a one person disorder Clinical Symptoms of Schizophrenia Positive/Psychotic Symptoms (acute; too much of a behavior - added to their personality) • excesses or distortions • disorganized speech (thought disorder) • incoherence • loose associations • made up words • percetitive speech - repetition (echo) • delusions(beliefs that held contrary to reality) • hallucinations • thought broadcasting (someone stealing their thoughts) Negative Symptoms (strong predictors; connected to cognitive issues) • behaviour deflicts • avolition (lack of energy) • alogia (lacking of speech, slow) • ahedonia (inability to experience pleasure) • flat affect (lack of emotional reactivity) • aociality (lack of motivation to engage in social interaction) Other symptoms ← Catatonia (motor abnormalities - hysterical posturing) - catatonic immobility (scared to move) - waxy flexibility (decreased response to stimuli) Inappropriate affect (ex. your mom dies and you laugh) - important to clinicians because its highly specific to schizophrenia Schizophrenia: It’s Diagnosis - DSM-IV-TR requires at least six months of disturbance for the diagnosis - The six month period must include at least one month of the the active phase, which is defined by the presence of at least two of the following:

- Delusions, hallucination disorganized speech, grossly disorganized or catatonic behavior and negative symptoms (only one of these symptoms is required if the delusions are bizarre or if the hallucinations consist of voices commenting or arguing) - The remaining time required within the minimum six months can be either a prodoromal (before the active phase) or a residual (after the active phase) period - problems during the prodromal and residual phases include social withdrawal, impaired role function, blunted or inappropriate affect, lack of initiative, vague and circumstantial speech, impairment in hygiene and grooming - odd beliefs or magical thinking and unusual perceptual experiences - Schizophreniform disorder: the symptoms are the same as those of schizophrenia but last only from one to six months - brief psychotic disorder: lasts from one day to one month ← ← ← ← ← ← ← ← ← ←

Difference Diagnosis: mood disorders schizoaffective disorder: Schizophrenia + mood disorder personality disorders: paranoid personality, can be thought of schizophrenia delusional disorder ** important to get the diagnoses right because of the treatment to be done**

Categories of Schizophrenia in DSM-IV - subtypes are based on symptom presentation - great overlap and not reliable - Disorganized schizophrenia (completely disorganized) - Catatonic schizophrenia - Paranoid schizophrenia - delusions of persecution - grandiose delusions - delusional jealousy - ideas of reference (patients incorporating unimportant events within) - undifferentiated schizophrenia - residual schizophrenia Etiology if Schizophrenia Genetic Data - family studies (highly inheritable) - twin studies (DZ twin - rare - MZ - high) - adoption studies Biochemical factors - Dopamine activity - drugs that affect in treating schizophrenia controls dopamine - side effects of lowering dopamine causes parkinson disease in the brain - Amphetamines can produce a paranoid state that resembles paranoid schizophrenia - Amphetamines can make a person with schizophrenia can be far worse Searching the brain for schizophrenia - frontal lobes ( - temporal lobes

- evidence from neuroimaging studies - subtypes of schizophrenia - executive type - normative type - mesial temporal type - global type ← ← ← ←

Biological treatments Shock and psychosurgery PREFRONTAL LOBOTOMY: surgical interruption of nerve tracts to and from the frontal lobe of the brain; often results in marked cognitive and personality changes

← Drug Therapies - Phenothiazine: Chlorpromazine (Thorazine) - Butyrophenones: Haloperidol (Haldol) - Thioxanthene: Thiothixene (Navane) - Tricyclic dibenzodiazepine: Clozapine (Clozaril) - Thienbenzodiazepine: Olanzapine (Zyprexa) - Benzisoxazole: Risperidone (Risperdal) ←

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