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General Adult Psychiatry ­ I
I. Schizophrenia
II. Disorders related to schizophrenia
III. Mood disorders
I. SCHIZOPHRENIA
A. Brief History1
?? 19th Century ­ All serious mental disorders seen as expressions of a
single entity
(Einheitpsychose, Griesinger) i.e. a unitary psychosis
?? Morel (1852) ­ proposed mental illnesses could be…

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o The 4 `A's:
?? Disturbances of Associations (thought disorder)
?? Affective flattening
?? Autism (social withdrawal)
?? Ambivalence (apathy)
And accessory symptoms:
o He believed these to be derived from loosening of associations
?? Hallucinations
?? Delusions
?? Catatonia
?? Abnormal behaviour
?? Kurt Schneider (1887-1967) - identified symptoms…

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Somatic passivity (bodily sensation or function imposed by external
agency)
Delusional perception
?? Kasanin (1933) - described schizoaffective disorder
?? Leonard (1957) ­ Separated schizophrenia from cycloid psychoses
(non-affective
psychoses with good outcome)
Further sub-divided schizophrenia into systemic (catatonia, hebephrenia,
paraphrenia)
and non-systemic (affect-laden paraphrenia, schizophasia and periodic
catatonia)
??…

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o Anabaptist sect in the USA
Populations with higher rates include: Isolated communities in Sweden and
Finland, Afro-
Caribbeans in the UK, Catholics in Canada, Tamils of Southern India.
?? Some studies suggest that incidence may be falling in industrialised
countries,
although there is some doubt as to whether this…

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6 Companion to Psychiatric Studies, 7th edition, eds Johnstone,
Cunningham Owens, Lawrie, Sharpe, Freeman, p398
7 New Oxford Textbook of Psychiatry, eds Gelder, Lopez-Ibor Jr,
Andreason, 2000, p 591
8 Companion to Psychiatric Studies, 7th edition, eds Johnstone,
Cunningham Owens, Lawrie, Sharpe, Freeman, p393
GAP ­ I Diet II: 2008…

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Non-verbal auditory
hallucinations
34% 15%
Other (tactile, gustatory) 36% 16%
3rd person auditory
hallucinations
32% 16%
Olfactory hallucinations 27% 13%
Visual hallucinations 23% 11%
GAP ­ I Diet II: 2008
6
The Chronic Syndrome
Characterised by:
?? Reduced intensity of delusions and hallucinations
?? Underactivity, social withdrawal, lack of drive…

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?? Include social withdrawal, apathy, lack of drive, under-activity,
slowness, poverty of
speech and thought.
?? They tend to be more prominent in the chronic phase. Negative
symptoms can be
primary or secondary to depression, medication, institutionalization or
other life
events.
?? Patients with primary negative symptoms have an earlier…

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Liddle (1987), using factor analysis, described 3 overlapping clinical
syndromes which he
linked with patterns of neuropsychological deficit and to regional cerebral
blood flow (see
Table 2). The most reproducible finding relates to psychomotor poverty.
Table 2: Cerebral and psychological correlates of Liddle's 3
symptom clusters
Syndrome Symptoms Regional cerebral…

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spontaneous
movement
Underactivity of
frontal cortex
Word generation
tasks, planning
tests
Cognitive features
?? Impairments in all domains of learning and memory
?? Disproportionate involvement of semantic memory, working memory,
attention and
executive function
?? Major determinant of poor functional outcome.
?? Evidence of cognitive impairment in unaffected twins of…

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better explained by other mechanisms, such as source monitoring errors
(auditory
hallucinations), failure to monitor one's own motor actions (delusions of
control),
deficits in spreading semantic activation (thought disorder) and inferential
biases
(persecutory delusions).
Subtypes of schizophrenia
?? Paranoid schizophrenia ­ delusions and hallucinations are prominent
features. This
is the…

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