Schizophrenia

All topics within Psychopathology, focusing on schizophrenia.

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Key terms

Syndrome: Clusters of symptoms and behaviours regulary found together.

Classification: The act of distributing into classes or categories of the same type.

Diagnoses: The recognition and identification of a disease or conditions by its signs(objective tests) and/or symptoms(patient reports).

Schizophrenia: A serious mental illness which cause a range of symptoms which make the patient lose touch with reality.

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Why is Classification Used in Psychopathology

1. To make communication between professionals in the field of psychopathology easier.

2. To understand the disorder, predicting the outcomes and for choosing a treatment.

3. To understand more about possible causes of mental health disorders.

4. To indicate preventative measures.

5. To stimulate research and make the research more reliable i.e. to make sure it is conducted on compariable groups.

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Books in Mental health: ICD 10 and DSM 4th edition

ICD: International Classification of Diseases 10th edition. Internationally used. Vague on mental health on has one chapter.

DSM: Diagnostic Systematic Manual 4th edition. American Manual. Detailed, who book on persoanlity and mood disorders.

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ICD 10 - Catergories 1 - 5

1. Organic: including gradual symptoms, mental disorders e.g. Dementia

2. Mental and behavioural disorders due to pychoactive substance abuse: e.g. Drug Enduced Psychosis.

3. Schizophrenia, Schizotypal and Delusional disorders.

4.Mood(affective) disorders: e.g. Recurrent Depressive Disorder.

5.Neurotic, stress related and somato form disorders: e.g. Anxiety Disorders.

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ICD 10 - Catergories 6 - 10

6. Behavioural syndromes associated with phyisological disturbances and physical factors: e.g. Anorexia.

7. Disorders of Psychological development: e.g. Autism.

8. Mental retardation.

9. Behavioural Emotional disorders with onset usually occuring in childhood or adolescence: e.g. Conduct Disorders.

10. Disorders of adult Personality and Behaviour: e.g. Paranoia

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Axes of The DSM 4th Edition

1. Clinical Syndromes: Contains a list of all mental disorders thought to be a cause of significant impairment e.g. Scizophrenia.

2. Personality Disorders and Mental Retardation: A list of disorders which begin in childhood or adolescnece.

3. Physical Disorders: Physical conditions that could contribute to the disorder or worsen the state of the disroder e.g. Brain Damage/ Injuries.

4. Severity of Social Stressors: Describes psychosocial and environmental problems e.g. School, Family Problems.

5. Highest level of adaptive functioning in the last year: A global scale of functioning is used to rate an individuals ability to function psychologically, socially and in terms of occupation on a scale, the lower the score the more serious the dysfunction.

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Advantages of Classification

1. Communication between mental health professionals is much easier if numerous symptoms can be incorporated into a single diagnosis - shorthand communication.

2. Prognoses - An accurate diagnosis can provide valuable information about the likely cause of an illness. this can help plan treatments to help manage the illness.

3. Aetiology - There is no single cause for most mental illnesses but certain disorders are more reliably associated with certain causes or aetiologies. Knowing the diagnoses can aid research in investigating the cause.

4. A reliable diagnosis can point to a therapy that could help alleviate symptoms. Drug choices can be made for treatments based on previous success.

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Diadvantages of Classification

1. Labelling can come with diagnosis. Labelling may help with finding an appropriate treatment but can lead to stigmatization.

2. Historical and Cultural context - Diagnostic manuals can reflect cultural/political thinking e.g. Homosexuality was included in early manuals. It could be damaging and upsetting for a practitioner to diagnose a mental illness to a person from a different culture.

3. What about grey areas? Diagnoastic systems assume there are 'normal' and 'abnormal' states. You either have a disorder or not. What about people who are slightly depressed etc?

4. Misdiagnoses - What if people are given the wrong treatment or institutuionalised?

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Systems that Psychopathology Use...

Should Be...

1. Exhaustive - All types of abnormal behaviour should be included.

2.Categories used should be mutally exclusive - Distinctions between disorders should be clear and not fuzzy.

3. Valid - Bringing about the results or ends intended.

4. Reliable - Showing the truth.

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Schizophrenia

Schizophrenia - The loss of contact with reality.

1% Chance of getting the disorder.

Age of Onset 15 - 45

No difference between men and women, however men tend to get it earlier.

Chronic Onset - slow gradual slide

Acute Onset - Very sudden usually after tragic incident.

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Symptoms of Schizophrenia

Passivity Experiences and Thought Disorders

Thought Insertion - Someone or something is putting thoughts into the mind of the sufferer.

Thought Withdrawal - Someone or something is removing the thoughts of the sufferer.

Thought Broadcasting - The thought that people can hear their thoughts aloud.

Hallucinations

Auditory Hallucinations - they hear a conversation thats not there or happening and/or hear a voice commenting on thier actions.

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Symptoms of Schizophrenia

Primary Delusions

Delusions of Grandeur - Believing that they are more important then they are. Typically associated with God.

Delusins of Persecution - The belief that people are out to get them - Paranoia.

Delusions of Control - The belief they have control over everything.

Disturbances of Thought Processes

Thought Disturbances - struggle to think about 1 thing at a time, including stopping in the middle of a sentence.

Language Disturbances - Word Salad - The conversation is completly random, however the person sees nothing wrong with what they are saying.

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Symptoms of Schizophrenia

Psychomotor Disturbances

Catatonia - Pulling a random pose and staying like it for hours on end, unaware of what they are doing.

Stereotypy - Sitting and rocking, unaware of what they are doing.

Disturbances of Affect

Blunting of Emotions - Telling them something and expecting a reaction, however they do not react.

Innapropriate Emotions - Overeaction of emotions or innapropriate emotions for the situation.

Flattened Effect - No emotions

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Type 1 and Type 2 Symptoms

Type 1 or Positive Symptoms Include:

Thought insertion, thought removal, thought broadcasting, aduitory hallucinations, delusions of grandeur, delusions of persecution, delusions of control, catatonia and stereotypy.

Type 2 or Negative Symptoms Include:

Thought disturbances, blunting of emotions, innapropriate emotions, flattened effect, apathy, loss of motivation, social wthdrawal, language disturbances.

Some may fit into both Type 1 and type 2 Symptoms list

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Types of Schizophrenia

Paranoid Schizophrenia: Delusions of persecution or grandeur, auitory or visual hallucinations, language and behaviour are relatively normal, often has later onset than other tpyes, paranoid schizophrenics tend to be arguementative and occasionally violent.

Disorganised Schizophrenia: Hallucinations, thought and language disturbances, disturbances of affect, socail withdrawal, usually diagnosed in adolescence or young adulthood.

Catatonic Schizophrenia: Motor Disturbances, including catatonic imobility. During this imobility another person could move the patients limbs into new positions, which would be held by the patients. A phenomenon know as waxy flexibility, agitated catatonia - for example bouts of wild and unpredicted behaviour.

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Types of Schizophrenia Cntd.

Undifferentiated Schizophrenia: A sort of catch all category. Used for people who do show symptoms of Schizophrenia, but not it such a pattern that they could be put in any one of these categories.

Residual Schizophrenia: The category that describes people who although they have had an episode of schizophrenia during the past six months and still exhibit soem symptoms, they do not show the symptoms strongly enough to merit being put into one of the other categories.

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Cause of Schizophrenia - Doapmine Hypothesis, Neur

The Dopamine Hypothesis suggests that Schizophrenia results from an excess activity of dopamine in certain parts of the brain.

It is not the amount of dopamine but the senistivity of Dopamine receptors.

Supporting Evidence

Amphetamines

Phenothiazines

Wong et al. 1986

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Cause of Schizophrenia - Doapmine Hypothesis, Neur

Evidence Against

Jackson 1990

Phenothiazines - delayed reaction on symptoms.

Dalman et al. 1999

Research done on dead schizophrenics

Drugs may only alleviate positive symptoms.

Reductionist view

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Cause of Schizophrenia - Neuroanatomical Explanati

Decreased brain weight and enlarged ventricles - Brown et al. 1986.

Enlarged Ventricles with smaller thalmic hippocampal and superior temporal volumes - Flaum et al. 1995.

Differences in pre- frontal cortex, the basal ganglia, the huppocampus and amygdala - Bauchsbaum 1990.

Structural abnormalities have been found more in those with chronic schizophrenia.

However it is inconclusive if these structural abnormalities are progressive prior to the onset of Schizophrenia or follow the onset.

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Cause of Schizophrenia - Neuroanatomical Explanati

Evaluation

There are many conflicting ideas to what part of the brain is affected, though there is conclusive eveidence to structural abnormalities.

Most studies using MRI scans have been carried out on people who have already been diagnosed with schizophrenia, therefore we cannot tell wether these structural abnormalities are cause or effect.

Prospective studies, which could help us in the direction of causality have been carried out on non- humans animals, therefore we cannot generalise these findings to humans.

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Cause of Schizophrenia - Substance Abuse

Smoking cannabis causes you to show symptoms of Schizophrenia.

In the Times, Dr Ashtari looked at 15 young cannabis users, who gave up a month before and found the same amount of white- matter damage in the young users as a schizophrenic.

Evaluation

Henquet et al.2005 - Heavy users = twice as likely to develop Schizophrenia

Caspi et al. 2005 - It was only higher risk in youths with specific genes.

Peralta and Cuesta. - Suggested that Schizophrenics take cannabis after experiencing negative symptoms.

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Cause of Schizophrenia - Viral Infections

Winter Births - People born within winter months of the year are more likely to develop Schizophrenia - Hope-Simpson 1981

Viral Infections - Children who have contracted viruses are 5 times more likely to get Schizophrenia and viruses during pregnancy is likely to cause Schizophrenia - jones and Cannon 1998.

Birth Complications - Complications at birth including pre-eclampsia increases risk - Dalman et al. 1999.

Maternal Stress - Children whos mother are stressed are more likely to have increased chance of getting schizophrenia - Van os and Selten 1998.

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Cause of Schizophrenia - Viral Infections

EvaluationThe link between viral infections and Schizophrenia is only possible in those who are genetically predisposed.

It is unlikely that birth complications are the sole case for Schizophrenia, as it is common at births for there to be complications.

Hard to say that maternal stress causes schizophrenia, it is also hard to prove as stress is impossible to isolate as the mother may drink, smoke etc.

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Comments

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