Abnormal Psychology Chapter 13
Abnormal Psychology Chapter 13 PSYC 3014
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This 4 page Class Notes was uploaded by Megan Standiford on Sunday April 10, 2016. The Class Notes belongs to PSYC 3014 at Virginia Polytechnic Institute and State University taught by Dr. John Richey in Winter 2016. Since its upload, it has received 12 views. For similar materials see Abnormal Psychology in Psychlogy at Virginia Polytechnic Institute and State University.
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Date Created: 04/10/16
Chapter 13 Schizophrenia o An extremely serious disorder o A massive break from reality o Psychotic-spectrum o Originally called "dementia praecox" Early madness o Emile Kraeplin o Schizo (split) + Phren (mind) o Madness, insanity (?) Neither of these appear in the DSM o Formerly thought to be caused by demonic possession o A vastly heterogeneous disorder o MANY different kinds of symptom presentations o Can be difficult to diagnosis o Symptoms: DSM 5 2 or more of the following 1. Delusions a. Odd or bizarre beliefs; content is highly variable b. Receiving messages from the tv; or the way things are arranged around you c. Patient believes that "chance" events have special meaning for him/her 2. Hallucinations a. Bizarre sensory experiences b. Content is also highly variable c. Auditory hallucinations (most common) i. fMRI evidence that when schizophrenic patients 'hear auditory hallucinations ii. Activates the same brain regions as when you and I hear someone speak to us b. Tactile hallucinations- feeling insects crawling on ones body c. Olfactory/gustatory hallucinations- smells and tastes that are not real d. Visual hallucinations e. Often extremely debilitating f. Command hallucinations g. Fairly rare h. The patient is instructed or coerced to carry out some act 2 Disorganized speech 3 Catatonic/Disorganized Bx 4 "negative symptoms" a. The absence of certain things that should be there but are not (emotion, speech) 2 Positive symptoms a. The presence of things that should not be there (delusions, hallucinations, disorganized speech) Social/Occupational Dysfunction 1 For a significant portion of time since onset a. One or more major areas of functioning (work, interpersonal relations, self-care) are markedly below the level of achieved prior to onset Duration 1 Continuous signs of the disturbance for at least 6 months o Subtypes of schizophrenia Officially these have been eliminated from DSM 5 Not clinically stable across time Paranoia 1 Patient believes that persecutory forces are trying to harm him/her Thought broadcasting 1 Patient believes that his/her thoughts are being broadcasted to the world Thought insertion 1 Patient believes that others are inserting thoughts into his/her head Catatonia 1 Patient can appear to be in a coma-like state 2 Or patient cannot enact voluntary movements 3 Catalepsy a. Waxy flexibility Schizophrenia-like diagnosis Schizophrenoform disorder 1 Identical symptoms- shorter duration (<6 months) Scizoaffective disorder 1 Psychotic symptoms plus mood episode a. Depressive or manic Category or continuum? Epidemiology About 1% of the population 1 This may not sound like much, but it is more common than HIV, epilepsy and lunch cancer combined Sex distribution is Prevalence across sexes is about equal…however 1 Men a. Usual age onset ~21 years 2 Women a. Usual age onset ~28 years 6% of Schizophrenic pts are homeless, but 1/3 of homeless Americans are schizophrenic The great mystery in schizophrenia 1 Lower rates of childbearing Risk factors Genetics 1 Clusters within families 2 Genetic linkage methodology a. Genome wide association scans b. Sorts the entire genome to find genetic overlap in patients with the disorder 3 The problem is a. In human beings i. Rare variation in genes is common ii. Common variation in genes is rare Gene x Environment Heritability is NOT 100% (only 48% for MZ twins) A stress-diathesis model a. Two things required to produce disorder (vulnerability, stressful life event) Also called "two hit" hypothesis a. First hit- genetic liability b. Second hit- stressful life event Previous theories "Schizophrenogenic mother" a. Creating conditions that are sufficient for event (schizophrenia), even though mother does not have schizophrenia (offshoot of Freudian theory) "Expressed emotion" a. Decrease in expressed emotion between mother/father and child Neurodevelopmental Theories Cortical Interneuron Theory a. A deficiency in inhibitory signaling i. Reduced GABA synthesis in DLPFC (dorsal lateral prefrontal cortex) ii. Pre and post synaptic compensatory mechanisms cannot keep up iii. Desynchronizes Gamma oscillations of DLPFC neurons Neural Asynchrony Theory a. Consider this i. 1 neuron Is connected to about 3,000 others ii. How many spikes would be required for 1 neuron to spontaneously activate the whole brain? 4 spikes (3,000^4 > 90 billion) How does the brain prevent a single spike from becoming a runaway train? b. So the timing of rhythmic activity or cortical networks influences communication between neurons c. Highly compatible with interneuron theory d. Suggests that abnormalities in temporal synchronization of neural activity prevents normal neural cascades e. When this normal oscillation is disrupted, this increased the probability of coincidence events f. Take home message i. Timing is important, and schizophrenic patients may have neurons that are out of sync with others May lead to grey matter loss, due to excitotoxicity Treatment First generation antipsychotics Neuroleptics Also called typical antipsychotics Thorazine Dopamine (D2) receptor antagonist a. Antipsychotic effect One problem with first generation antipsychotics was extrapyramidal side effects Parkinsons-like side effects resulting from dopamine depletion a. Slurred speech b. Seizure c. Muscle rigidity d. Tardive Second generation antipsychotics Introduced in the 1980's AKA: atypical antipsychotics a. Abilify b. Seroquel Mechanism varies greatly from drug-to-drug Partial D2 receptor antagonists Cognitive behavioral therapy Cognitive remediation CBT is effective in preventing the transition from prodromal to "full" schizophrenia
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