psy 337

• excessive activity of dopamine (specially mesolimbic pathways)
• reduced activity of glutamate
• increased DA activity may block glutamate
• added effect of serotonin/5HT

• most antipsychotic meds/neuroleptics that reduce DA activity reduce positive symptoms
• amphetamines and other stims that increase DA activity increase positive symptoms
• increased DA receptors in the brains of schizos

• tend not to be useful for symptoms
• delay in clinical response to neuroleptics
• HVA not found in excess in cerebrospinal fluid - may be that DA receptors are important, not DA levels.

• Kraepelin and others - decrease activity in certain areas (limbic, prefrontal cortex)
• consistent evidence of brain abnormalities
• some abnormalities appear before onset but degeneration continues over time

• reduced overall brain weight
• enlargement of ventricles (20-50% of cases) - +ive relationship between enlargement and length/severity of schizophrenia
• cortical atrophy - grooves and clefts are wider
• subcortical atrophy - limbic areas, hippocampus and amygdala
• reduced metabolic activity in the brain

• unrealistic and bizarre beliefs not shared by others in the culture
• may be delusions of grandeur or persecution

• these beliefs are attempts to deal with and relieve anxiety and stress.
• a person develops 'stories' around some issue

beliefs as resulting from brain dysfunction that creates these disordered cognitions.

• indicate absence of insufficiency of normal behaviour
• apathy, limited thought or speech, emotional/social withdrawal
• 25% of schizophrenics display these

inability to initiate and persist in activities

• absence of speech
• reflects negative thought disorder rather than inadequate communication skills

• 25% of schizophrenics
• no facial expressions - does not indicate lack of emotion
• speech flat and toneless
• seem unaffected by surrounding events

variety of erratic behaviours that affect speech, motor behaviour, and emotional reactions

• jump from topic to topic
• talk illogically
• tangentiality
• derailment

• laughing or crying at inappropriate times
• hoarding
• catatonia

• motor dysfunctions that range from wild agitation to immobility
• waxy flexibility

• preoccupation with one or more delusions or frequent auditory hallucinations
• cognitive skills and affect are relatively intact

• disorganised speech
• disorganised behaviour
• flat or inappropriate affect
• self- absorbed - look in mirror a lot.
• few remissions

• motoric inability - catalepsy or stupor
• excessive (purposeless) motor activity
• extreme negativism or mutism
• peculiarities of voluntary movement and posturing
• echoalia or echopraxia

• absence of prominent delusions, hallucinations, disorganised speech, and grossly disorganised or catatonic behaviour
• continuing evidence of the disturbance, with two or more schizo symptoms

• experience symptoms of schizophrenia for a few months only
• good premorbid social and occupational functioning
• absence of blunted or flat affect
• onset of psychotic symptoms within 4 weeks of first change in behaviour
• confusion at height of episode

• uninterrupted period of illness with depressive and/or manic episodes concurrent with schizophrenic symptoms
• 2 weeks of delusions/hallucinations without mood symptoms

• delusions only
• erotomanic
• grandiose
• jealous
• persecutory
• somatic
• mixed

delusions that another person, usually of higher status, is in love with the individual

delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person

delusions that the individuals sexual partner is unfaithful

delusions that the person (or someone close) is being malevolently treated in some way

delusions that the person has some physical defect or general medical condition

characteristic of more that one of the other types of delusions

• presence of one or more positive symptoms lasting 1 month or less.
• often precipitated by extremely stressful situations

• folie à deux
• individual develops delusions simply as a result of a close relationship with a delusional individual
• delusion is similar in content to that of the delusional other

• inherited tendency to develop disease
• prenatal/birth complications - viral infection during preg/birth injury affect child's brain cells

• helps patient and family understand the disease and symptom triggers
• teaches family communication skills
• provides resources for dealing with emotional and practical challenges

• can occur in hospital or community settings
• teaches patient social, self-care, and vocational skills

• neuroleptics clarify thinking and perceptions of reality, reduce hallucinations and delusions
• drug treatment must be consistent to be effective. inconsistent dosage may aggravate existing symptoms or create new ones

• ketamine blocks glutamate receptors
• amphetamine increases DA activity
• 

• measured density of D2 receptors in the caudate
• 

found ventricles enlarged in schiz but not non-schiz twins. suggest environment, not genetics

• 34 Ss with first ep psychosis, 36 controls.
• MRI assessed brain volume at baseline and 12 months later.
• only reduction in schiz grey matter

• almost 50% of schizos experience stress 1-3 weeks before onset
• could be result of premorbid symptoms

adopted kids of schizophrenic mums only developed severe schizophrenia if they came from maladjusted foster families

• in northern hemisphere, schiz more common among people born in Jan-March.
• related to mums becoming sick with the flu earlier in the season, during second trimester

• schiz especially high following major flu epidemic in 1957
• increased proportion only for those in utero in 2nd trimester during epidemic

• prevalence 2-3 times higher in offspring of older fathers
• stress hormones increase glucocorticoids but elevated cortisol can potentially damage brain development