psy 337

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  1. biochemical factors:
    • excessive activity of dopamine (specially mesolimbic pathways)
    • reduced activity of glutamate
    • increased DA activity may block glutamate
    • added effect of serotonin/5HT
  2. evidence for effect of dopamine
    • 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
  3. flaws with neuroleptic theories:
    • 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.
  4. structural abnormalities in schizophrenics
    • 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
  5. evidence for structural abnormalities
    • 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
  6. delusions
    • unrealistic and bizarre beliefs not shared by others in the culture
    • may be delusions of grandeur or persecution
  7. motivational view of delusions
    • these beliefs are attempts to deal with and relieve anxiety and stress.
    • a person develops 'stories' around some issue
  8. deficit view of delusions
    beliefs as resulting from brain dysfunction that creates these disordered cognitions.
  9. negative symptoms
    • indicate absence of insufficiency of normal behaviour
    • apathy, limited thought or speech, emotional/social withdrawal
    • 25% of schizophrenics display these
  10. avolition
    inability to initiate and persist in activities
  11. alogia
    • absence of speech
    • reflects negative thought disorder rather than inadequate communication skills
  12. affective flattening
    • 25% of schizophrenics
    • no facial expressions - does not indicate lack of emotion
    • speech flat and toneless
    • seem unaffected by surrounding events
  13. disorganised symptoms
    variety of erratic behaviours that affect speech, motor behaviour, and emotional reactions
  14. disorganised speech
    • jump from topic to topic
    • talk illogically
    • tangentiality
    • derailment
  15. inappropriate affect and disorganised behaviour
    • laughing or crying at inappropriate times
    • hoarding
    • catatonia
  16. catatonia
    • motor dysfunctions that range from wild agitation to immobility
    • waxy flexibility
  17. paranoid type
    • preoccupation with one or more delusions or frequent auditory hallucinations
    • cognitive skills and affect are relatively intact
  18. disorganised type
    • disorganised speech
    • disorganised behaviour
    • flat or inappropriate affect
    • self- absorbed - look in mirror a lot.
    • few remissions
  19. catatonic type
    • motoric inability - catalepsy or stupor
    • excessive (purposeless) motor activity
    • extreme negativism or mutism
    • peculiarities of voluntary movement and posturing
    • echoalia or echopraxia
  20. residual type
    • absence of prominent delusions, hallucinations, disorganised speech, and grossly disorganised or catatonic behaviour
    • continuing evidence of the disturbance, with two or more schizo symptoms
  21. schizophreniform disorder
    • 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
  22. schizoaffective disorder
    • uninterrupted period of illness with depressive and/or manic episodes concurrent with schizophrenic symptoms
    • 2 weeks of delusions/hallucinations without mood symptoms
  23. delusional disorder
    • delusions only
    • erotomanic
    • grandiose
    • jealous
    • persecutory
    • somatic
    • mixed
  24. erotomanic
    delusions that another person, usually of higher status, is in love with the individual
  25. grandiose
    delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
  26. jealous
    delusions that the individuals sexual partner is unfaithful
  27. persecutory
    delusions that the person (or someone close) is being malevolently treated in some way
  28. somatic
    delusions that the person has some physical defect or general medical condition
  29. mixed type (delusion)
    characteristic of more that one of the other types of delusions
  30. brief psychotic disorder
    • presence of one or more positive symptoms lasting 1 month or less.
    • often precipitated by extremely stressful situations
  31. shared psychotic disorder
    • 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
  32. natural history of schizophrenia
    Image Upload
  33. biological influences
    • inherited tendency to develop disease
    • prenatal/birth complications - viral infection during preg/birth injury affect child's brain cells
  34. treatment - individual, group and family therapy
    • helps patient and family understand the disease and symptom triggers
    • teaches family communication skills
    • provides resources for dealing with emotional and practical challenges
  35. treatment - social skills training
    • can occur in hospital or community settings
    • teaches patient social, self-care, and vocational skills
  36. treatment - medications
    • 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
  37. Krystal et al. 2005 - administration of amphetamine and ketamine to healthy Ss
    • ketamine blocks glutamate receptors
    • amphetamine increases DA activity
    • Image Upload
  38. Wong et al. 1986 - D2 receptor density in people with schiz
    • measured density of D2 receptors in the caudate
    • Image Upload
  39. Suddath et al. 1990 - MRI scans of MZ, schiz discordant twins
    found ventricles enlarged in schiz but not non-schiz twins. suggest environment, not genetics
  40. Cahn et al. 2002 - change in brain volume
    • 34 Ss with first ep psychosis, 36 controls.
    • MRI assessed brain volume at baseline and 12 months later.
    • only reduction in schiz grey matter
  41. Brown & Birley, 1968 - stress
    • almost 50% of schizos experience stress 1-3 weeks before onset
    • could be result of premorbid symptoms
  42. Tienari et al - adoption study
    adopted kids of schizophrenic mums only developed severe schizophrenia if they came from maladjusted foster families
  43. seasonal evidence for viral infection theory
    • 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
  44. Mednick et al. 1988 - Iceland flu
    • schiz especially high following major flu epidemic in 1957
    • increased proportion only for those in utero in 2nd trimester during epidemic
  45. paternal age risk factor
    • prevalence 2-3 times higher in offspring of older fathers
    • stress hormones increase glucocorticoids but elevated cortisol can potentially damage brain development
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psy 337
2013-04-29 02:42:39

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