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• Schizophrenia

  A psychotic disorder
• Diagnostic criteria (ICD-11) for schizophrenia

  • Person must have at least two symptoms for at least one month, with one from the first four in the table
• Symptoms of schizophrenia

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behaviour
  • Negative symptoms
• Schizophrenia is rare in children
• Very early onset schizophrenia


  Difficult to find an effective combination of drugs
• Avatars can trigger emotions
• Persecutory ideation may be more common in people with higher levels of trait anxiety and/or paranoia, and can be affected by situations, such as being in the VR environment with avatars
• Parental consent and child assent are important when studying children, especially very vulnerable children
• Genetic explanation of schizophrenia

  Family and twin studies suggest a predisposition to schizophrenia can be inherited, concordance rate for monozygotic (MZ) twins = 42%, dizygotic (DZ) twins = 9%, genome-wide association studies show certain alleles are more common in schizophrenia
• Biochemical (dopamine) explanation of schizophrenia

  Excess dopamine in the mesolimbic pathways may result in positive symptoms, lack of dopamine in mesocortical pathways may cause negative and cognitive symptoms
• Cognitive explanation of schizophrenia

  People with schizophrenia lack the ability to recognize their own actions and thoughts as being carried out by themselves
• Schizophrenia likely results from an interaction of nature and nurture, environmental (epigenetic) factors can cause genes to be expressed or silenced, diathesis-stress model suggests some are genetically predisposed but only develop symptoms if they encounter situational stressors
• Antipsychotic drugs


  Can be given orally or transdermally, regular check-ups help monitor dosages, symptoms and side effects, order of prescription based on evidence-based protocols, treatment-resistant patients may be given mood stabilising drugs and electroconvulsive therapy (ECT)
• Electroconvulsive therapy (ECT)


  An addition, not an alternative, to medication, believed to trigger gene expression and improve neural connectivity, involves delivering brief, controlled seizures to the brain via electrodes
• Cognitive-behavioural therapy (CBT) for schizophrenia


  Therapists develop supportive therapeutic alliances, links between events, sensations, thoughts and feelings are discussed, clients are helped to identify early warning signs and use stress management/coping skills, techniques include symptom diaries, challenging delusions, thought linkage, and paced activity scheduling
• CBT was more effective than befriending in the long term for reducing symptoms of schizophrenia
• Meta-analyses take a nomothetic approach, allowing for generalisations due to large sample sizes, idiographic studies may help understand the role of social support and therapeutic alliance
• ECT is controversial in many cultures, but in China, more than 50% of people with schizophrenia receive ECT, possibly due to cultural differences in power distance index
• First generation antipsychotics


  Medications used to treat schizophrenia and related psychotic disorders
• Second generation atypical antipsychotics

  More recent innovation of medications used to treat schizophrenia and related psychotic disorders
• Both first and second generation antipsychotics work to reduce the severity of the symptoms of schizophrenia
• Chlorpromazine


  A drug that works by blocking dopamine receptors in the limbic and cortical regions of the brain, linking to the dopamine hypothesis
• Many patients report diminished positive symptoms after several weeks on antipsychotic drugs
• Some patients may display no response to antipsychotic drugs, in an instance known as "treatment-resistant schizophrenia"
• Electroconvulsive therapy (ECT)


  A biological treatment which serves to help reduce symptoms of schizophrenia by passing an electric current through the brain to induce a mild seizure
• The seizure in ECT is thought to "reset" the brain's neurological pathways and thus alleviate symptoms to some degree
• ECT can have side effects such as tissue damage, bone damage, memory loss and in rare cases death
• To reduce the effect of memory loss, the electrical current in ECT is applied unilaterally, across a single hemisphere of the brain rather than two, where the usually non-dominant hemisphere is targeted
• A single course of ECT may involve treatments ranging from 6-12 sessions, at intervals of about twice per week
• The exact mechanism behind ECT's success is not clear, it is only ever conducted in extreme circumstances such as acute episodes or prolonged catatonia
• Cognitive behavioural therapy (CBT)


  A "talking" therapy in which a patient talks in an unstructured interview with a trained clinician, where the patient is taught to recognise and evaluate the thoughts which underline their behaviours and symptoms
• The Sensky et al study compared the effectiveness of around 20 sessions of CBT to "befriending" sessions, finding that both resulted in an overall reduction in both positive and negative symptoms of schizophrenia, but the improvements continued even up to the follow up phase in CBT patients, but NOT in those treated using the "befriending" control sessions
• Antipsychotic medication has been proven to show a significant reduction in both positive and negative symptoms of schizophrenia at a rate of about 50% after 6 weeks of administration
• Antipsychotics have side effects such as weight gain, drowsiness, insomnia and various motor issues like extrapyramidal symptoms (EPS), which may cause non-adherence to medication and high relapse rates
• Newer atypical antipsychotics produce fewer unwanted side effects than first-generation antipsychotic medications
• The main strength of ECT is that it is highly applicable as an effective last-resort treatment for those with mental disorders who are resistant to all other treatments
• ECT is mainly useful in treating acute, but severe episodes of mental disorders such as schizophrenia
• ECT comes with several drawbacks such as affecting the central nervous system, bearing many side effects, and having high relapse rates
• The lack of understanding of the mechanism by which ECT operates on the brain has led to it being harshly criticised by medical professionals as it lacks empirical evidence
• CBT is an effective medication in treating schizophrenia, especially in cases where other treatments have failed to work (treatment-resistant schizophrenia)