schizo

• • “Psychosis is defined as grossly impaired reality testing”
• Schizophrenia is a disorder characterised by ‘primary’ psychosis.
• • Secondary’ psychosis can occur within
  • As consequence of Bipolar disorder 
  • Depression 
  • Substance use 
  • Neurological conditions
• DSM-5

  • Two or more (but must have one of 1,2 or 3)

  1. Delusions 
  2. Hallucinations 
  3. Disorganised Speech 
  4. Disorganised (or catatonic) behaviour 
  5. Negative Symptoms (diminished emotional expression or motivation)

  • Greater than 6 months 
  • Functioning impaired / distress 
  • Not better explained by substance use issues, psych diagnosis 
• • Hallucinations → “…a sensory perception in the absence of a corresponding external or somatic stimulus… with or without insight”
• • Delusions → A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. 
• • Delusions of reference - belief that someone on radio/tv is talking to them directly who knows special awareness of them through communications
• • Persecutory delusions - belief someone is out ot get you, harm you (neighbours, friends etc) 
• • Grandiose delusions - belief that you have special powers, particular important, huge role playing in saving planet etc 
• Erotomanic delusions - where people are particularly entangled in romantic relationships with people they've never met
• • Somatic Delusions - delusional beliefs, fixed and firm belief about bodily symptoms
• Thought Insertion - idea that someone has put thoughts in head that are not your own
• Disorganised behaviour

  • Behaviour which is not typical of the person’s culture or inappropriate to the context in which it takes place
• Catatonia (stuporous or excited)– muscular rigidity, stupor; repeated gesturing; flailing; unusual postures
• • Avolition/Apathy – lack of motivation, interest in things
• • Asociality – social withdrawal, spend time alone
• • Anhedonia – inability to find pleasure in things
• • Blunted affect – lack of outward expression of emotion
• • Alogia – ‘poverty of speech’; doesn’t talk
• • Lifetime prevalence is about 0.7%
• • More prevalent among men (1.4:1)
• Peak age of onset is ~25
• Emile Kraepelin (1856-1926)

  • One of the founders of scientific psychiatry 
  • Largely remembered for work on psychosis 
• • Atypical antipsychotics appear to boost prefrontal dopamine - 2nd generation 
• • Negative symptoms are linked to hypo-activity of dopamine neurons in the prefrontal cortex. 
• • Conventional 1st generation antipsychotics affect (i.e. decrease) striatal dopamine
• • Enlargement of ventricles - estimated to be 18% larger 
• • Prefrontal Cortex - most developed human part of brian, range of higher order cognitive functioning 
  • Decision-making 
  • Working memory 
  • Reasoning, Judgement 
  • Goal-directed behaviour 
  • Top-down control over impulses
• • Synaptic pruning
  • Increase in neurons and increase in connections, decreases through development - thought to improve efficiency of brain 
• • Predictive Coding Theory
  • Focuses on delusional thinking 
• • Prediction Error (PE) is a method through which animals use new information to update beliefs
• • Theories suggest that schizophrenia patients overweight evidence in favour of beliefs and underweight evidence contrary
• Environment - Risk Factors

  • Birth complications (e.g. lack of oxygen) 
  • Prenatal exposure to infection (e.g. toxoplasmosis, flu)
  • Adolescent drug use (marijuana use; but contentious area)
  • Early cognitive deficits (lower IQ, cognitive performance in retrospective and prospective studies, e.g.as young as 7 years old)
  • Low socio-economic status - likely due to issues with reverse causation 
  • Early trauma/abuse
• • Social skills training → Improve functionality
• • CBT → Manage negative symptoms and stress
• Family therapy & psychoeducation → improve the level of support and understanding from the patients' family
• negative symptoms

  • avolition/apathy
  • asociality
  • anhedonia
  • blunted affect
  • alogia
• disorganised behaviour

  • decline in daily functioning
  • inappropriate or unusual emotional responses
  • dressing in odd manner
  • catatonia
• emile kraeplin - dementia praecox

  • progressive neurodegenerative disease
  • results in irreversible loss of cognitive function
  • hallucinations
• emile kraeplin - manic depression

  • alternation between depression and manic psychosis