SCHIZOPHRENIA

• Schizophrenia is one of the most chronic and disabling of the major mental illnesses affecting thought processes

  
• Schizophrenia


  A disintegration of the personality, with a split between thinking and emotion (but not a split personality)
• Schizophrenia


  Involves a range of psychotic symptoms (where there is a break from reality)

  
• Schizophrenic patients generally lack insight into their condition, i.e. they do not realise that they are ill
• Symptoms of schizophrenia


  • Positive symptoms
  • Negative symptoms

  
• Positive symptoms


  An excess or distortion of normal functions
• Negative symptoms


  A diminution or loss of normal functions
• 1% of the population experience schizophrenic symptoms
• No difference in prevalence of schizophrenia between males and females

  
• Age of onset in males is late teens, early 20's
• Age of onset in females is late 20's, early 30's
• ICD-10 and DSM V


  The two main classification systems used to diagnose schizophrenia
• For a diagnosis of schizophrenia, two or more symptoms must be present for more than one month along with reduced functioning
• Delusions


  A belief that is unreal, e.g. 'I am the Queen, God, Elvis etc.'
• Paranoid delusions


  Feeling persecuted or harassed (usually unfounded beliefs that develop into obsessions)
• Grandeur delusions


  Delusions of having special powers, talents or importance
• Reference delusions


  Delusions that events, objects or other people in the environment relate to the individual in a special way
• Thought insertion and broadcasting

  Delusions that thoughts are being put into the individual's mind or that their thoughts are being broadcast to others
• Hallucinations


  A perception that is not real, e.g. hearing, smelling, feeling or seeing something that isn't there
• Auditory hallucinations


  Hearing voices that seem real, even though no one else can hear them
• Visual hallucinations


  Seeing other people, strange creatures or heavenly bodies that aren't really there
• Formication

  The hallucination/sensation of things crawling on your skin
• Disordered thinking


  Confused and muddled thinking, where thoughts seem to wander off with no obvious connection
• Apathy


  Lack of effort or energy to do everyday things, no desire to learn new things, meet new people, or have new experiences, don't care about your own problems
• Flat affect


  General lack of emotion
• Deteriorated appearance


  Neglect of personal hygiene and grooming
• Impaired social interaction


  Withdrawal from social situations and relationships
• Anhedonia


  Reduced ability to experience pleasure, things that used to bring pleasure no longer do
• Alogia


  Poverty of speech, reduced ability to express thoughts and feelings verbally
• Catatonic movement


  Unusual motor behaviour, such as maintaining a rigid posture or repeating the same movements over and over
• Historically, a number of 'Types of Schizophrenia' have been identified, but these have been removed from DSM V because they are not viewed as 'stable' conditions

  
• The most common type was Paranoid schizophrenia (approx. 35-40% of sufferers), with main features of delusions and hallucinations
• Other 'types' were Disorganised, Catatonic and Undifferentiated schizophrenia
• Undifferentiated schizophrenics (approx. 20% of sufferers) don't fit neatly into any of the other types and often had symptoms drawn from all the different types
• Biological Explanations


  Explain schizophrenic symptoms in terms of physiological processes and biological factors
• Dopamine Hypothesis


  The brain of schizophrenic patients produces more dopamine (a neurotransmitter) than the brain of a "normal" person

  
• Dopamine


  A neurotransmitter directly responsible for motivation and reward, also impacts motor control and cognitive functions
• The link between dopamine and schizophrenia was developed from research into Parkinson's disease

  
• Schizophrenics have an abnormally high number of dopamine receptors, particularly the D2 receptors, in the subcortical regions of the limbic system

  
• Dopaminergic pathways involved in schizophrenia

  • Mesolimbic pathway
  • Mesocortical pathway
  • Nigrostriatal pathway
  • Tuberoinfundibular (TI) pathway