Schizophrenia Description and Etiology Symptoms of Schizophrenia Positive Symptoms Negative Symptoms Pathological Characteristics that are additions to normal lacking or are reduced behavior ie ie reduced range of hallucinations emotion reduced delusions amount of speech Psychomotor Symptoms Odd gestures excited movement motionless stupor Hallucinations Perceptions in any sensory modality without relevant or adequate stimuli Auditory may hear sounds that other people do not hear Visual may see images that are not really there May also have a difficult time distinguishing relevant from irrelevant information Tactile strange or unusual sensations on the skin Olfactory may smell smells that are not there Taste may have unusual tastes that are not caused by physical objects Delusions Beliefs that are unfounded and contrary to reality Persecution the belief that others are out to get you Grandiosity the belief that you have special powers or abilities Guilt belief that you have committed some crime or have done something that is unforgivable Reference may attach special meanings to things or the behaviors of others Control beliefs that others are controlling thoughts feelings or behaviors or that the patient has control over others thoughts behaviors or feelings or events Somatic something is physically wrong with their body even if the doctor says that nothing is wrong Disorganized Thinking or Speech Loose associations or derailment ideas slip off track to matters that are unrelated Tangentiality circumstantiality difficulty reaching answers in a succinct way Incoherence thought patterns do not make sense Conceptual difficulties difficult to think in abstract terms Unusual word use Neologisms Word salad Perseveration Clang association Inappropriate Affect Any range of emotion that does not fit the content of the situation May laugh when describing serious events May have unexplainable shifts in mood May become angry in positive situations Mood may be inappropriately intense Might be caused by internal stimuli hallucination Disorganized Behavior People may dress oddly Act in inappropriate manners child like or silly Collect odd items Act sexually inappropriate in front of others masturbating exposing oneself Negative Symptoms Avolition lack of energy or interest in routine activities Alogia poverty of speech and poverty of content of speech Anhedonia inability to experience pleasure Flat or blunted affect little facial expression patients appear dull Asociality social withdrawal impairments in social functioning Psychomotor Symptoms Reduced spontaneous movements Catatonia Decrease in reactivity to environment stupor Patients make repeated gestures excitement Catatonic Rigidity and Posturing Patients will keep odd postures for a prolonged period of time Resist efforts to be moved negativism Waxy flexibility DSM Criteria A Characteristic Symptoms Two or more of the following each present for a significant portion of time during a 1 month period or less if successfully treated 1 2 3 4 5 delusions hallucinations disorganized speech e g frequent derailment or incoherence grossly disorganized or catatonic behavior negative symptoms affective flattening alogia avolition B Social occupational dysfunction One or more major areas of functioning such as work interpersonal relations or self care are markedly below the level achieved prior to the onset C Duration Continuous signs of the disturbance persist for at least 6 months Incidence Impacts about 1 of the population Typically occurs in males between the ages of 18 25 Typically occurs in females between the ages of 25 30 Can happen earlier or later than those age groups There is thought to be a bimodal period in women another age period where there is a high onset typically late 30 s early 40 s About 10 15 may commit suicide Often more present in cities rather than rural areas Often more common in lower SES populations Types of Schizophrenia Catatonic motor immobility or excessive motor activity disorganized behavior Repetition of words or speech unusual postures held for a long period of time Paranoid presence of hallucinations and or delusions negative symptoms are not prominent but may be there to a very minor extent Disorganized speech and behavior are disorganized and often not goaldirected flat or inappropriate affect Types of Schizophrenia Undifferentiated meet criteria for schizophrenia but none of the other categories are met no prominent hallucinations or delusions catatonic im mobility Residual there has been at least one episode of schizophrenia positive symptoms are not present negative symptoms are present Often seen as a transition period between an episode and remission Etiology Walker et al 2005 Schizophrenia is a brain disease Its etiology involves the interplay between genetic and environmental factors Multiple developmental pathways eventually lead to disease onset Brain maturational processes play a role in the etiological process Genetic Factors Diathesis Stress Model But Concordance rate is never more than 50 Unexpressed genetic vulnerability is common Combination of physiological vulnerability and life stresses may be needed Adoption studies indicate an interaction between genes and environment Tienari et al 1994 adoption study Rate of schizophrenia significantly higher than in the matched control adoptees However genetic vulnerability was mainly expressed in association with disruptive adoptive environments Elevated rate of schizophrenia was not detected in adoptees reared in healthy family environments Prenatal and Postnatal Factors Prenatal Obstetrical complications OCs Pregnancy labor and delivery complications Hypoxia fetal oxygen deprivation most strongly linked to Schz Maternal infection Flu during second trimester brain development Maternal stress during pregnancy Effects on HPA Axis Postnatal Brain Injury Do these act independently or interact with a genetic vulnerability i e do genetics increase response to brain damage Premorbid Development What happens prior to onset of symptoms Childhood Lower IQ grades in school difference greatest as age increases Less responsive in social situations less positive emotion and have poorer social adjustment Delays and abnormalities in motor development deficits in the acquisition of early motor milestones such as bimanual manipulation and walking Environmental Stressors Stressful life events Family environment predating onset of symptoms increases risk Neglect abuse