PSYCH 330 1st Edition Lecture 20 Outline of Last Lecture I. N/AOutline of Current Lecture II. Biological Basis of SchizophreniaIII. Brain AbnormalitiesIV. Expressed EmotionV. Typical vs Atypical Antipsychotics and How Effective they areVI. Psychological Intervention TreatmentsVII. New Treatment for SchizophreniaCurrent LectureBiological BasisSchizophrenia has a strong genetic component:- A child born to a parent that has schizophrenia has a 15% chance of also developing it.- A child born to two parents that have schizophrenia has a 50% chance of also developingit.- A child born to parents without schizophrenia has a 1% chance of developing it.- MZ (Identical):DZ (Fraternal)= 3:1 (60% chance vs. 20%).Genetic Markers:- There is no one gene that causes Schizophrenia.- There are 7 “candidate genes”.- These 7 genes are believed to be related to symptoms of Schizophrenia.- Not in the “if there is a flaw/mutation in one of these genes you will develop Schizophrenia” way, but these genes need to be looked into for causing a predisposition to Schizophrenia.Eye tracking:- Schizophrenics have issues with smooth-pursuit eye tracking (following a pen with your eyes).These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.- They have abnormal (saccadic/jerking) patterns when following the pen. This suggests a neurological abnormality.Schizo-Virus?- Controversial (NOT conclusive to be thought of as an actual virus condition).- Schizophrenics showed a higher rate of their mother developing influenza in the 1st and/or 2nd trimester of pregnancy.- Schizophrenics are also more often born in winter months (6-8x more than other seasons).- It is likely that sickness could/would react with genetic predisposition.- This is more of a theory of venerability factor than a virus that causes Schizophrenia.Neurotransmitters:- Called the “Dopamine Hypothesis”.-Dopamine is increased in the limbic system-Causes positive symptoms.-Dopamine is decreased in the cortical areas-Causes negative symptoms.Support for Dopamine Hypothesis?Evidence Supporting:- Dopamine Antagonists-Most effective on hallucinations & delusions.-Less effective in reducing thought disorder & withdrawal.- Amphetamines, Cocaine, Crack, etc.-Mimic symptoms of schizophrenia; also heighten dopamine levels.In type 1 Schizophrenics:- Increased dopamine levels in limbic system postmortem.Relation to Parkinson’s Disease:- Drugs reduce temors.- Can also induce “schizophrenic-like” symptoms (Mainly positive symptoms).- Also worsens symptoms in schizophrenic patients.Evidence Refuting:- Response to antipsychotics are gradual.-The medication takes only a few hours to block dopamine receptors.-But it takes patients 6-8 weeks to respond to treatment.-This indicates something else is going on besides dopamine levels.- Clozapine-It is an effective treatment for Schizophrenia.-However, it has minimal effects on dopamine.Conclusion to Dopamine Hypothesis:- It’s a combination of chemical imbalances (Likely Dopamine and Serotonin).\Brain Abnormalities- Patients with Schizophrenia have smaller overall brain sizes.- Their brains are symmetrical (Normally the right hemisphere is larger than the left).- They have enlarged ventricles (like autistic patients).-Related to: Cognitive impairment, more negative symptoms, poorer treatmentresponse.-Is that a cause or effect? (Not related to prolonged antipsychotic use). We aren’t sure.- Frontal lobe (negative and positive symptoms).-Caused by decreased activity (fewer active synapses).- Abnormalities in the Basal Ganglia.-Responsible for fine motor movement.Expressed Emotion (EE)EE is regarding the family of the patient who suffers from Schizophrenia.- There is a risk of emotional over-involvement in the family, which doesn’t help the patient.- There is also a risk of critical attitudes toward the patient, which can be very detrimental.- This causes higher relapse rates-It is correlational data-NOT causal.- EE is most common in Caucasians, not African Americans. Typical vs. Atypical AntipsychoticsTypical:- Reduces dopamine levels.-Thorazine, Hadol, Stelazine, Mellaril.- Causes extrapyramidal symptoms.-Akinesia (Lack of facial expression, monotonous speech).-Tardive Dyskinesia (Involuntarily facial/body movement).-These result from long-term use in high doses (occurs in 50%).-Effects generally not reversible.Atypical:- Reduces dopamine AND serotonin levels.-Abilify, Clozaril, Risperdal, Zyprexia, Seroquel.- Fewer side-effects.-Agranulocytosis (Dramatic decrease in while blood cell count; can’t fight infections well;requires frequent blood tests to monitor).-Weight gain, increased triglycerides (higher cholesterol), diabetes, CVD.How Effective are They?- These medications are used for Schizophrenia as well as Bipolar Disorder.-And also Autism, OCD, and Dementia (Less commonly)For Schizophrenia:- Generally (typical & atypical medications) are equally effective.-Typical=Better for positive symptoms.-Atypical=Better for negative symptoms.- In patients treated:-40% had a good response, 40% had a partial response, 20% were non-responsive.-Those that were non-responsive had more type 2 symptoms.Psychological InterventionsCognitive Rehabilitation:- Building attention & memory skills.- Object sorting to improve concept understanding (WCST).- Social perception: Slides of people in different activities-assesses emotions and appropriateness of behaviors.Family Therapy:- More involvement the better.- Psychoeducation is very important.- Addresses EE.Behavior Therapy:- Social skills training (verbal and non-verbal)- Substance abuse and weight management.- Supported employment.New Treatment For SchizpophreniaTranscranial Magnetic Stimulation (TMS).- Magnetic current to cerebral cortex.- 10 days, about 10 minutes a day treatment.- Minimal side effects.- Adequately supported data as an effective treatment to MDD.- Helps with auditory hallucinations-Causes less command hallucinations, and less intense hallucinations.- Does not help with delusions.- Might help negative symptoms-limited data to