Psych 202 1st Edition Lecture 26 Psychopathology 4 Delusions are at the heart of schizophrenia o Fixed belief of knowing that something is true and nothing persuading you otherwise that is completely false Disorder of thought content o Disorganized speech disorder of thought form Formal thought disorder Schizophrenia o Two of the following for a significant portion of time during a one month period must have at least one of the first three listed Delusions Hallucinations Disorganized speech frequent incoherence Grossly disorganized or catatonic behavior Negative symptoms diminished emotional response or lack of motivation o For a significant portion of time since the onset of the disturbance level of functioning in one of more major areas such as work interpersonal relations or self care is markedly below the level achieved prior to the onset o Continuous signs of the disturbance persist for at least 6 months This 6 month period must include at least one month of symptoms that meet criteria A active phase symptoms and may include periods where the symptoms are less extreme o Other disorders and conditions have been ruled out bipolar disorder reactions to drugs or other medical conditions Jerry case o Powerful sense of disorder thought form formal thought disorder o Incoherence makes no sense o Talking about sperm and egg and heat o Flat blunted affect Talking about being electrocuted punished and killed And had no emotion about it Social symptoms lack of emotional responsiveness Positive symptoms delusions hallucinations formal thought disorder disorganized speech Negative symptoms social withdrawal apathy flat affect Mrs Wilcox case 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 o Disorganized speech no she made sense except some of her inferences for example the idea that a tornado knocked down her sister s house and they had arranged for that to happen to her as a conspiracy o Diminished emotional responses no she has fear doesn t have negative symptoms doesn t have flat affect o Very organized system of delusionality of systemized paranoid delusions that they are out to get her and killed her mother her mom had heart attack and it was not a conspiracy o Doesn t trust her own doctor willing to go to doctor but barely o Hearing voices that are telling her that they are out to get her and telling her what is going on David case o Paranoid schizophrenic o Almost everything he says is coherent not much disorganized speech o A lot of delusionality o Peculiarity in his behaviors he is a street person o May have some hallucinations o Grossly disorganized behavior o No negative symptoms no flat affect o He is angry and everything he says fits his paranoia o Positive symptoms hallucinations probably many delusions much paranoia o Lack of insight he doesn t see that he has the problem that he has Ms Leonard o Delusions thinks she is pregnant by her Saint Bernard dog She would continue to believe what she believes even if challenged o Many hallucinations looking around and preoccupied on something inside her the voices are criticizing her very prominent o No disorganized speech she makes sense o Many negative symptoms her behavior is disorganized a lot of flat affect talks with an absence of emotion very withdrawn from other people o Also has many positive symptoms 1 out 100 people meet criteria for schizophrenia Etiology the role of genetic predisposition o Chart o The lack of 100 concordance in MZ twins demonstrates that despite clear evidence of genetic environmental factors have causal force o 10 of fraternal cases meet criteria o The more closely someone is genetically related to someone with schizophrenia the more likely they will develop problem as well o It is not entirely genetically determined o Dopamine dysfunction Antipsychotic medications are dopamine antagonists Mechanism of action of typical antipsychotic medications is as dopamine antagonists The drug molecule competes with dopamine at postsynaptic sight and doesn t allow dopamine transmission to occur Which creates side effects Also the acute presentation seen in amphetamine psychosis is clinically indistinguishable from paranoid schizophrenia Convinced somebody is out to get them These data are part of the support for theory that schizophrenia etiology is importantly linked to dopamine excesses or dopamine receptor dysfunctions Non genetic etiology the cerebral ventricle story o Ventricles spaces inside brain where liquids flow o In schizophrenia ventricles seem to be larger not as much brain tissue MRI data MZ twin discordance o Schizophrenia in identical twins when twins differ only the one afflicted with schizophrenia typically has enlarged fluid filled cranial cavities The difference between the twins implies some nongenetic factor such as a virus is also at work o Something non genetic is going on virus o People who become schizophrenic are disproportionally conceived during flu season and winter months in general o Identical twins are more likely to contract same virus Etiology structurally disorganized pyramidal neurons in hippocampus o Hippocampus memory and cognitive processing Etiology the role of family communication o There has been heated debate about whether disturbed family communication is a meaningful cause of schizophrenia o These debated began with some neo psychoanalytic theories postulating what schizophrenogenic mothers create ego dispositions towards schizophrenia in offspring profound fixations predisposing psychotic thinking A cold and confusing mom Would create an ego disposition that would be weaker that would develop problems in reality testing Ex Engage in double binding behaviors Express love and hate in the same moment I love you but I hate you in the same moment creates a large sense of confusion for child becomes mistrusting child o Mothers are blamed for their children s problems o Freud did a lot to contribute to this o These theories are not longer in vogue and are poorly supported in research data o However a very robust literature on expressed emotion EE shows reliable effects on the probability of a discharges schizophrenic patient being re hospitalized in the future relapse o Expressed emotion refers to o The expressed emotion data from one classic study are summarized in the next slide Expressed emotion effects in schizophrenic families on 9 month relapse rates Family