Psych 202 1st Edition Lecture 26 Psychopathology 4-Delusions are at the heart of schizophreniaoFixed belief of knowing that something is true and nothing persuading you otherwise that is completely false-Disorder of thought contentoDisorganized speech: disorder of thought form-Formal thought disorder-SchizophreniaoTwo+ 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)oFor 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 onsetoContinuous 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 extremeoOther disorders and conditions have been ruled out (bipolar disorder, reactions to drugs,or other medical conditions-Jerry caseoPowerful sense of disorder thought form - formal thought disorderoIncoherence: makes no senseoTalking about sperm and egg and heatoFlat/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 caseThese 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.oDisorganized 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 conspiracyoDiminished emotional responses - no, she has fear, doesn’t have negative symptoms, doesn’t have flat affectoVery 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 conspiracyoDoesn’t trust her own doctor, willing to go to doctor but barelyoHearing voices that are telling her that they are out to get her and telling her what is going on-David caseoParanoid schizophrenicoAlmost everything he says is coherent, not much disorganized speechoA lot of delusionalityoPeculiarity in his behaviors, he is a street personoMay have some hallucinationsoGrossly disorganized behavioroNo negative symptoms, no flat affectoHe is angry and everything he says fits his paranoiaoPositive symptoms: hallucinations probably, many delusions, much paranoiaoLack of insight* he doesn’t see that he has the problem that he has-Ms. LeonardoDelusions: thinks she is pregnant by her Saint Bernard dog-She would continue to believe what she believes, even if challengedoMany hallucinations: looking around and preoccupied on something inside her, the voices are criticizing her, very prominentoNo disorganized speech, she makes senseoMany negative symptoms: her behavior is disorganized, a lot of flat affect, talks with an absence of emotion, very withdrawn from other peopleoAlso has many positive symptoms-1 out 100 people meet criteria for schizophrenia-Etiology: the role of genetic predispositionoChartoThe lack of 100% concordance in MZ twins demonstrates that despite clear evidence of genetic environmental factors have causal forceo10% of fraternal cases meet criteriaoThe more closely someone is genetically related to someone with schizophrenia, the more likely they will develop problem as welloIt is not entirely genetically determinedoDopamine 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 storyoVentricles: spaces inside brain where liquids flowoIn schizophrenia: ventricles seem to be larger, not as much brain tissue-MRI data: MZ twin discordanceoSchizophrenia 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 workoSomething non-genetic is going on, virusoPeople who become schizophrenic are disproportionally conceived during flu season andwinter months in generaloIdentical twins are more likely to contract same virus-Etiology: structurally disorganized pyramidal neurons in hippocampus?oHippocampus: memory and cognitive processing-Etiology: the role of family-communication?oThere has been heated debate about whether disturbed family communication is a meaningful "cause" of schizophreniaoThese 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 childoMothers are blamed for their children's problemsoFreud did a lot to contribute to thisoThese theories are not longer in vogue, and are poorly supported in research dataoHowever, 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)oExpressed emotion refers to:oThe expressed emotion data from one classic study are summarized in the next slide:-Expressed emotion effects in schizophrenic families on