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WSU PSYCH 333 - Schizophrenia
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PSYCH 333 1nd Edition Lecture 15 Outline of Last Lecture I. What are Somatic SymptomsII. Somatic Symptom DisorderIII. Illness Anxiety DisorderIV. Somatic Symptom DisorderV. Neurobiological TheoriesVI. Cognitive-Behavioral FactorsVII. Conversion DisorderVIII. Etiology of Conversion DisorderIX. Related DisordersOutline of Current Lecture II. SchizophreniaIII. Genetic CausesIV. Environmental CausesV. Psychological/Social FactorsCurrent Lecture- Schizophrenia:o Symptoms: Positive symptoms.- Things that are of excess, things that shouldn’t be there but are. Negative symptoms.- Lack of, things that should be there but aren’t. Disorganized symptoms. Motor symptoms.o Positive symptoms: Delusions; unrealistic beliefs firmly held despite disconfirming evidence.- Does not refer to commonly held cultural belief.- Types: persecutory (paranoia), erotomanic (delusions of romance with a celebrity), grandiose (super-inflated sense of self), referential (special messages coded for them), thought broadcasting (everyone can hear their thoughts), and thought insertion (others can put a thought in your mind without speaking).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. Hallucination; perception without sensory stimulation.- Can be any sensory modality.- Most common; auditory (hearing things that aren’t there), visual (seeing things that aren’t there).o Negative symptoms: Avolition- lack of motivation. Asociality- lack of social interest. Anhedonia- lack of positive affect.- Interest of positive emotions. Blunted affect- lack of emotional range.- Broader range, can’t feel anger, sadness, or happiness. Alogia- lack of words.o Disorganized/motor symptoms: Disorganized speech.- Tangentiality (able to see the logic of the tangent), loose association (cannot see the logic), word salad (just words, no connection), clanging (go off in a rhyming). Disorganized behavior.- Child-like behavior, there is no association between what they are doing and what they’re goals are (voluntary movement). Catatonia (motor symptoms).- Excitation, excessive movement with purpose (involuntary movement)- Stupor, completely immobile and wax-like flexibility.- Genetic Causes:o Family history of schizophrenia increases risk. The close the relative, with schizophrenia, is to you your chances increase. Bipolar disorder.o Twin studies. Mono-zygotic twin, share 100% of genes and your chances increase if your twin has it. Di-zygotic twins, are as genetically close as siblings and chances don’t increase as much. o Adoption studies. Research on twins that are raised separately but share 100% of their genetics to show that the genetic component is very crucial.o Familial high-risk studies. Birth complication  predominant negative symptoms. Familial instability  positive symptoms. Other risks; low IQ, neurobiological functioning, and interpersonal problems.o Molecular genetics: DTNBP1 – role unclear; may impact dopamine and glutamate. NGR1 – glutamate’s NMDA receptors; myelination. COMT – executive functioning; prefrontal cortex. BNDF – cognitive functioning (not just in schizophrenia).o Take away message. There is no “schizophrenia” gene. May be related to the number of genetic mutations, rather than specific mutation/deletions.o Dopamine hypothesis. Came from literature on “Amphetamine Psychosis.” Excess dopamine receptors, hypersensitivity to dopamine. Primarily explains positive symptoms, does not account for negative or disorganized symptoms. Mesocortical pathway.- Dopamine pathways: VTA  PCF; VTA  hypothalamus, amygdala, hippocampus, and nucleus accumbens.o Other neurotransmitters. Serotonin.- Dopamine helps regulate 5HT-2 receptors, GABA in the PFC.- 5HT also helps regulate dopamine in the mesolimbic pathway. Glutamate.- Low levels in individuals with schizophrenia.- PCP can trigger schizophrenia-like symptoms by disrupting NMDA receptors.- Helps regulate dopamine.- May help explain cognitive deficits in schizophrenia.o Neuroanatomy. Enlarged ventricles. Prefrontal cortex dysregulation.- Speech, emotion, goal-directed behavior.- Low metabolic rates in schizophrenia.- Low frontal lobe activation related to negative symptoms.- Reduced cortical volume, but same number of neurons – loss of dendritic spines. Reduced cortical volume in temporal lobe. Reduced volume in basal ganglia, hippocampus, and other structures in the limbic system.- Reduced hippocampal volume may be related to chronic HPA-axis activation.- Reactivity to stress, rather than level of stress.o Biological treatments: Antipsychotic medications.- First generations – blocks D2 receptors.- Second generation – actions not completely understood; impact dopamine and 5HT receptors, amongst others. Side effects.- Tardive dyskinesia.o Irreversible side effect, involuntary motor movement especially with the mouth. - Extrapyramidal symptoms – “Parkinsonian” side effects.- Weight gain, metabolic side effects.- Agranulocytosis – lower number of white blood cells (2nd generation).- Environmental Causes:o Complications during birth/pregnancy. Hypoxia, lack of oxygen to the brain. Maternal infection (toxoplasmosis, influenza).o Cannabis use, especially in adolescence. Interaction with stress, high levels of dopamine. Interaction with COMT gene.- Psychological/Social Factors:o Reactivity to stress.o Socioeconomic status (SES). Sociogenic (being poor causes schizophrenia) vs. social selection hypotheses (having schizophrenia causes low SES).o Family. Expressed emotion. Family discord.o Psychosocial treatment. Psychoeducation. Social skills training. Family therapy.- Psychoeducation, reduce expressed emotions, communication/problem-solving, social skills. CBT.- Testing delusional beliefs, reality testing, and negative expectations about future. Cognitive remediation.- Improve cognitive deficits through mental exercises. Case management.- Address issues related to low SES, lack of access to health care, difficulty caring for self.- Coordination of services. Residential treatment.- Similar to a “halfway house” – in between hospitalization and home.- Vocational


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WSU PSYCH 333 - Schizophrenia

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