PSYCH 333 1nd Edition Lecture 15 Outline of Last Lecture I What are Somatic Symptoms II Somatic Symptom Disorder III Illness Anxiety Disorder IV Somatic Symptom Disorder V Neurobiological Theories VI Cognitive Behavioral Factors VII Conversion Disorder VIII Etiology of Conversion Disorder IX Related Disorders Outline of Current Lecture II Schizophrenia III Genetic Causes IV Environmental Causes V Psychological Social Factors Current 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 2 nd 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 rehabilitation care management and social skills