Schizophrenia & Neuropsychological Examination (Etiology (Stress…
Schizophrenia & Neuropsychological Examination
What is Schizophrenia?
Is the diagnosis useful/valid?
Distinction between schizophrenia and other psychotic disorders?
Does diagnosis prove useful in terms of prognosis and treatment response?
Poor diagnostic specificity
Schiz = Split Phren = Mind
Diagnostic characteristics (DSM-5)
Grossly disorganized / catatonic behavior
Two or more of these symptoms must have been experienced for a significant proportion of time within the preceding month.
Must have experienced marked social and/or occupational dysfunction and suggested behavioral disturbance for at least 6 months.
Lifetime prevalence of nearly 1 %.
Usual onset between 18-25.
1 out of 5 have an optimal course of illness.
Comorbid substance abuse occurs in 50%.
Voices: Commanding or commenting
"Sensory perceptions of stimuli that are not really there"
most common symptom
of schizophrenia (present in 75 % of those in hospital care)
"A belief that is not held within a person's culture or subculture"
Example: Being under threat from an organized conspiracy
Delusions of persecution
Delusions of grandeur
Delusions of control
Delusions of reference
Increased reliance on currently occuring information without taking previous events into account.
5 negative symptoms
Studies show only a minor benefit.
Social skills training
“Negative symptoms” involve absences of or deficits in something that is typically present in healthy people.
Related Studies: Main Findings
Involves a three-way conversation between therapist, patient and a digital simulation (“avatar”) of one of his/her hallucinated voices.
Speech transformation software to change the therapist’s voice.
6-8 short sessions of 45 min.
Promising studies comparing AVATAR therapy with control groups.
The patient is encouraged to confront the avatar, and, through the dialog, to get to a point where it is no longer intimidating and may even become encouraging and supportive.
Preventing a first episode of psychosis
Early detection and intervention in people at ultra-high risk of developing psychosis can be successful to prevent or delay a first psychosis.
Antipsychotic medication showed efficacy, but more trials are needed.
Omega-3 fatty acid needs replication.
Integrated psychological interventions need replication with more methodologically sound studies.
The findings regarding CBT appear robust, but the 95% confidence interval is still wide.
Serious mental illness and disrupted caregiving for children
The objective is to study how often severe psychiatric disorders adversely affect a person’s
ability to be a parent, indicated by the child being placed in out-of home care.
Parental schizophrenia is strong risk factor for placement of children in out-of-home care.
The global cognitive impairment in schizophrenia
The present study extends findings from 1980–2006 of a substantial,
generalized cognitive impairment in schizophrenia
, demonstrating that this finding has remained robust over time despite changes in assessment instruments and alterations in diagnostic criteria, and that it manifests similarly in different regions of the world despite linguistic and cultural differences.
The region of the world in which a cognition study is conducted has little impact on the effect sizes reported, regarding cognitive impairment.
No significant relationship
between duration of illness and cognitive impairment.
Assertive community treatment (ACT)
Assertive community treatment (ACT) is a form of community-based mental health care for individuals experiencing serious mental illness that interferes with their ability to live in the community, attend appointments with professionals in clinics and hospitals, and manage mental health symptoms.
This Danish study compares treatment from ACT with treatment by standard community mental health teams.
ACT was significantly better in sustaining contact with patients.
Patients who received ACT had a larger reduction in inpatient service-use, increased adherence to antipsychotic medication, improved social functioning, and higher user satisfaction.
How can this important value be implemented in rehabilitation settings?
Three critical steps
reorientation from patient to personhood. Go beyond diagnostic criteria and functional checklists and initiate
each new relationship by getting to know the person and his/her environment.
reorientation of valued knowledge and expertise. This approach suggests that the knowledge, skills and competencies of the service user her/himself, family members, significant others and peers are appreciated as being at least equally as important as the traditional professional knowledge base.
partnership and negotiations in decision-making. Mental health problems can be seen and met as an integral part of people’s lives as opposed to an isolated brain disease or functional deficit. Patience, avoiding hasty decisions, valuing many voices and perspectives, focusing on capacities and assets and on what a person’s perfect day would look like, and appreciating disagreements are components highlighted in person-centered practices.
Contribute to the onset of psychotic symptoms.
Schizophrenic patients likely suffered a high level of stressful and traumatic life events compared to the nonclinical population.
25-40 % of patients have a comorbid PTSD.
Patients are 15 times more likely to be sexually abused than the nonclinical population.
People may suffer from intrusive trauma-related memories of past events in a similar manner to a presentation of PTSD, but it is the appraisal of these experiences that may lead to psychosis.
In treatment clinicians should be mindful of the high prevalence of stressful or traumatic life events and conduct an assessment relatively early in the course of intervention.
Dopamine (D2 receptor) dysregulation underly positive symptoms.
Dopamine is associated with attaching salience to a specific stimulus. Therefore, if there is an excess of dopamine activity then a sense of salience will be attached to random stimuli, producing the experiences reported with delusions of reference.
Most anitpsychotic medication influence the dopamine system.
There is considerable evidence for a hereditary component to schizophrenia.
Antipsychotic drugs are known to be effective but also associated with side effect like drowsiness, weight gain, extrapyramidal side effects.
Schizophrenia patient have shown to have cognitive deficits both before the onset throughout the course of the disorder.
Two CB models have been proposed by Garety et. al. They both incorporate the role of negative core beliefs, hypervigilance for threat, scanning for confirmatory evidence and safety behavior.
Cognitive Behavioral Treatment for psychosis (CBTp). A meta-analysis showed moderate positive effects.
Contradictory information from parents produce unavoidable conflict from which the child mentally withdraw.
"Expressed emotion" (EE)
The emotional atmosphere of a family, and how this appears to be associated with the relapse of psychotic symptoms.
Relapse of positive symptoms was associated with family environments that were hostile, critical or overinvolved.
Interventions aimed at reducing EE (particularly through psychoeducation) have shown to reduce rates of relapse significantly.
Self-labeling due to stigma.
CBT and psychoeducation may benefit the patient.
Recent findings have contributed to what is widely accepted to be a genetic vulnerability, which has evolved into a