Schizophrenia
Diagnosis
Etiology:
Presence of at least 2 core active phase symptoms (delusions, hallucinations, disorganized speech) for at least 1 month. Others include, grossly disorganized behavior, and negative symptoms. Continuous signs of the disorder for at least 6 months.
Dopamine hypothesis: excess of D or oversensitivity to its effects (supported by improvement by introducing drugs that reduce D)
Research
Concordance rates
0.3-0.7% in the general population
monozygotic twins .48, child of two parents with diagnosis, 0.46, bio siblings .10,
high rates for African Americans may be result of misdiagnosis. These individuals are more likely to experience hallucinations and delusions as symptoms of depression and other disorders
Double Bind communication: What is said doesn't match the tone or body language of what is spoken (e.g., She's a good friend) with a sarcastic tone
Treatment
Pharmacological
Traditional Antipsychotics: haloperidol and fluphenazine are classic. Reduce D and great for reducing active phase symptoms. Less effective for negative symptoms (e.g., stunted emotions, facial expression). Side Effects include extrapyramidal effects like tardive dyskinesia(restlessness tremors, spasms), neuroleptic malignant syndrome (high fever, variable blood pressure, severe confusion)
2nd gen / atypical antipsychotic. Treats both positive and negative symptoms, less extrapyramidal effects and tardive dyskinesia. BUT can cause agranulocytosis (decrease in white blood cells)
Clinical
CBT, social skills training, supported employment, psychoeducation
Prognosis
1.) Female, 2.) acute and late (age) onset, 3.) Good premorbid adjustment, 4.) Presence of a precipitating event, 5.) Brief duration of active phase, 6.) insight into illness, 7.) family history of a mood disorder, and 8.) no family history of schizophrenia
Expressed emotion. High levels associated with high risk for relapse and rehospitalization
open criticism or hostility or alternatively, overprotectiveness and emotional overinvolvement
Peak age is mid 20s for males and late 20s for females
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Physiological
elevated levels of serotonin
impairments in dorsolateral prefrontal cortex cause poor working memory. Linked to schizophrenia
Enlarged ventricles. Smaller than normal hippocampus, amygdala, and globus pallidus. Problems in the frontal lobe (hypofrontality) are responsible for negative symptoms and lower than normal performance on certain cognitive tasks