negative symptoms of schizophrenia
Flattened affect/emotional blunting
Reduced speech/paucity of speech
Social withdrawal
Self-neglect
Loss of motivation and initiative
Deficits in WM, executive function and processing speed
positive symptoms of schizophrenia
Hallucinations (perception without a stimulus)
Delusions
Disorganized
speech/thought disorder
Lack of insight (most common)
Failure to appreciate symptoms are not real
suspiciousness
What are delusions
unshakable belief in something that’s untrue
can contain conspiracy and thoughts or actions of being controlled by external force or person
When the patient tries to make sense of hallucinations it can lead to the development of delusions
When do postive and negative symptoms occur?
Most patients start with negative symptoms during childhoor, and later with the onset of positive symptoms they look for clinical help
What factor may contiubute in their development to having delusion?
Early life experiences such as bullying or child abuse may lead to cognitive biases (e.g. tendency to view negative events as resulting from the hostile acts of others) – cognitive biases are more common in people at risk of schizophrenia
When is schizophrenia usually diagnosed?
late adolescence or early adulthood
But there are mild cognitive and motor impairments in childhood
Causes: Genetic factor.
GREATEST RISK FACTOR: positive family history
Heritability of schizophrenia = 80%
Lifetime risk in the general population = below 1%,
Schizo is a …. (genes) disorder
Polygenic disorder: More than 100 loci are significantly associated with schizophrenia that interact with each other and the environment
Enviromental factor
experienced premature birth
in utero adversity (e.g. maternal infections, starvation during pregnancy)
low birth weight
oxygen deficiency in the tissues immediately before and after birth
Environmental stressors (e.g. social isolation, urban life, migrants because they are a racial/ethnic minority)
Patients with supportive parents do better than patients with critical or hostile parennts
WHat do these early enviromental factors indicate?
This indicates that its pathogenesis begins early in neurodevelopment, despite its appearance in early adulthood
Can appear as mild cognitive and motor impairments in childhood (e.g. falling behind in class)
G x E interaction
risk factors point to an interaction between biological, psychological and social risk factors
E.g., support: o risk for schizophrenia explained by polygenic risk scores was x5 greater in those who experienced perinatal complications
Drug abuse
Cocaine + amphetamines can induce a picture identical to paranoid schizophrenia
-Patients with schizophrenia smoke more cannabis than the general population
->Early cannabis use increases future risk of schizophrenia x2
Clinical course of schizo
(explain graph of neg and pos symptoms)
-Negative symptoms are more stable (no treatment) and positive go up and down
- Pos symptoms disappear or get much lower but negative stay the same
Treatment medication
Atypical antipsychotics (D2 recepot blockers)
Clozapine
ONLY IMROVE POS SYMPTOMS
Treatment Psychological
3
CBT
Family therapy
Psychoeducation
CBT
can reduce persistent symptoms + improve insight by reappraising symptoms and breaking down cognitive biases
Has the potential to break the cycle in which the stress of experiencing psychosis is itself an exacerbating
Is Psychodynamic therapy useful in Schizo patients?
no it increases relapse risk
Is the common perception true that schozi has a poor recovery prognosis?
No
More than 80% of patients with their 1st episode of psychosis will recover
but Many patients have a lifelong vulnerability to recurrent episodes of illness
Are people with schizophrenia aggressive?
yes they are more likely than persons without this disorder to engage in AGB toward others
are people with schizophrenia more criminal?
yes they are at increased risk for nonviolent crime, at higher risk to engage in violent crime, and at even higher risk to kill as compared to the general population
2 pathways that lead schizophrenics to be aggressive
- History of antisocial behaviour that began in childhood
- no history of antisocial behaviour before AGB
History of antisocial behaviour that began in childhood
Most people with schizophrenia who commit crimes engage in delinquency (Straftat) and/or AGB prior to the first episode
20-40% with schizo in adulthood have Childhood conduct disorder before
Individuals with CD in childhood/adolescence + schizophrenia in adulthood are responsible for most crimes committed by schizophrenics
Antisocial behavior that onsets in childhood and remains stable over the life span
Factors (genetic and environmental) contributing to schizophrenia that is preceded by CD include
Failing to learn no-to-behave aggressively in early childhood
Impairments in understanding emotions in the faces of others
Maltreatment/nonoptimal parenting
§ Subsequent re-victimization
no history of antisocial behaviour before AGB
Others with no history of antisocial behaviour begin engaging in AGB as illness onsets
Hypothesis: AGB is a response to increased positive symptoms, reflecting an increase in dopamine production that leads to stress dysregulation
-> f patients take antipsychotics (which reduce positive symptoms) AGB will decrease
delusions when accompanied by anger
