schizophrenia

1. schizophrenia

2. HOW MANY MARKS FOR THIS OPTION ON EXAM? • The Schizophrenia option will constitute between 5-8 marks on the exam. • This schizophrenic option will only be examined in the SHORT ANSWER section of the exam

3. KEY KNOWLEDGE: • This knowledge includes: • Application of a biopsychosocial framework to understanding SCHIZOPHRENIA and its management. • Psychotic Disorder: Schizophrenia • Biological contributing factors: genetic predisposition; drug-induced onset; changes in brain activity; the use of medication that blocks dopamine to treat psychosis • Psychological contributing factors: impaired mechanisms for reasoning and memory, the use of psychotherapies in management including cognitive, behavioural and remediation therapies, stress management • Socio-cultural contributing factors: social disadvantage, trauma and psycho-social stress as risk factors; psychoeducation, supportive social (including family) environments, removal of social stigma • The interaction between biological, psychological and socio-cultural factors which contribute to an understanding of the disorder and its management

5. Psychotic disorder and psychosis • Psychotic disorder used to describe a group of disorders characterised by difficulties with thinking, distorted perceptions and loss of contact with reality • Person has difficulty differentiating between perceptions constructed from reality or self-generated perceptions

6. Psychotic and psychosis • The term psychotic is used to describe someone who is experiencing symptoms of psychotic disorder. • If someone is described as experiencing psychosis it means they are experiencing psychotic symptoms. • It does NOT mean they are: serial killers, psychopaths, violent or dangerous like many films may suggest!

7. Most psychotic disorders develop gradually, although some can occur abruptly. • Presence of psychotic disorder is preceded by recognisable changes in perception, thoughts, feelings and behaviour • This is called the prodromal phase. • Prodromes (early symptoms) can last for up to 2 years before clearly distinguishable symptoms of psychotic disorder are evident.

8. Dsm-iv-tr psychotic disorders

9. misconceptions • Schizophrenics are psychopaths • Schizophrenics are violent and aggressive • Schizophrenics have split personality • Most serial killers are schizophrenic • All schizophrenics are clearly recognisable in the general population

11. What is schizophrenia? – the facts • Extremely complex disorder • People with schizophrenia have just ONE personality • A psychotic disorder characterised by disturbances in thinking, delusions, hallucinations and disorganised behaviour • Commonly have little ‘insight’ into their disorder – they are unaware they have a mental illness • Affects 1% of the population

12. In order to be diagnosed an individual must have some symptoms persisting for at least 6 months

13. Schizophrenia symptoms • Positive symptoms experience that happen in addition to normal experiences: • EG) Hallucinations, delusions, disorganised thought, behaviour and speech processes. • Negative symptoms involve a loss or decrease of normal functioning: • EG) Loss of pleasure, motivation, interest in activities and socialising

14. Delusions • A fixed, false belief that is held with absolute certainty, even when there is strong factual evidence that does not support it. • The following types of delusions are common: • Delusions of persecution • Delusions of reference • Delusions of control • Delusions of grandeur • Thought broadcasting • Thought insertion

15. hallucinations • Perceptual distortions of sensory information during which the individual sees, hears, feels, tastes, or smells something that is interpreted as real but does not exist in reality. • Most common are auditory hallucinations which involve ‘hearing voices’ • Voices heard are usually unfriendly and critical • Critical hallucination: A voice that constantly criticises an individual • Command hallucination: A voice command the individual to do something they would not normally do.

16. Disorganised speech • Speech of schizophrenic sufferers is often illogical, jumbled and disconnected reflecting their disorganised thinking. • Communication with others is often difficult • Common signs of disorganised speech include: • Derailment – Speech that rapidly shifts from one topic to another • Perseveration – Constant repetition of words and statements • Neologisms – Made up words

17. Grossly disorganised or catatonic behaviour • Grossly disorganised behaviour – erratic, inappropriate, unusual and purposeless. • May not attend to personal hygiene, may urinate in the street, may shout obscenities for no reason • Catatonic behaviour – Disturbed actions or movements, or lack of movement. • Agitated state: Person waves arms in air and shouts • Catatonic posturing: Person holds a pose in an awkward position for a long period of time • Catatonic stupor: Person remain motionless for a long period of time • Waxy Flexibility: Person can be moulded to any position like a wax figure

18. Negative symptoms • Loss or absence of normal thought processes, emotions and behaviours. • Affective flattening: Reduction in the range and intensity of emotional expression. • Avolition: Lack of energy or enthusiasm • Alogia: Reduction of speech content and fluency

19. Biological contributing factors • Biological factors contribute to schizophrenia in significant ways as it is considered to be a brain disorder: • Genetic predisposition • Drug induced onset • Lower levels of brain activity in the frontal lobe • Excessive activity of dopamine

20. Genetic predisposition • An increased risk to developing schizophrenia due to factors associated with genetic inheritance. • Having a genetic predisposition puts an individual at higher risk, however, it does not mean they will definitely develop the disorder • No single gene is related to schizophrenia, rather it is a variety of genes that contribute

21. Gottesmans studies (1991) • Concluded schizophrenia is partly genetic in origin

22. DIAGNOSED genetic predisposition 17% 17% 17% 9% DIAGNOSED 9% DIAGNOSED 48%

23. Adoption studies • Eliminates the possibility that being raised in an environment with a parent(s) with schizophrenia increases the likelihood of developing the disorder • Supports hereditary as a contributing factor in schizophrenia

24. DRUG INDUCED ONSET • Some people take drugs recreationally to alter their perception of the world • The use of long term drugs can trigger psychotic symptoms • These drugs include: • 1. Hallucinogens EG) LSD • 2. Stimulants EG) Ecstasy, Cocaine • 3. Phencyclidine EG) ‘Angel Dust’ • 4. Cannabis EG) Marijuana • A person under the influence of the following drugs may see or hear things that don’t exist in reality and they may have paranoid delusions

25. DRUG INDUCED ONSET • Substance-induced psychosis in the DSM is a disorder that is characterised by delusions and hallucinations that are judged to be due to the direct physiological effects of a drug. • For some individuals these psychotic experiences take some time to wear off. • Factors such as the quantity, frequency, potency and half-life of the drug consumed depend on the rate of the psychotic symptoms wearing off. • For some, psychotic symptoms may persist and drug use triggers the onset of a recurrent lifelong psychotic illness such as schizophrenia

26. Changes in brain activity • Neuroimaging devices have provided evidence of specific brain abnormalities in schizophrenics • Brain activity in the prefrontal cortex is reduced – This is known as hypofrontality • Change in temporal lobes. Activation of auditory cortices during auditory hallucinations

27. Dopamine • Neurotransmitter - dopamine believed to have a contributory role in the development of schizophrenia when its activity is excessive or is present in high levels • Dopamine is associated with pleasure, motivation, emotional arousal, and the control of voluntary movements. • In some brain areas low levels of dopamine are related to decreased mobility symptomatic of Parkinson’s disease. • In other brain areas dopamine is associated with a distinct sense of pleasure and often called the dopamine reward system.

28. Dopamine hypothesis • Positive symptoms of schizophrenia are related to excessive activity of dopamine. • Dopamine hypothesis based on two observations: • 1/ Anti-psychotic medication blocks dopamine to reduce psychotic symptoms • 2/ Drugs that enhance dopamine (EG. Amphetamines) induce psychotic symptoms. • Not all schizophrenia sufferers respond to anti-psychotic medication • Research has shown there may be a number of neurotransmitters and biochemical processes involved in psychotic symptoms.

29. Anti-psychotic medications • Anti-psychotic medications are drugs designed to relieve the symptoms of psychosis • Anti-psychotics are dopamine antagonists which means they reduce the symptoms of psychosis by blocking dopamine activity at the synapse.

30. Anti-psychotic medications • There are two main types of anti-psychotic • medications: • Typical anti-psychotics: the older ‘first generation’ of anti-psychotics that were developed during the 1950s. • Atypical anti-psychotics: the newer ‘second generation’ of anti-psychotics that have been developed since the 1990s. • Atypical anti-psychotics have fewer side effects.

31. Limitations of Anti-psychotic medications • They do not cure schizophrenia • Psychotic symptoms return if the person stops taking the medication • The medications can produce a number of very unpleasant side effects, such as nausea and weight gain, that can cause people to stop taking their medication • Although anti-psychotics can block dopamine activity almost instantly (within minutes), psychotic symptoms usually do not subside until about four to six weeks and it can take several months before the full benefits are felt

32. Psychological contributing factors • Two cognitive problems that have been extensively researched in relation to schizophrenia are impairments in reasoning and memory.

33. Impairments in reasoning • Reasoning involves goal-directed thinking in which inferences are made or conclusions are drawn from known or assumed facts or pieces of information • Probabilistic reasoning involves making judgments related to probability, or the likelihood of something happening or being true • Probabilistic reasoning impairment is a contributing factor to delusions.

34. Impairments in memory • Memory impairment among individuals with schizophrenia can involve all memory systems, including sensory memory, working memory and/or all types of long-term memory • Memory impairment is often described as one of the major disabilities associated with schizophrenia

35. CBT • According to CBT, people with schizophrenia have a different reasoning style to people who do not have schizophrenia • A commonly used therapy involves assisting the individual with schizophrenia to identify and change the thoughts responsible for maintaining their symptoms • CBT attempts to: • identify the thoughts that may be misinterpretations of situations • carefully examine each thought and evaluate how realistic it is • Try to generate alternative thoughts that are more realistic, helpful and balanced.

36. The cognitive component of CBT in the management of schizophrenia often involves helping the client to become aware that in some situations they may be ‘jumping to conclusions’, identify the thoughts that may be misinterpretations of situations, carefully examine each thought and evaluate how realistic it is, and to try to generate alternative thoughts that are more realistic, helpful and balanced

38. The behavioural component of CBT in the management of schizophrenia may consist of two components called behavioural experiments and behavioural strategies • Behavioural experiments are planned experiential (‘hands-on’) activities that are undertaken by clients in or between cognitive behavioural therapy sessions. • Behavioural strategies are behaviourally based interventions that help reduce the impact of hallucinations or preoccupation with a delusion on a person’s life. EG) Listening to music.

39. Cognitive remediation • Cognitive remediation refers to the use of training techniques to promote improvement in targeted cognitive impairments. • Techniques may focus on: • • attention and concentration • • reasoning • • problem solving • • decision making

40. Stress management • Stress management the use of various techniques to alleviate or cope with the effects of stress. • EG) Meditation, physical activity etc

41. Socio-cultural contributing factors

42. Social disadvantage • Social disadvantage refers to the range of difficulties that block life opportunities and that prevent people from participating fully in society. • For example: • Poverty • Poor physical or psychological health, • Disability • Lack of education or work skills • Being subject to unfair treatment or discrimination

43. The social causation hypothesis proposes that membership of a low SES group can trigger the development or onset of schizophrenia • The social drift hypothesis proposes that membership of a low SES group, and therefore social disadvantage, is a consequence of schizophrenia.

44. trauma • Trauma refers to an event that a person experiences, witnesses or confronts that is extremely distressing and to which the person’s response involves intense fear, helplessness or horror. • Some examples include: • Childhood sexual, physical or emotional abuse • Rape • Natural disasters • War experiences • Serious car accidents

45. Psycho-social stress • Stress in itself does not cause schizophrenia. Although there is research evidence that stress can act upon a pre-existing vulnerability to trigger the onset of schizophrenia or worsen the symptoms of individuals who have schizophrenia. • A psycho-social stressor is any event arising through interaction with others that causes or contributes to a stress response.

47. psychoeducation • Psychoeducationis the process of increasing an individual’s knowledge and understanding of their mental disorder and its management. • Common in psychoeducation programs for schizophrenia is education about: • The nature of the disorder • What having schizophrenia is like for the individual • What it is like for people living with someone who has schizophrenia • Medication and the role of hospitalisation • Types of psychotherapies that are available and suitable • Schizophrenia course and relapse

48. Research has shown that the more educated a person is about their mental disorder and how it affects their own life and the lives of others, the more control that person has over their disorder. psychoeducation

49. Supportive social environments • Up until the 1960s, people with mental disorders were admitted to a psychiatric hospital • Nowadays, most people with schizophrenia remain in the community with their families • For many people with schizophrenia, their family is the primary source of long-term support. • The primary caregiver may feel anger that this has happened in the family, or grief at how the person has been changed by their illness. • It is important to acknowledge and talk about these feelings, seeking professional support if necessary.

50. Research evidence indicates that the social support provided by members of a person’s social network outside their immediate family is also important in the management of schizophrenia and can reduce the risk of relapse. Social networks