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Welcome to the Schizophrenia WikiaEdit

CLASS PROJECT ONLY. TYLER CHRISTIAN THOMPSON. ABNORMAL PSYCHOLOGY. This wiki covers all essential information with regards to schizophrenia. Early history, symptoms, prevalence, causes, and treatments will be discussed.

Early HistoryEdit

In 1899, German psychiatrist Emil Kraeplin expanded on the publications of Haslam, Morel, and Pinel to give us a comprehensive overview of the disorder. Kraeplin had two significant contributions to the field of psychopathology. First, he consolidated three symptoms previously thought of as distinct disorders: paranoia, hebephrenia, and catatonia. He believed them to all be related and included them under the term "dementia praecox", premature loss of the mind. Second, he separated dementia praecox from bipolar disorder.

Eugen Blueler, a Swiss psychiatrist coined the name we use today, "schizophrenia". It comes from the Greek words for "split" and "mind". He believed that the behaviors shown by schizophrenia were the result of associative splitting of the basic functions of personality. Affected individuals' inability to hold a constant stream of thought lead to his conclusion that the connections in the brain responsible for diverse functions were destroyed or blocked, and that explained the diverse symptoms associated with the disorder.

Symptoms Edit

The symptoms of schizophrenia are diverse and cover a wide array of behaviors. These symptoms can impact all areas of functioning that we rely on every day. Symptoms are divided into three groups: positive, negative, and disorganized.

Positive Symptoms Edit

These are described as the obvious forms of psychosis. It is important to note that here, "positive" does not mean good or beneficial. It refers to visibility and active manifestations of abnormal behavior, as they are not seen in healthy individuals. These psychotic behaviors include hallucinations and delusions.

Hallucinations Edit

Hallucinations are imagined and disturbed sensory input. People with hallucinations see, hear, feel, or smell things that no one else can. The most common hallucinations involve hearing voices. The auditory hallucination is very interesting, because there is a true physical response to the voices. During an auditory hallucination, blood flows into Broca's area of the brain, the region responsible for speech production. Individuals with schizophrenia aren't hearing anything from the outside world, they are "listening" to themselves and believing that the words are coming from someone else.

Delusions Edit

False beliefs that are unchanging in the face of evidence are classified as delusions. These misrepresentations of reality are also known as disorders of thought content. There are two main types of delusions and two views of the cause of these delusions.

Delusions of Grandeur Edit

The mistaken belief that one is famous or extremely powerful is a delusion of grandeur. Many people believe they have special powers that will save the world or that their actions will influence world history. A famous example of grandeur is The Three Christs of Ypsilanti. In this case study, three men believing to be Jesus are put together and studied. Amazingly enough, each one concluded that the other two were mentally ill, while remaining steadfast in his belief that he was Jesus.

Delusions of Persecution Edit

A delusion of persecution is any belief that someone or some group is trying to harm you in some way. The method could be through spying, stalking, poisoning, or plotting to murder.

Negative Symptoms Edit

This cluster of symptoms is characterized as a lack of normal emotion and behavior. These symptoms include avoltion, alogia, anhedonia, and affective flattening. These symptoms are harder to identify than positive symptoms and are often misinterpreted as symptoms of depression.

Avolition Edit

Sometimes referred to as apathy, avolition is the inability to initiate and persist in basic activities. People with this symptom have no interest in performing even basic activities they would otherwise indulge in, such as personal hygiene.

Alogia Edit

Alogia is the absence of speech.The person may respond to questions very briefly and with little enthusiasm. One may feel she is "pulling teeth" to prompt a response to a schizophrenic with alogia. This symptom is not explained by brain damage or lower than average cognition. Some have suggested that this symptom is a result difficulty finding words to express thoughts.

Anhedonia Edit

This symptom refers to a general lack of pleasure in individuals suffering from schizophrenia. Individuals with anhedonia are generally indifferent to activities that are seen as objectively pleasurable like eating and sexual relations.

Affective Flattening Edit

The affect of a person is the observable expression of emotion through gestures and facial expression. One has a flat affect when there is diminished emotional expressiveness. Normal signs of emotion such as laughter or crying may be absent when those behaviors are appropriate. Speaking in monotone is another example of flattening.

Disorganized Symptoms Edit

These symptoms are thought of as erratic and haphazard patterns of speech, motor function, and emotional response that don't fit into the positive or negative symptoms clusters.

Disorganized Speech Edit

People with schizophrenia may ramble on illogical subjects that have no meaning, jump from topic to topic in quick succession, or refuse to answer questions and respond with randomness. Tangentiality is often used to describe these individuals. They have loose connections in their thoughts and go off on tangents while never coming full circle to finish the original thought. This video gives an example of someone with disorganized speech associated with schizophrenia.

Disorganized Affect and Behavior Edit

Disorganized behavior can include shouting, agitation, or other outbursts when not appropriate. Catatonia is also observed. Many individuals seem to have "waxy flexibility" and move only when someone else positions him or her. Emotions are absent or wildly out of control. 

Etiology Edit

Onset of schizophrenia is associated with several different factors. Genetic, neurobiological, psychological, and social influences contribute to the development of this disorder.

Genetic Influences Edit

Schizophrenia appears to be heritable. Family studies have shown increased risk of developing schizophrenia when a blood relative also has schizophrenia. Monozygotic twins have a 45% chance of sharing the disorder (cite the textbook). Offspring of individuals with schizophrenia have a 12% chance of developing schizophrenia. It has been shown that certain dominant behaviors previously defined as schizophrenia subtypes are not heritable, only a general predisposition for schizophrenia. Portions of chromosomes numbers 1,2,3,5,6,8,10,11,13,20,22 are implicated with the causation of schizophrenia (insert source).

Neurobiological Influences Edit

Dopamine Edit

Dopamine is linked to schizophrenia via circumstantial evidence. Antipsychotic drugs that block the use of dopamine are beneficial to many who suffer from schizophrenia, L-dopa increases dopamine and causes schizophrenic like symptoms in those without schizophrenia, and amphetamines, which increase dopamine, can make psychotic symptoms worse in those with schizophrenia. An increase in dopamine is associated with an increase in schizophrenic symptoms, and those with or those related to individuals with schizophrenia are more excitable and release more dopamine when expecting a reward of any kind[1]. Despite this evidence, other drugs that aren't effective at blocking dopamine's reuptake are also effective in treating schizophrenia, so the relationship between the disorder and dopamine may be more convoluted.

Brain Structure Edit

A number of schizophrenic individuals have enlarged lateral ventricles[2]. The cause for concern is this: the ventricles can only grow larger than normal if other parts of the brain are smaller or underdeveloped. This has led researches to believe that many people with schizophrenia may have a common brain abnormality. Frontal lobes of the brain also seem to be less active in schizophrenics as compared to a healthy individual. Less blood flows through the frontal lobe, indicating lesser functionality.

Prenatal & Perinatal Influences Edit

Some evidence exists to show that mothers' behaviors during pregnancy and complications during birth increase the risk for developing schizophrenia. Expecting mothers who acquire influenza during the second trimester have an increased risk for birthing a child with schizophrenia. The thought behind being that the virus damages fetal brain development. Lack of oxygen during childbirth is also correlated to schizophrenia with the same reasoning as viral infection.

Psychosocial Influences Edit

Stress is implicated with schizophrenia. Many people with schizophrenia note that in the weeks prior to first onset, they had experienced a highly stressful event like death in the family or loss of employment. One research study used a natural disaster to study how people with different illnesses responded to the stress. Schizophrenics uniformly reported low self esteem and avoidance coping. This finding indicates that people with certain responses to stress may be more likely to develop schizophrenia or related symptoms as a result of high stress.

Treatment Edit

The various methods and forms of schizophrenia treatment include biological/pharmacological as well as psychocial interventions.

Antipsychotic Medications Edit

This branch of treatment revolves around the thought that schizophrenia is largely a heritable brain disorder and not a result of poor coping or the environment. The current medicinal treatment for schizophrenia is largely based around neuroleptics. This class of drugs, developed in the 1950's, diminishes the effects of the positive symptoms. Hallucinations and delusions are reduced in many patients. Neuroleptics are dopamine antagonists, their major action is interfering with the dopamine levels and activity in the body. Their efficacy is also contributing to the dopamine theory of schizophrenia as causation. Not every neuroleptic is always helpful to each individual, and one study researched which drugs within the neuroleptic class are beneficial to those who resisted the first generation drugs, using risperidone and clozapine as the alternatives. They found that 67% of the risperidone group and 65% of the clozapine group were clinically improved [3]. Empirical evidence from this study and others alike show the promise and efficacy of the biological intervention.

Psychosocial Intervention Edit

For some, medications do not significantly improve functioning to a level of relative normality. For those individuals who need more help in order to lead productive lives, there is psychological and social therapy. The real dysfunction with schizophrenia is a result of erratic symptoms that impede on patients' abilities to lead full lives. Many are homeless, jobless, and have few social peers. Psychosocial treatment aims to give people with schizophrenia extra social, occupational, and life skills necessary to contribute to society and have healthy lives. Family therapy, group homes, assertive community treatment, and vocational rehabilitation are all examples of effective treatment plans [4].

Combatting Stigma Edit

Many individuals with schizophrenia endure forms of stigma. They are labeled as dangerous and selectively avoided. Families affected by the disorder routinely hide the problem from their peers and neighbors. The stigma attached to the afflicted is without merit. Most schizophrenics aren't dangerous or violent, and in most cases, the violence is self inflicted. Because of so much fear about these people, many do not offer help, which leads to further deterioration and more schizophrenics living on the street. Society is worsened when we turn our backs on people with mental health issues. It is not voluntary and it isn't their fault, so we should not abandon people who desperately need our help.

Resources Edit

This section is for those seeking help for themselves or for others. The DSM has more concrete information for diagnosis and access to helplines, as does the national institute of mental health.

http://www.oregon.gov/dhs/vr/ovrs%20inservice/DSM%20IV%20diagnostic%20criteria%20session%20I%20-%20Schizophrenia%20and%20Psychosis.pdf

http://www.nimh.nih.gov/health/publications/schizophrenia-easy-to-read/index.shtml

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