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Schizophrenia Spectrum Disorders


Schizophrenia. So most movies that depict Schizophrenia are pretty bad, usually showing individuals as murderers, monsters, or relating them to the supernatural. However, these three I think are pretty good. A Beautiful Mind, I Never Promised You a Rose Garden, and Canvas. So if your interested in getting more of a qualitative sense of some of these conditions, check out some of the movies.

And like I said in the previous lesson, unless otherwise stated, the narrative quotes here are from, voices from the inside. These are some of the topics we're gonna be looking over. So classifications, symptoms, prevalence, risk factors, physiology and treatments. Classifying Schizophrenia Spectrum. Okay, so these are the eight disorders that are contained within the category, Schizophrenia Spectrum and you don't need to know much about most of these.

We're mostly gonna just be looking at Schizophrenia. I'm gonna say a little bit about these three. And just so you know why we're not talking about these four at the bottom, Schizotypal, I covered this in Personality Disorders. This is a condition that, for whatever reason, the DSM 5 puts this in both, Schizophrenia and in Personality Disorders.

A Brief Pyschotic Disorders when someone has a psychotic break and it lasts less than a month and then the person experiences full recovery. And then, these aren't really schizophrenic conditions, this is when symptoms appear like Schizoprhenia. So Substance could be methamphetamines LSD, a medical condition, maybe a brain tumor or epilepsy would produce visual hallucinations in some cases.

So let's look at these top four. And I'm gonna start with Schizophrenia. And before I move onto the next slide, just a little word on prevalence. So I've got all these very fine-tuned percentages up here, right? Thing to know about Schizophrenia. If you just remember 1%.

1% prevalence that's super oversimplified but I think if you just know Schizophrenia has about a prevalence of 1% you're okay. Schizophrenia is a mental condition that tends to be serious and chronic. It's found across cultures, and it usually first presents in late teens, 20s, or 30s, includes distortions in perception, thought, communication. And it tends to come on gradually.

And a diagnosis doesn't occur until after six consecutive months of symptoms. Do you need to know that? Well I think so actually because that's what distinguishes Schizophrenia from some of its related diagnoses. So just know six consecutive months. Schizophreniform Disorder is just like schizophrenia but the symptoms are only present one to five of the six months prior to diagnosis.

And so a lot of people with Schizophreniform go on to develop schizophrenia. Schizoaffective disorder is a type of Schizophrenia condition that is accompanied by strong mood symptoms. That resemble bipolar or depressive disorders and so this is above and beyond the agitation which is actually quite common among people with schizophrenia.

We're talking about mania and depression here and, Delusional Disorder, a type of psychosis consisting of delusions but without hallucinations or cognitive confusion. And in the next few slides, I'm gonna talk about symptoms, and so it'll be more clear what are the differences here. What are delusions, what are hallucinations and what do I mean by cognitive confusion.

The symptoms of schizophrenia fall into four major categories. Positive, negative, cognitive, and mood and most people will have symptoms in more than one category. Positive symptoms include hallucinations, delusions, agitation, and they are the type of symptom we usually think of when we hear the word schizophrenia. And that's because they're the most striking symptoms.

They are sometimes also called effective or paranoid symptoms. And agitation we're all familiar with's, a state of extreme irritability. Hallucinations involve the experience of directly perceiving something that isn't physically present. In schizophrenia this tends to be auditory. 75% of people with schizophrenia have auditory hallucinations and as you probably know these are not just simple thoughts, or fantasies, or internal dialogue.

They're experienced as vividly real and unfortunately they often also are cruel or scary. A delusion is an unrealistic belief or attitude that is firmly held in the absence of evidence. And yes, this is subject to cultural norms and judgments. Some of the most influential innovators were once called delusional.

But here, we're mostly talking about a false sense of a situation, such as an outlandish conspiracy theory, of believing one is a deity, having delusions about being famous. Those are some common experiences among those who have delusions. Captured in one woman's experience with schizophrenia, Lori Schiller, My voices egged me on but they never seemed satisfied.

I was never good enough for the rude chanting demons in my head. The only thing that seemed to placate them was when I hurt myself. So, she's discussing positive symptoms of course, right because this a hallucination. And one thing I wanna point out also about this quote is that in this case she 's experiencing the voiced within her head.

And some people have auditory hallucinations where the voices seem to be coming from outside of their own body. And here we see more about the scary quality of the hallucinations that many people experience. The voices taught me about a hell that was beyond all religious beliefs. It was worse than the worst horror movie I had ever seen, worse than my worst nightmare.

And it was completely and totally real. The voices told me so. And the voices told me they would take me there. Here we are looking at both hallucinations and delusions. So the belief that what is going on is real. There can often be a paranoid quality to both hallucinations and delusions, so for instance believing a voice is out to get them, believing aliens are coming, FBI is tracking, these are all very common.

But sometimes the hallucinations and delusions do have cheerful qualities too. They're not always negative, hallucinations can also be visual, although less frequently so, which we see here. Looking in the mirror I could see that my body had become a composite of all bodies. Half my face was Asian, an arm and leg were black, but it was more subtle than that.

Everything that had ever lived had contributed their best cell to make what I now called me. So in a certain light, this could actually seems more maybe insightful or profound than psychotic. But again, we're not looking at symbolic or thought-based, this is an actual hallucination.

Okay, so those were all examples of positive symptoms. Negative symptoms are often described as flat affect, showing no emotion, could be not talking, blanking out, may be the person talks but in, In a way without expression. And just for the record, people with depression are also often described as having flat affect.

Cognitive symptoms in which the person is disoriented. There's a lot of confusion, attention difficulties, could be disorganized speech, and mood symptoms. Which refer to unusual emotional patterns that seem to contradict the situation. And example of this would be being cheerful about being suicidal. Or being angry about something like the color of the house or getting something in the mail and not being able to describe it in a way that's an outsider would be able to understand the justification for the anger.

So let's move on to talking about Prevalence and Gender. More men have schizophrenia. And you don't need to know the exact difference because it's not a huge difference. And it varies by culture a bit, it's less than twice as many. Men develop it a little earlier in life, and they have more negative symptoms than do women.

Women initially respond better to treatment, but their symptoms tend to worsen more overtime. And both of these could be due to, they could be psychological, they could be about compliance issues to be taking medication, it's not really clear. One other thing to know is that women are uniquely vulnerable, one example is that some cultures that's believe that mental illness can be cured through marriage.

And so a woman who's having these kinds of symptoms might be paired up with somebody through an arranged marriage. And in that case where she's both, basically living with a stranger and also having these symptoms, abuse is far more likely. What are the risk factors? Well schizophrenia does have a strong genetic component, but many people with a predisposition never develop the disorder.

Among identical twins, if one child develops schizophrenia, there's about a 40 to 60% likelihood that you're going to see the condition appear in the twin as well. Even if the twins are raised by different families. Don't need to memorize those actual statistics, but do know that twin studies have contributed to the view that schizophrenia is partly genetic. There's a saying in public health that genetics loads the gun and environment pulls the trigger.

And so what that means is that with a lot of conditions there's a predisposition, but it's not necessarily going to manifest unless certain situations occur. And what types of environmental influences then might increase the likelihood that someone will develop Schizophrenia? Well in the next item am gonna rattle of a bunch or risk factors but please keep in mind that Schizophrenia a lot of people, with Schizophrenia had pretty regular happy childhoods.

But any of these conditions here can increase the likelihood of the schizophrenia developing. Having a close relative, being malnourished as an infant, autoimmune condition. Trauma such as violence or living in a war area, poverty, near poverty, being an immigrant or migrant, urban environments, uniquely triggers schizophrenia, and using cannabis, especially as a young teen.

Although, that last point has been debated for decades. I only even put this up here because recently, in the last three years or so, there has been a lot of research that indicates there probably is some role. That cannabis actually does play, these are going to be more strong correlations. Physiological correlates, I'm going to talk a little bit about neurological characteristics of some people with schizophrenia.

An underactive frontal lobe, and that's true in most mental disorders including bipolar and depression. An overactive parietal lobe and that makes sense because the parietal lobe is where a lot of sensory perception occurs. And so people with schizophrenia have more of this activity going on and that's consistent with hallucinations.

Scientists used to believe that the problem with schizophrenia was having too much dopamine. And that's because dopamine blockers have been so successful in treating a lot of patients with psychotic symptoms, but it's actually more complicated than that. In this picture we see this purple line here that kind of extends up this way right.

All of these purple lines are meant to indicate dopamine pathways within the brain. And with schizophrenia they found that on average there are lower dopamine levels in the frontal lobe. So there wouldn't be much dopamine coming up this direction. But there are higher than average dopamine levels in the mesolimbic region.

And the mesolimbic region is what I have here in this green box, so it's that whole area, what looks to be the head of the soma here. Is the ventral tegmental area. The dopamine from there is released into the nucleus accumbens here where the axon terminal is projecting. And so this pattern of having high levels of dopamine in the mesolimbic area Is particularly correlated with positive symptoms of schizophrenia.

It's also just a very powerful pathway in the process for a lot of people. It's active in addictions. The mesolimbic pathway is sometimes also called the reward pathway or addiction pathway. And one last thing I'll say for physiology is that, among those who've had symptoms for many years, there are often enlarged lateral ventricles.

And that happens normally in the aging process anyway, but it that happens earlier among those with schizophrenia. Another part of the brain that's typically affected in schizophrenia is the corpus callosum. And also it's common to see a reduction in frontal lobe volume. Okay, so treatments, antipsychotics.

You don't need to know the specific names of any the medications, but I think you should know the chemistry. At the very most general level. So know that most antipsychotics are dopamine antagonists. They block dopamine. In addition to that, some also have histamine blocking activity.

In other instances we'll see some kind of medication probably a dopamine antagonist that is also a serotonin antagonist. And then in other cases we have dopamine antagonists that are paired with serotonin agonists. So just know that all of these can be blocked to treat schizophrenia and in some cases serotonin seems to be helpful.

Social and behavioral treatments are typically geared to help people cope with the symptoms they have. And for avoiding or reducing the risks or the impacts of things such as substance use disorders, unemployment, social isolation. Group therapy works well for many people. On average those with schizophrenia die about 15 years earlier than the general population.

However with good treatment many individuals can live a long time, have families, jobs, hobbies we associate with a full life. And some people with schizophrenia only ever have one or two times of their life when they actually experience the full-blown symptoms. And so I've been presenting this from a more extreme perspective, but there's a variety of intensity.

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