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Questions and Answers
What is the prevalence of schizophrenia?
What is the prevalence of schizophrenia?
Lifetime prevalence just under 1%
What are delusions in schizophrenia?
What are delusions in schizophrenia?
What is a hallucination in schizophrenia?
What is a hallucination in schizophrenia?
What percentage of patients can be considered as having a favorable outcome 15 to 25 years after the development of the disorder?
What percentage of patients can be considered as having a favorable outcome 15 to 25 years after the development of the disorder?
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______ is a disorder of thought form in schizophrenia.
______ is a disorder of thought form in schizophrenia.
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What are negative symptoms in schizophrenia?
What are negative symptoms in schizophrenia?
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Which type of antipsychotic medication blocks the action of dopamine?
Which type of antipsychotic medication blocks the action of dopamine?
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All patients benefit from antipsychotic medications.
All patients benefit from antipsychotic medications.
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Which type of therapy focuses on improving cognitive skills?
Which type of therapy focuses on improving cognitive skills?
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What is a core feature of schizophrenia?
What is a core feature of schizophrenia?
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Lower IQ is a protective factor for schizophrenia.
Lower IQ is a protective factor for schizophrenia.
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What is impaired in patients with schizophrenia?
What is impaired in patients with schizophrenia?
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What is affected in patients with schizophrenia?
What is affected in patients with schizophrenia?
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What is abnormal in patients with schizophrenia?
What is abnormal in patients with schizophrenia?
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What is correlated with cognitive impairments in patients with schizophrenia?
What is correlated with cognitive impairments in patients with schizophrenia?
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What is a problem in patients with schizophrenia?
What is a problem in patients with schizophrenia?
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What is abnormally low in some patients with schizophrenia?
What is abnormally low in some patients with schizophrenia?
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What is a problem in the brain of patients with schizophrenia?
What is a problem in the brain of patients with schizophrenia?
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What is missing in patients with schizophrenia?
What is missing in patients with schizophrenia?
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What is a risk factor for schizophrenia?
What is a risk factor for schizophrenia?
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What is associated with abnormal states?
What is associated with abnormal states?
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Bad families cause schizophrenia.
Bad families cause schizophrenia.
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What environment more than doubles the chance of a relapse?
What environment more than doubles the chance of a relapse?
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What is a risk factor for schizophrenia?
What is a risk factor for schizophrenia?
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What is a risk factor for schizophrenia?
What is a risk factor for schizophrenia?
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What is a correlate of schizophrenia?
What is a correlate of schizophrenia?
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What is a diathesis-stress model of schizophrenia?
What is a diathesis-stress model of schizophrenia?
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Study Notes
Schizophrenia and Other Psychotic Disorders
Prevalence and Epidemiology
- Lifetime prevalence of schizophrenia: just under 1%
- Age of onset: 18-30 years old, more common and severe in men
- Risk factors: older father, parent in dry cleaning business, first- and second-generation immigrants (especially from black Caribbean and African countries)
- Schizophrenia tends to "run in families" - 10% prevalence in first-degree relatives and 3% in second-degree relatives
Clinical Picture
- Delusions: fixed, firm beliefs despite clear contradictory evidence, e.g. being controlled by external agents, private thoughts being broadcast
- Hallucinations: sensory experiences without external stimuli, most common in auditory modality
- Disorganized speech: disorder of thought form, using language in unconventional ways
- Disorganized behavior: impairment of goal-directed activity, e.g. catatonia, unusual dress, and behavior
- Negative symptoms: absence or deficit of normally present behaviors, e.g. reduced expressive behavior, avolition
Other Psychotic Disorders
- Schizoaffective disorder: features of schizophrenia and severe mood disorder
- Schizophreniform disorder: schizophrenia-like psychoses lasting at least 1 month but less than 6 months
- Delusional disorder: delusional beliefs with otherwise normal behavior
- Brief psychotic disorder: sudden onset of psychotic symptoms or disorganized speech or catatonic behavior
Genetic and Biological Factors
- Genetic factors: schizophrenia tends to "run in families", higher concordance rates in identical twins
- Molecular genetics: candidate genes involved in processes believed to be aberrant in schizophrenia
- Endophenotypes: discrete, stable, and measurable traits thought to be under genetic control
- Prenatal exposures: viral infection, rhesus incompatibility, and pregnancy and birth complications
- Interaction between genes and environment: genetic liability may predispose individuals to suffer more from environmental factors
Brain Abnormalities
- Neurocognition: cognitive impairment is a core feature of schizophrenia, lower IQ may be a risk factor
- Social cognition: impaired recognition, thinking, and response to social information
- Loss of brain volume: patients with schizophrenia have enlarged brain ventricles, progressive brain deterioration
- Affected brain areas: reductions in frontal and temporal lobe volume, white matter problems, and impaired brain functioning
Psychosocial and Cultural Aspects
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Family environment: adverse family environments have little consequence if child is not at genetic risk for schizophrenia
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Cultural factors: schizophrenia may be triggered or exacerbated by cultural and social factors### Psychosocial and Cultural Aspects of Schizophrenia
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Expressed emotion (EE) is a measure of the family environment based on how a family member speaks about the patient during a private interview with a researcher.
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Three main elements of EE: criticism, hostility, and emotional overinvolvement (EOI).
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High-EE home environment more than doubles the chance of a relapse, especially for chronically ill patients.
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Researchers are still trying to understand how EE affects the brain.
Urban Living and Schizophrenia
- Children who spend the first 15 years of life in an urban setting are 2.75 times more likely to develop schizophrenia than those in rural settings.
- If everyone lived in relatively rural settings, the number of schizophrenia cases could decrease by 30%.
Immigration and Schizophrenia
- Recent immigrants have a much higher risk of developing schizophrenia.
- There is no evidence that this can be explained by cultural misunderstandings.
- Immigrants with darker skin have a much higher risk of developing schizophrenia than those with lighter skin.
- Healthy people who feel discriminated against are more likely to develop psychotic symptoms than healthy people who do not perceive any discrimination.
Cannabis Use and Abuse
- People with schizophrenia are twice as likely to smoke cannabis as people in the general population.
- Cannabis may accelerate the progressive brain changes that seem to go along with schizophrenia.
- Patients with schizophrenia who also use cannabis show more loss of gray matter over the course of a 5-year follow-up than patients who do not use cannabis or healthy controls.
Diathesis-Stress Model of Schizophrenia
- Biological factors play a role in schizophrenia, including genetic predispositions shaped by environmental factors such as prenatal exposures, infections, and stressors.
- No simple answer to what causes schizophrenia; genetics and environment combine in such a way that brain pathways develop abnormally.
- Nongenetic risk factors for schizophrenia include older father, virus exposure, obstetric complications, urban upbringing, head injury, cannabis use, and migrant status.
Clinical Outcome and Treatment of Schizophrenia
- Around 38% of patients have a favorable outcome and can be thought of as being recovered 15 to 25 years after development of the disorder.
- Around 12% of patients need long-term institutionalization.
- Around one-third show signs of continued negative symptoms.
Pharmacological Approaches
- First-generation antipsychotics block the action of dopamine.
- Second-generation antipsychotics have fewer extrapyramidal symptoms.
- Researching the role of estrogen may provide new treatment options.
The Patient's Perspective and Other Approaches
- Not all patients benefit from antipsychotic medications.
- May show clinical improvement but still need help.
- Side effects may lead patients to discontinue taking the medication.
- Some patients may try to avoid taking medications because, to them, needing to take medications confirms that they are mentally ill.
- Case management, family therapy, psychoeducation, social-skills training, cognitive remediation, cognitive-behavior therapy, and exercise may also be useful in treating schizophrenia.
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Description
Learn about the prevalence and symptoms of schizophrenia, as well as other psychotic disorders and their differences. Explore the genetic and biological risk factors and more.
