Podcast
Questions and Answers
What term did Eugen Bleuler use to describe the splitting of psychic functioning in dementia praecox?
Which of the following is NOT considered a primary symptom according to Bleuler’s 4 As?
What did Kurt Schneider identify as a first rank symptom of schizophrenia?
According to DSM-5 criteria, what is a requirement for the diagnosis of schizophrenia?
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Which type according to Ernst Kretschmer is associated with a propensity for schizophrenia?
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Which of the following symptoms must be present for most of a month if untreated according to DSM-5?
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What is considered a negative symptom of schizophrenia?
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What distinguishes the asthenic and pyknic types in Kretschmer's classification?
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What characterizes grossly disorganized or catatonic behavior in individuals?
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Which of the following symptoms is classified under negative symptoms of schizophrenia?
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What is the definition of alogia in the context of schizophrenia?
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Which subtype of schizophrenia is characterized by stereotypical behaviors and a generally childish demeanor?
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What does the term 'avolition' refer to in the context of negative symptoms?
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Which phase is typically the first in the typical course of schizophrenia?
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What is commonly observed in individuals with reduced emotional expression?
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What was the DSM 5's decision regarding the classification of schizophrenia subtypes?
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What is a common presentation of depression in children prior to puberty?
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What percentage of individuals with major depressive disorder experience full remission within 6-12 months?
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Which of the following factors is identified as a general medical factor linked to major depressive disorder?
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In elderly individuals, what is a common misconception regarding their depression symptoms?
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What is the heritability percentage of major depressive disorder as indicated in genetic findings?
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Which neurotransmitters are primarily involved in the monoamine hypothesis of major depressive disorder?
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Which of the following is NOT a characteristic associated with the course of major depressive disorder?
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What commonly occurs in adolescents presenting with major depressive disorder?
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What is a key concept of Beck’s negative cognitive triad in relation to depression?
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How does chronic stress affect the brain according to the HPA axis hypothesis?
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What is the relationship between serotonin levels and suicidal behavior?
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What does cognitive behavioral therapy (CBT) target in treating depression?
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Which of the following statements about resperine is true?
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What condition is characterized by hyperactivity of the HPA axis?
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What results from the depletion of serotonin precursors in healthy individuals?
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Which of the following is a limitation associated with antidepressants?
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What is suggested as a potential risk factor for depression according to the HPA axis hypothesis?
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Which discovery can be associated with the gut-brain axis hypothesis?
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How do fecal microbiota transplants (FMT) from anxious and non-anxious mice differ in their effects?
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What cognitive impairments are observed in Major Depressive Disorder (MDD)?
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In comparisons between BPD and MDD, what is noted about executive functioning?
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What kind of cognitive test results were observed in the 48-year-old man with a history of depression?
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What association was found between fecal microbiota transplantation (FMT) for IBS and mood changes?
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What distinguishes the impairment in cognitive function between BPD and MDD?
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Study Notes
Dementia Praecox & Schizophrenia
- Dementia praecox was originally thought to be a biological illness with hallucinations, delusions, and a deteriorating course.
- Eugen Bleuler renamed the concept to "schizophrenia" in 1908, identifying it as a group of illnesses characterized by a "splitting" of psychic functioning, not split personality.
- Key symptoms of schizophrenia include disturbances in associations, affect, ambivalence, and autism (withdrawal into their own world).
- These symptoms indicate a disconnection between thoughts, emotions, and behaviors, leading to difficulty interacting with the world.
Ernst Kretschmer's Approach to Diagnosis
- Kretschmer proposed a link between body type and mental illness: asthenic types (thin and weak) were prone to schizophrenia, while pyknic types (squat and fleshy) were prone to bipolar disorder.
- He correlated body type with criminal behavior: asthenic types were more likely involved in petty theft and fraud, athletic types in violent crimes, and pyknic types in both.
Kurt Schneider's Approach to Diagnosis
- Schneider identified "first-rank symptoms" of schizophrenia, including auditory hallucinations (e.g., thought echo, voices commenting on actions), thought insertion and withdrawal, thought broadcasting, passivity experiences (sensation, movements, thoughts), delusional personalization of perceptions, and primary delusions "out of a clear blue sky".
- He also described "second-rank symptoms", which include sudden delusional ideas, perplexity, depressive and euphoric mood changes, and emotional impoverishment
DSM-5 Criteria for Schizophrenia Diagnosis
- The DSM-5 defines schizophrenia based on positive and negative symptoms.
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Positive Symptoms:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
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Negative Symptoms:
- Blunted affect
- Alogia (poverty of speech and thought)
- Avolition (lack of motivation and goal-directed behavior)
- At least two of these symptoms must be present for at least a month, with at least one being a positive symptom.
- The illness must also significantly impair functioning in work, interactions, self-care, or expected development.
- There must be evidence of continuous disturbance for at least 6 months, including a month of symptoms in their untreated state.
Grossly Disorganized/Catatonic Behavior
- This includes a disconnect between the individual's actions and their environment, manifested as either too little (frozen posture, stupor) or too much (bizarre, frenzied, purposeless behavior) movement.
- It also involves bizarre affect, where there's a mismatch between the person's reported emotions and their outward expressions.
- Inappropriate dressing for the weather and being untidy are also common features.
Negative Symptoms
- Affect: Reduced emotion, ranging from blunting to flattening. There may be a contrast between internal and external emotional experiences.
- Alogia: Poverty of speech (limited output) or thought (lack of detail and content in what's said) with the individual often reporting "empty" thoughts.
- Avolition: Lack of impulses and inclinations, leading to inactivity and a lack of engagement.
- Other negative symptoms include social withdrawal, amotivation.
- These symptoms are harder to treat clinically and predict a poor outcome.
Dimensions/Subtypes of Schizophrenia
- There are different types of schizophrenia, including:
- Paranoid: Prominent delusions and hallucinations, with a later onset.
- Disorganized (Hebephrenic): Characterized by "childish silliness" and disorganized behavior.
- Catatonic: Marked by stupor and/or excited behaviors.
- Undifferentiated: Symptoms are difficult to distinguish from other types.
- Residual: Blunting, withdrawal, and mild psychosis.
- Simple Deteriorative: Early onset, negative symptoms, slow course.
- The DSM-5 discontinued these subtypes due to a lack of specificity, reliability, and prognostic value.
Typical Course of Schizophrenia
- Premorbid phase: Late childhood, early adolescence - changes in sleep, grades, and social behavior.
- Prodromal period: Late teens, early 20s - subtle symptoms that might follow significant changes in life (e.g., moving, new school).
ABC of Depression
- The ABC model describes the key components of depression:
- Affective: Feelings of sadness, hopelessness, guilt, worthlessness, loss of interest and pleasure.
- Behavioral: Change in activity level, such as social withdrawal, decreased energy, and sleep disturbances.
- Cognitive: Negative thoughts, difficulty concentrating, and recurring thoughts of death or suicide.
Presentation and Age
- Prior to puberty: Weight gain, irritability, anxiety on separation, and somatic complaints.
- Adolescence: Irritability, rebelliousness, conduct problems, academic decline, and change in friends.
- In the elderly: Agitation, denial of depression, hypochondriacal concerns, memory and concentration problems.
Course of Major Depressive Disorder (MDD)
- Short-term: ~50% experience full remission in 6-12 months.
- Longer-term: ~90% do not have full remission after 2 years.
- Recurrence: ~40-75% experience lifetime recurrence with an average interval of 5 years between episodes. Some have recurrence within a year, while others stay free.
Risk Factors for Depression
- Genetic: Heritability of depression is estimated at ~40%, rising to ~70% in twins with recurrent, severe depression.
- Specific Medical Factors: “vascular depression” linked to microvascular dysfunction, thyroid dysfunction, stroke, traumatic brain injury (TBI), epilepsy, Parkinson’s disease, and steroid/hormonal treatments.
- General Medical Factors: Chronic pain.
The Monoamine Hypothesis
- The hypothesis suggests that depression is caused by an imbalance of one or more monoamines (serotonin, norepinephrine, dopamine) in the brain.
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Evidence for the theory:
- Reduced monoamine levels in people with depression.
- Antidepressants increase monoamine levels and improve mood.
- Depleting dietary precursors of serotonin is associated with relapse in recovered patients.
- Lower levels of serotonin and its by-products in people who died by suicide.
Limitations of the Monoamine Hypothesis
- Low monoamine levels don't automatically cause depression in healthy individuals.
- Antidepressants are ineffective for many.
- Reserpine (which reduces monoamines) induces depression only in a minority.
- Antidepressants increase monoamines quickly but mood changes take several weeks.
- The ideal and problematic levels of monoamines are unknown.
Cognitive Theories of Depression
- Propose that depression arises from negative distortions in perception, memory, and problem-solving.
- This theory suggests an individual’s cognitive vulnerabilities, formed through experiences or trauma, are triggered by similar experiences later in life.
- Beck's negative cognitive triad describes dysfunctional schemas (belief systems) about the self, the world, and the future (e.g., "I'm unlovable, no one loves me, no one ever will").
- Individuals with dysfunctional attitudes similar to Beck's are ~7 times more likely to develop depression and twice as likely to relapse.
- However, it's unclear if negative thoughts cause depression or vice versa.
Cognitive Behavioral Therapy (CBT)
- Remains one of the most effective treatments for depression.
Hypothalamic-Pituitary-Adrenal (HPA) Axis Hypothesis
- The HPA axis is the body's stress system, responsible for the "fight or flight" response.
- Under stress, the HPA axis increases cortisol levels, leading to higher glucose and lower production of brain-derived neurotrophic factor (BDNF).
- Chronic stress can lead to atrophy of the prefrontal cortex, hippocampus, and amygdala, possibly inhibiting neurogenesis (the creation of new neurons) and impairing the HPA axis's ability to return to normal functioning.
- This damage impairs the brain's ability to process negative emotions, display adaptive behaviors, and maintain motivation to engage with the world. It is associated with chronic HPA hyperactivity, which is a consistent finding in depression and is resolved with successful antidepressant treatment.
- It remains unclear whether HPA hyperactivity is a cause or a consequence of depression, but is likely influenced by genetic vulnerabilities and early life experiences.
The Gut-Brain Axis Hypothesis
- Suggests that gut bacteria (microbiota) influence neurotransmitter production, which in turn affects mood.
- There are distinct differences in gut bacteria between depressed and healthy individuals.
- Depleting gut microbiota in rats leads to depression-like behavior, while increasing microbiota reverses this effect.
- Faecal microbiota transplantation (FMT) from anxious or depressed individuals into other animals produces anxiety or depression-like behavior, while FMT from non-anxious or non-depressed individuals produces the opposite effect.
- FMT from depressed humans into rats induces behavioral features of depression.
Depression: A Complex Interaction of Factors
- Depression is increasingly attributed to a combination of recent events that trigger existing long-term vulnerabilities
Cognitive Comparison of Borderline Personality Disorder (BPD) and Major Depressive Disorder (MDD)
- Both BPD and MDD are characterized by cognitive dysfunction, with deficits in sustained and divided attention, processing speed, executive functioning, verbal learning, and memory.
- These deficits tend to be more severe in BPD than in MDD.
- Despite this, there's variation in findings, with some studies showing comparable severity between the disorders.
- The main difference is in verbal memory, mental flexibility, and inhibitory control, which are more impaired in BPD patients than in depressed patients.
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Description
This quiz explores the historical context and evolution of schizophrenia, originally termed dementia praecox by Eugen Bleuler. It also examines Ernst Kretschmer's theories linking body types to mental illnesses, with a focus on schizophrenia and bipolar disorder symptoms.
