Neuropsychiatric Conditions and Schizophrenia
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Neuropsychiatric Conditions and Schizophrenia

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Which of the following is NOT considered a neuropsychiatric condition?

  • Mental illnesses
  • Acute stress response (correct)
  • Sleep disorders
  • Neurodegenerative conditions

    • What term did Eugen Bleuler introduce to describe the fragmentation of the psyche?

  • Dementia praecox
  • Neurodegeneration
  • Schizophrenia (correct)
  • Psychosis

    • Which of the following is a negative symptom of schizophrenia?

  • Disorganized speech
  • Delusions
  • Avolition (correct)
  • Hallucinations

    • What is one of the key challenges in diagnosing neuropsychiatric conditions like schizophrenia?

    <p>Symptoms often overlap with other disorders.</p> Signup and view all the answers

    During which phase of schizophrenia do subtle symptoms typically appear, often in the late teens or early 20s?

    <p>Prodromal phase</p> Signup and view all the answers

    Which diagnostic approach focused on first rank symptoms such as thought insertion and auditory hallucinations?

    <p>Schneider's approach</p> Signup and view all the answers

    What was the primary focus in Emil Kraepelin's early 20th-century classification of schizophrenia?

    <p>The biological nature of the illness</p> Signup and view all the answers

    Which of the following is a characteristic feature of schizophrenia recognized in the diagnostic criteria?

    <p>Disorganized behavior</p> Signup and view all the answers

    Which statement accurately reflects a limitation of the Monoamine Hypothesis of Depression?

    <p>Reducing dietary building blocks does not impact depressed individuals.</p> Signup and view all the answers

    What hypothesis suggests that gut bacteria can influence mood through neurotransmitter production?

    <p>Gut-brain axis Hypothesis</p> Signup and view all the answers

    Which cognitive dysfunction is more severe in Borderline Personality Disorder (BPD) compared to Major Depressive Disorder (MDD)?

    <p>Executive functioning</p> Signup and view all the answers

    What is NOT a featured part of Dementia with Lewy Bodies (DLB)?

    <p>Clear communication</p> Signup and view all the answers

    Which factor is emphasized as important in addressing mental distress?

    <p>Direct conversation about mental health problems</p> Signup and view all the answers

    What characteristic distinguishes visual hallucinations (VH) observed in DLB from those in other disorders?

    <p>They are persistent and often detailed.</p> Signup and view all the answers

    Which neurotransmitter is specifically associated with lower levels in individuals who commit suicide, according to the Monoamine Hypothesis?

    <p>Serotonin</p> Signup and view all the answers

    In the context of cognitive distortion theories of depression, which view relates to the development of dysfunctional schemas?

    <p>Beck's negative cognitive triad</p> Signup and view all the answers

    What effect does chronic pain have in relation to depression?

    <p>It is a significant general medical factor linked to depression.</p> Signup and view all the answers

    What is a suggested outcome when the HPA axis is in a hyperactive state?

    <p>Atrophy of specific brain areas</p> Signup and view all the answers

    What is a significant risk factor for relapses in schizophrenia patients?

    <p>Presence of paranoia</p> Signup and view all the answers

    Which demographic aspect is linked with more severe symptoms in schizophrenia?

    <p>Gender</p> Signup and view all the answers

    Which of the following statements is true regarding the cognitive impact of schizophrenia?

    <p>Cognitive issues are often present before the first episode.</p> Signup and view all the answers

    In bipolar disorder, what is a symptom of mania that must be present for a week to meet the criteria for diagnosing a manic episode?

    <p>Decreased need for sleep</p> Signup and view all the answers

    What is the typical lifetime prevalence rate of schizophrenia?

    <p>1%</p> Signup and view all the answers

    What is the false positive rate concerning the identification of schizophrenia?

    <p>50-90%</p> Signup and view all the answers

    According to risk factors identified, which group has the highest incidence of developing schizophrenia?

    <p>First or second generation migrants</p> Signup and view all the answers

    What is a noted effect of maternal factors in the development of schizophrenia?

    <p>Maternal malnutrition</p> Signup and view all the answers

    Which type of depression is characterized by a depressed mood lasting for at least two weeks and must include specific core symptoms?

    <p>Major depressive disorder (MDD)</p> Signup and view all the answers

    Which of the following statements best describes the biological explanation for schizophrenia?

    <p>Associated with excessive dopamine activity</p> Signup and view all the answers

    What proportion of individuals with major depressive disorder report another episode later in life?

    <p>90%</p> Signup and view all the answers

    In schizophrenia prognosis, what percentage of patients are expected to struggle with day-to-day functioning?

    <p>75-95%</p> Signup and view all the answers

    What criterion must be met for diagnosing psychotic depression?

    <p>Presence of delusions</p> Signup and view all the answers

    Which of the following conditions has a female-to-male ratio of 2:1 for its more severe form?

    <p>Bipolar disorder type II</p> Signup and view all the answers

    What significant advantage does the prodromal phase offer in mental health diagnosis?

    <p>It allows for an optimal opportunity to mitigate functional disabilities.</p> Signup and view all the answers

    Which statement accurately reflects the prognosis of individuals diagnosed with schizophrenia?

    <p>The prognosis categorizes into four quarters, each indicating varying levels of support needed.</p> Signup and view all the answers

    What was found regarding the false positive rate in the diagnosis of schizophrenia?

    <p>It can sometimes reach between 50-90%.</p> Signup and view all the answers

    What is a noted potential consequence of medications prescribed for psychotic conditions?

    <p>They may lead to difficulties in daily tasks such as managing finances and cooking.</p> Signup and view all the answers

    Which behavior is typically observed in adolescents experiencing signs of depression?

    <p>Rebelliousness</p> Signup and view all the answers

    What percentage of individuals with Major Depressive Disorder (MDD) are expected to experience full remission within 6-12 months?

    <p>50%</p> Signup and view all the answers

    In older adults, which of the following is a common presentation of depression?

    <p>Focus on hypochondriacal concerns</p> Signup and view all the answers

    Which of the following factors is linked to the genetic risk of developing severe recurrent major depression?

    <p>Higher heritability rates in twins</p> Signup and view all the answers

    What is a notable limitation of the Monoamine Hypothesis in understanding depression?

    <p>It fails to explain why some individuals with low monoamines are not depressed.</p> Signup and view all the answers

    After how many years does the average interval between episodes of recurrent major depression occur?

    <p>5 years</p> Signup and view all the answers

    What prenatal factor is suggested to double the risk of developing schizophrenia?

    <p>Maternal malnutrition</p> Signup and view all the answers

    Which symptom is NOT typically associated with major depressive disorder?

    <p>Excessive energy</p> Signup and view all the answers

    Which cognitive functions are most commonly impaired in individuals with schizophrenia?

    <p>Mental speed and reasoning</p> Signup and view all the answers

    Which demographic factor influences how depression symptoms are expressed in the elderly?

    <p>Cognitive impairment</p> Signup and view all the answers

    What demographic characteristic is associated with a higher incidence of schizophrenia?

    <p>Urban residence</p> Signup and view all the answers

    What is the impact of advanced paternal age on the risk of schizophrenia?

    <p>Increases risk equally for both genders</p> Signup and view all the answers

    Which factor most likely contributes to false positives in schizophrenia diagnosis?

    <p>Overlap with mood disorders</p> Signup and view all the answers

    In what way do cognitive impairments in schizophrenia relate to treatment outcomes?

    <p>They are independent of positive symptoms or medications</p> Signup and view all the answers

    What has been observed regarding the cognitive skills of children at familial high risk for schizophrenia by age 4?

    <p>They generally lag behind their peers in cognitive development</p> Signup and view all the answers

    Which of the following are examples of disorders that influence the brain and body?

    <p>Depression</p> Signup and view all the answers

    What is the method of diagnosis for schizophrenia typically used?

    <p>Excluding other possible mental disorders before concluding with schizophrenia.</p> Signup and view all the answers

    At the end of the 1800s, Kraepelin identified 'dementia praecox' which involved:

    <p>A biological illness involving hallucinations and delusions, with a long-term deteriorating course.</p> Signup and view all the answers

    Which body type did Kretschmer believe was prone to schizophrenia?

    <p>Asthenic-types</p> Signup and view all the answers

    Eugen Bleuler described schizophrenia in four categories including:

    <p>Associations, Affect, Ambivalence and Autism</p> Signup and view all the answers

    How did Schneider contribute to the understanding of schizophrenia?

    <p>He classified schizophrenia into different subtypes based on symptoms.</p> Signup and view all the answers

    Select all that are negative symptoms of schizophrenia:

    <p>Avolition</p> Signup and view all the answers

    How many people with schizophrenia have no prodromal period before the onset of frank psychosis?

    <p>20%</p> Signup and view all the answers

    What is common in the period following psychosis amongst schizophrenic patients?

    <p>Psychotic symptoms typically stabilise</p> Signup and view all the answers

    Which is not a key risk factor for suicide amongst schizophrenic patients?

    <p>Low IQ</p> Signup and view all the answers

    In the structural account of schizophrenia, which brain regions are associated with the positive symptoms of schizophrenia?

    <p>Mesolimbic Pathway and Ventral Tegmental Area</p> Signup and view all the answers

    The theory that schizophrenia results from congenital anomalies in brain development and excessive pruning during adolescence is called:

    <p>Neurodevelopmental Hypothesis</p> Signup and view all the answers

    How common is childhood abuse/trauma amongst individuals with schizophrenia?

    <p>50%</p> Signup and view all the answers

    Which feature of schizophrenia is most influential for quality of life?

    <p>Level of cognitive impairment</p> Signup and view all the answers

    What is the typical cognitive performance of people with schizophrenia?

    <p>1.5-2 standard deviations below average</p> Signup and view all the answers

    Which results in greater cognitive deficits?

    <p>Bipolar Disorder</p> Signup and view all the answers

    What are the 4 parts of Dementia with Lewy Bodies?

    <p>Fluctuating cognition, visual hallucinations, REM sleep disturbances, and Parkinsonian-like motor features</p> Signup and view all the answers

    How common are visual hallucinations amongst those with Dementia with Lewy Bodies (DLB)?

    <p>~80%, and more common in women</p> Signup and view all the answers

    Study Notes

    Neuropsychiatric Conditions

    • Neuropsychiatric conditions significantly disrupt emotions, thinking, and behavior, impacting brain functioning.
    • These conditions include mental illnesses, neurodegenerative conditions, and sleep disorders.
    • Neuropsychiatric conditions affect numerous individuals, with approximately 45% of Australians between 16 and 85 years old experiencing a mental disorder at some point.
    • More than 20% of Australians have experienced a mental disorder in the past twelve months.

    Schizophrenia

    • A disabling and persistent brain disorder that disrupts how a person interprets reality, thinks, feels, and behaves.
    • One of the most common and disabling psychiatric disorders.
    • Clinical diagnosis made by exclusion.
    • Patients often exhibit diverse presentations, and symptoms can fluctuate over time.

    Evolution of the Concept of Schizophrenia

    • Emil Kraepelin (late 1800s) coined the term "dementia praecox," describing a biological illness characterized by hallucinations, delusions, and a long-term deteriorating course.
    • Eugen Bleuler (1908) introduced the term "schizophrenia" to describe the "breaking up of the psyche," highlighting the four "A's" of associations, affect, ambivalence, and autism (withdrawal).
    • Kretschmer's approach to diagnosis involved analyzing body types, suggesting that asthenic individuals (thin) were prone to schizophrenia, while pyknic individuals (squat) were more likely to experience bipolar disorder.
    • Schneider's approach focused on "first-rank" symptoms, including auditory hallucinations, thought insertion and withdrawal, thought broadcasting, passivity experiences, and delusional personalization of perceptions.

    Schizophrenia Symptoms

    • Criterion A symptoms: Delusions, hallucinations (auditory being most common), disorganized speech, disorganized/catatonic behavior, and negative symptoms.
    • Negative symptoms: Affect blunting, alogia (poverty of speech or thought), avolition (lack of motivation), social withdrawal, amotivation.
    • Negative symptoms are generally more challenging to treat.

    Course of Schizophrenia

    • Typical Course:

      • Premorbid phase
      • Prodromal phase (subtle symptoms often emerging during late teens/early 20s, lasting 2-4 years, with approximately 20% experiencing no prodromal period).
      • Frank psychosis
      • Recovery with waxing and waning, but enduring vulnerability to stress.
      • Post-psychotic depression commonly occurs.
      • Psychotic symptoms tend to stabilize, but negative symptoms often increase over time.

    • Predicting Onset:

      • Early intervention is crucial to mitigate adverse effects.
      • Identifying individuals who will develop schizophrenia can be challenging due to non-specific early symptoms, such as changes in mood, sleep, and concentration.
      • False-positive diagnoses can have significant impacts on life goals, medication side effects, and stigma.
      • False-positive rates are rising (50-90%), potentially indicating other underlying conditions.
      • Delusions and communication difficulties are considered the most reliable predictors of schizophrenia.

    Prognosis and Outcome

    • 75-95% of individuals with schizophrenia experience challenges with daily functioning.
    • Prognosis varies widely across countries, influenced by supportive environments.
    • Relapse rates are significantly higher for individuals not on medication (approximately 60% within a year compared to 20% on medication).
    • Approximately one-third of individuals with schizophrenia attempt suicide, and 10% eventually commit suicide.
    • Risk factors for poor outcomes include male gender, higher IQ, social functioning, and recent psychosis.

    Demography of Schizophrenia

    • Lifetime prevalence: 1%
    • Males are more likely to be diagnosed than females.
    • Males typically experience an earlier onset, often before the age of 25.
    • Females are more likely to be diagnosed between the ages of 25-35.
    • Males tend to experience more severe and persistent negative symptoms that lead to poorer outcomes.

    Explanations for Schizophrenia

    • Genetic Account: Individuals with a close family member diagnosed with schizophrenia have a higher likelihood of developing the condition.

    • Limitations of Genetic Explanation:

      • During the Nazi regime, a significant portion of individuals with schizophrenia in Germany were sterilized or murdered.
      • Despite this, the incidence rate of schizophrenia in Germany is now higher.
      • A reproductive rate of approximately 50% suggests that numerous genes contribute to the development of schizophrenia.

    • Biochemical Account:

      • Dopamine hypothesis suggests that an excess of dopamine in the brain contributes to schizophrenic symptoms.
      • Drugs that increase dopamine levels can induce symptoms resembling schizophrenia.

    • Structural Accounts:

      • Loss of brain cells
      • Reduced cell density in specific brain regions
      • Loss of connectivity.
        • Prefrontal cortex (PFC) abnormalities linked to negative symptoms.
        • Alterations in the cortico-basal ganglia-thalamocortical tract associated with positive symptoms.
      • Neurodevelopmental hypothesis:
        • Congenital brain development anomalies
        • Developmental problems during adolescence, including excessive pruning of synapses.

    • Psychosocial and Psychoanalytic Accounts:

      • Limited evidence supporting the claim that family patterns directly cause schizophrenia.
      • Children of mothers with schizophrenia are at an increased risk of developing the disorder, particularly if raised in adverse circumstances.
      • Childhood abuse or trauma is a factor in approximately half of cases.

    • Influence of Experience and Environment:

      • Gender: Three males for every two females diagnosed.
      • Migration: Increased prevalence in first or second-generation migrants.
      • Maternal Factors:
        • Maternal malnutrition
        • Maternal viral infections during pregnancy
        • Pregnancy and birth complications
        • Advanced paternal age
      • Urban birth
      • Higher risk in developed countries.
      • Living in higher altitudes
      • Cannabis use

    Cognitive Impact of Schizophrenia

    • Cognitive dysfunction is a core feature of schizophrenia.
    • Cognitive testing provides stronger predictive value for schizophrenia than brain imaging.
    • Cognitive impairment significantly impacts quality of life.
    • Cognitive deficits are often unresponsive to current treatment options.
    • Individuals with schizophrenia frequently perform 1.5-2 standard deviations below average on cognitive tests.
    • Common cognitive difficulties include problems with mental speed, attention, working memory, learning, reasoning, problem solving, and social cognition.

    Course of Impairment

    • Children who will develop schizophrenia may experience deficits in IQ and executive skills as early as age 4.
    • They often lag behind their peers academically, beginning at the start of school.
    • Cognitive decline typically occurs following the first psychotic episode.
    • Research findings regarding the course of cognitive decline are mixed, with some studies indicating continued deterioration while others suggest a leveling off.

    Mood Disorders

    • Types of Depression:
      • Major Depressive Disorder (MDD): lasting for at least two weeks.
      • Bipolar Disorder (BPD).
      • Psychotic Depression.
      • Dysthymia.
      • Mixed Depression and Anxiety.

    Bipolar Disorder (BPD)

    • Criteria:

      • Abnormally elevated or irritable mood lasting at least one week.
      • During the mood disturbance, three or more of the following symptoms:
        • Increased self-esteem or grandiosity.
        • Decreased need for sleep.
        • More talkative than usual.
        • Flight of ideas.
        • Distractibility.
        • Psychomotor agitation or goal-directed activity.
        • Risky or pleasurable behaviors.

    • Prevalence of BPD:

      • Approximately 2% of Australians (lifetime prevalence).
      • Equal sex ratio for Bipolar I (mania and depression), while females are twice as likely as males to experience Bipolar II (milder mania).
      • Onset typically occurs during adolescence or young adulthood.
      • Onset after the age of 50 may be associated with medical triggers.

    MDD

    • Approximately 20% of the population will experience a depressive episode at some point.

    • Depression tends to be cyclical.

    • Most likely to occur during the 20s.

    • Females are more likely to be diagnosed than males.

    • Often not a lifelong illness.

    • Criteria for MDD:

      • Five or more symptoms present during a two-week period (including symptoms 1 and 2):
        • Depressed mood
        • Loss of interest or pleasure (anhedonia) in all or most activities.
        • Significant weight loss or gain.
        • Insomnia or hypersomnia.
        • Psychomotor agitation or retardation.
        • Fatigue or loss of energy.
        • Feelings of worthlessness or excessive guilt.
        • Diminished ability to think or concentrate.
        • Recurrent thoughts of death or suicidal ideation.

    • Prior to puberty:

      • Weight gain, irritability, anxiety on separation, and somatic complaints.

    • Adolescents:

      • Irritability, rebellious behavior, conduct problems, academic decline, and changes in friendships.

    • Elderly:

      • Agitation, denial of symptoms, focus on health problems, and difficulties with memory and concentration.

    Course of MDD

    • Short-term Course:
      • Approximately 50% experience a full recovery within a year.
    • Long-term Course:
      • 90% no longer experience a full-blown depressive episode two years later.
    • Recurrence:
      • Most individuals will experience another depressive episode in their lifetime.
      • Repeated episodes tend to result in shorter periods of remission and longer episode durations.

    Risk Factors for MDD

    • Genetic:

      • Approximately 40% of risk for depression is inherited, with a higher rate for severe depression.
      • Individuals may inherit a genetic predisposition to depression.

    • Specific Medical Factors:

      • Vascular conditions, such as stroke, are linked to depression.
      • Thyroid dysfunction, stroke, traumatic brain injury (TBI), and epilepsy are also associated with an increased risk of depression.

    • General Medical Factors:

      • Chronic pain can be a significant risk factor for depression.

    Theories of Depression

    • Monoamine Hypothesis:

      • Proposes that MDD is caused by an imbalance of one or more monoamine neurotransmitters (MAO).

      • Evidence for the Monoamine Hypothesis:

        • Drugs that reduce MAOs have been associated with depression-like symptoms.
        • Drugs that increase MAOs can alleviate depression.
        • Depleting dietary building blocks for serotonin is linked to depressive relapses.
        • Individuals who commit suicide often have lower serotonin levels.

      • Limitations of the Monoamine Hypothesis:

        • Reducing dietary building blocks for MAOs does not induce depression in healthy individuals.
        • Antidepressant medications are not effective for all patients.
        • While drugs increase MAOs rapidly, changes in mood take several weeks to become apparent.
        • The concept of ideal or problematic MAO levels remains undefined.

    • Cognitive Theories of Depression:

      • Depression stems from negative cognitive distortions, sometimes referred to as the "sunglasses theory."

      • Individual vulnerabilities are often triggered by specific experiences.

      • Beck's negative cognitive triad focuses on dysfunctional schemas related to the self, the world, and the future.

        • Evidence for Cognitive Theories:

          • Individuals with dysfunctional thinking patterns similar to Beck's negative cognitive triad are more likely to develop depression.

        • However, it is important to acknowledge that:

        • Depression may lead to depressive thoughts.

      • Cognitive Behavioral Therapy (CBT) remains one of the most effective treatments for depression.

    • HPA Axis Hypothesis:

      • The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in stress response. When exposed to stress, the HPA axis releases cortisol and glucose, while reducing the production of other chemicals.

      • Persistent stress leads to shrinkage (atrophy) of the prefrontal cortex (PFC), hippocampus, and amygdala.

      • Damage to these brain regions contributes to difficulties with emotional regulation and maladaptive behaviors.

        • Evidence for the HPA Axis Hypothesis:

          • HPA hyperactivity is a consistent finding in depression and often resolves with antidepressant treatment.

        • However, it is crucial to consider that:

          • HPA hyperactivity may be a risk factor for depression rather than a direct cause.

    • Gut-Brain Axis Hypothesis:

      • Proposes that gut bacteria influence neurotransmitter production and subsequently affect mood.
      • Distinctive differences in gut microbiota exist between individuals with depression and healthy individuals.
      • Depletion of the microbiome in rats leads to depressive behavior, while increasing gut microbiome reverses this effect.
      • Fecal microbiota transplant (FMT) can sometimes induce anxiety.

    • Depression is increasingly attributed to a combination of recent events and long-term risk factors.

    Cognitive Comparison of Bipolar Disorder (BPD) and MDD

    • Both BPD and MDD are associated with cognitive dysfunction, encompassing deficits in sustained and divided attention, processing speed, executive functioning, verbal learning, and memory.
    • Effect sizes are generally larger for BPD.
    • Residual impairment in attention and executive functioning is more common in BPD.
    • Most research suggests that individuals with BPD experience more severe cognitive deficits compared to those with MDD.

    Neuropsychiatric Symptoms in Degenerative Conditions: Dementia with Lewy Bodies (DLB)

    • DLB is the second or third most common type of dementia.
    • Often described as a hybrid of Alzheimer's disease and Parkinson's disease.
    • DLB is characterized by four core features:
      • Fluctuating cognition.
      • Recurrent, well-formed visual hallucinations.
      • REM sleep disturbances.
      • One or more spontaneous motor features of Parkinson's disease.

    Visual Hallucinations

    • Recurrent, detailed, and visually complex.
    • Typically involve people or animals appearing in the home, but can also include perceptual distortions.
    • More prevalent in women (approximately 80% overall).
    • Often emerge early in the course of the disease.
    • Importance of distinguishing VH in DLB from other conditions: - VH are not unique to DLB, but they tend to occur early, are persistent. - VH are not always mood congruent. - Visual hallucinations are the most common type. - There is a correlation between VH and more significant visuospatial problems.

    Basis of VH in DLB

    • The underlying cause of VH in DLB remains unclear.
    • Potential theories:
      • Problems with visuoperception? This theory is not supported by the fact that individuals with posterior cortical atrophy (PCA) have visuoperception problems but do not experience hallucinations.
      • DLB patients might have hypometabolism in the occipital lobes, leading to the constant experience of hallucinations.
      • Fluctuating cognition may be a contributing factor.

    Conclusion

    • Mental distress does not always signify a mental disorder. - Consider: - Characteristics of the experience. - Cultural context. - Personal context.
    • Therapy can provide significant benefit even if it cannot completely cure a condition.
    • Early intervention is crucial for positive outcomes.
    • Simple acts of talking and engaging with individuals experiencing mental health challenges can be significantly helpful.
    • Directly address mental health concerns and encourage professional help.

    Post-Psychotic Depression

    • Post-psychotic depression is common after psychosis.
    • While psychotic symptoms tend to stabilize, negative symptoms increase.

    Predicting Onset

    • Early detection and intervention are crucial for mitigating functional disability.
    • Difficulty concentrating, low motivation, sleep disturbances, and mood swings are common prodromal signs.
    • However, these signs are non-specific, with approximately 50% of teenagers exhibiting compatible symptoms.
    • False positives are a concern, potentially impacting life goals, medication side effects, and social stigma.
    • False positive rates can range from 50% to 90%.
    • Studies have shown that up to 51% of patients referred for "schizophrenia" may have different conditions.
    • Tracking individuals with Attenuated Psychosis Syndrome revealed that 30% transitioned to psychosis and 21% developed schizophrenia.
    • Attenuated odd ideas and disorganized communication are strong predictors of psychosis.

    Prognosis and Outcome

    • Outcomes can vary significantly based on the "4 Quarters Rule."
    • More recent data suggests less encouraging prognoses, with challenges in life skills such as medication management, cooking, shopping, finances, and laundry.
    • Employment rates are low, with only 9-12% supporting themselves through work.

    ABC of Depression

    • Depression involves three components:
      • Affective: Feelings of sadness, hopelessness, and worthlessness.
      • Behavioral: Changes in activity levels, including withdrawal, decreased energy, or agitation.
      • Cognitive: Negative thoughts, difficulty concentrating, and pessimism.

    Presentation and Age

    • Prior to Puberty: Weight gain, irritability, separation anxiety, and somatic complaints.
    • Adolescents: Irritability, rebelliousness, conduct problems, declining grades, and changes in peer groups.
    • Elderly: Agitation, denial of depressive symptoms, focus on hypochondriacal concerns, memory problems, and concentration difficulties.

    Course of MDD

    • Short-term: Approximately 50% experience full remission within 6-12 months.
    • Longer-term: 90% no longer experience full depression symptoms after two years.
    • Recurrence: 40% to 75% experience a lifetime recurrence, with an average interval of 5 years between episodes.
    • Repeated Episodes: Trend towards shorter remissions and longer episodes.

    Risk Factors

    • Genetic: Heritability estimated at 40%, increasing to 70% in twins with recurrent, severe depression.
    • Medical:
      • "Vascular Depression" linked to microvascular dysfunction.
      • Thyroid dysfunction, stroke, traumatic brain injury, epilepsy, Parkinson's disease, and certain steroid and hormonal treatments.
      • Chronic pain.

    The Monoamine Hypothesis

    • The monoamine hypothesis proposes that depression is caused by an imbalance of neurotransmitters like serotonin, norepinephrine, and dopamine.
    • Support for this hypothesis comes from:
      • Depressive-like behavior in humans and animals following the administration of drugs that reduce monoamines.
      • Low levels of monoamines in people with depression, with increases in monoamine levels observed with effective drug treatments.

    Neurodevelopmental Hypothesis

    • The "Two-Hit Model" suggests that early brain development and later environmental stress contribute to psychosis.
    • Congenital brain anomalies, such as disrupted laterality, lead to premorbid symptoms and subtle neurological signs.
    • Developmental challenges during adolescence, particularly excessive synaptic pruning and reduced plasticity, further increase vulnerability.

    Psychosocial and Psychoanalytic Accounts

    • No strong evidence supports a causative role for specific family patterns in psychosis.
    • Children of mothers with schizophrenia are at higher risk if raised in adverse environments.
    • Childhood abuse or trauma is a significant risk factor, with 50% of individuals experiencing psychotic symptoms reporting abuse in their childhood.
    • High levels of negative expressed emotion within families increase relapse rates.

    Influence of Experience and Environment

    • Risk Factors:
      • Male sex: 3 men for every 2 women.
      • First- or second-generation migrants, especially those of African descent.
      • Maternal malnutrition, as seen during the Dutch "Hunger Winter" or Chinese Cultural Revolution.
      • Maternal viral exposure during gestation, such as flu, measles, or potentially herpes simplex 2.
      • Pregnancy and birth complications, including pre-eclampsia, asphyxia, and emergency cesarean sections.
      • Advanced paternal age.
      • Urban birth or residence (increased risk 2.4 times).
      • Higher prevalence in developed nations.
      • Residence at higher altitudes, particularly in males, potentially linked to vitamin D or ultraviolet light exposure.
      • Cannabis use.

    Cognitive Findings in Schizophrenia

    • Cognitive impairment is a core feature of schizophrenia, independent of positive symptoms or medication.
    • Cognition is a stronger predictor of outcome and quality of life than brain imaging.
    • Cognitive deficits are not responsive to existing treatments.
    • Impairment is highly variable between individuals, but frequently 1.5-2 standard deviations below average.
    • Debates exist regarding specific versus global deficits, with processing speed potentially impacting downstream cognitive functions.
    • Areas particularly impacted include mental speed, attention, working memory, learning, memory, reasoning, problem-solving, and social cognition.

    Course of Impairment

    • By age 4, children at high familial risk for schizophrenia exhibit deficits in IQ and executive functioning.
    • These children typically lag behind a year at school entry and experience declining or slower gains in performance throughout their education.
    • Cognitive decline often occurs with the onset of the first psychotic episode.
    • Research findings on cognitive decline versus stabilization over time are mixed.

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