Schizophrenia - PDF

ALPER ARTAN, AYŞEGÜL EVREN, AHMET HAKAN GÜLER, SERKAN ARDA KAKAÇ, ABDULKADİR KANADAŞI, AHMET RAŞİT KARA, HATİCE KAYA, ALİ UMUT KOCAGÖZ, MUSTAFA AHMET YURTOĞLU Outline What is schizophrenia DSM-5 Diagnostic Criteria for Schizophrenia Theories Treatments Symptom Remission by Antipsychotic Medi...

ALPER ARTAN, AYŞEGÜL EVREN, AHMET HAKAN GÜLER, SERKAN ARDA KAKAÇ, ABDULKADİR KANADAŞI, AHMET RAŞİT KARA, HATİCE KAYA, ALİ UMUT KOCAGÖZ, MUSTAFA AHMET YURTOĞLU Outline What is schizophrenia DSM-5 Diagnostic Criteria for Schizophrenia Theories Treatments Symptom Remission by Antipsychotic Medication Part of a Film that Demonstrates Schizophrenia o  Psychosis state involving a loss of contact with reality as well as an inability What is to differentiate between reality and one’s subjective state schizophrenia Schizophrenia disorder consisting of unreal or disorganized thoughts and perceptions as well as verbal, cognitive, and behavioral deficits Psychosis is its core diagnostic symptom Figure 1 Schizophrenia Spectrum and Other Psychotic Disorders Along the Continuum (Nolen-Hoeksema, 2020, p.211) Five Domains of Psychotic Symptoms Positive Symptoms Delusions Hallucinations Disorganized thought (speech) Disorganized or catatonic behavior Negative symptoms (e.g., restricted emotional expression or affect, and avolition/asociality) involves loss of certain qualities of the person Table 1 Types of Delusions (Nolen-Hoeksema, 2020, p.214) DSM-5 Diagnostic Criteria for Schizophrenia o A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2, or 3: 1. Delusions 2. Hallucinations 3. Disorganized speech (i.e., frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (i.e., diminished emotional expression or avolition)  B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).  C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).  D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the active and residual periods of the illness. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. F. If there is a history of autism spectrum disorder or communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia are also present for at least 1 month (or less if successfully treated). Specify if: With catatonia Theories o Biological Genetic Contributers to Schizophrenia Theories Structural and Functional Brain Abnormalities Neurotransmitters Figure 2 Risk for Schizophrenia and Genetic Relatedness (Gottesman & Shields, 1976, as cited in Nolen-Hoeksema, 2020, p.227) Genetic Contributers to Schizophrenia Family, twin, and adoption studies all indicate the presence of a genetic component to the transmission of schizophrenia (Allen et al., 2008). Still, many other biological and environmental factors may influence how and whether the disorder manifests itself, epigenetic factors can influence the expressions of the genes important for schizophrenia. Structural and Functional Brain Abnormalities Damage to the Developing Brain Birth Complications Prenatal Virus Exposure Structural and Functional Brain Abnormalities The most consistent finding is that there is a gross reduction in gray matter in the cortex of people with schizophrenia Abnormal activity in the Prefrontal cortex for people at risk for schizophrenia because of family history (Lawrie et al., 2008). Reductions and abnormalities in white matter (material that forms the connections between areas of the brain) (Karlsgodt et al., 2008). Structural and Functional Brain Abnormalities Enlargement of ventricles (fluid filled spaces in the brain) People with schizophrenia show enlargement of ventricles (Lawrie et al., 2008) People with schizophrenia with enlarged ventricles also tend to have more severe symptoms than other people with schizophrenia and less responsive to medication. Birth Complications and Prenatal Virus Exposure Birth complications are more frequent in the histories of people with schizophrenia (Cannon et al., 2003; Kotlicka-Antczak et al., 2017). There are high rates of schizophrenia whose mothers were exposed to viral infections while pregnant (Cannon et al., 2003). Neurotransmitters Original dopamine theory Excess levels of dopamine in the brain symptoms of schizophrenia neuroleptics Does not fully explain the negative symptoms Revised dopamine theory (Davis et al., 1991) Addresses the negative symptomes by the prefrontal area of the brain Low dopamine activity here might lead to the negative symptoms of schizophrenia Neurotransmitters Revised dopamine theory (Davis et al., 1991) Many of its components continue to be supported. Serotonin Glutamate Gamma-aminobutyric acid (GABA) Psychosocial Social Drift and Urban Birth Stress and Relapse Schizophrenia and the Family Theories Cognitive Perspectives Cross-Cultural Perspectives Social Drift and Urban Birth Social drift explanation Schizophrenia symptoms drifting downward in social class Social status and environment might also influence schizophrenia Schizophrenia is more likely to be born in a large city than a small city (Lewis et al., 1992). Stress and Relapse Stressful circumstances new episodes Schizophrenia and the Family Expressed emotion Cognitive Perspectives Fundamental difficulties in attention, inhibition, and adherence to the rules of communication lead people with schizophrenia to try to conserve their limited cognitive resources (Beck & Rector, 2005) Cross-Cultural Perspectives Different cultures vary greatly in how they explain schizophrenia (Hopper, 2008; Karno & Jenkins, 1993; Larøi et al., 2014). Most have a biological explanation for the disorder. Theories that attribute the disorder to stress, lack of spiritual piety, and family dynamics are mixed with biological explanations. Treatments o  Biological Insulin Coma Therapy ECT Treatments Typical Antipsychotic Drugs Atypical Antipsychotics Insulin Coma Therapy People with schizophrenia would be given massive doses of insulin—the drug used to treat diabetes—until they went into a coma. When they emerged from the coma, however, patients rarely were much better, and the procedure was very dangerous. It was used in 1930's ECT(Electroconvulsive Therapy) During this procedure, small electric currents pass through the brain, intentionally causing a brief seizure. Typical Antipsychotic Drugs These drugs block dopamine receptors in the brain, and they were the first to treat positive symptoms of schizophrenia. Their strong side effects cause many people to discontinue the medications. In addition, these drugs are less effective against negative symptoms, thus the individuals still have difficulties in functioning in their daily life. Chlorpromazine (Thorazine): Calms agitation and reduces hallucinations and delusions in patients with schizophrenia. Side Effects Sexual dysfunction, visual disturbances, weight gain or loss, depression. Akinesia: Slowed motor activity, monotonous speech, expressionless face. Akathesis: An agitation that causes people to pace and unable to sit still. Tardive Dyskinesia: A neurological disorder that involves involuntary movements of tongue, face, mouth or jaw. (Adams et al., 2007) Relapse 78% of people with schizophrenia relapse within 1 year. 98% relapse within 2 years. Only 30% relapse if they continue the treatment. (Gitlin et al., 2001) Atypical Antipsychotics Clozapine (Clozaril in U.S.), mainly binds to the d4 dopamine receptors but also influences other neurotransmitters such as serotonin (Sajatovic, Madhusoodanan, & Fuller, 2008). Seem to be more effective in treating schizophrenia, and although they do not have neurological side effects of typical antipsychotics, they may have other side effects like dizziness, nausea, sedation, seizures, hypersalivation, weight gain.  Behavioral ,Cognitive, and Social Treatments Psychosocial Family Therapy Assertive Community Treatment Treatments Programs Behavioral, Cognitive and Social Treatments These treatments are given in addition to medications and can increase patients’ level of everyday functioning and significantly reduce the risk of relapse (Barkhof et al., 2012). Cognitive treatments include helping people with schizophrenia recognize and change their demoralizing attitudes toward their ilness so they are comfortable seeking help when needed and not feel excluded from society (Beck & Rector, 2005; Garety & Freeman, 2013). In psychiatric hospitals and residential treatment centers, token economies sometimes are established, based on the principles of operant conditioning. Social interventions include self-help support groups. These groups discuss the impact of the disorder on their lives. Also group members can improve their social skills within the group where they feel included. Family Therapy Successful therapies combine basic education on schizophrenia with the training of family members in coping with their loved one’s inappropriate behaviors. Families are taught about the disorder’s biological causes, its symptoms, and the medications and their side effects. The hope is that these informations will reduce self-blame in family members, increase their tolerance for the uncontrollable symptoms of the disorder, and guide them in monitoring their family member’s use of medication and possible side effects. On average, approximately 24 percent of people who receive family- oriented therapy in addition to drug therapy relapse into schizophrenia, compared to 64 percent of people who receive routine drug therapy alone. (Pitschel-Walz, Leucht, Baumi, Kissling, & Engel, 2001) Assertive Community Treatment It is a type of community-based mental health treatment that provides intensive, team-based care to individuals with schizophrenia. The goal is to help individuals manage their symptoms, improve their quality of life, and live independently in their communities. These programs provide comprehensive services for people with schizophrenia, relying on the expertise of medical professionals, social workers, and psychologists to meet the variety of patients’ needs 24 hours a day. Symptom Remission by Antipsychotic Medication (Levine et al., 2011) https://doi.org/10.1016/j.schres.2011.09.018 About the Study Objective Examining remission rates and their variation by antipsychotic medication in chronic schizophrenia. Method The study used Positive and Negative Syndrome Scale (PANSS) to examine remission rates of symptoms for five different drugs: Olanzapine, ziprasidone, perphanazine, quetiapine and risperidone. Participants 1460 patients seeking treatment for chronic schizophrenia, 1006 actually started the drug treatment. (Levine et al., 2011) (Levine et al., 2011) About the Study Results Temporal symptomatic remission attainment over any period was observed among 44.5% of participants, this rate dropped to 21% in 3 months and 12% in 6 months. Attained and sustained remission rates were generally higher among the patients who are treated with olanzapine. (Levine et al., 2011) A Beautiful Mind (2001) - IMDb https://drive.google.com/file/d/1qFmdxWxsVh4mJehi_FiCeK5f gwicJIK-/view?usp=sharing (Howard, 2001, 1:30:03-1:33:58, 1:34:57-1:39:02) Thank You For Your Attention  References Adams, C. E., Awad, G., Rathbone, J., & Thornley, B. (2007). Chlorpromazine versus placebo for schizophrenia. Cochrane Database of Systematic Reviews, 2, CD000284. https://doi.org/10.1002/14651858.CD000284.pub2 Allen, N. C., Bagade, S., McQueen, M. B., Ioannidis, J. P., Kavvoura, F. K., Khoury, M. J., Tanzi, R. E., & Bertram, L. (2008). Systematic meta-analyses and field synopsis of genetic association studies in schizophrenia: The SzGene database. Nature Genetics, 40, 827–834. https://doi.org/10.1038/ng.171 Barkhof, E., Meijer, C. J., de Sonneville, L. M. J., Linszen, D. H., & de Haan, L. (2012). 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