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Transcript of Schizophrenia Prezi
Dr. Emile Kraepelin in the 1887, was the first physician to describe schizophrenia which he called, dementia praecox. He believed this disease progessively destroyed the personality and the person's ability to function independently.
Eugen Bleuler first termed the disease the schizophrenia in 1911. He believed that schizophrenia was a groups of symptoms including disordered thought processes and a personality that was fragmented. He felt that the cause of schizophrenia was psychological and caused by familial stressors. Really Ancient History..... However, written documents that identify Schizophrenia can be traced to the old Pharaonic Egypt, as far back as the second millennium before the common era. Depression, dementia, as well as thought disturbances that are typical in schizophrenia are described in detail in the Book of Hearts. The Heart and the mind seem to have been synonymous in ancient Egypt. The physical illnesses were regarded as symptoms of the heart and the uterus and originating from the blood vessels or from purulence, fecal matter, a poison or demons.
It appears this condition has been a part of human history for a very long time.
What does this mean? What do you already know? Here's a video A quick quiz Its important to remember however, that all the chemical, genetic and physical changes that take place within the individual with schizophrenia are seen in asymptomatic individuals.
Consequently there must be other factors to take into consideration.
These are usually refered to as the 'trigger factors' Biological Causes of Schizophrenia A simple blood test would make all our lives’s easier!
The science magazine "New Scientist" reported on February 5, 2005 on a new blood test being developed for the diagnosis of schizophrenia, as reported in a genetics journal. It is still early, and this still needs to be validated in larger studies and by other groups, but the initial small sample was positive.
The early results suggest a 95% to 97% accuracy level - which should help a great deal in early diagnosis and potential prevention of serious psychotic episodes. Biological Causes of Schizophrenia What is happening?
It appears that there is an increase in dopamine activity in the mesolimbic pathway of the brain in the majority of individuals with schizophrenia. Anti-psychotic medication work to block D2 dopamine receptors with the intention that they reduce positive symptoms of schizophrenia. However this biochemical event can be seen with individuals with no other symptoms of schizophrenia. (C. Schmauss and H. M. Emrich 1984) Biological Causes of Schizophrenia Dopamine and the action of opiates: A reevaluation of the dopamine hypothesis of schizophrenia with special consideration of the role of endogenous opioids in the pathogenesis of schizophrenia, Claudia Schmauss , Hinderk M. Emrich Biol Psychiatry. 2005 May 15;57(10):1117-27.
Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington H, Taylor A, Arseneault L, Williams B, Braithwaite A, Poulton R, Craig IW.
Schizophrenia Causes, Risk Factors & Prevention · Schizophrenia Genetics Interview of Daniel Weinberger, MD, Senior Investigator, National Institute of Mental Health Demian Rose, MD, PhD 2006
A search for specific and common susceptibility loci for schizophrenia and bipolar disorder: a linkage study in 13 target chromosomes, Maziade M et al
Molecular Psychiatry [2001, 6(6):684-93]
Genomic scan for genes predisposing to schizophrenia Hilary Coon et al, 2005
Increased Diffusivity in Superior Temporal Gyrus in Patients with Schizophrenia: A Diffusion Tensor Imaging Study Lee K. et al, Schizophr Res. 2009 Mar;108(1-3):33-40.
American Journal of Medical Genetics B , vol 133, p 1
Genetic liability, illicit drug use, life stress and psychotic symptoms: preliminary findings from the Edinburgh study of people at high risk for schizophrenia
P. Miller et al 2005 Further Reading Biological Causes of Schizophrenia Right up to date:
There is some evidence to suggest that there is an increased incidence of schizophrenia amongst individuals whose grandmother was malnourished
It is hoped a cure for schizophrenia will have been developed within the next 10yrs. Biological Causes of Schizophrenia If this is a biological/genetic condition is there a test?
There appears to be a consistent reduction in the Superior temporal gyrus (STG) and the dorsolateral prefrontal cortex (DLPFC), this can be seen on modern biomedical imaging scans. However these changes can occur in cognitively typical individuals and only occur in schizophrenia after a prolonged psychotic event. Biological Causes of Schizophrenia Maternal Trauma and Schizophrenia:
Some research suggests that any trauma during pregnancy, maternal exposure to certain substances such as lead, alcohol or drugs may cause an increase in the child developing schizophrenia as they mature.
Drugs and Schizophrenia:
Again there is much research into the links between early onset schizophrenia and the use/misuse of drugs and alcohol. Biological Causes of Schizophrenia How do genetic factors contribute to developing schizophrenia? Biological Causes of Schizophrenia Genetic Predisposition: Biological Causes of Schizophrenia
Negative Symptoms include:
Losing interest and motivation in life and activities, including relationships and sex
Loss of life skills and deficits noted in self care activities
Lack of concentration, not wanting to leave the house and changes in sleeping patterns
Being less likely to initiate conversations and feeling uncomfortable with people, or feeling that there is nothing to say
People with schizophrenia are far more likely to harm themselves than be violent toward the public. Violence is not a symptom of schizophrenia Biological Causes of Schizophrenia Unusual Speech Patterns
Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. (Word Salad)
Neologisms – Made-up words or phrases that only have meaning to the patient.
Perseveration – Repetition of words and statements; saying the same thing over and over.
Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
Individuals movements can become completely fixed. People with catatonic schizophrenia can be highly suggestible. They may automatically obey commands, imitate the actions of others, or mimic what others say. This is extremely rare. Biological Causes of Schizophrenia Individuals experience both Positive and Negative Symptoms.
Positive Symptoms include:
Hallucinations which may effect all five senses, more usually auditory or visual. Most people with schizophrenia report 'hearing voices' as being the most troubling experience. (DSM IV, 2000). The voices can be pleasant but can also be hostile, abusive or even command the person to act in ways they would not normally. This may lead the individual presenting in a way that could be harmful to themselves or others. (Thompson,2000)
Individuals may also hold strong beliefs that are not based on any observable reality. These are known as 'delusions'. Again these may lead the individual to act in a way that endangers themselves or others. An example of this could be that they believe they connected to high profile figures in society, such as Royalty or politicians. In some instances this may lead the individual to try to make contact with these persons.
Individuals also report finding their thought processes or cognitions affected in that they are unable to concentrate and experiences of 'being controlled' as though their body is not their own and it is being controlled by external forces. Biological Causes of Schizophrenia Biological Causes of Schizophrenia Schizophrenia effects 1:100 individuals globally.
Generally, schizophrenia effects men and women differently:
The onset of the condition in men tends to be earlier, reaction to medication less effective and the prognosis is poorer.
Women tend to have a better response to medication, and women appear to experience less disruption in their overall well being. Biological Causes of Schizophrenia Trigger Factors for Schizophrenia:
Prenatal exposure to a viral infection
Low oxygen levels during birth (from prolonged labour or premature birth)
Exposure to a virus during infancy
Early parental loss or separation
Physical or sexual abuse in childhood
'Double Bind' language and high expressed emotion in child rearing
Lack of significant nuturer during infancy and childhood
Maternal use/misuse of drugs and/or alcohol
Early exposure to drugs. Biological Causes of Schizophrenia Biological Causes of Schizophrenia Responsible Genes
It appears there are several chromosomes or loci that may be responsible for contributing to the development of schizophrenia
Catechol-O-methyl transferase research indicates for individuals (aged 15yrs and over) with one faulty version of this gene, who smoke cannabis are up to 1,000 times more likely to develop schizophrenia
Chromosomes 11q, 3q, 18q and 6p abnormalities are also implicated.
Chromosome 22 more closely and in particular a gene encoding a protein called WKL1.
Since the concordance rate among MZ twins is not 100% and people can apparently carry the genotype for schizophrenia without ever developing the disease, there probably is not a single dominant gene for schizophrenia. Biological Causes of Schizophrenia What is happening? Biological Causes of Schizophrenia How does Schizophrenia compare to other common illnesses: Biological Causes of Schizophrenia Positive and Negative Symptoms I need a willing volunteer...... Neuroleptic Malignant Syndrome(NMS) which is a life- threatening neurological disorder most often caused by an adverse reaction to antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability and cognitive changes such as delirium, and is associated with elevated creatine phosphokinase. It must be recognised and treated within the first 24hrs. It is now relatively rare. Drugs Used In Psychiatry Side Effects:
The most troubling issue surrounding the use of antipsychotic medications are the reported and clinically observable side effects.
These are often very distressing for patients and consequently cause many patients to stop taking their medications.
This is one of the major causes for Mental Health patients being readmitted to hospital Drugs Used In Psychiatry Common Antipsychotics:
Sulperide Drugs Used In Psychiatry www.rcpsych.ac.uk/.../antipsychoticmedication.aspx
Preskorn SH, Ross R, Stanga CY (2004). "Selective Serotonin Reuptake Inhibitors". In Sheldon H. Preskorn, Hohn P. Feighner, Christina Y. Stanga and Ruth Ross. Antidepressants: Past, Present and Future. Berlin: Springer. Drugs Used In Psychiatry http://www.patient.co.uk/health/Schizophrenia.htm
http://www.mayoclinic.com/health/antidepressants/MH00067 Drugs Used In Psychiatry Other Reported Side Effects:
Increased risk of stroke
Sudden cardiac death
Significant weight gain may also occur. Drugs Used In Psychiatry Atypical:
Risperidone Drugs Used In Psychiatry How do they work:
All antipsychotics work on the dopamine system but all vary in regards to which receptors within this system they have an affinity for. Each antipsychotic medication reacts differently
The vast majority of antipsychotics work by blocking the absorption of dopamine, Dopamine is one of the substances in the brain responsible for transmitting messages across the gaps, or synapses, of nerve cells. Too much dopamine in a person's brain speeds up nerve impulses to the point of causing hallucinations, delusions, and thought disorders. By blocking the dopamine receptors, antipsychotics reduce the severity of these symptoms. The brain has several types of dopamine receptors, and it is the unselective blockage by antipsychotic drugs causes the side effects.
Antipsychotics are less effective at treating negative symptoms of schizophrenia, however it is thought that as the Atypical antipsychotics are less sedating and therefore offer are less likely to effect motivation levels. Drugs Used In Psychiatry Atypical:
These are more commonly known as second generation antipsychotics.
These medications differ from typical antipsychotics in that they are less likely to cause extrapyramidal side effects.
They are also associated with the following benefits; higher rates of concordance, higher efficiency in patients with treatment resistant schizophrenia, lower risk of suicides, better functional capacity and an improved quality of life.
Although atypical antipsychotics are thought to be safer than typical antipsychotics, they still have severe side effects. Drugs Used In Psychiatry There are two main types of antipsychotic medications:
Typical antipsychotics are usually the older or 'first generation' of antipsychotics. These medications reduced the severity of the most disabling features of psychotic disorders but are marked by severe disabling and sometimes life threatening side effects. The standard effectiveness of antipsychotic medications is measured against one of the earliest one of these; 'The chlorpromazine equivalence' Drugs Used In Psychiatry Antipsychotics :
Usually known as Neuroleptics
These are a range of medications that are used to treat psychotic conditions such as, schizophrenia and bipolar disorder. They can also be used to augment treatments for people with severe anxiety or depression.
They were first introduced in the 1950's and have marked benefits for the treatment of positive effects of psychotic disorders. Drugs Used In Psychiatry Side effects are more commonly known as ‘Extra Pyramidal Side effects’.
Tardive Dyskinesia,a serious movement disorder, which is progressive and can be life threatening. Drugs Used In Psychiatry Its not all about medication.... Psycho social Interventions make up the bulk of on-going support Engagement and outcome-orientated assessment; giving hope and optimism
The family’s and carer's assessment of the patient’s needs
Psychological management of psychosis - CBT, coping strategy enhancement, self- monitoring approaches and training in problem-solving;
Assessment and self recognition of trigger factors and relapse signatures; mood diaries
Medication management, via motivational interviewing techniques; inclusion in medication decisions.
CPA reviews; care planning http://www.nice.org.uk/nicemedia/live/11786/43607/43607.pdf