Schizophrenia精神分裂症

Chapter11SchizophreniaSchizophrenia精神分裂症OneofthepsychoticdisordersMajordisturbancesin:»Thought»Emotion»BehaviorDisorderedthinkingFaultyperceptionandattentionInappropriateorflatemotionsBizarremotoractivityDisruptedinterpersonalrelationshipsSchizophreniaDisorderimpactsfamilies&friends»Difficulttolivewithsomeonewhoexperiencesdelusions,hallucinations,andparanoia.»Socialskillsdeficitscommon–Isolation,fewsocialcontactsSymptomsimpactemployability»Oftenleadtounemployment&homelessnessSubstanceabuse&suiciderateshighSchizophreniaLifetimeprevalence~1%OccursequallyinmenandwomenOnsettypicallylateadolescenceorearlyadulthood»MendiagnosedataslightlyearlierageDiagnosedmorefrequentlyinAfricanAmericans»MayreflectdiagnosticianbiasComorbidity:substanceabuseClinicalDescriptionofSchizophreniaNosingleessentialsymptom»Heterogeneityofsymptomsacrosspatients»Positive&negativesymptomspositive,disorganized&negativesymptomsPositiveSymptoms:excesses&distortionsDelusions»Firmlybeliefsheldcontrarytoreality»Resistanttodisconfirmingevidence»Persecutorydelusionscommon:65%Hallucinations»Sensoryexperiencesintheabsenceofsensorystimulationfromtheenvironment»Moreoftenauditory(74%)thanvisual»Patientsmisattributetheirownvoiceasbeingsomeoneelse’svoice–IncreasedlevelsofactivityinBroca’sareaduringhallucinations–problemintheconnectionsbetweenthefrontallobeareas(theproductionofspeech)andthetemporallobeareas(theunderstandingofspeech)NegativeSymptoms:BehavioraldeficitsThesesymptomstendtoendurebeyondanacuteepisodeAvolition»LackofinterestanddriveAlogia»Povertyofspeech»PovertyofcontentAnhendonia»InabilitytoexperiencepleasureFlataffect:66%»ExhibitslittleornoaffectinfaceorvoiceAsociality»Inabilitytoformclosepersonalrelationships»BeginninginchildhoodbeforetheonsetofothersymptomsDisorganizedSymptomsDisorganizedspeech»Incoherence–Inabilitytoorganizeideas»Looseassociations(derailment)–Rambles,difficultystickingtoonetopic»Probleminexecutivefunctioning(problemsolving,planning,andmakingassociationsbetweenthinkingandfeeling)andintheabilitytoperceivesemanticinformationDisorganizedbehavior»Oddorpeculiarbehavior–Silliness,agitation,unusualdressOtherSymptomsCatatonia»Motorabnormalities»Repetitive,complexgestures–Usuallyofthefingers,handsandarmmovements»Catatonicimmobility–Maintainunusualpostureforlongperiodsoftimee.g.,standononeleg»Waxyflexibility–anotherpersoncanmovethepatient’slimbsintopositionsthatthepatientwillthenmaintainforlongperiodsoftimeOtherSymptomsInappropriateaffect»Emotionalresponsesinconsistentwithsituation–e.g.,laughuncontrollablyatafuneral;shiftrapidlyfromoneemotionalstatetoanotherfornodiscerniblereason–Thissymptomisquiterare–SpecifictoschizophreniaCriteriaforSchizophreniainDSM-IV-TRTwoormoreofthefollowingsymptomsforatleast1month:»Delusions»Hallucinations»Disorganizedspeech»Disorganizedorcatatonicbehavior»NegativesymptomsSocialandoccupationalfunctioninghavedeclinedsinceonsetSignsofdisturbanceforatleast6months;CategoriesofSchizophreniainDSM-IV-TRDisorganizedschizophrenia»Incoherence,disorganizedspeechandbehavior»FlatorinappropriateaffectCatatonicschizophrenia»Prolongedimmobilityorpurposelessagitation»SeldomtodayParanoidschizophrenia»Delusions,hallucinationsrelatedtopersecutionorgrandiosity»Grandiositydelusions:anexaggeratedsenseoftheirownimportance,power,knowledge,oridentity.»Ideasofreference:incorporateunimportanteventswithinadelusionalframeworkandreadpersonalsignificanceintothetrivialactivitiesofothers–e.g.,newscastonTVisaboutmeUndifferentiatedschizophrenia»Meetcriteriaforschizophreniabutnotforanyofthe3mainsubtypesResidualschizophrenia»NolongermeetsfullcriteriaforschizophreniabutstillexhibitssomesignsofthedisorderEvaluationofSubtypesDiagnosisofsubtypesdifficult»ReliabilitylowPoorpredictivevalidityOverlapofsymptomsamongsubtypes»E.g.delusionsOtherPsychoticDisordersSchizophreniformDisorder»Symptomsarethesameasthoseofschizophrenia»Symptomlastonlyfrom1to6monthsBriefPsychoticDisorder»Symptomdurationof1dayto1month»OftentriggeredbyextremestressOtherPsychoticDisordersSchizoaffectiveDisorder»SymptomsofbothmooddisorderandschizophreniaDelusionalDisorder»Persistentdelusions–Persecution,jealousy,beingfollowed,erotomania,somatic»Non-bizarredelusions–e.g.,jealousy,erotomania»NoothersymptomsofschizophreniaEtiologyofSchizophrenia:GeneticsNotlikelythatdisordercausedbysinglegeneBehaviorgeneticsresearch»Familystudies&Twinstudies(Table11.2)–Theriskincreasesasthegeneticrelationshipbetweenprobandandrelativebecomescloser–MZ(44.3%)DZ(12.08%)–Negativesymptomsmayhaveastrongergeneticcomponent»Adoptionstudies–Table11.3EtiologyofSchizophrenia:GeneticsMoleculargeneticsresearch»Linkagestudies–Anumberofchromosomesimplicated–Resultsinconsistentandmarkedbyafailuretoreplicate»Associationstudies–TwogenesidentifiedDTNBP1:encodingaproteincalleddysbindinNGR1:linkedtotheneurotransmitterglutamate’sreceptors&theprocessofmyelinationTable11.2FamilyandTwinGeneticStudiesTable11.3CharacteristicsofAdoptedOffspringofMotherswithSchizophreniaEtiologyofSchizoph