Overview exam 4

Overview- Schizophrenia 1 This lecture begins the final section of the course, focusing on schizophrenia, other psychotic disorders, and developmental disorders. The instructor, whose research area is schizophrenia, outlines the upcoming lectures and dives into schizophrenia's symptoms, prevalence, common misconceptions, and course. The goal is to comprehensively understand schizophrenia before moving on to diagnostic criteria, videos, ideology, and treatment in subsequent lectures. Detailed Summary The lecture first clarifies the course structure, with three lectures on schizophrenia, one on other psychotic disorders, and two on developmental disorders. Schizophrenia, a severe and heterogeneous mental illness affecting about 1% of the population, is characterized by a loss of contact with reality. It often impacts those of lower socioeconomic status and is slightly more common in men, with different onset ages between genders. Common misconceptions about schizophrenia are addressed, such as its confusion with dissociative identity disorder, the belief that people with schizophrenia are violent, and the idea that all cases are chronic. In fact, about a quarter of patients achieve complete remission after an initial psychotic episode, a quarter recover with treatment, a quarter have episodic illness, and a quarter develop a chronic condition. The lecture then delves into schizophrenia's symptoms, divided into positive, negative, and psychoot (catatonic) symptoms. Positive symptoms include delusions (like persecution, reference, grandeur, and control), disorganization (loose associations, neologism, perseveration, clanging), hallucinations (auditory, visual, tactile, somatic, olfactory), and inappropriate affect. Negative symptoms involve the absence of normal functions, such as poverty of speech (alogia), blunted affect, loss of volition (avolition/apathy), loss of pleasure (anhedonia), and social withdrawal (asociality). Psychoot symptoms are abnormal movements due to a disturbed mental state, including catatonic stupor, rigidity, posturing, and excitement..

[Audio] The course of the disorder typically affects people from their late teens to mid-30s, with males having an earlier onset. It consists of a prodromal phase with early signs like brief intermittent psychotic symptoms or attenuated positive symptoms, an active phase with a full-blown psychotic episode, and a residual phase where the person attempts to regain normal function. Recovery varies, with factors like rapid onset, higher functioning at onset, older age, and a stress-triggered psychosis associated with better outcomes. Schizophrenia is defined by a loss of contact with reality, and its prevalence is around 1%. It is more common in lower socioeconomic groups and males, showing gender differences in onset age. Most individuals are not violent, and not all cases are chronic. The disorder includes positive symptoms such as delusions, disorganization, hallucinations, and inappropriate affect, as well as negative symptoms characterized by the absence of normal functions like speech, emotion, motivation, pleasure, and social interaction..

[Audio] Schizophrenia is a complex condition characterized by a range of symptoms, including positive symptoms such as hallucinations and delusions, disorganization, and lack of insight. These symptoms can significantly impact an individual's daily life, leading to difficulties in work, relationships, and self-care. At least two specific symptoms, such as delusions, hallucinations, or disorganized speech, must be present along with significant dysfunction and a six-month disturbance. Dysphoric mood, sleep and eating disturbances, cognitive impairments, and lack of insight are common features of the disorder. A genetic vulnerability is thought to be triggered by environmental stress according to the diathesis-stress model, which is supported by family, twin, and adoption studies. However, the dopamine hypothesis, although widely accepted, has limitations, as dopamine-related medications only treat positive symptoms, and there are inconsistencies in the relationship between dopamine and schizophrenia. Brain structure differences, such as increased ventricular size and reduced frontal and temporal lobe mass, are also observed, along with functional differences like hypofrontality..

[Audio] Schizophrenia is caused by biological factors, which include abnormal brain structure, the winter birth hypothesis, and abnormal brain function. Studies show that people with schizophrenia have larger ventricles and reduced lobe mass compared to healthy individuals. Moreover, research suggests that the timing of birth may also contribute to the development of the condition, with people born in the winter months being more likely to develop it. Additionally, abnormalities in brain function, such as hypofrontality, have been linked to schizophrenia. These findings emphasize the significance of considering biological factors in understanding the complex etiology of this disorder..

[Audio] Schizophrenia is a complex mental health condition that affects approximately one percent of the global population. It is characterized by a disconnection from reality, and its impact is not limited to the individual alone. Those from lower socioeconomic backgrounds and men are more likely to be affected, with varying onset ages between genders. Social labeling can lead to individuals becoming trapped in a mentally ill role, while family dysfunction, particularly high expressed emotion, contributes to higher relapse rates. The neurodevelopmental model highlights early motor and cognitive impairments, along with obstetric complications, as risk factors for schizophrenia, all interacting with the environment. Pre-morbid functioning, social skills, life events, and social class all influence the progression of schizophrenia. Antipsychotics serve as the primary treatment, although typical antipsychotics come with severe side effects, whereas atypical antipsychotics exhibit distinct side-effect profiles. Behavioral interventions such as symptom monitoring, behavioral experiments, and role-plays, as well as other psychosocial approaches like insight therapy, family therapy, and social therapy, play crucial roles in treatment..

[Audio] Schizophrenia has several subtypes, including schizoaffective disorder, brief psychotic disorder, and delusional disorder. Schizoaffective disorder involves having both psychotic symptoms and mood episodes, with specific conditions for diagnosis. The duration of this disorder is more than one month but less than six months, and it is characterized by the presence of one or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior. Brief psychotic disorder, on the other hand, is characterized by short-term psychosis, with different specifiers based on stressors or postpartum onset. This disorder typically lasts between one day and one month. Delusional disorder, however, involves having one or more delusions for a month or longer without other psychosis symptoms and without significant functional impairment. There are five subtypes of delusional disorder, including erotomanic, grandiose, jealous, persecutory, and somatic. Other specified schizophrenia spectrum and other psychotic disorder is a catch-all category with four sub-types. Additionally, psychotic disorder due to a general medical condition and substance-induced psychotic disorder are also discussed..

[Audio] The lecture introduces childhood disorders, distinguishing between disruptive externalizing disorders like ADHD, oppositional defiant disorder, and conduct disorder, characterized by outward behaviors. Additionally, emotional internalizing disorders such as depression and anxiety in children are discussed, highlighting the overlap and differences in their manifestation compared to adulthood. The main focus then shifts to neurodevelopmental disorders, particularly autism spectrum disorder. The history of ASD diagnosis is explored, tracing it back to its initial confusion with childhood schizophrenia and its recognition as a distinct disorder in 1980. The instructor explains how DSM-4 had various designations within the autism spectrum, which were unified into ASD in DSM-5, with four primary criteria: persistent social communication deficits, restricted and repetitive behaviors, symptoms in early childhood, and impairment of daily function. The instructor provides examples of restricted and repetitive behaviors, such as stimming, excessive routine adherence, restricted fixated interests, and unusual sensory behaviors. Social communication deficits are also detailed, including non-verbal/verbal communication issues, lack of social-emotional reciprocity, and difficulties in relationship development. The prevalence of ASD is discussed, noting its impact across all ethnic and socioeconomic groups, the significant male-to-female ratio, and its familial transmission. The increase in the prevalence rate since 2000 is analyzed, considering factors like expanded definition, better diagnosis, increased awareness, parental age, assortative mating, and potentially unknown environmental factors. Finally, the lecture emphasizes that vaccines do not cause autism..

[Audio] Restricted and repetitive behaviors in individuals with Autism Spectrum Disorder (ASD) include stimming, routine adherence, fixated interests, and unusual sensory behaviors. These behaviors can manifest in various ways, such as hand flapping, spinning, or repeating certain actions. Individuals with ASD may also exhibit a strong preference for routine and structure, which can lead to difficulties when faced with changes or unexpected events. Additionally, they may develop intense interests in specific topics or activities, which can sometimes appear obsessive. Unusual sensory behaviors can range from sensitivity to certain sounds or smells to seeking out intense sensory experiences, such as deep pressure or vibrations. Social communication deficits in ASD involve difficulties with both verbal and non-verbal communication, as well as social-emotional reciprocity and relationship difficulties. Individuals with ASD may struggle to initiate or maintain conversations, understand nuances of language, or recognize and respond to social cues. They may also have difficulty understanding and interpreting facial expressions, tone of voice, and body language. Furthermore, they may experience difficulties in forming and maintaining relationships, which can lead to feelings of isolation and loneliness..

[Audio] Individuals with schizophrenia may experience difficulty in enhancing their social skills, which can lead to challenges in daily life. Various approaches have been developed to address this issue, including the Lovas method, which involves intensive behavioral training, and the TEACH approach, structured learning for adolescents and adults. Additionally, biological treatments such as SSRIs and antipsychotics have also been used to improve social skills. However, it is essential to note that treatment for schizophrenia is controversial, with some advocates promoting neurodiversity. Associated characteristics of the condition include cognitive impairments, such as poor working memory and weak central coherence, as well as difficulties in detecting social cues and developing theory of mind. Diagnosis is reliable by two years, but early signs may lack specificity, and regression can occur. Strong genetic components and brain overgrowth due to reduced neuronal pruning are implicated in the etiology of the condition. Treatment goals focus on reducing harmful behaviors and improving communication and social skills..

[Audio] The symptoms of schizophrenia include both positive and negative symptoms. Positive symptoms include hallucinations, delusions, and disorganized speech and behavior. Negative symptoms, on the other hand, are characterized by flat affect, poverty of speech, and social withdrawal. Moreover, cognitive symptoms like impaired attention, memory, and executive function are also typical of this condition. When diagnosing schizophrenia, it is essential to rule out other conditions that may exhibit similar symptoms, including schizoaffective disorder, mood disorder with psychotic features, delusional disorder, brief or schizophreniform disorders, substance/medication-induced psychotic disorder, and medical conditions like delirium, dementia, and neurological disorders..

[Audio] Pharmacological treatment approaches for schizophrenia include the use of antipsychotics, particularly second-generation agents, which are effective in managing positive symptoms such as hallucinations and delusions. For treatment-resistant cases, clozapine may be considered. It is crucial to monitor side effects when using these medications. Psychosocial therapies, such as cognitive-behavioral therapy for psychosis, social skills training, family psychoeducation, supported employment, and assertive community treatment, can help individuals with schizophrenia develop coping strategies and improve their daily functioning. Comorbidities should be addressed, education provided, and relapse prevention measures implemented to ensure optimal outcomes. It is important to note that hallucinations in schizophrenia typically manifest as auditory voices, whereas visual hallucinations are less common. Negative symptoms, such as flat affect, differ from mood symptoms of depression, where patients may appear blunted rather than sad. Cognitive impairments, including attention and memory deficits, play a significant role in functional impairment. Schizophrenia requires a duration of at least six months to meet diagnostic criteria, distinguishing it from brief or reactive psychosis..

[Audio] Schizophreniform Disorder typically lasts between one and six months, with at least one month of active symptoms. During this time, mood episodes account for less than half of the overall duration of psychosis. The symptoms experienced are similar to those seen in schizophrenia, and it's not uncommon for the condition to have an acute onset. Approximately one-third of individuals who experience Schizophreniform Disorder will recover, while others may go on to develop schizophrenia. Those who exhibit good premorbid function and confusion tend to have a better prognosis. Schizoaffective Disorder, on the other hand, involves at least six months of symptoms, with at least two weeks of psychosis occurring independently of mood episodes. In contrast to schizophrenia, major depression or mania are present for most of the illness. Individuals with Schizoaffective Disorder can often function well outside of their delusional beliefs. Delusional Disorder, meanwhile, is characterized by the presence of one or more non-bizarre delusions lasting at least one month, with no other prominent psychotic symptoms..

[Audio] Brief Psychotic Disorder is characterized by good recovery, with some individuals progressing to schizophrenia. The duration of this disorder ranges from one day to less than one month, and it typically involves at least one core symptom. Stress or postpartum-related factors often contribute to its development. While there may be emotional turmoil, full mood episodes are not present. The prognosis varies depending on the individual case, and atypical presentations can also occur. In addition, Other Specified/Unspecified Psychotic Disorder includes examples such as shared psychotic disorder and attenuated psychosis. When considering differential diagnoses, it is essential to rule out Mood Disorders with Psychosis, Substance/Medication-Induced Psychosis, Medical Conditions, and Schizotypal Personality Disorder..

[Audio] Symptoms of inattention and/or hyperactivity-impulsivity must have been present for at least six months across multiple settings, including home, school, and work. For adults, this requires having at least five symptoms of inattention or hyperactivity-impulsivity. Furthermore, symptoms must have started before the age of twelve and cause significant impairment in daily life..

[Audio] Stimulants have been found to be effective in approximately 70-80% of patients, making them the first-line treatment option. Non-stimulants such as atomoxetine, bupropion, or certain antidepressants/antihypertensives like clonidine can serve as alternative options. The primary goals of medication management are to improve attention and reduce impulsivity while closely monitoring potential side effects..

[Audio] Individuals with Specific Learning Disorders experience difficulties with specific academic skills, such as reading, writing, or math, despite having normal intelligence and motivation. These struggles can manifest in various ways, including slow and effortful reading, misunderstandings of text, poorly structured written work, difficulty copying, and frequent math errors. Frustration or avoidance of academic tasks are also common symptoms. To distinguish SLDs from other conditions, it is crucial to rule out intellectual disability, inadequate schooling, or sensory impairment. Additionally, ADHD may coexist with SLD, but impulsivity is not a requirement. With early intervention and support, individuals with SLD can manage their struggles and achieve success..

[Audio] Schizophrenia is a lifelong condition, but with targeted support, many individuals can succeed. Without intervention, it can impair self-esteem and academic attainment. Early identification and remediation improve outcomes. A psychoeducational evaluation by a psychologist or specialist assesses the discrepancy between ability and achievement, using standardized achievement tests and cognitive tests. School reports, observation of academic performance, and evaluation for comorbid ADHD or dyslexia-specific tests are also gathered. Specialized educational strategies, such as Orton-Gillingham for reading, speech/language therapy, occupational therapy for writing, and math tutoring, are used to accommodate individual needs. Accommodations like extra time, oral exams, and assistive technology are often provided. Family education and school-home collaboration are essential. SLDs are not cured by medication, and early intensive intervention yields the best improvement..

[Audio] Disturbances in movement can manifest in various ways, including psychomotor agitation, where an individual may exhibit restless or agitated behavior, such as pacing back and forth, fidgeting, or rapid hand movements. On the other hand, psychomotor retardation can cause individuals to appear slow-moving, lethargic, or even catatonic. These disturbances can significantly impact daily functioning, making it challenging for individuals to engage in activities they once enjoyed. Furthermore, heightened perceptions and hallucinations can lead to disorganized thinking and speech, resulting in loose associations, neologisms, perseveration, and clanging. These symptoms can make communication difficult, both verbally and nonverbally. As a result, individuals with schizophrenia may struggle to express themselves effectively, leading to frustration and feelings of isolation..

[Audio] Schizophrenia is characterized by various symptoms, including feelings of being overwhelmed by sensory experiences, perceptions that occur without external stimuli, and inappropriate emotions. These symptoms can manifest as poverty of speech, blunted affect, loss of volition, loss of pleasure, and social withdrawal. Psychomotor symptoms may also be present, such as catatonic stupor, rigidity, posturing, and excitement. The course of the disorder typically follows a pattern of emergence between late adolescence and early adulthood, with varying degrees of severity and duration. Diagnostic criteria for schizophrenia require the presence of at least two of the following symptoms during a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. These symptoms must persist for at least six months, with possible prodromal or residual periods..

[Audio] Schizophrenia is characterized by various symptoms, including disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. These symptoms result in significant dysfunction in work, interpersonal relations, and self-care. The duration of this disturbance is typically six months or longer, and it can include both prodromal and residual periods. Associated features of schizophrenia include dysphoric mood, disturbances in sleeping and eating patterns, inability to concentrate, and lack of insight. There are also subtypes of schizophrenia, known as Type I and Type II, which differ in terms of their positive and negative symptoms. Type I schizophrenia is marked by relatively good premorbid adjustment, good responsiveness to traditional antipsychotic drugs, and a fair outcome of the disorder. In contrast, Type II schizophrenia is characterized by relatively poor premorbid adjustment, poor responsiveness to traditional antipsychotic drugs, and a poor outcome of the disorder. Both types of schizophrenia are associated with abnormal neurotransmitter activity and brain structures..

[Audio] Schizophrenia is caused by a combination of genetic and environmental factors. Individuals with a family history of schizophrenia are more likely to develop the disorder, with the closer the relationship, the higher the likelihood. Identical twins have a higher concordance rate than fraternal twins, indicating a strong genetic component. Children of parents with schizophrenia who were adopted developed the disorder at the same rate as those who remained with their biological parents, suggesting that the genetic factor plays a crucial role. Research on neurotransmitters such as dopamine and serotonin has identified abnormalities in these systems that may contribute to the development of schizophrenia. Additionally, studies have implicated abnormalities in brain structure and function, including changes in ventricular size, frontal cortex, temporal lobes, amygdala, and prenatal brain injury, as well as impaired temporal cortex function and hypofrontality..

[Audio] Schizophrenia is a complex condition influenced by both sociocultural and neurodevelopmental factors. Sociocultural factors such as social labeling, family dysfunction, and expressed emotion can contribute to its development. For example, individuals growing up in families with high levels of conflict or criticism may be more likely to develop the disorder. Similarly, social problem-solving skills, social skills, and social cognition can also play a role. Neurodevelopmental factors such as early problems with motor skills, IQ, obstetric complications, and premorbid functioning can also contribute to its development. For instance, individuals with difficulty with motor skills or a low IQ may be more susceptible to developing the disorder. Certain life events, such as season of birth, can also influence the risk of developing schizophrenia. Treatment for schizophrenia typically involves medication, specifically antipsychotics that block the dopamine receptor. However, these medications can have side effects such as extrapyramidal symptoms. Atypical antipsychotics that block both the dopamine and serotonin receptors are also available, offering a more targeted treatment option..

[Audio] Schizophrenia is a complex condition that affects many aspects of an individual's life. Despite the availability of medications, many people with schizophrenia continue to experience significant symptoms and difficulties. To address these challenges, adjunctive treatments such as cognitive-behavioral therapy, or CBT, have been developed. These therapies aim to help individuals develop strategies to cope with their symptoms and improve their overall functioning. CBT focuses on how symptoms interfere with achieving goals, rather than simply reducing symptoms themselves. By using techniques like strong focus on monitoring and coping, behavioral experiments, and role-plays, CBT helps individuals better manage their symptoms and improve their daily lives. Additionally, psychosocial therapies such as insight therapy, family therapy, and social therapy offer valuable support and guidance. These therapies provide individuals with the tools they need to navigate their experiences and achieve greater independence..

[Audio] Schizoaffective disorder is characterized by a prolonged period of illness where both positive and negative symptoms of schizophrenia coexist with a major mood episode. This condition typically lasts for more than a month but less than six months. In contrast, brief psychotic disorder is marked by the sudden onset of psychotic symptoms such as delusions, hallucinations, disorganized speech, or grossly disorganized behavior, lasting more than a day but less than a month. Delusional disorder, on the other hand, involves the presence of one or more delusions for at least a month, without any significant impairment in daily life or unusual behavior..

[Audio] Schizophrenia is often misdiagnosed because of its complexity. Common misconceptions include persistent auditory hallucinations, delusions with significant overlapping mood episodes, attenuated psychosis syndrome, and delusional symptoms in partners of individuals with delusional disorder. Additionally, other conditions can be mistaken for schizophrenia, including psychotic disorder due to a general medical condition, substance-induced psychotic disorder, and various childhood disorders such as ADHD, ODD, CD, depression, separation anxiety, autism spectrum disorder, intellectual disability, and specific learning disorder..

[Audio] The development of autism as a distinct disorder started in the 1950s, but it wasn't recognized as a separate entity from childhood schizophrenia until the 1980s. Research conducted during the 1970s was crucial in distinguishing between autism and schizophrenia. Notably, the developmental timelines of these two conditions differ significantly, and they do not co-occur in families. The DSM-5 diagnostic criterion for autism spectrum disorder emphasizes the importance of persistent deficits in social communication and social interaction, as well as restricted and repetitive patterns of behavior. These criteria include manifestations such as stereotyped or repetitive motor or verbal behaviors, excessive adherence to routines, and unusual sensory behaviors..

[Audio] Individuals with autism may exhibit a range of behaviors, including a fascination with lights or spinning objects, which is a manifestation of their restricted and repetitive patterns of behavior, interests, or activities. They may also display marked deficits in nonverbal and verbal communication, such as reduced eye-to-eye gaze, gesturing, and facial expressivity. Moreover, they may lack social-emotional reciprocity, exhibiting abnormal social approach and initiation, reduced sharing, and difficulty developing and maintaining relationships. These characteristics are indicative of autism and emphasize the significance of comprehending this intricate condition..

[Audio] Social cognition refers to the perception, processing, and interpretation of social information. This concept encompasses various aspects, including basic face processing and emotion recognition, theory of mind, and biological motion detection. Essentially, it involves understanding complex social dynamics and recognizing patterns in human behavior. When we see a face, we instantly gather information such as whether we know the person, their gender, age, and emotional state. We can even recognize individuals from faces, as demonstrated by remarkable abilities such as identifying high school classmates with high accuracy many years later. Notably, our memory for other visual stimuli, like objects, is not as impressive..

[Audio] Faces are unique because they contain specialized neural regions and expert perceptual abilities. Face perception takes a prolonged developmental course, starting even in neonates. Infants who receive restricted visual input during this period may experience long-term impairments in face perception. The inversion effect, where faces become less recognizable when viewed upside down, also increases with age. People with autism tend to exhibit abnormal visual scanning patterns while viewing faces, which can impact their ability to develop theory of mind. Theory of mind is crucial for understanding others' thoughts and intentions. In autism diagnosis, the presence of first-order false beliefs and second-order false beliefs is a key indicator. Autism can be reliably diagnosed by the age of two, although some cases may involve regression. The etiology of autism is still debated, with both psychological and biological factors playing a role. Some theories suggest bad parenting practices contribute to the development of autism, while others propose genetic or brain overgrowth as the primary causes. Treatment outcomes vary, but basic principles include maximizing engagement with the environment and involving parents early on..

[Audio] Schizophrenia is a complex condition that affects approximately one percent of the global population. It is characterized by a disruption in an individual's ability to perceive and interpret reality, leading to a range of cognitive, emotional, and behavioral symptoms. The impact of this disorder is not limited to the affected individual, as it also affects their family members, friends, and caregivers. Schizophrenia can manifest differently across individuals, making it essential to adopt a comprehensive approach when addressing its diagnosis and treatment. Behavioral methods such as Lovaas and TEACCH have been employed to help manage the symptoms of this disorder. Additionally, biological interventions like SSRIs have shown promise in alleviating some of the symptoms associated with schizophrenia. It is crucial to recognize that schizophrenia is not solely a product of an individual's biology, but rather a multifaceted condition influenced by various factors, including environmental, psychological, and sociocultural elements. By acknowledging this complexity, we can work towards developing more effective treatments and improving the overall quality of life for those affected by this disorder..