Gurleen Kaur
Clinical psychology 60 hrs internship program
3rd July Batch
Assignment
Part 1: Describe the primary symptoms of
schizophrenia (positive and negative symptoms).
Schizophrenia is a psychotic disorder that includes a
collection of symptoms that affects the mind and results
in individual’s loss of contact with the reality. It is
defined by abnormalities in one or more of the
following five domains: Delusions, Hallucinations,
Disorganized thinking(speech), grossly disorganized or
abnormal motor behaviour(including catatonia).
Symptoms of schizophrenia have been categorised into
Positive and Negative symptoms:
Positive Symptoms( additions in thought, emotion
and behaviour)
Delusions- are fixed beliefs that are firmly held on
inadequate grounds and are not amenable to change
in light of conflicting evidence.
o Types-
Persecutory delusions- belief that one is
going to be harmed, harassed or plotted
against and so forth by an individual,
organization or other group. These are the
most commonly found delusions.
Referential delusions-Believing that
specific gestures, comments, or
environmental hints are personally
directed is also common.
Grandiose delusions- where someone
thinks they possess extraordinary abilities,
wealth, or fame.
Erotomanic delusions-where a person
wrongly believes someone else is in love
with them
Nihilistic delusions-the belief that a
significant disaster is imminent.
Somatic delusions- are centered on
concerns about health and bodily
functions.
Thought withdrawal- belief that one’s
thoughts have been removed by some
outside force.
Thought insertion- belief that alien
thoughts have been put into one’s mind.
Delusions of control- belief that one’s
body or actions are being acted on or
manipulated by some outside force.
Hallucinations- Hallucinations are experiences
similar to perceptions but happen without any
external stimulus. They are vivid and clear, as
intense as regular perceptions, and cannot be
controlled voluntarily. These can occur in any
sensory form, but auditory hallucinations are the
most common in schizophrenia and related
disorders.
o Types-
Auditory hallucinations includes patients
hearing sounds or voices that speak words,
phrases or sentences directly to the
patient(second person hallucination) or
talk to one another referring to the patient
as he/she(third person hallucination).
Tactile hallucinations include feeling
forms of tingling or burning sensation.
Somatic hallucinations include feeling like
something happening inside one’s body
such as snake crawling inside one’s
stomach.
Visual hallucinations includes vague
perception of colour or distinct visions of
people or objects.
Gustatory hallucinations are those wherein
food or drinks start tasting strange.
Olfactory hallucinations are those where
patients experience foul smell, smoke or
smell of poison or of a dead body.
Disorganized thinking (speech) also known as
formal thought disorder is typically inferred from
the individual’s speech. An individual might jump
from one topic to another (derailment or loose
associations). Their responses to questions may be
only vaguely related or completely unrelated
(tangentiality). Individuals may also show
circumstantiality where they have an inability to
answer a question without giving excessive,
unnecessary detail. However, in circumstantiality,
the person does eventually return to the original
point unlike tangentiality. Patients may also exhibit
preservation which includes repetition of thoughts
or persisting thoughts.
Negative symptoms (reduction in thoughts, emotions
and behaviour)
Grossly disorganized or abnormal motor behaviour
can appear in various forms, from childlike
"silliness" to unpredictable agitation, and can
interfere with goal-directed activities and daily
tasks. Catatonic behaviour involves a significant
reduction in responsiveness to the environment,
which can manifest as resistance to instructions
(negativism), maintaining a rigid or bizarre
posture, or complete lack of speech and movement
(mutism and stupor). It can also include
purposeless, excessive motor activity without clear
reason (catatonic excitement). Other features of
catatonia are repetitive movements, staring,
grimacing, mutism, and echoing others' speech.
Two prominent negative symptoms of
schizophrenia are diminished emotional expression
and avolition. Diminished emotional expression
involves reduced facial expressions, eye contact,
speech intonation (prosody), and hand, head, and
facial movements that normally convey emotions.
Avolition is a decrease in self-motivated,
purposeful activities, leading to prolonged
inactivity and disinterest in work or social
engagements. Other negative symptoms include
alogia, anhedonia, and asociality. Alogia is
characterized by reduced speech output, anhedonia
by a diminished ability to feel pleasure or recall
previous enjoyable experiences, and asociality by a
lack of interest in social interactions, which may
stem from avolition or limited social opportunities.
Part 2: Explore the genetic and environmental
factors that contribute to schizophrenia and discuss
the role of brain structure and neurochemical
imbalances.
Genetic Causal Factors
Family Studies: Schizophrenia is known for its genetic
heritability, often described as "familial." Research has
shown high rates of schizophrenia among biological
relatives of probands (the initial cases identified in
genetic studies). Gottesman (1991) discovered a strong
link between the closeness of the genetic relationship
and the risk of developing the disorder. For example,
first-degree relatives (parents, siblings, and offspring)
who share 50% of their genes with a schizophrenic
proband have about a 10% prevalence of the disorder,
while second-degree relatives, sharing 25% of their
genes, have a lifetime prevalence of around 3%. Twin
and adoption studies are used to determine whether
biological or environmental factors are more significant
in schizophrenia.
Twin Studies: Researchers compare concordance rates
for monozygotic (MZ) and dizygotic (DZ) twins to
study schizophrenia's heritability. Concordance rates are
significantly higher in identical twins than in fraternal
twins or ordinary siblings. An example is the Genain
quadruplets, all of whom had schizophrenia. Gottesman
(1996) found an average concordance rate of 46% for
MZ twins, three times higher than the 14% for DZ
twins. The ratios for MZ and DZ twins range from 3:1
to 5:1, with higher rates if the index twin has severe
symptoms. Fischer (1971, 1973) studied MZ twins
discordant for schizophrenia, finding that the offspring
of the non-schizophrenic twins also had a high
incidence of the disorder, supporting the genetic
hypothesis.
Adoption Studies: These studies compare
schizophrenia concordance rates between biological and
adoptive relatives of individuals adopted out of their
biological families at an early age. Greater concordance
among biological relatives suggests a hereditary
influence, while higher concordance among adoptive
relatives indicates environmental causes. Heston (1966)
found that 16.6% of children born to schizophrenic
mothers developed schizophrenia, compared to none in
the control group. Other studies, such as those by
Rosenthal et al. (1963) and Malaspina et al. (2001),
support the genetic influence, showing higher rates of
schizophrenia in biological relatives of adoptees with
the disorder and linking greater paternal age at
conception to higher rates of schizophrenia.
Structural Brain Abnormalities in Schizophrenia
Studies using imaging and post-mortem techniques
reveal structural brain abnormalities linked to
schizophrenia. Findings include a 4-6% reduction in
brain volume, enlarged ventricles, and abnormalities in
the temporal lobe, limbic structures, and frontal cortex.
Specific reductions are noted in the amygdala and
hippocampus. MRI scans show decreased cortical grey
matter and right hemisphere white matter linked to
severe symptoms. Volume reductions in the temporal
lobe correlate with memory deficits and severe negative
symptoms, and increased neuronal density is found in
certain prefrontal cortex areas. These abnormalities are
more pronounced in males.
Dopamine Hypothesis in Schizophrenia
The Dopamine Hypothesis links schizophrenia to
excessive dopamine activity in the brain. Evidence
includes the effectiveness of neuroleptics, which block
dopamine receptors, and the symptom-exacerbating
effects of drugs that increase dopamine activity.
Environmental factors
The incidence of schizophrenia is influenced by birth
season, with late winter/early spring and summer births
linked to higher rates. Growing up in urban areas and
belonging to certain minority ethnic groups also
increases the risk of developing schizophrenia and
related disorders.