swings of fashion in schizophrenia l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Swings of Fashion in Schizophrenia PowerPoint Presentation
Download Presentation
Swings of Fashion in Schizophrenia

Loading in 2 Seconds...

play fullscreen
1 / 29

Swings of Fashion in Schizophrenia - PowerPoint PPT Presentation


  • 117 Views
  • Uploaded on

Swings of Fashion in Schizophrenia. The Kraepelinian Disease Model. 1896-1940. Psychoanalytical Model. 1940-1976. Psychotic people are not categorically different

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Swings of Fashion in Schizophrenia' - jeanine


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
swings of fashion in schizophrenia
Swings of Fashion in Schizophrenia

The Kraepelinian Disease Model

1896-1940

Psychoanalytical Model

1940-1976

slide2

Psychotic people are not categorically different

  • The experience and behaviour of people with schizophrenia is “much more socially intelligible than has come to be supposed by most psychiatrists”
  • Psychiatry is often a coercive agent for social control
  • Parents cause schizophrenia
swings of fashion in schizophrenia4
Swings of Fashion in Schizophrenia

The Kraepelinian Disease Model

1896-1940

Psychoanalytical Model

1940-1976

Genetic-Brain Disease Model

1976-2000

the diagnosis of schizophrenia is a contentious issue for many patients
The Diagnosis of Schizophrenia is a Contentious Issue for Many Patients

You are a Schizophrenic!

the years of warring factions
The Years of Warring Factions
  • Kraepelinians maintained that schizophrenia was just a simple brain disease while antipsychiatrists claimed that psychotic people were saner than those who treated them.
  • Geneticists boasted there was no role for environment while psychologists called geneticists fascists; and charities hated each other even more than they hated psychiatrists.
  • These disputes brought disrepute on the mental health services and allowed politicians to ignore the needs of the mentally ill
swings of fashion in schizophrenia7
Swings of Fashion in Schizophrenia

The Kraepelinian Disease Model

1896-1940

Psychoanalytical Model

1940-1976

Genetic-Brain Disease Model

1976-2000

Increasing Emphasis on Social Factors

2000-2006

alternative models in 2008
Alternative Models in 2008

Persist with the Neurodevelopmental Model ?

Welcome the Kraepelinians back ?

Switch to a Cognitive or Social Model ?

the critics
The Critics

“It is now almost a hundred years since Kraepelin introduced his concept of dementia praecox, the direct forerunner of ……the modern concepts of schizophrenia. Criticising these concepts has been a popular sport

is 112 years of schizophrenia enough
Is 112 years of schizophrenia enough?
  • Overlap with schizotypy and into minor psychotic symptoms in the normal population
  • Overlap with affective psychosis
  • Are dimensions better than categorical diagnosis?
slide12

The Mad

The Sane

12

only psychiatrists believe there is a categorical distinction between sanity and insanity
Only psychiatrists believe there is a categorical distinction between sanity and insanity

“No excellent soul is exempt from a mixture of madness” 

Aristotle

“Sanity is very rare: every man almost, and every woman, has a dash of madness”

Ralph Waldo Emerson

“Insanity in individuals is something rare – but in groups, parties, nations and epochs, it is the rule”

Friedrich Nietzsche

“The statistics on insanity are that 1 out of every 4 Americans is suffering from mental illness. Think of your three best friends. If they are okay then it’s you”

Rita Mae Brown

are minor psychotic symptoms in the general population of relevance to schizophrenia
Are minor psychotic symptoms in the general population of relevance to schizophrenia?
  • 8580 individuals aged 16-74 were interviewed as part of a large survey of mental health in the UK population
  • The Psychosis Screening Questionnaire of Bebbington et al (1995) was used to identify those with psychotic symptoms
  • We examined the correlates of these symptoms

Johns L et al. Br J Psych. 2004;185:298-305.

correlates of minor psychotic symptoms in the general population
Correlates of Minor Psychotic Symptoms in the General Population
  • Low verbal IQ
  • Low education
  • Living in cities
  • Cannabis dependence
  • Life events/victimisation
  • Neurotic symptoms
  • Ethnic minorities

Minor psychotic symptoms in the general population are related to the same variables as is schizophrenia.

Psychosis is at one extreme of a distribution of psychotic symptoms

continua in medical disorders

Diastolic blood pressure of 85 mmHg

Continua in Medical Disorders
  • Many medical disorders are considered to be at the extreme end of a continuum (eg, obesity, hypertension, diabetes, anemia)
  • A categorical division is imposed at the point at which it seems useful to initiate treatment

HEALTHY ill

  • Psychotic illness is at the extreme of a dimension upon which we impose a categorical distinction at the point at which it seems useful to initiate treatment
know your own psychosis levels
Know Your Own Psychosis Levels
  • Do you ever feel that others are against you?
  • Do you believe that others are influencing your mind?
  • Do you believe that other people talk about you?
  • Can you communicate with animals?

Do you ever feel that your manager/professor is against you?

Do you believe that drug companies are influencing your mind?

Do members of your clinical/research team gossip about you?

If you have a pet, can you tell what it is thinking?

the traditional kraepelinian dichotomy
The Traditional Kraepelinian Dichotomy

True schizophrenia

True bipolar disorder

After Pak Sham.

traditional kraepelinian dichotomy in real life

Misdiagnosis

Clinicalschizophrenia

Clinicalbipolar disorder

Schizoaffective disorder

Traditional Kraepelinian Dichotomy (in real life)

True schizophrenia

True bipolar disorder

motor and language development in pre symptomatic children
Motor and Language Developmentin Pre-symptomatic Children

Pre-schizophreniform

0.2

0.1

0.0

Co-efficient

-0.1

-0.2

-0.3

-0.4

IQ

Receptive language

Expressive language

Motor development

Cannon M et al. Arch Gen Psychiatry. 2002;59:449-456.

motor and language development in pre symptomatic children21
Motor and Language Developmentin Pre-symptomatic Children

Pre-schizophreniform

Pre-manic

0.4

0.3

Co-efficient

0.2

0.2

0.1

0.1

0.0

0.0

IQ

Co-efficient

-0.1

Receptive language

Expressive language

Motor development

-0.2

-0.3

-0.4

IQ

Receptive language

Expressive language

Motor development

Cannon M et al. Arch Gen Psychiatry. 2002;59:449-456.

slide22

The genetic relationship between schizophrenia and bipolar disorder

A

Additive genetic

Schizophrenia

Schizoaffectivedisorder

Bipolar disorder

Cardno et al 2002

slide23

A1

E1

The genetic relationship between schizophrenia and bipolar disorder

A

Additive genetic

Developmentalimpairment

Schizoaffectivedisorder

Bipolar disorder

Cardno et al 2002

slide24

Neuregulin

Dysbindin

DISC1

COMT

ETC, ETC

Genes for psychosis

exist

the implications of the findings
The Implications of the Findings
  • Schizophrenia is subject to genetic influence!
  • But it is equally clear that geneticists exaggerated the influence!
  • The genes are multiple, of small effect, and to interact with each other and with environmental factors
  • The genes are distributed through the normal population
  • People with schizophrenia are not categorically different
dopamine as the wind of psychotic fire
Dopamine as the “Wind of Psychotic Fire”
  • When individuals are acutely psychotic, they show an excessive release of dopamine (Laruelle et al 1996)
  • Dopamine normally mediates the attachment of salience to ideas and objects (Berridge and Robinson, 1998)
  • Heightened DA transmission leads to aberrant assignment of salience to external and internal stimuli (Kapur, 2003).
  • Delusions arise from attempts to explain this abnormal salience (Maher, 1983)
d imensional view grouping of symptoms
Dimensional view: grouping of symptoms

negative

manic

positive

depressed

disorganisation

dimensions or diagnosis
Dimensions or Diagnosis?
  • Dimensions are marginally better than categorical diagnoses
  • However, using both provides more clinical information than either alone
  • DSM V and ICD 11 should use both
towards dsmvi and icd12
Towards DSMVI and ICD12
  • The term psychosis will have been replaced by the term Dopamine Sensitisation Disorder of the Associative Striatum (DSDAS)
  • This will be routinely diagnosed by neurochemical imaging
  • Different genes and different environmental factors will have been mapped onto the 5 symptom factors and the developmental dimension of DSDAS