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Figure 3.4 Meta-analysis of absolute regional brain volumes in schizophrenic patients and controls, from a total of 58 studies. This figure shows how the mean volumes of different brain regions from people with schizophrenia differ from those of controls. Figure reproduced with permission from Wright IC, Rabe-Hesketh S, Woodruff PW, et al. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry 2000 157 16-25 Figure 3.5 Some structural brain abnormalities possibly implicated...

Structural Imaging And Anatomical Studies

The core brain structural finding in schizophrenia, of lateral ventricular enlargement (Figure 3.1) is now well established, but the degree of enlargement is relatively small (Figure 3.2) about 25 on average1. Monozygotic twins discordant for schizophrenia can be distinguished from their co-twins on the basis of ventriculomegaly and decreased temporal cortical volume (Figure 3.3)2. Numerous other morphological abnormalities have been reported (Figures 3.43 and 3.5). People with schizophrenia...

Factors Affecting Prognosis

Certain clinical features are associated with a poor prognosis early or insidious onset, male sex, negative symptoms19,20 (Figure 1.8), lack of a prominent affective component or clear precipitants, family history of schizophrenia, poor premorbid personality, low IQ, low social class, social isolation, and significant past psychiatric history. Several studies have demonstrated an association between longer duration of untreated illness and poorer outcome. For example, Loebel and colleagues21...

Cannabis Consumption At Age 18 And Later Risk Of Schizophrenia

Patients as a group may be of lower birth weight than the general population. The morphological abnormalities that have been reported in schizophrenia are consistent with a neurodevelopmental event occurring in fetal or early development. Some believe that the onset of frank psychotic symptoms reflects the delayed sequelae of an earlier developmental aberration, which is then expressed as the brain continues to develop in adolescence and adult life - sometimes termed the 'doomed from the womb'...

Auditory Eventrelated Potentials

Figure 3.16 Abnormalities in evoked potentials have consistently shown abnormalities in schizophrenia. The P300 auditory event-related potential (ERP), seen here as one of several components of the auditory ERP, is seen as a response to 'oddball' or unexpected stimuli, and shows robust changes in both amplitude and latency in schizophrenic patients and their relatives. Figure 3.16 Abnormalities in evoked potentials have consistently shown abnormalities in schizophrenia. The P300 auditory...

Concordance Rates For Schizophrenia From Twin Studies

Figure 2.6 Concordance rates for schizophrenia in studies of dizygotic twins. The implication of the lack of 100 concordance in monozygotic twins is that there must be environmental etiological factors involved in the genesis of schizophrenia. Data from references 4-10 Figure 2.6 Concordance rates for schizophrenia in studies of dizygotic twins. The implication of the lack of 100 concordance in monozygotic twins is that there must be environmental etiological factors involved in the genesis of...

Pet Schizophrenia D2 Occupancy

High D2 receptor availability no occupancy Clozapine treated patient with schizophrenia Medium D2 receptor availability medium ( 60 ) occupancy Typical antipsychotic-treated patient with schizophrenia Low D2 receptor availability high (80 +) occupancy Figure 4.2 Three single photon emission tomography (SPET), scans of striatal D2 and D2-like receptor availability at the level of the basal ganglia. In the scan on the left from a healthy volunteer there is no receptor occupancy and therefore 100...

Psychological Therapies

Psychoanalytic psychotherapies have largely been discredited in the management of schizophrenia, and indeed cast something of a shadow over the development of more effective approaches to treatment. However, a number of very promising new approaches are now emerging. Cognitive behavioral therapy CBT encompasses a variety of interventions. At its core is the idea that if patients can be presented with a credible 'cognitive' model of their symptoms, they may develop more adaptive coping...

References

Effect of chlorpromazine or haloperidol on formation of 3-methoxytyramine and normetanephrine in mouse brain. Acta Pharmacol Toxicol 1963 20 140-4 2. Creese I, Burt DR, Snyder SH. Dopamine receptor binding predicts clinical and pharmacological potencies of antischizophrenic drugs. Science 1976 19 481-3 3. Angrist B, van Kammen DP. CNS stimulants as a tool in the study of schizophrenia. Trends Neurosci 1984 7 388-90 4. Lieberman JA, Kane JM, Alvir J. Provocative tests...

The Acute Illness

Drawings Schizophrenic Patients

The onset may be rapid, or slow and insidious. In the latter situation in particular, there may be a prolonged period of undiagnosed illness in which the affected person slowly becomes more withdrawn and introverted. They may develop unusual interests, particularly of a religious or philosophical kind, and drift away from family and friends. They may also begin to fail in their occupation or schoolwork. This process can take weeks to years but eventually, often with a seemingly precipitating...

Sideeffects Of Typical Antipsychotics

Acute neurological side-effects secondary to dopamine D2 receptor blockade with typical antipsychotics include acute dystonia. This is characterized by fixed muscle postures with spasm, e.g. clenched jaw muscles, protruding tongue, opisthotonos, torticollis, oculogyric crisis mouth open, head back, eyes staring upwards . It appears within hours to days and young males are most at risk. It should be treated immediately with anticholinergic drugs procyclidine 5-10 mg or benztropine 50-100mg...

Inner Speech And Auditory Hallucinations

Schizophrenia Inner Speech 2011

Figure 3.13 This study investigated the hypothesis that a predisposition to verbal hallucinations is associated with a failure to activate areas concerned with the monitoring of inner speech. Subjects, who included patients with schizophrenia both with and without a significant history of hallucinations, as well as normal controls, were asked to imagine sentences being spoken in another person's voice. The figure illustrates positron emission tomography data superimposed on a normal magnetic...