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Agenda
Schizophrenia:Acategorical diagnosis?
healthy
ill
healthy
ill
Schizophrenia:Acategorical diagnosis?
Subclinical psychotic experiences:
Delusions Hallucinations
Psychotic experiences
Psychotic symptoms
Psychotic disorder
Inthehealthygeneralpopulation:
Schizophrenia:Acategorical diagnosis?
Schizophrenia
Bipolar Disorder
Schizophrenia:Acategorical diagnosis?
Schizophrenia
Bipolar Disorder
Dimensionalapproachtopsychoticdisorders
Psychosis
(delusions,hallucinations)
Mania
Negativesymptoms
Depression
Cognitive impairment
Dimensionalapproachtopsychoticdisorders
Psychosis (delusions, hallucinations)
Mania
Negativesymptoms
Depression
Schizophrenia
Cognitive impairment
Dimensionalapproachtopsychoticdisorders
Schizophrenia
Mania
Negative symptoms
Mania
Negative symptoms
Depression
Cognitive impairment
Depression
Cognitive impairment
schizoaffective disorder
SymptomsofSchizophrenia
negativesymptoms
affective symptoms
PositiveSymptoms
Hallucinations: auditory hallucinations: discussing,arguing or commentating voices,quite commonly threats andaccusations; alsonoises suchasfootsteps visual hallucinations: objects,people,fantastic creatures,animals,religious images can be incolour or black andwhite olfactory,gustatory andtactile hallucinations
PositiveSymptoms
Delusions: afalse belief,firmly sustained,despite ofwhat others believe and despite ofobvious proof or evidence tothe contrary ANDnot accepted by other members ofthe persons culture or subculture Delusions ofreference Persecutory delusions Systematized delusions often based around fear;commonly with fantastic explanations about science,technologyandconspiracy thought withdrawal,thought insertion andthought broadcasting
NegativeSymptoms
affective blunting:inability tounderstand andexpressemotions alogia:decrease inverbalcommunication e.g.poverty ofspeech,blocking anhedonia:loss ofability tofindpleasure from relationships/activities avolition:loss ofwillor drive e.g.hygiene social withdrawal
Disorganisation
formalthought disorders: disorganisation ofthe form(not content)ofthought e.g.tangentialthought,loosening ofassociations/derailment,neologisms, echolalia,incoherence bizzare andcatatonic behaviours: echopraxia,catatonic exitement,negativism,posturing or stupor
Affective Symptoms
Depression often occurs before the first psychotic episode postschizophrenic depression Anxiety Aggression
Factoranalysis ofschizophrenicpsychopathology
Factoranalysis ofschizophrenicpsychopathologyII
Kopelowicz etal.2008: Positive Negative AgitationMania DepressionAnxiety Picardi etal.2012: Positive Negative Disorganized Activation Depression
Schizophrenia
Dopamine hypothesis Dopamine excess inthe Dopamine deficiency in limbic system the prefrontal cortex positivesymptoms negativesymptoms
MATRICS
MATRICS:Measurement AndTreatmentResearchtoImprove Cognition inSchizophrenia
SpecificgoalsoftheNIMHMATRICSare: Tocatalyzeregulatoryacceptanceofcognitioninschizophreniaasatargetfor drugregistration. Topromotedevelopmentofnovelcompoundstoenhancecognitionin schizophrenia. Leverageeconomicresearchpowerofindustrytofocusonimportantbut neglectedclinicaltargets. Identifyleadcompoundsandifdeemedfeasible,supporthumanproofof concepttrialsforcognitioninschizophrenia
MATRICSConsensusCognitiveBattery
Speed ofProcessing:Category Fluency,(BACS)Symbol Coding,TMTA Attention/Vigilance: CPT Identical Pairs Working Memory: LetterNumber Span(verbal),WechslerMemory Scale Spatial Span(nonverbal) VerbalLearning:HopkinsVerbalLearning Test(HVLT) VisualLearning: BriefVisuospatial Memory Test(BVMT) Reasoning andProblemSolving: Neuropsychological AssessmentBattery (NAB) Mazes Social Cognition: MayerSaloveyCaruso EmotionalIntelligence Test Managing Emotions
MATRICSConsensusCognitiveBattery
BriefAssessmentofCognitioninSchizophrenia (BACS): SymbolCoding CategoryFluency:AnimalNaming TrailMakingTest:PartA Timedpaperandpenciltestinwhichrespondentusesa keytowritedigitsthatcorrespondtononsensesymbols Oraltestinwhichrespondentnamesasmanyanimalsas she/hecanin1minute Timedpaperandpenciltestinwhichrespondentdrawsa linetoconnectconsecutivelynumberedcirclesplaced irregularlyonasheetofpaper Computeradministeredmeasureofsustainedattentionin whichrespondentpressesaresponsebuttonto consecutivematchingnumbers Usingaboardonwhich10cubesareirregularlyspaced, respondenttapscubesinsame(orreverse)sequenceas testadministrator Orallyadministeredtestinwhichrespondentmentally reordersstringsofnumberandlettersandrepeatsthemto administrator Orallyadministeredtestinwhichalistof12wordsfrom threetaxonomiccategoriesispresentedandthe respondentisaskedtorecallasmanyaspossibleaftereach ofthreelearningtrials Atestthatinvolvesreproducingsixgeometricfiguresfrom memory Seventimedpaperandpencilmazesofincreasingdifficulty thatmeasureforesightandplanning
ContinuousPerformanceTestIdenticalPairs(CPTIP)
HopkinsVerbalLearningTestRevised (HVLTR)
MATRICSConsensusCognitiveBattery
Example:
(Augustetal.2012)
(Kernetal.2011)
Etiologic factors
Pathogenesis Pathology
Pathophysiology
Progression of pathology
Prevention of manifestdisease
and/or
vulnerability
triggering factors stressfactors lifeevents Drugs
schizophrenia
recovery inducing or relapse provocing factors
remission
relapse
chronic
positiveoutcome
negativeoutcome