Brain volume—larger ventricles—3% reduction in brain volume
səhifə 27/30 tarix 27.04.2018 ölçüsü 469 b. #49225
Brain volume—larger ventricles—3% reduction in brain volume Males more affected than females Not specific to schizophrenia Cortical tissue loss increases over time Specific brain areas Problems in frontal and temporal lobes as well as neighboring (medial temporal) areas such as hippocampus and thalamus Not specific to schizophrenia, not shown in all schizophrenia Abnormally low frontal lobe activity associated with negative sx Neurochemistry Dopamine hypothesis Pharmacological action of Thorazine Amphetamine induced psychosis Drugs increasing dopamine may create psychotic sx Dysregulated dopamine may create aberrant salience (pay more attn to stimuli that are not relevant or important) But no strong evidence that pts with dopamine are producing more dopamine than controls Focus is on receptor sensitivity Social class—more schizophrenia in lowest class Social class—more schizophrenia in lowest class Why? Poor tx from others , poor ed, no opportunity Or social selection theory (most, not all variance, by this) Urban environment—2.7x risk Family—expressed emotion (critical, hostile, and overinvolved) increases relapse No evidence for schizophrogenic mother Immigration—migrants are at 2.7x risk Black skin migrant have higher risk than migrant with white skin Appears to be related to stress and discrimination Clinical outcome 15-25 yrs after developing schizophrenia, about 38% have a favorable outcome, but this does not mean a return to premorbid functioning 16% recover to point that they no longer need tx 12% need long term institutionalization 1/3 show signs of continued negative sx Spontaneous improvements late in life sometimes occur First generation—thorazine, haldol—neuroleptics First generation—thorazine, haldol—neuroleptics Block action of dopamine by blocking D2 receptors Work best for + symptoms Side effects—drowsiness, dry mouth, wt gain, tardive dyskinesia, extrapyramidal side effects( involuntary movements , such as shaking or rigidity) Second generation Clozaril, Risperdal, Seroquel, Geodon, Abilify Fewer extrapyramidal side effects Decrease in both + and – sx Block a wider array of receptors, including D4 Side effects include drowsiness, drooling, wt gain, diabetes, agrunulocytosis (drop in white blood cells) Family therapy Goal to reduce EE Involves education, coping, problem solving, communication Case management Social skills training Cognitive-behavioral—goal is to decrease intensity of + sx, reduce relapse, decrease social disability. Results promising. Think A Beautiful Mind Individual treatment Ageism 80% of the elderly report having experienced ageism, such as people assuming they have memory or physical impairments due to age 31% report being ignored or not taken seriously because of their age 58% report being told jokes that make fun of older persons (Palmore, 2005, 2004, 2001) Positive ageism—emphasize that there are no disadvantages to growing old. Elderly are a growing population: 1900 4% were over 65 2000 13% 2040 21-25%--baby boomers Number of people over 80 will double in the next 10 years—fastest growing segment of the population Three groups Young old 65-74 Old-old 75-84 Oldest old 85 and up Over 95: more clear-headed, agile, and healthy than those in their 80s and early 90s. Many of these are sexually active, working, enjoying the outdoors and the arts. Resistant to disabling and terminal infections. People themselves credit good frame of mind and healthy regular behaviors (diet and exercise, not smoking) Cohort effects—consequences of being born at a particular time Time of measurement—events at a particular point in time affect research, too People often blame age for the problems of the old, but 10-20% have psych problems Depression in later life Depression in later life Overall as many as 20% of people experience depression in old age—highest rates in older women Some studies indicate that depression decreases with age Depression increases risk of developing significant medical problems Also risk of secondary depression—30% of those with chronic health problems are depressed Increased risk for suicide—even more than among the young 19/100,000 (compared to 12/100,000 for other adults). Among white men over 85 it is 65/100,000 Risk factors for suicide: physical illness, hopelessness, social isolation, loss of loved one Depression may be confused with cognitive problems—those who are depressed complain more of memory problems than the demented do. Tend to underestimate their abilities. Make more errors of omission Treatment does work Antidepressants—side effects—drugs break down differently later in life ECT—back in favor Cognitive tx Interpersonal tx Dostları ilə paylaş:
