SymptomsofSchizophrenia

CaitrionaObermann&KarstenHeekeren Psychiatric UniversityHospitalZurich

Agenda

Schizophrenia acategorical diagnosis? Symptomsofschizophrenia

Psychopathology Cognitive Deficits (MATRICS)

Schizophrenia:Acategorical diagnosis?

healthy

ill

healthy

ill

Schizophrenia:Acategorical diagnosis?
Subclinical psychotic experiences:

Delusions Hallucinations
Psychotic experiences

Psychotic symptoms

Psychotic disorder

Inthehealthygeneralpopulation:

58%prevalence rate 7590%transitory,disappear over time

(Rssleretal.2007,vanOsetal.2009)

Schizophrenia:Acategorical diagnosis?

Schizophrenia

Bipolar Disorder

Schizophrenia:Acategorical diagnosis?

Schizophrenia

Bipolar Disorder

No clear boundaries to other psychiatric disorders!

Dimensionalapproachtopsychoticdisorders
Psychosis
(delusions,hallucinations)

Mania

Negativesymptoms

Depression

Cognitive impairment

(adapted from vanOsandKapur 2009)

Dimensionalapproachtopsychoticdisorders
Psychosis (delusions, hallucinations)

Mania

Negativesymptoms

Depression
Schizophrenia

Cognitive impairment

(adapted from vanOsundKapur 2009)

Dimensionalapproachtopsychoticdisorders
Schizophrenia

Psychosis (delusions, hallucinations)

Psychosis (delusions, hallucinations)

Mania

Negative symptoms

Mania

Negative symptoms

Depression

Cognitive impairment

Depression

Cognitive impairment

schizoaffective disorder

Bipolardisorder (adapted from vanOsundKapur 2009)

SymptomsofSchizophrenia

positivesymptoms cognitive dysfunction disorganisation

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

Liddle 1987: Psychomotorpoverty syndrome Disorganisation syndrome Reality distortion syndrome

Emsley etal.2003: Positive Negative Disorganized Excited Anxiety/Depression

Factoranalysis ofschizophrenicpsychopathologyII

Kopelowicz etal.2008: Positive Negative AgitationMania DepressionAnxiety Picardi etal.2012: Positive Negative Disorganized Activation Depression

Schizophrenia

PositiveSymptoms hallucinations delusions

NegativeSymptoms affective blunting avolition Cognitive Symptoms

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)

WechslerMemoryScale3rdEd. (WMSIII):SpatialSpan LetterNumberSpan

HopkinsVerbalLearningTestRevised (HVLTR)

BriefVisuospatial MemoryTestRevised (BVMTR) Neuropsychological AssessmentBattery (NAB):Mazes

MATRICSConsensusCognitiveBattery

Social Cognition: MayerSaloveyCaruso EmotionalIntelligence Test Managing Emotions

Example:

MATRICS:Healthy controlsvs.schizophrenia individuals

(Augustetal.2012)

MATRICS:Cognitive impairment profile of schizophrenia individuals

(Kernetal.2011)

MATRICS:Discrimination ofschizophrenia individuals vs.community residents

Correctly identified: - 81.8 % SZ - 75.7 % Controls

(adapted from Kernetal.2011)

MATRICS:Discrimination ofschizophrenia individuals according employment status

Correctly identified: - 84.4 % Workers - 45 % Non-Workers

(adapted from Kernetal.2011)

Stages ofschizophrenic illness opportunities for disease modification

Premorbid Prodromal Psychotic
clinical expression

Etiologic factors

Pathogenesis Pathology

Pathophysiology

Progression of pathology

Targeted prevention of disease

Prevention of manifestdisease

Early intervention tocorrect pathophysiology

Treatmenttoprevent illness progression and disability (Tandon etal.2010)

hereditary factors predisposing factors

and/or

discrete cerebralzerebrale impairment,e.g. virus infection pre or postnatal psychosocial factors

vulnerability
triggering factors stressfactors lifeevents Drugs

schizophrenia
recovery inducing or relapse provocing factors

heredity cerebralimpairment psychosocial factors

remission

relapse

chronic

Course ofthe schizophrenic disease

positiveoutcome

negativeoutcome

Lifeexpectancy ofpatients with schizophrenia is reduced by 1215years!

(Saha etal.2007,vanOsundKapur 2009)

Thank you for your attention