Medical psychology, she tries to understand how the human psyche about the disease, the patient and the physician. The field of this discipline is thus both broader and different.
Psychosomatic illnesses and somatic complaints are that the onset and progress can be traced in part to unconscious mental disorders.
These are mainly asthma, eczema, ulcerative colitis, certain high blood pressure. The causes of these diseases are varied, but each time, a psychological factor, among others, may be incriminated.
For the general psychiatrist Henri Ey, ‘psychiatry is the branch of medicine that is to the pathology of the life of relationship, level of integration that ensures autonomy and human adaptation to the conditions of its existence. (…) The psychiatrist is neither a policeman nor a political activist, a doctor …’.
For Perlemuter, ‘psychiatry is the medical specialty that focuses on the pathological changes of cognitive activity and integrative brain, thyme or mood and emotion. It supports not only the intellectual and characterological disorders of the individual but also the disruption of the relationship he establishes with his entourage. ‘
When the patient comes to see himself, the psychiatrist seeks to define the symptoms that prompted the consultation: their permanent or intermittent, the existence of identical background etc..
In most cases, the patient is aware of his problems but he may be difficult to express them as neurotic manifestations are often judged by the subject as completely absurd.
Sometimes the patient presenting with somatic symptoms and the doctor will diagnose psychological disorder but will sometimes struggle to gain acceptance. Other times, the patient consults, persuaded to be normal, oblivious to his troubles, driven to desperation by his relationship problems with his entourage.
The psychiatrist must then locate the character structure of patient anxiety, relationship of dependency vis-à-vis the environment, emotional immaturity, sensitivity to the frustrations of neurotic order. Emotional withdrawal, disinterest evoke such a schizophrenic dissociation. Paranoid structure is known before the austerity of lifestyle, obedience to strict rules, the attitude of distrust.
Mythomaniacal trends are recognized at the difficulties of overlap, the tendency to minimize problems and roles of prestige.
When the patient is seen by the psychiatrist at the request of the entourage, the first patient is different and requires careful handling. Often the patient denies and disputes the description of the disorder is made.
Shyness refers to a neurotic inhibition, the hysteric adopts a spirit of seduction. One problem is fear of contact early schizophrenia. Is the paranoid psycho: he brings his medical records, taking notes etc..
They confirm the diagnosis of psychiatric disorders because of their negativity in particular as regards the electroencephalogram (EEG), CT scan and magnetic resonance imaging.
They can be global or partial, and are manifested by a loss of intellectual capacity in the broad sense orientation in time and space, language understanding, etc..
The overall loss events of interest immediately or gradually all integrative functions, cognitive and memory of the intellect:
By definition, these are diseases of the personality, minor severity, not involving serious behavioral problems and do not require hospitalization (internment).
Neuroses expressed by disorders in which patients are conscious and whose occurrence is related to psychological trauma (recent or old). The neurotic subject has an accurate perception of reality that surrounds him, his condition he can describe in general.
Psychotic subjects had a false perception of reality (delusions) and the world around him.He interprets the elements of the outside world in a sense.
Psychological imbalance is defined by acting out. From childhood disorders are obvious: lies, theft, running away prelude to delinquency. The problem of criminal responsibility is of course in the foreground.
The subject psychopath is unable to resist his urges, whatever they are. It works immediately, without thinking about the consequences of his act, which moreover do not matter to him. He lacks the capacity to anticipate, predict. It is often dangerous to society. That’s one reason to doubt the deterrent of the death penalty.
They are carrying out active pleasures or regressive fantasy that replace the normal performance of the sexual act and its enforcement genital:
This concept has gradually imposed on psychiatrists to describe subjects who, by their manner, their behavior and their relationship style were significantly different personalities so-called normal or routine provided without presenting symptoms of a mental disorder characterized.
For Schneider, the ‘personality disorders are purely quantitative deviations of the personality, statistically rare and whose attitudes and behaviors are a cause of suffering for the subject himself or his entourage.’
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Definition of Schizophrenia: Breakup of personality
This mental illness is extremely complex develops most often in young adults. Psychiatrists make the diagnosis of personality coexist or dislocated when successive abnormal behaviors such as hallucinations, visual or auditory, language delusional, hermetic or chaotic, incoherent lines. There was also a depressed mood or overly euphoric, disorganized thinking, much of emotional disturbance.Its multiple causes, physiological or psychological are still far from being elucidated. However, it has made progress in its drug treatment.
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A study reveals that the French are the champions of pessimism. And how do you approach the year 2011? With optimism or pessimism?
The term schizophrenia includes a generic set of psychological disorders with a common core brain, but say different in their presentation and evolution. It uses the plural to refer to these schizophrenia.
‘Schizophrenia’ from ‘schizo’ the Greek ‘σχίζειν (schizein) meaning fractionation’ φρήν (phrên) designating the mind. So a ‘Break the spirit, not in the sense of a ‘split personality’ as we sometimes hear, but in the sense of losing touch with reality, or a psychoanalytic point of view, a conflict between ego and reality.
Schizophrenia is a psychosis, manifested by signs of dissociation, emotional discordance and delusional activity, which results in an altered sense of self, cognitive and social dysfunction and behavioral up to autistic withdrawal. The term is also frequently used figuratively, especially in the press to talk about attitudes or simply contradictory.
It usually reaches 0.5% to 1% of the population. Its diagnosis is based solely on the statements of the patient, listening and analysis, there is no screening test in the laboratory. A psychological examination can also diagnose structure.Studies indicate that genetic factors, environmental, neurobiological, psychological and social role in the onset of the disease (drugs and medications can also cause the onset or worsening of symptoms), but we do manages to isolate an organic cause.
The treatment is done by taking antipsychotics, but may also consist of psychotherapy, vocational rehabilitation or even forced hospitalization in severe cases.
Individuals with schizophrenia are at greater risk of suffering from the elements of comorbidity such as anxiety and depressive disorders. They are also more affected by addictive disorders, as well as social problems such as long-term unemployment, homelessness and poverty. The estimated life expectancy of people living below 10 to 12 years to average life expectancy because of the higher risk of health problems and a higher suicide rate (about 5%) .
- 1 Schizophrenia and violent crime
- 2 Comorbidities
- 3 Historical Milestones
- 4 Etiological model bio-psycho-social
- 4.1 Anatomy of the brain and schizophrenia
- 4.2 Genetic and environmental factors
- 4.2.1 Genetic
- 4.2.2 Environmental
- 4.3 Neurobiology
- 4.3.1 Neuro-developmental early
- 4.3.2 Model dopaminergic
- 4.3.3 Role of glutamate and NMDA receptors
- 4.3.4 Neurophysiological and neuroimaging data
- 5 Schedules
Schizophrenia and violent crime
The subject is particularly sensitive because of the heavy media coverage in the 2000 killings committed by subjects with schizophrenia. Nevertheless, there are serious studies done on the subject, particularly on the Swedish population due to the existence of documented records on health and crime.
Sweden has several databases on its population to the intersection of criminological and diagnostic data on more than three decades between 1973 and 2006 which allows to focus on the respective share of schizophrenia and substance abuse in over-representation of subjects suffering from schizophrenia among the perpetrators of violent crime. The interpretation of the data shows that this disease is correlated with violent crime but that this correlation is greatly reduced if one takes into account the various associated addictions. According to the same record and over 13 years, 45 crimes were committed per 1000 inhabitants of which 2.4 were attributable to subjects suffering from schizophrenia or other psychosis, or 5%.These conclusions are found in other studies: the risk of violence among people with substance abuse (but without psychosis) is similar to those of individuals suffering from psychosis with addictions. The risk is greater for subjects with substance abuse than for subjects with psychosis, regardless of comorbidity.
Comorbidities, or association of other diseases are common in schizophrenia: intoxication, abuse and substance dependence, anxiety disorders, mood disorders, suicide, social disability, medication error. Overall, patients with schizophrenia live 10 to 12 years younger than the average life expectancy in the general population.
Historically, the psychiatrist Emil Kraepelin was the first to make the distinction between dementia praecox described fifty years before him by Benedict Augustin Morel, and other forms of madness. It was later renamed schizophrenia by psychiatrist Eugen Bleuler as it became clear that the designation of Kraepelin is not an adequate description of the disease.
In 1898 Emil Kraepelin, speaking of early dementia, are three variations:
In 1919, the psychoanalyst Victor Tausk was the first to develop a psychoanalytic theory of schizophrenia. In 1950 the Swiss psychoanalyst Marguerite Sechehaye is one of the first to adapt the technique to treat a Freudian schizophrenic patient, Renee.
In 1952, Largactil is accredited as a neuroleptic which will mark a watershed in the history of schizophrenia in particular because it will facilitate the psychotherapeutic approach. In 1958 haloperidol was invented in Belgium, it is more efficient and much less sedative than Largactil. Note that the introduction of neuroleptics was spread over several years – even decades – because it raised many and fierce resistance by some psychiatrists, including Henri Baruk and Ey in France.
In 1956, Gregory Bateson, Donald D. Jackson, Jay Haley and John Weakland publish their joint article Towards a theory of schizophrenia which introduces the concept of ‘double bind’ or ‘paradoxical’ (double bind).The role of context in the development of schizophrenia does not oppose other possible causes, and it is clarified later in these terms:
It is a multifactorial disease resulting in a neuropsychiatric disorder order (altered brain function and relational). It is considered a mixture of genetic predisposition (familial tendency individual or attached to the genome) and environmental predispositions (contamination by a virus, lifestyle, environment or recurrent stressful situation), a significant event for the subject and possibly endogenous innocuous or will be a particularly acute form of stress and then play a trigger causing the crisis.
It is believed that the early stages of individual development are crucial, especially during the fetal stage and during early interactions with the mother (this is a restrictive interpretation of this last point that has led to a discourse strongly towards guilt on families).It will be noted for the record, instead of the mesolimbic dopamine system in the brain. The role of dopamine in this disease has been proposed from the observation of improvement of delusional symptoms and dissociation with the use of neuroleptics at the time of their discovery, but only a cog takes aspect of a very complex combination of factors. Thus the neurochemical many other neurotransmitters play roles in schizophrenia such as serotonin. Each time a new light is focused on one of them his involvement in the psychic life is eagerly explored by researchers in all fields of psychopathology.
Anatomy of the brain and schizophrenia
There are anomalies in the temporal lobe, found at magnetic resonance imaging of the brain of schizophrenic adolescents (decrease of the surface of the collateral sulcus), this anomaly appears during changes of the brain during adolescence. The importance of these changes is not apparently related to the duration of the disease nor the doses of drugs taken by patients.
Genetic and environmental factors
Statistically, it is observed that for most people the disease is present clinically during late adolescence, while for most women it is sometimes later, the elder son or unique are statistically most affected. None of these arguments plead for a genetic origin.
One hypothesis is that the heritage may predispose an individual to this disease: identical twins, in the case of a schizophrenic, his twin has a 40% risk of being too. Similarly, the probability of being reached is higher in case of infringement of a case in the same family, but this does not necessarily or always a genetic cause, because the twins may have been exposed in utero to all immune consequences of a viral infection of the mother or a vaccine or a co-factor or environmental factor.
Some environmental factors contributing to the outbreak of the disease especially in the first weeks of development.To this we must add the individual factors such as a birth in the winter.
Viruses come in repeatedly on the front of the stage to explain schizophrenia symptoms resulting from the combination schizophrenia / virus: in particular herpes virus infections of type 1 and Bornavirus.
Schizophrenics frequently consume toxic substances, which complicates the development of their disorders. This consumption is somehow calming research often ineffective or even aggravating. Some chronic poisoning tables give pseudo-schizophrenic.
According to Dr. Dolores Malaspina, chair of the department of psychiatry at New York University School of Medicine, perchlorethylene, toxic substance used in dry cleaning, would increase by 3.5 times the risk of developing schizophrenic symptoms. The Virginia Tech killer, Cho Seung-hui could have been affected by this substance, his parents having a dry cleaning business.
Both directions to help understand the impact, one considers that cannabis is the earliest episodes of schizophrenia and therefore promotes, the other notes after consumption and therefore no direct link unless a kind of self-medication users.
Thus various studies aimed at establishing a correlation between chronic cannabis use and increased vulnerability to brief psychotic episodes and schizophrenia. This means that some people with a vulnerability to schizophrenia (for example) but who have not developed symptoms of the disease during their lifetime in normal stress conditions, have failed and will enter this disease because of their consumption cannabis. The relative risk is about 4, meaning that a priori (without knowing the degree of vulnerability of a person), a person has four times more risk for schizophrenia if it was not consuming cannabis steadily.This view insists that this is not the order in which symptoms appear, order very difficult to prove, but the result can be compared: a person consuming cannabis has 4 times more likely to be a non-schizophrenic consumer.
These studies are complemented by other studies that establish a possible relationship between schizophrenia and cannabis, without first defining the psychotic symptoms but lists the symptoms and then link them to schizophrenia, which may constitute a form of bias. On the other hand, there are other conflicting studies. It is thus suggested that cannabis use is a large increase since the 1980s, if a genuine correlation existed with schizophrenia, we should have seen the same pattern of increase in diagnoses, which is not the case .
Anyway, at present research, according to the INSERM ‘cannabis use appears as one of many causal factors (neither necessary nor sufficient) that accompanies the onset of schizophrenia without affecting the evolution favorably, on the contrary these products aggravate symptoms. In light of the studies reviewed by experts, it nevertheless appears that all those exposed to cannabis do not become schizophrenic. ‘
It also considers that the processes related to early development of the nervous system are important, especially during pregnancy. For example, women who were pregnant during the severe famine of 1944 the Netherlands had an increased risk for their child to develop the disease later. Similarly, studies have compared the Finnish mothers who learned of the death of their husbands in the Winter War of 1939-1940, when they were pregnant, mothers who learned of the death of their husbands after pregnancy.These studies showed in the first case a greatly increased risk for the child to develop the disease, suggesting that even psychological trauma in the mother may have an adverse effect. In addition, there are now clear indications that prenatal exposure to viral or bacterial infections increases the risk of developing schizophrenia, confirming the existence of a link between a developmental disorder and the risk of developing the disease .
Some researchers suggest that this interaction between environmental factors in childhood and neurobiological risk factors that determines the likelihood of developing schizophrenia later in life. It is considered that the neurological development of the child is sensitive to elements of a disrupted social environment such as trauma, violence, lack of warmth in personal contacts or hostility. Each of these elements has been identified as a risk factor.Research has suggested that positive or negative effect of the child’s environment interact with genetic and developmental processes of the nervous system with long-term consequences for brain function. This combination of factors play a role in vulnerability to psychosis, which occurs later in adulthood.
The schizophrenic disorders are frequently associated with dysfunction of the mesolimbic dopaminergic pathway. This theory, known as ‘dopamine hypothesis of schizophrenia’, is based on the fact that most substances antipsychotic properties have an effect on the dopamine system. This is the chance discovery of a class of drugs, phenothiazines, which is the origin of this discovery. Antipsychotic drugs or neuroleptics including acting on the dopaminergic system have been developed further and remain a common treatment for early indication.
However, this theory is now considered too simplistic and incomplete, especially as new drugs (atypical antipsychotics), such as clozapine, are as effective as older drugs (or typical antipsychotics), such as haloperidol. But this new class of molecules also has effects on the serotonin system, and could be a slightly less effective blocker of dopamine receptors. According to the psychiatrist David Healey, pharmaceutical companies have promoted biological theories are too simple to promote biological treatment they offer.
Role of glutamate and NMDA receptors
Interest has also focused on another neurotransmitter, glutamate, and diminished function of a particular type of glutamate receptor, the NMDA receptor.This theory originates from the observation of abnormally low levels of NMDA receptors in the brain of schizophrenic patients examined postmortem, and the discovery that this receptor blocking substances, such as phencyclidine and ketamine can mimic in the subject Healthy symptoms and cognitive impairment associated with the disease.
The ‘glutamate hypothesis of schizophrenia is now becoming increasingly popular, particularly because of two observations: first, the glutamatergic system may act on the dopaminergic system, and secondly, reduced glutamatergic function has been associated with a low level of performance tests that require the operation of the hippocampus and the frontal lobe, which are known to be involved in schizophrenia. This theory is also supported by clinical trials showing that molecules that are co-agonists of the NMDA receptor associated complex are effective in reducing symptoms of schizophrenia.Thus, the amino acid D-serine, glycine and D-cycloserine facilitates NMDA receptor function through their action on the site receiving co-agonist glycine. Several placebo-controlled clinical trials, and to increase the concentration of glycine in the brain, showed mainly a reduction in negative symptoms.
Neurophysiological and neuroimaging data
With the recent development of imaging techniques, many works are devoted to differences in structure or function in certain brain regions in schizophrenic patients.
It was long believed that the brains of schizophrenics was essentially normal in appearance. Early indications of structural differences came from the discovery of an enlargement of cerebral ventricles in patients with negative symptoms were particularly marked. However, this result is not usable at the individual level because of the great variability between patients.A link between ventricular enlargement and exposure to antipsychotic drugs has been suggested.
More recent studies have shown that there are many differences in brain structure depending on whether or not people have a diagnosis of schizophrenia. However, as in previous studies, most of these differences are only detectable when comparing groups and not individuals.
Studies implementing neuropsychological testing combined with brain imaging techniques like functional magnetic resonance imaging (fMRI) or positron emission tomography (PET) have sought to highlight differences in functional brain activity patients. They showed that these differences occur more frequently in the frontal lobes, hippocampus and temporal lobes.These differences are strongly associated with cognitive deficits frequently associated with schizophrenia, particularly in the field of memory, attention, problem solving, executive function and social cognition.
Electroencephalographic recordings (EEG) of people with schizophrenia on tasks predominantly perceptual showed no activity in the gamma frequency band (high frequency), indicating a weak integration of critical neural circuits in the brain. Patients with severe hallucinations, delusional beliefs and disorganized thinking were also lower frequency synchronization. Medications taken by these individuals did not allow the return rate to the gamma frequency range. It is possible that alterations in the gamma band and working memory are related to alterations in inhibitory interneurons producing gamma-aminobutyric acid (GABA).Was observed in the dorsolateral prefrontal cortex of schizophrenic patients, an impairment of particular subclass of GABAergic interneurons characterized by the presence of the protein parvalbumin.