10: Schizophrenia Course & Treatment Flashcards
What are the symptoms of schizophrenia?
- Positive symptoms: Hallucinations
- Cognitive dysfunction
- Attention/vigilance
- Processing speed
- Reasoning and problem solving
- Verbal learning and memory
- Visual learning and memory
- Working memory
- Social cognition
What is the significance of cognitive impairments in schizophrenia?
- Core feature of the illness
- Onset in childhood/early adolescence
- Observed in some family members
- Orthogonal (statistically independent) to hallucinations and delusions
- Cognition may provide a more reliable relationship to functional status than symptomatology
What is the neurodevelopmental model of schizophrenia?
Postulates that schizophrenia is caused by a subtle defect in cerebral development that disrupts late-maturing, highly evolved neocortical functions, and fully manifests itself years later in adult life.
Makes it difficult for researchers to study the disorder before onset.
What is the neurodegenerative model of schizophrenia?
Data suggests that loss of gray matter over time (neurodegenerative process) may cause schizophrenia.
It is difficult to unravel the effects of medication treatment, other potential toxicities (e.g., diabetes, nicotine use) from the primary illness.
What is the stress-diathesis model?
Diathesis: genetic vulnerability
Stress: environmental insult
Diathesis + Stress can lead to expression of SZ
What are the results of monozygotic twin studies regarding risk of developing schizophrenia?
Monozygotic twins (100% genes shared) have a 50% risk of developing schizophrenia if their twin has the illness.
Dose-response relationship suggests that although genes matter, they are not the sole factor.
What have adoption studies revealed regarding schizophrenia?
Risk is greater in biological relatives of index adoptees who had schizophrenia than the biological relatives of mentally health control adoptees.
Genetics play important role.
What have linkage studies revealed regarding schizophrenia?
Have identified several potential gene locations on chromosomes 1, 6, 8, 13, 15 & 22.
Multiple genes implicated in the condition; multifactorial disease with several genes and environmental factors playing a role.
What are the highest potential contributors to schizophrenia based off odds ratios?
- Family history (10:1)
- CNS damage (7:1)
- Prenatal bereavement (6:1)
- Rubella infection (5:1)
What is the prevalence, development and course of schizophrenia?
- Occurs worldwide regardless of gender, race, culture or religion (1%)
- Usually develops between the ages of 16 and 25, although women later than men
- Some onset acute, some more gradual
- Families undergo severe distress; schizophrenia often family crisis
What factors predict poor prognosis for schizophrenia?
- Early onset
- No precipitating factors (insidious onset)
- Poor premorbid social, sexual and work history
- Withdrawn, autistic behavior
- Family Hx of SZ
- Poor support systems
- Negative symptoms
- Neurological signs and symptoms
What are the treatment recommendations for schizophrenia?
- Antipsychotics for positive symptoms
- Cogntive behaviorally-oriented psychotherapy to reduce severity of symptoms
- Supported employment to assist in obtaining and maintaining competitive employment
- Family intervention to reduce rates of relapse and re-hospitalization
- Assertive community treatment to reduce hopsitalizations and homelessness
What is “recovery” for schizophrenia?
- Something akin to cure
- Symptom remission
- No need for maintenance medication
- Return to premorbid level of functioning
- Recovery = symptomatic remission; some succes in social and occupational functioning
- A process, rather than end-state; living with illness
- Strengths-based, rather than symptom-based:
- Hope
- Respect
- Empowerment
- Recovery is a model that involves the nature of treatment
What are elements of recovery?
- Self-direction
- Individualized and person-centered
- Empowerment
- Holistic
- Non-linear
- Strengths-based
- Peer support
- Respect
- Responsibility
- Hope
