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3018 - Abnormal Psychology > 13 Schizophrenia > Flashcards

13 Schizophrenia Flashcards

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1
Q

Psychosis refers to the loss of contact with reality characterised by what two factors?

A
  1. Impaired perceptions

2. Impaired thought processes

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2
Q

What are 5 of the positive symptoms of schizophrenia?

A
  1. Hallucinations
  2. Delusions
  3. Thought disorder
  4. Behavioural disturbances
  5. Lack of insight
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3
Q

What are 9 of the negative symptoms of schizophrenia?

A
  1. Social withdrawal
  2. Anhedonia
  3. Emotional blunting
  4. Confusion
  5. Amotivation
  6. Apathy
  7. Self-neglect
  8. Poverty of speech
  9. Poverty of content
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4
Q

How does the DSM-5 define hallucinations?

A

Perception-like experiences that occur in clear sensorium in absence of any external stimulus.

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5
Q

What percentage of patients with schizophrenia report hallucinations?

A

75%

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6
Q

Voices heard in schizophrenia can be _________ but are typically __________.

A

Voices heard in schizophrenia can be comforting but are typically hostile.

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7
Q

Are schizophrenics more aggressive than the general population?

A

No, it’s a myth.

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8
Q

What are delusions according to DSM-5?

A

False firmly held beliefs despite what others believe and despite evidence to the contrary. These beliefs must NOT be culturally accepted.

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9
Q

What is the most common type of delusion in SZ?

A

Paranoid or persecutory delusions

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10
Q

What are delusions of reference in SZ?

A

Belief that TV is talking about you.

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11
Q

What kind of delusions in SZ and bipolar are deemed as grandiose delusions?

A

False beliefs one has special powers, abilities, influence, achievements or another identity that typically relates to power, wealth or fame.

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12
Q

What are nihilistic delusions in SZ?

A

Belief that a catastrophe will occur (says DSM)

Belief that you or part of you is dead (says everyone else)

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13
Q

What kind of somatic delusions are typical of SZ?

A

False belief that ones organs are diseased. Distinguished from hypochondriasis as the diseases are really odd - e.g. infected by insects, dismorphophobia – guy thought nose was two big, got surgery, it didn’t shift belief, confronted surgeon with rifle.

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14
Q

What are delusions of passivity in SZ?

A

Belief that under control by others.

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15
Q

What are misidentification delusions in SZ?

A

Belief that someone you know has been replaced by an imposter.

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16
Q

What is a knight’s move in SZ speech?

A

An illogical segue from one subject to another. “I am going to the movies. So the bleach is placed on the hair.”

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17
Q

What are some negative manifestations of thought disorder in SZ?

A

Reduced stream of thoughts and poverty of speech.

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18
Q

What are some positive manifestations of thought disorder in SZ?

A

Circumlocution
Derailment – comments slipping from one to next
E.g. ‘Went to the tennis court. Met the judge. Last day of judgement.’
Tangentiality –irrelevant responses
Echolalia
Word salad
Neologisms

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19
Q

What are the main subtypes of psychotic disorders?

A
  • Schizotypal disorder –a personality disorder characterised by psychotic symptoms
  • Delusional –1 month of delusions, no other symptoms
  • Brief psychotic disorder – sudden, less than 1 month, return to functioning
  • Schizophreniform –psychotic symptoms for between 1 and 6 months; lack of impaired functioning
  • Schizoaffective –SZ plus mood disorder
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20
Q

What is the A criterion for schizophrenia?

A

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

  1. Delusions.
  2. Hallucinations.
  3. Disorganized speech (e.g., frequent derailment or incoherence).
  4. Grossly disorganized or catatonic behavior.
  5. Negative symptoms (i.e., diminished emotional expression or avolition).
21
Q

What are the B & C criteria for schizophrenia?

A

B. Clinically significant impact to functioning. (Functioning below that prior to onset of the disorder).

C. Continuous signs of disturbance are present for at least 6 months, with at least one month of psychotic symptoms.

22
Q

What are the 5 subtypes of schizophrenia in DSM-IV (deleted in DSM-5)?

A
  • Paranoid
  • Catatonic
  • Disorganised – disorganised speech and affect, no delusions
  • Residual - history of SZ, unusual beliefs, negative symptoms
  • Undifferentiated –diagnosis for SZ, but not of other subtypes
23
Q

What’s the lifetime prevalence of schizophrenia?

A

1%-2%

24
Q

What’s the female:male ratio for schizophrenia?

A

2:3 - more males get SZ

25
Q

In which countries and settings is schizophrenia more common?

A

In developed nations and in urban settings.

26
Q

What’s the typical age of onset for schizophrenia?

A

Late teens to mid-30s. Early onset associated with poorer outcomes.

27
Q

What are some outcome statistics for schizophrenia?

A

20% recover completely
50% classified as unable to work
66% difficulty with at least one daily living activity

28
Q

What’s the suicide risk for schizophrenics?

A

20% attempt, 5% succeed.

29
Q

What are the four phases in the course of schizophrenia?

A
  1. Prodromal phase: median length for symptoms to develop is two years (but highly variable)
  2. Acute phase: time between onset of active symptoms and treatment is typically 1 year. (Better outcomes if treated early).
  3. Early recovery phase
  4. Late recovery phase: reintegration
30
Q

What percentage of schizophrenics relapse within 2-5 years of treatment?

A

80-90%

31
Q

What are some positive prognostic factors for schizophrenia?

A
  • good premorbid functioning
  • acute onset
  • later age of onset (for females)
  • precipitating event (e.g. drug psychosis)
  • low substance use
  • brief duration of active phase
  • absence of structural brain abnormalities
  • no family history of schizophrenia
32
Q

What are some negative prognostic factors for schizophrenia?

A
  • Poor premorbid functioning
  • Slow insidious onset
  • Prominent negative symptoms
  • Long duration of untreated psychosis
  • Slower or less complete recovery
  • Lower SES
  • Migrant status
  • No social support network
  • Family history of SZ
33
Q

How heritable is schizophrenia?

A

Highly. 46.3% risk for children with two affected parents. 44.3% concordance for MZ twins.

34
Q

What is the dopamine hypothesis?

A

Schizophrenia caused by overproduction of dopamine or oversensitivity of dopamine receptors.

35
Q

What evidence is there for the dopamine hypothesis?

A
  1. Psychosis responds to anti-dopaminergic medication.
  2. Amphetamine psychosis
  3. Excess L-Dopa in Parkinson’s precipitate psychotic episodes
36
Q

What are some neurological differences in schizophrenics?

A
  1. Enlarged ventricles
  2. Brain tissue loss in prefrontal cortex
  3. Smaller left hippocampal volume (also in those only with family history of SZ)
37
Q

What environmental factors may contribute to SZ?

A
  • Obstetric complications – increases risk fourfold, birth complications found in 40% of schizophrenics
  • Urban birth
  • High paternal age
38
Q

Birth at what time of year is more associated with SZ?

A

Late winter, early spring.

39
Q

What is the primary intervention for schizophrenia?

A

Medication.

40
Q

What is the response to medication for schizophrenics?

A

80-90% with positive symptoms respond. Less effective with negative symptoms.

41
Q

What antipsychotics are successful for positive, but not negative, symptoms?

A

First-generation antipsychotics –e.g. Haloperidol

42
Q

What antipsychotics are successful for reducing (but not eliminating) negative symptoms of SZ?

A

Second-generation antipsychotics (olanzapine, clozapine, risperidone)

43
Q

What percentage of schizophrenics show no improvement in response to medication?

A

10-20%

44
Q

What are some of the common side effects of antipsychotic medication?

A

Extrapyramidal side effects:

  • Parkinson’s disease-type symptoms
  • Tardive dyskinesia (involuntary movements of face and jaw)
  • Finger tremors, shuffling gait, drooling, twisted posture

These side effects often treated with anti-Parkinson drugs

Also, weight gain, diabetes, heart disease

45
Q

What family factors contribute to relapse?

A

Relapse rates are higher for patients from families high in expressed emotion (EE).

46
Q

What psychotherapies have proven effective in reducing relapse?

A

Family therapy

CBT

47
Q

CBT has proved useful in what regards in SZ patients?

A
  • Reducing relapse and hospitalisation
  • Reducing positive and negative symptoms
  • Improving social functioning

Gains maintained at 2-year follow-up.

48
Q

For how long so Schizophrenia symptoms have to be present for a diagnosis?

A

6 months with no more than 1 month without symptoms.

3018 - Abnormal Psychology (26 decks)

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