2.4 Schizophrenia + Psychoaffective Disorders Flashcards
define psychosis
loss of contact with external reality characterised by impaired perceptions and thought processes
what are the characteristic symptoms of schizophrenia
delusions, hallucinations, disorganised speech, grossly disorganised/catatonic behaviour, negative symptoms
how many of the characteristic symptoms must be present for how long, and at least one must be which ones?
2+ for a significant portion of a 1 month period, AT LEAST ONE must be EITHER: delusions, hallucinations, or disorganised speech
what are the 4 broad clinical indicators of schizophrenia
A. characteristic symptoms
B. clinically significant impact to social/occupational functioning
C. continuous signs of disturbance for 6 months
D-F. not better accounted for by other illness, substance abuse etc
define positive symptoms
the presence of problematic behaviours
give examples of positive symptoms
hallucinations, delusions, formal thought disorder, behavioural/motor disturbances
define negative symptoms
the absence of behvaiours we would expect in a healthy person
give examples of negative symptoms
affective flattening, avolition, alogia
define affective flattening subclasses
social withdrawal, anhedonia (loss of enjoyment of previously enjoyed activitie)s), emotional blunting, confusion
define avolition subclasses
amotivation, apathy, self-neglect
define alogia subclasses
poverty of speech + content - might be quiet or incomprehensible despite patient expecting to be understood
define hallucination + give examples of types
perception-like experience occurring in absence of external stimulus - vivid, clear, involuntary
- 75% get hallucination
- mostly auditory, then visual, smell, taste, tactile
describe the characteristics of auditory hallucinations
- hearing voices distinct from own thoughts
- third person commentary
- often start out comforting
- derogatory
- commands to perform unacceptable behaviours
NOTE: cross-cultural studies - different interpretation of voices
define delusions
false firm beliefs despite what other believe, despite evidence
what are paranoid/persecutory delusions
false belief one is being persecuted/harmed by someone/group
what are referential delusions
neutral event interpreted to have personal meaning, e.g. a news broadcast interpreted as a personal message
what are grandiose delusions
false belief one has special powers, status, abilities
what are erotomanic delusions
false belief that another person is in love with you
what is formal thought disorder
disorganised thinking, poverty of thought
what are formal thought disorder symptoms
- circumlocution - long-winded indirect descriptions
- derailment - slip from one idea to next
- tangentiality - irrelevant responses to q’s
- echolalia - parrot-like repetition
- word salad - incomprehensible stream of words
- clang asscn. - phrases linked through sound –> pass me the spoon, moon, I’m cocoon
what are examples of grossly disorganised and abnormal motor behaviour
- catatonic behaviour: decrease in reactivity to environment
- stupor, grimacing, mutism, echolalia, waxy flexibility
describe the age of onset of schizophrenia
- adolescence/early adulthood
- preceded by gradual deterioration in functining
- coincide w stressful life period
what are the primary prognostic factors
early onset = poorer outcomes
early treatment = better outcomes
what is the typical clinical course?
- highly variable
- 50% unable to work
- 30% attempt suicide; 5-10% complete suicide
list the stages of clinical course of psychotic disorders
- premorbid phase: cognitive/motor/social deficits
- prodromal phase: brief positive symptoms/functional decline
- psychotic phase: positive symptoms
- recovery phase: negative symptoms, cognitive/social deficits, functional decline
what factors indicate someone will respond well to treatment?
- good premorbid functioning
- acute onset (recognisable)
- precipitating event
- low substance use
- absense of structural brain abnormalities
- no family history of schizophrenia
what factors indicate someone will respond poorly to treatment?
- poor premorbid functioning
- slow onset
- prominent negative symptoms
- low socio-economic/migrant
- poor social support network
outline the aetiological factors of schizophrenia
NOT WELL UNDERSTOOD
* wide range of disorders w presumed common underlying biological vulnerability
* reasonable genetic vulnerability factors make vulnerable to triggering events
neurochemical, neuroatanomical factors
outline the neurochemical factors of schizophrenia
dopamine hypothesis posits that there’s an overproduction or oversensitivity of dopamine receptors.
* dopamine activity assc with +ve symptoms; brain degeneration assc w -ve symptoms
what are the neuroanatomical factors/changes assc w schizophrenia?
ENLARGED VENTRICLES - >2x bigger
* loss of brain tissue - prefrontal cortex loss = negative symptoms, damage to executive functioning/cognition
* non-genetic brain abnormalities predate onset of psychosis and WORSEN W PROGRESSIVE ILLNESS
how effective/used are medications for schiz?
PRIMARY INTERVENTION
* helps w’ +ve symptoms - helps 60% w +ve symptoms
* 40% relapse rate
treat w antipsychotics + mood stabilisers/antidepressants
how do psychological interventions work as treatment?
- tailored to stage of illness
- work w families as well
- therapy designed to target deficits e.g. social skills, medication compliance, stress, reducing impact of hallucinations
- CBT reasonably effective
