3 - Schizophrenia Flashcards
Who coined the negative term for Schizophrenia, Dementia Praecox (dementia of the young)?
Emil Kaepelin
Who coined the phrase, Schizophrenia in 1911, and what four disturbances did he come up with that characterise it?
Eugen Bleuler; Affect; ambivalence; associations; preference for fantasy over reality
What are two myths about people with schizophrenia?
They’re dangerous and have split personalities
What’s the peak onset age for males and females, and what ages are rare?
Males: 15-25; females: 25-35; 50 yrs
Are men or women more likely to develop schizophrenia?
Men
What percentage of people will attempt suicide?
Approx. 50%
People with schizophrenia have a shorter average lifespan. Which SES groups show a disproportionate amount of this illness?
Lower SES groups
Why is schizophrenia the most expensive of all mental disorders?
Direct treatment costs; loss of productivity; public assistance costs
In the DSM-5 criteria, two or more of the symptoms must occur two or more times during one month, and at least one needs to be 1, 2, or 3. What are they?
Delusions; hallucinations; disorganised speech
As well as at least one of the first three symptoms in the DSM-5, what other symptoms may be present?
Grossly disorganised or catatonic behaviour; negative symptoms (affect flattening; alogia; avolition)
Describe the rest of the DSM-5 criteria for schizophrenia
Social occupational dysfunction; continuous duration for 6 months; schizoaffective and mood disorder excluded; substance/medical condition excluded; can coexist with ASD or communication disorder
What is a delusion, and what are the three most common types?
Disturbances in content of thought (misrepresentation of reality); Persecution; reference; grandeur
If a person that has a firm belief that the world is going to end, which type of delusion may they have?
Nihilistic delusion
What’s Capgras syndrome?
A delusional belief that a person close to them is a body double/imposter
What’s Cotard’s syndrome?
A delusion that they’ve had an impossible bodily change (e.g. they don’t have a heart)
The umbrella term for disturbances in form of thought is known as loosening of associations; describe 5 of them
Neologism - made up words; Perseveration - repeat a point over (stuck on one idea); Word Salad - make no sense (mish mash); Circumstantiality - go off topic; Tangentiality - never get back to the point
What’s the most common form of hallucinations ?
Auditory
Describe the disturbances in affect (breakdown in outward expression of emotion) that can occur
Restricted affect - less outward display; Blunted affect - even less; Flat affect - almost no emotional expressivity
What’s the collective term for disturbances in psychomotor behaviour? Provide two types
Catatonia; Stupor - reduction or slowing of movement; Rigidity - adopt an unusual position for long periods
What are the positive symptoms (excess behaviours) of schizophrenia ?
Delusions; hallucianations; loose associations; disorganised behaviour
What are the negative symptoms (deficits) of schizophrenia ?
Flat affect; apathy; social withdrawal; poor attention
When are schizophrenia specifiers used?
After a year duration
Compare Type I and Type II?
Type I: sudden onset; normal intellect; no brain damage; no negative symptoms; good drug response (better prognosis); Type II: is the opposite
If a person varies between prodromal, active, and residual phases, what does this suggest about the disorder?
It’s episodic
What percentage of people remain significantly impaired?
40-50%
What features predict good prognosis?
Good premormid adjustment; no family history; sudden onset; precipitating stress; good reponse to medication; positive symptoms; later onset age; female gender
What features differentiate schizophreniform disorder from schizophrenia?
Duration at least 1 month but less than 7 months; impaired social/occupational functioning not required
What features differentiate schizoaffective disorder from schizophrenia?
Boundary between schizophrenia and mood disorders; prominent episode of mood disturbance concurrent with criterion A symptoms; delusions/halluciantions for at least 2 weeks in absence of mood disturbance
What’s the prominent feature of delusional disorder?
One or more delusions and never met criterion A schizoprenia
Describe psychotic disorder
Sudden onset of at least 1 of first four criterion A; lasts at least one day but less than a month and full return to premorbid functioning
What have genetic linkage studies shown about the aetiology of schizophrenia
Schizophrenia is a heterogeneous disorder and therefore likely to have polygenic influences (there’s no single gene)
What’s the concordance rate of developing schizophrenia among biological relatives?
48-50%
What did the variability in the presenting problems of the Genain Quadruplets suggest about schizophrenia aetiology?
There must be unshared environmental influences
What’s the biological view about the aetiology of schizophrenia?
Excess dopamine activity
What drugs are used to target the symptoms, and what side effects can occur?
Neuroleptics (decreases dopamine); Stiffness and tremors as seen in Parkinson’s
What are some problems with the dopamine hypothesis?
Many of the drugs are effective in treating other disorders; Clozapine primarily blocks seretonin receptors
Which neurotransmitters does current research focus on?
Seretonin pathways; GABA and glutamate
What structural brain changes have been found?
Enlarged ventricles; decreased frontal, temporal, whole brain volume; volumetric differences in twins discordant for the disorder
What functional brain changes have been found?
Reduced activity in frontal regions
What’s a problem with the neurobiological research of aetiology?
There’s no specific indicator of brain dysfunction
What evidence has been found regarding neurodevelopmental problems as possible causes?
Fetal neurodevelopment (obstetrical complications, e.g. hypoxia); maternal infection (season of birth); maternal stress; postnatal brain insults (e.g. head injury before 10)
What are some major limitations of the biological view?
Biological abnormality is at most a correlation; difficult to determine whether abnormalities are related to disease process or treatment; pathology in one area doesn’t mean the primary area has been defined; a single pathological process can cause a wide range of phenomena in different individuals
What has the behavioural view contributed in understanding aetiology?
Failure to attend to relevant social cues results in bizarre behaviour; acquisition of behaviours through operant conditioning; but unable to account for the origins of various symptoms
What is the behavioural view more successful at than determining aetiology?
Modifying problematic behaviours (ignoring bizarre behaviours/reinforcing appropriate verbal/social responses)
List some theoretical frameworks focused on family environments
Schizophrenogenic mother; double-bind communication (inconsistent messages); family structure; communication deviance; expressed emotion
Describe the concept of expressed emotion
Family stress may precipitate relapses (e.g. criticism; hostility; emotional over-involvement)
How likely is a person to relapse if living in a high EE family?
3.7 times more likely (in the first 9 months after discharge)
What have family burden studies focused on?
Patient’s problem behaviours (esp. negative symptoms); families’ reactions (emotional, e.g. sense of loss; family conflict); needs of families (information on illness; practical guidance; community resources); taking the burden of blame from them
What are some limitations of family views?
No empirical evidence of earlier views; findings are correlational; also occur in families of patients with other disorders; reciprocal relationship not taken into account; impact of living with a family member with the disorder neglected
Diatheses may include genetic factors, physical trauma prenatally or during birth; brain or neurotransmitter abnormalities; psychosis prone personality. What stressors may interact with these to lead to developing schizophrenia?
Physical trauma (prenatally or during birth); psychological and social; environmental hazards (urban living and poverty); high EE family
What does CBT contribute in the way of psychosocial interventions?
Psychoeducation; social skills training; coping strategies enhancement training (problem solving; strategies for increasing medication compliance; identifying warning signals; stress management)
What do psychosocial interventions such as the broad rehabilitation approach, and family interventions focus on?
Broader practical difficulties; Supplementing drug treatment with family intervention to reduce relapse
What moderate improvements were found in Kurtz and Mueser’s meta-analysis of social skills training?
Performance based measures of social and daily living; community functioning; negative symptoms
What’s been found in regards to anti-psychotics (neuroleptics/major tranquillisers)?
Positive symptoms respond better than negative symptoms; about 25% don’t improve on classical antipsychotics; side-effects of traditional ones (e.g. tardive dyskinesia - uncontrollable grimacing)
What approach is necessary to foster a multifaceted treatment?
Community approach (deinstitutionalisation); effective community care (coordinated services; short-term/partial hospitalisation; half-way houses; advocacy)
Among mental disorders, where does schizophrenia sit in terms of disease burden?
It’s the second leading cause
Which symptoms are characteristic of the active phase of the disorder?
Hallucinations, delusions and disorganised speech
Prodromal signs and symptoms are similar to those associated with schizotypal personality disorder. What do they include?
Peculiar behaviours (e.g. talking to oneself in public); unusual perceptual experiences; outbursts of anger; increased tension and restlessness; social withdrawal; indecisiveness; and lack of willpower
Define anhedonia
The inability to experience pleasure
Tom is indecisive, ambivalent, apathetic and has lost his willpower. He has ceased to work towards personal goals or to function independently. What symptom is he experiencing?
Avolition
Define alogia
A speech disturbance, which refers to impoverished thinking or poverty of speech
What are the most remarkable features of inappropriate affect?
Incongruity and lack of adaptability in emotional expression (e.g. giggling while describing a terrifying experience)
According to the DSM-5, active phase symptoms must occur in the absence of what?
A major depressive or manic episode
Why were the symptom-based subtypes of schizophrenia dropped from the DSM-5?
They don’t strongly predict either the course of the disorder or response to treatment; have relatively poor diagnostic reliability and are frequently unstable over time; patients who fit a particular subtype during one episode frequently qualified for a different one in a subsequent episode; MZ twins will not necessarily exhibit symptoms of the same subtype
Men tend to have an earlier age of onset than women, show poorer functioning, more schizotypal traits, more chronic symptoms, and poorer response to treatment. How do typical symptoms compare between genders?
Men show more negative symptoms; more withdrawn and passive; women experience more hallucinations and paranoia; are more emotional and impulsive
IPSS investigators found that clinical and social outcomes were significantly better for patients in which countries, and why do experts propose this is?
Developing countries (e.g. India and Nigeria); Greater tolerance and acceptance extended to people with psychotic symptoms
Which enzyme/gene is involved with breaking down dopamine?
Catechol O-methyltransferase (COMT)
Which areas of the brain, which play a crucial role in the regulation and integration of emotion and cognition, have shown decreases in size in schizophrenic patients?
Limbic regions such as hippocampus, parahippocampus, amygdala and thalamus
Describe the the social selection hypothesis
Low SES may be an outcome rather than cause of schizophrenia; regardless of the social class of family origin, many patients may gradually drift to a lower social class (due to cognitive and social impairments)
Among the various types of comments that can contribute to a high EE rating, which is most strongly related to patients’ relapse?
Criticism
A proposal was considered for a new disorder in the DSM-5 , Attenuated Psychosis Syndrome, in an attempt to identify symptoms early. What kind of people does this describe?
Those that fall somewhere between unusual and psychotic; they show at least one psychotic symptom in attenuated form (but was deemed as unreliable and validity unsupported)
What criteria should a vulnerable marker fulfill?
Should: distinguish between people who already have schizophrenia and those who don’t; be a stable characteristic over time; identify more biological relatives of patient than the general population; be able to predict the future development of the disorder among those who haven’t yet experienced a psychotic episode
Which kinds of impairments may be signs of vulnerability to developing schizophrenia?
Working memory impairments; eye-tracking dysfunction
What are extrapyramidal symptoms?
Motor side effects to antipsychotic drugs; e.g. muscular rigidity, tremors, restless agitation, peculiar involuntary postures and motor inertia
As well as clozapine, what are some other second generation (or atypical) antipsychotics, and how do they compare to the traditional drugs?
Risperidone; olanzipine; quetiapine; They’re as effective for treating positive symptoms; less likely to produce motor side effects; useful in maintenance treatment to reduce relapse
What are some disadvantages with second generation antipsychotics?
They’re no more effective for treating negative symptoms; they produce additional, some serious side effects (e.g. weight gain and obesity, increasing risk for diabetes, hypertension and coronary heart disease, leading to poor compliance which increases relapse)
Antipsychotics act by blocking dopamine receptors in cortical and limbic brain areas, and also affect a number of other neurotransmitters such as what?
Serotonin; norepinephrine; acetylcholine
Studies of brain metabolism and blood flow have identified functional changes in which regions of the brain?
Frontal lobes; temporal lobes; basal ganglia
