337 Schizophrenia Flashcards
1
Q
dementia praecox
A
- Emile Kraeplin’s conceptualization of schizophrenia (the first to propose groupings of psychotic syndromes)
- early dementia: begins at an early age, then progressive deterioration of cognitive abilities
- Kraeplin began the conceptualization of BP and schizophrenia as distinct forms of dysfunction (despite overlap in genes, etiology, symptoms)
2
Q
Eugen Bleuler
A
- contemporary of Kraeplin; people with DP didn’t always show linear deterioration over time and could emerge later in life
- primary deficit was loose associations (disorganized thinking came first, but caused the other positive symptoms)
- first to use the term ‘schizophrenia’ for split mind (shattered cognitive ability, not DID)
- considered schizophrenia a group of disorders
- led to a more broad definition which increased rates of prevalence as people in N. America preferred Bleuler’s conceptualization over Kraeplin’s more narrow one
3
Q
six major signs/symptoms of Schz
A
- disturbances in perception
- content of thought
- form of thought
- affect
- motoric
- relating
4
Q
disturbances in perception
A
- hallucinations: no stimulus is present but a perception occurs (vs. illusion in which a stimulus is present but misperceived)
- hallucinations can be ‘positive’ (seeing things that aren’t there) or ‘negative’ (not seeing something that is there)
- hallucinations occur in the same time and physical space as other (real) perceptions so makes them difficult to differentiate
- can occur in all sensory modalities
- hearing your own thoughts (but perceived as someone else), voices talking about you (poor prognosis), voices narrating your behaviour
- somatic passivity experiences: bodily sensations imposed by external forces
- voices could be misinterpreting your own thoughts
5
Q
misinterpreted self-talk study
A
- Ps reading words into a microphone that immediately transmitted those words in a distorted voice into their headphones
- people with schizophrenia with auditory hallucinations more likely to make misattributions about their own speech to someone else
- also much more likely to make these misattributions if the words they were saying were derogatory
6
Q
disturbances in content of thought
A
- delusions: false belief based on an incorrect inference, firmly believed despite contradictory evidence
- mild end: over-valued ideas (false belief, but can entertain the possibility that it could be false; common in schizotypal PD and prodromal schz)
7
Q
common delusions
A
- controlled by an outside force: lost the ability to act volitionally in the world
- grandiose: famous, important, royalty
- jealousy: partner being unfaithful
- nihilistic: belief that oneself or the world doesn’t exist
- persecutory: people scheming, plotting, out to get you
- of reference: someone or some event is trying to signal something significant to you
- somatic: something is wrong with a part of your body
- often have multiple fragmented delusions
- thought withdrawal: vacuum sucking out your thoughts
- thought insertion: planted in your mind or they belong to someone else
- thought diffusion/broadcasting: other people hearing their thoughts while they can’t necessarily hear their own
- made impulses: external force causing you to do things without intent, acts aren’t always conscious
- made feelings: external force giving you affective experiences
- made volitional acts: attributing your motivation to do something to some external force
8
Q
disturbances in form of thought
A
- formal thought/speech disorder
- derailment: similar to loose associations (can’t follow the logic) but no pressured speech
- word salad (extreme): no logical or grammatical structure, words not even recognizable
- alogia: poverty of speech or content of speech (not conveying information)
- neologisms: making up new words or giving existing words new meaning
- blocking: related to thought withdrawal, stops speaking abruptly
- illogical thinking
9
Q
disturbances in affect
A
- blunted/flat (anhedonia is common, can be difficult to distinguish profound anhedonia in MDD from flat affect): blunted expression of affect though they might still have rich inner experiences of emotion
- inappropriate affect: laughing in the wrong situations
- difficulty perceiving emotions: identifying or tracking others’ emotional changes
10
Q
psychomotor disturbances
A
- catatonia (much rarer now)
- catalepsy/waxy flexibility: patients immobile but you can move them and they’ll stay in that position
- stupor: immobile and unresponsive to the environment (but no brain damage)
- posturing: assuming strange positions on their own
- mutism (still sometimes common)
- catatonic excitement: looks like psychomotor agitation, but looks purposeless and avolitional
- catatonic negativism: immobile and resisting attempts to be moved
- echolalia: senseless and avolitional repetition of auditory input
- echopraxia: avolitional repetition of movements
11
Q
disturbance in relating
A
- very withdrawn
- preoccupied with a fantasy world that only they can see, others don’t interact with (when supplemented by hallucinations, can be terrifying)
- disordered volition: aimless and purposeless (has overlap with MDD)
- anhedonia
12
Q
positive vs. negative
A
- positive: presence of symptoms that shouldn’t be there (hallucinations, delusions, inappropriate affect)
- negative: absence of things that should be there (blunted affect, alogia, avolition)
- positive responds better to meds, negative hard to treat
- very few people have only negative symptoms
13
Q
schizoaffective disorder
A
- poor reliability, still controversial (thought of as a residual category)
- not a very distinct diagnosis, but also not just an atypical form of mood disorder or schizophrenia
- prognosis is better than schizophrenia, but worse than mood disorders
14
Q
prevalence rates schizophrenia
A
- 0.7-1%
- 1.4:1 male to female ratio
- women tend to present with more symptoms of depression (can explain gender prevalence differences)
- female sex hormone (estrogen) may be protective
- child-onset before age 13 is very rare
- prevalence rates increase for boys and girls in teens (more for boys)
- prevalence peaks again for women in late 40s (menopause, less estrogen)
15
Q
Schz in childhood (under 13)
A
- very rare, more common in boys
- always insidious onset which makes it hard to tell where actual onset begins
- usually early speech and language problems (noticeable differences in social, cognitive, motoric deficits)
- delayed motor development, poor coordination (not reaching motor milestones like crawling, difficulty with smooth pursuit)
- unlikely to remit
- higher rates of schizotypal and Schz in relatives (higher genetic loading for child-onset)
16
Q
course of Schz
A
- only 20-30% able to live independently
- another 20-30% have persistent moderate impairment and Sx
- the last 50% have lifelong severe impairment
- minority have periods of recovery
- Schz has poorer prognoses and more impairment than other psychotic and nonpsychotic disorders
- more benign course in countries that are not yet industrialized (demands of industrialized countries may make it difficult to find somewhere to exist OR because babies with fetal/birth complications are less likely to survive)
- tend to die younger (even 20 yrs younger)
- death by suicide is most common, then cardiovascular disease (smoking very common bc it manages sx, antipsychotics can have health-related side effects)
17
Q
good prognostic indicators
A
- good premorbid adjustment (had friends)
- acute onset (less than 1 month)
- manic and depressive symptoms
- confusion or disorientation during psychotic episodes)
- family history of mood disorders
- patients with 5 good indicators = 80% had more positive outcomes
18
Q
bad prognostic indicators
A
- poor premorbid adjustment
- insidious, gradula onset
- negative symptoms (esp. blunted affect)
- family history of Schz
- lower IQ
- patients with many bad indicators = 40% had positive outcomes
19
Q
Schz comorbidity
A
- substance abuse (alcohol and nicotine)
- substances could trigger it (esp. ones that mimic symptoms, but also marijuana)
- suicide risk (20% attempt, 5% complete) especially for young men (good premorbid functioning may have more pronounced risk)
20
Q
schizophrenia and violence
A
- perception of dangerousness and violence that isn’t founded
- very slight increased risk population-wide (this could be driven by higher rates of substance use)
- aggression more common in younger males with a history of violence (tendency to stop taking meds, toward impulsivity, substance abuse)
- higher likelihood that people with Schz are likely to be victims of violence or will commit suicide
21
Q
heritability of schz
A
- risk gets more and more elevated as you increase genetic overlap with a proband who has schz (Mz, Dz, kids, siblings, parents)
- higher concordance in Mz twins than any other family member (28% vs. 6% in Dz) but still not as heritable as bipolar
- offspring of the discordant co-twin (no schizophrenia with a twin who has it) is still much higher (17.4) so genetics playing a role
