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Clinical Psychology > 9: Schizophrenia & Disorders of Self > Flashcards

9: Schizophrenia & Disorders of Self Flashcards

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1
Q

How did Emil Kraepelin (1856-1926) classified severe mental health problems?

A

Affective + non-affective categories

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2
Q

What does the category “dementia praercox”, devised by Emil Kraepelin mean?

A

Senility of the young

  • assumed to be a tangible morbid process in the brain = accounting for slide into dementia
  • but symptoms assumed unintelligible
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3
Q

What type of behaviours so sufferers of dementia praecox exhibit?

A
  • intellectual impairment
  • problems with attention + memory
  • hallucinations
  • delusions
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4
Q

Who is Eugen Bleuler (1857-1939?

A

Coined term SZ

  • Schizen = slip
  • Phren = mind
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5
Q

How did Eugen Bleuler explain SZ?

A
  1. Primary disorder
    - affect, ambivalence, autism
  2. Secondary disorders
    - response to primary disorder
    - delusions, hallucinations
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6
Q

What is the diagnostic criteria for SZ?

A
  1. need 2 or more of the following (Psychosis)
    - delusions
    - hallucinations
    - disorganised speech
    - grossly disorganised or catatonic behaviour
    - negative symptoms - emotional flattening + apathy
  2. deterioration of work, relations/ self-care
  3. continues for at least 6 months
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7
Q

Psychotic xp are key features of what other diagnoses within DSM V and how are they different from SZ?

A
  1. Schizoaffective Disorder
    - prominent psychotic xp + less mood disturbance
  2. Bipolar affective disorder
    - greater emphasis on affect + activity levels
    - the manic predominance
    - less disturbances of social functioning
  3. Severe depression w/ psychotic symptoms
    - greater emphasis on depression
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8
Q

What are the Neo Kraeplinian assumptions of mental illness?

A
  1. Boundary clear between sick + normal
  2. Discrete mental illnesses - not one but many
  3. Primary focus of psychiatric physicians should be biological underpinnings
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9
Q

What are some positive symptoms?

A

GAIN

  • delusions
  • Hallucinations
  • Disorganised thinking
  • Misperceptions
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10
Q

What are some negative symptoms?

A

LOSE

  • Blunted affect
  • Poor initiation + planning w/ task
  • Poverty of speech
  • Anhedonia
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11
Q

What are some different ways symptoms can be categories?

A
  1. Positive
  2. Negative
  3. Mood
  4. Manic
  5. Anxiety
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12
Q

What is a general problem with diagnosis?

SZ fq = 1%

Chronicity
- SZ patients die younger
-

A

= people present certain symptoms but they can vary thought time

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13
Q

What is the frequency of SZ?

A

1% pop

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14
Q

What is the chronicity f SZ?

A
  • SZ patients die younger
  • males 5.1 greater mortality
  • higher suicide rates
  • More physical disease + homelessness
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15
Q

What is the management of SZ with medication like?

A
  • 80/30% relapse rate after 1 yr

- greater affect on acute psychotic symptoms of SZ

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16
Q

What is thought to be the etiology of SZ?

A
  1. Convergence of different problems = syndrome, not just a single disease
  2. Brain abnormalities, although only 1/2 show it
  3. Stress diathesis Model
  4. Dopamine Hyp
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17
Q

What support is there for the genetic component of SZ?

A

1 SZ parent = 10%
2 SZ parents = 45%
= familia presentation

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18
Q

What is there to challenge the genetic component of SZ?

A
  • not 100%
  • only 11% cases of SZ have 1/+ parents with same diagnosis
  • 37% of all SZ cases = not first/ second degree relative with same diagnosis
    (Gottesman + Erlenmeyer- Minling, 2001)
  • family = genetic + social component
  • TWINS
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19
Q

What % of SZ cases have one or more parents with the same diagnosis?

A

11%

Gottesman + Erlenmeyer- Minling, 2001

20
Q

What % of SZ cases do not have a first/ second degree relative with same diagnosis?

A

37%

Gottesman + Erlenmeyer- Minling, 2001

21
Q

What is the age of onset SZ like?

A
  • build up at adolescent, but does show onset at all ages

- gives clues about what it is about development = higher onset of age

22
Q

What are the courses + outcome of SZ treatment like?

A
  • Only 15% make 100% social, symptomatic recovery
  • ranges from 60/50%
  • have to consider treatment method

previous treatment = avoid school/ stressful situations

VS NOW = go back and stay the same

23
Q

What factors are related to a good prognosis in SZ?

disease process ? or the chronicity emerging before onset of psychosis?

A
  1. Late onset
  2. Obvious precipitating factors
  3. Acute onset
  4. Good premorbid social, sexual + work history
  5. Married
  6. Family/ personal history of mood disorders
  7. Good support systems
  8. positive symptoms
24
Q

What factors are related to poor prognosis in SZ?

A
  1. Young + insidious onset
  2. No precipitating factors
  3. Poor premorbid social, sexual + work history
  4. Withdrawn, autistic behaviour; assultative history
  5. Single, divorced/ widowed
  6. Neurological signs + symptoms/ prenatal trauma
  7. Family history of SZ
  8. No remission in 3 years; many relapses
25
Q

Was psychosis thought to be continuous/ discontinuous?

A

discontinuous esp positive og thought
BUT Hearing voices - a continuum with anomalies of normal xp
= 11% of gen pop xp hallucinations (Tien, 1991)

26
Q

What did Posey + Losch (1983) find when they asked students if they had any auditory hallucinations?

A
  • most = heard someone call name
  • whilst falling asleep
  • conversation with dead relative
27
Q

What is the causal connundrum with SZ (Gilmore (2010)?

A
  • SZ = result of complex interaction between thousands of genes + multiple environmental risk factors
  • high comorbidity
    not a single disease process

= Stress- vulnerability (Diathesis) Model
(Zubin + Spring, 1977)

28
Q

SZ has high comorbidity with what other disorders?

A
  1. 91% accompanied w/ substance abuse/ mental heal disorders (Judd, 1989)
  2. Strongest relationship with mood disorder!
29
Q

Although twin studies do support the genetic factor of SZ, what is its limitation?

A

MZ
w/ diagnosis = 16.8%
W/OUT diagnosis = 17.4%

30
Q

What is the new understanding of phenotypes in severe mental illness (eg Ronald et al)?

A
  1. Paranoia, hallucinations, anomalous xp all on a continua with normality
  2. Genetic vulnerability to psychosis + depression shared
  3. Environmental influences are also common across disorders + play an important role independently + dependently
31
Q

What is a criticism of the DSM even though there is value in having a label (help/ benefits) Frances + Widiger, 2012?

A

result of a practical necessity

  • not based on causes
  • influenced by pharmaceutical industry
  • worry more about false negatives than false positives
32
Q

What are the 2 different types of error?

A
  1. False positives (type 1)
    - receive a positive result for a test, when you should have received a negative results
  2. False negatives (type 2)
    - opposite
33
Q

What are alternative diagnostic approaches?

A
  1. Dimensional
    - bipolar, SZ + Schizoaffective disorder explained by 5 dimensions
  2. Trans-diagnostic approach
    - Return to all-encompassing psychosis syndrome ( First, Carpenter et al, 2009)
    - focus on the specific symptom = no SZ/ bipolar disorder left to explain
34
Q

What is the advantage of the dimension approach vs categorical?

A

= continuum of the different aspects eg

ad = people go up and down = explains this

35
Q

What is a problem with the trans- diagnostic approach?

A
  • people hear not just the symptom investigated but other symptoms
36
Q

suggestion for why catatonis a common symtom of most SZ patients?

A

Reposne to thetraditoinal trateent

= institutionaism

37
Q

What are some traditional treatments for SZ?

A
  • Institutionalism

- Neuroleptic medication

38
Q

Why do up to 74% of people who take medication for SZ discontinue?

A

BAD side effects
OLD = movement disorders
NEW = weight

39
Q

Even though medication can have bad side effects, why is medication still given to SZ patients?

A

Actually effective for managing symptoms of SZ + relapse

40
Q

What has been found about the effectiveness of the psychological treatment CBT for SZ in the 2014 NICE meta-analysis?

A

= small but robust effects on:

  1. Total + positive symptoms up to 12 months post treatment
  2. Depression
  3. Social functioning - some
  4. Hallucinations - on specific measures
  5. At risk mental health
41
Q

Although treatment is available, what big obstacle is there?

A

difficult to deliver for all those whose need it

42
Q

What are some current research on CBT in people with psychosis in the UK?

A
  1. CBT for psychotic symptoms
    - alt to medication + focus on voices
  2. Low intensity targeted intervention for psychotic symptoms
    - paranoia = worry, social anxiety
  3. At risk mental states:
    - CBT for youth at high risk
  4. Improving social recovery
    - can you directly target?
43
Q

What is the Symptom- disability Gap in early Psychosis?

A

Medication given when social disability high + symptoms are present
- but later, when symptoms decrease, social disability continues to persist
= need to focus on helping social disability too

44
Q

What are the advantages of early intervention?

A
  • reduces admissions

- has LT health + economic + social benefits

45
Q

Before Early Intervention, what was the social recovery at 2 years like (Fowler et al, 2010: Cocchi et al, 2012)?

A

15% then

NOW = >50%

46
Q

What are some ongoing studies on early intervention?

A
  1. GETUP (Mirella Ruggerie, 2012)
    - effectiveness of multicomponent psychosocial intervention VS TAU pragmatic cluster
  2. SUPERDEN (Birchwood, owler, Jones, Singh et al)
    - national evaluation of early psychosis
  3. SUPERDEN3 (Fowler et al)
    - Trail of social recovery CBT
47
Q

What is suggested to be a key indicator of social disability across disorders?

A

Co-morbidity + non-specific psychopathology

= depression + social anxiety

Clinical Psychology (17 decks)

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