Abnormal Final on Psychosis

Question 1

Schizophrenia

2) How can it be characterized?

3) What is the likelihood of full
recovery?

4) What socioeconomic group is most at risk?
5) How much does Schizophrenia cost per year?

Answer 1

Schizophrenia is a complex syndrome with a broad spectrum of cognitive and emotional dysfunction

2) Disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions.
3) Full recovery is rare, need constant medication and therapy.
4) The homeless population are most at risk of schizophrenia.
5) Cost billions

Question 2

Perspectives: Emil Kraeplin

Answer 2

Combined several insanity symptoms: catatonia (immobile and excited agitation), hebephrenia (silly, immature emotionality), and paranoia (grandiosity/persecution) combined to dementia praecox.

Early age of onset, poor outcome, many symptoms of hallucinations, delusion, negativism, and stereotyped behaviours.

Question 3

Perspectives Eugen Bleuler

Answer 3

Combined German words of Skhizen and phren= split mind

Characterized as a breakdown of associative threads of base functions in personality

Difficult maintaining thoughts is typical in all patients.

Question 4

Psychosis Clinical Description

2)How does the media affect public perception of schizophrenia/

Answer 4

Broad term aimed at unusual behaviours (delusions, hallucinations)
Affect all functions,

2)media distorts patients to make them appear dangerous
700 people with schizophrenia less likely to commit crimes compared to past inmates.

Question 5

1) Schizophrenia Spectrum Disorders
2) Where does Schizotypal personality disorder fit?
3) How many of the core positive symptoms is necessary?

Answer 5

Number of variants exist, include schizophreniform, schizoaffective, delusional disorder, and brief psychotic disorder.

Schizotypal is included and creates third dimension of disorganized symptoms.

Need 1 of: hallucinations, delusions, or disorganized speech.

Question 6

Delusions: What kind of a symptom are they?

2) What types of delusions exist?
3) Do delusions contribute to depression?

Answer 6

Misrepresentation of reality or disorder of thought content, positive symptom.

2) Delusions of grandeur= mistake belief of fame and glory,
Persecution= may be more disturbing with others being believed to get them.
Cotard’s= part of body changed in an impossible way. Capgras= believe someone replaced family member, ex: Tony Rosato.

3) Found delusional people had a stronger meaning in life with sense of purpose, less depression compared to unaffected.

Question 7

Hallucinations

2) What type of hallucinations are most common
3) What are some characteristics of hallucinations?

Answer 7

Experience of sensory events without input from external environment
2) Auditory are most common on own,

3) They are often unoccupied, as in they may occur without realization. They are also restricted from sensory input, meaning anything the person does to stop the hallucination does not affect the hallucination.

Question 8

Negative Symptoms

Answer 8

Experienced by 1/4 of population with schizophrenia.

Question 9

Avolition

2) What is Apathy?
3) What is the prognosis compared to other negative symptoms?

Answer 9

Inability to initiate and persist in activities

2) relates to emotional withdrawal
3) poor

Question 10

Alogia (4 pts.)

Answer 10

1) Absence of speech, brief replies
2) Uninterest in conversation, reflect negative thought content
3) Not inadequate communication skill
4) trouble finding right words in formulating thoughts.

Question 11

Anhedonia

2) Who else experiences anhedonia?
3) What complication does Anhedonia create?

Answer 11

Lack of pleasure in activities which once brought pleasure.

2) Experienced by others with mood disorders, relates to eating, socializing, and sex, questioned as it seemed to correlate with depression
3) Anhedonia relates to delay in seeking treatment.

Question 12

Asociality

2) What predicts Asociality?

Answer 12

Similar to avolition, lack interest in social relations, result of limited opportunity to interact.

2) Best predictor was chronic cognitive impairment, or difficulties in information processing. Both contribute to social skills deficits, and other difficulties.

Question 13

Affective flattening

2) Does someone with the flat affect experience a complete lack of emotion

Answer 13

2/3 people, no emotions displayed when expected, vacant stare, flat speech, and toneless manner, unaffected by environment

2) While there is no reaction to emotional situations, schizophrenics still experience emotions. Simply have problems expressing the emotion.

Question 14

Disorganized symptoms

Answer 14

Least understood cluster of symptoms. Erratic behaviour affecting speech, motor behaviour, and emotional reactions.

Question 15

Disorganized speech

2) What about conversation topics?
3) What is another name for disorganized speech, there are two.

Answer 15

Characterized as a frustrating conversation lacking insight or awareness.

2) Result in associative splitting and cognitive slippage where they jump from topic to topic. May go off on tangent with no specific questions
3) Can be referred to as tangentiality, loose association/derailment.

Question 16

Inappropriate affect/disorganized behaviour

Answer 16

Affect= laughing/crying at inappropriate times, bizarre behaviour like hoarding, unusual in public.

Question 17

Catatonia

2) What makes catatonia different from hallucinations and delusions?

Answer 17

Active behaviour with curious motor dysfunction like wild mobility and agitation ending in immobility.

2) Patient move fingers in stereotyped ways, unusual posture held as though in fear, catatonic immobility. suggesting it exists on a spectrum.

Question 18

Catatonic immobility

Answer 18

Waxy flexibility, when moved retain positiom.

Question 19

Schizophreniform disorder

What makes it different from schizophrenia?

Answer 19

Lasts a few months, disappear as result of treatment or time but ultimately unknown, .2% prevalence, onset in four weeks of first change in behaviour, confusion at apex of symptoms.
No blunted or flat affect.

Question 20

Schizoaffective Disorder

Answer 20

Schizophrenia and symptoms of mood disorder, symptoms present for 2 weeks in absence of prominent mood symptoms. Can be bipolar or depressive.

Question 21

Delusional Disorder

Answer 21

Major feature is delusion, belief contrary to reality, absence of hallucinations and disorganized thoughts, not organic, isolate due to suspicion, long-standing delusions over several years.

Question 22

Subtypes of Delusional Disorder (7)

1) Erotomanic
2) Grandiose
3) Jealous
4) Persecutory
5) Somatic
6) Mixed
7) Unspecified

Answer 22

1) Erotomanic: Believe another is in love with self
2) Grandiose: Believe they have a great undiscovered talent which is undiscovered.
3) Jealous: believe significant other is unfaithful.
4) Persecutory: Believe someone is conspiring against, cheating, spying, following, poisoning, harassing, obstruct pursuiting.
5) Somatic: Bodily functions/sensations make up delusions.
6) Mixed: no one subtype dominates.
7) Unspecified: Dominant belief can not be described in types.

Question 23

Brief Psychotic Disorder

Answer 23

One or more positive symptoms for few days lasting month or less, regain previous ability in functioning and precipitated by stress-inducing situations.

Question 24

Attenuated Psychosis Disorder

Answer 24

Sufficient distress to seek help, risk early schizophrenia= prodromal, not full schizophrenia but early intervention treating symptoms. Symptoms are perceived by victim as troubling and bizarre.

Question 25

Stats

Answer 25

Lifetime prevalence for female and male: .2-1.5% average of 1%. In BC was .4%.
Canada: 1.3% and older received at some point. Low life expectancy due to high risks of suicide, accidents, obesity, angina, and respiration problems.

Question 26

Onset

When are symptoms most severe?

2) How many go through a prodromal stage, what is such a stage and how long does it last?
3) What occurs in isolation and what do they predict?

Answer 26

Most severe symptoms in adolescence/early adulthood, clinical features like poor coordination in muscles, mild cognitive and social problems.

2) 85% go through prodromal stage- 1-2 years with less severe and unusual behaviours (ideas of reference, magical thinking, and illusions)
3) In isolation we see marked impairments in functioning and lack initiative, interests, or energy. If any markers are found in first 2-years then it may develop into a disorder and the length of duration increases causing hesitation to seek help.

Question 27

What else predicts schizophrenia’s onset?

2) Explain what relapse refers to in schizophrenia and what such episodes result in.

Answer 27

Personality factors, amount/quality of social support play role in seeking treatment, but once treatment does occur it takes longer to recover.

2) Relapse being another schizophrenic episode, the rate depends on prognosis which in this case is poor, high suicide risk, longer periods of recovery yet 22% had episode improve with no lasting impairments while remaining 78% had lasting impairments between relapse episodes.

Question 28

Cultural Factors

2) What is significant about these cultures?
3) What had England found?

Answer 28

Some believe it a pejorative label for eccentric individuals, experience contradicts this,
2) Cultures who support the sufferers reality end up improving the disorder significantly, due to culture, biology,

3) England found stereotype against black people being diagnosed more against will.

Question 29

Genetic Influences

2) So is schizophrenia caused by genes?

Answer 29

Super strong, all subtypes found in family of 1000, severity in parent’s influenced likelihood of children getting it, familial spectrum present is seemingly related to schizophrenia, likely they were at risk not just for schizophrenia but all psychological disorders.

2) No, the genes just predispose someone to be likely to a higher likelihood of stressors triggering schizophrenia.

Question 30

Family Studies

1) Stats for Identical, Fraternal, and the Quadruplets.
2) Why were Myra and Hester significant?
3) What type of mutation occurred with the quadruplets?
4) What is another possible explanation for the change in quadruplets.

Answer 30

Greatest chance with 48% if identical/monozygotic, 17% for dizygotic/fraternal, family of quadruplets proved a discrepancy.

2) Myra lived with mild form continuously and worked with family while other sister, Hester had mild form but remained dependent.
3) De novo mutation with sisters sharing genetic mutation in either egg or sperm.
4) On the other hand see unshared environment where identical siblings having different prenatal and familial experiences due to stress.

Question 31

Adoption studies

1) What happens if the biological mother had schizophrenia? What if she does not?
2) What can be gathered from this?

Answer 31

2) If mother had disorder rose to 22% if adopted. 1.7% of children with parents without disorder developed it, if dizygotic but no disorder then 17%.
2) Even if the mother has genetic tendency, a good environment offsets the risk.

Question 32

Gene-environment interactions

Answer 32

Cannabis in youth created modest risk and found specific genetic profile with COMT, VAL, MET (dont care bout those three) developed disorder at later age due to cannabis.

Question 33

Linkage and Association Studies, search for markers, and multiple genes

2) What trait was found deficient in schizophrenics?
3) What has trait loci research found in regard to chromosomes. What would cause the severity and risk to increase?

Answer 33

In looking at how traits were linked to genetic markers found regions in genes of 1-23, 8, 23, and 22 had associations.

2) Common traits found smooth-pursuit eye tracking was deficient in many a schizophrenic.
3) Quantitative trait loci research suggests schizophrenia is caused by different genes located on chromosome, gradations of severity with disorder and risk increased with number of relatives in family.

Question 34

Neurobiological Influences

1) Which neurotransmitter is the most controversial and why?
2) What dopamine antagonist was instrumental?
3) Why are neuroleptics the be all end all then?

Answer 34

1) Dopamine is controversial yet enduring theories, thanks to agonists and antagonists initiating/inhibiting chemical messengers, D2 receptor had neuroleptics affect receptor.
2) L-dopa was one such antagonist for Parkinson’s, caused schizophrenia symptoms in some, amphetamines are similar and worsen psychotic symptoms in schizophrenics.
3) Those helped by neuroleptics had symptoms subside slower than expected should have been days not weeks, reduced negative symptoms of schizophrenia only temporarily as they returned.

Question 35

Dopamine complications

1) What does Clozapine do?
2) What does a deficiency in the D1 receptor do? What is another name for it?

Answer 35

1) Clozapine helps people but is not the neuroleptic medication of choice, weaker antagonist pointing to dopamine being complex, striatal dopamine stimulation suggested it blocked receptors
2) Deficiency in prefrontal D1 receptor resulted in other type of dopamine sites for planning and organizing. See lower activity and negative symptoms which lowered prefrontal activity AKA hypofrontality.

Question 36

Glutamate

Answer 36

Third area of neurochemical interest, involving transmission, excitatory chemical in all areas of brain, NMDA studied for results of PCP and ketamine resulting in psychotic-like symptoms without schizophrenia, complex awaiting clarification.

Question 37

Brain Structure

Child studies, what was found?

2) What brain structure was found to be enlarged? What does it suggest?
3) What does the Wisconsin Card Sorting Task reveal?

Answer 37

Children with affected parent showed subtle problems like abnormal reflexes/inattentiveness, tasks and attention in reaction time exercises proved the problems persisted into adulthood.

2) Reliable observation in enlarged ventricles, dilation points to adjacent brain parts not being developed properly, occurred more in men, links to hypofrontality in identical twins being due to lack of oxygen in intrauterine space.
3) Wisconsin Card Sorting Task looked at organization and planning, decrease activity in dorsolateral prefrontal cortex implicated as well but ultimately points to hypofrontality.

Question 38

Viral infection: What are the two sources?

Answer 38

No descriptions since 1800s, virus like AIDS had schizo-virus theory arise, prenatal exposure to Type A2 influenza in Helsinki, Finland found mothers in second trimester more likely to have schizophrenia.

2) Parasites of Toxoplasma gondii in cat feces transmitted by oocysts from litter boxes, 2-3 times likely to have antibodies, affect brain in utero with affecting number of fingertip dermal cells which were only a third compared to other children not exposed.

Question 39

Psychological Causes

2) What is a location based stress which may precipitate schizophrenia?
3) What type of sociological causes are present?
4) What is the other side of the sociogenic theory?

Answer 39

Stress studied in amount, type, and cause and was associated with increased risk for developing schizophrenia.

2) Urban stress may precipitate onset, veterans displayed symptoms after returning which dissipated. Relapses were found to occur when stressful events increased in month prior, increase depression as well leading to relapse, 55% had no major life event
3) Social class and schizophrenia had negative correlation as well, tendency to be in lower class, cross-culturally replicated. Stress in lower life predispose to likelihood of schizophrenia or sociogenic hypothesis.
4) Schizophrenia could make ability to hold jobs impossible resulting in downward social drift into lower social class, social selection hypothesis.

Question 40

Family and relapse

Historically, how was the mother perceived?

2) What is expressed emotion?
3) Are there any cross-cultural discrepancies?

Answer 40

Mother as cold, dominant, reject, double bind portrayed communication style with conflicting messages causing schizophrenia, not supported but contribute to relapse.

2) Expressed emotion found to follow discharge from hospital, higher EE predicted relapse with chronic schizophrenia, 3.7 times more likely to relapse, intrusive, high emotional responses, negative attitude, and low tolerance with unrealistic expectations. Saw symptoms as intentional.
3) Discrepancies across India, Mexico, Britain, and north America point to cultural variation, overinvolvement is supportive while reactions do not lead to the disorder. Found by Suzanne King to be more of a response than the cause.

Question 41

Treatment (History)

Answer 41

16th century had removal of stone of madness, not different from lobotomies, causing cognitive/emotional deficits, Kenya has kisii listen to patients find location of noises, get them drunk then cut out scalp piece and scrape skull in area of voices. Now use neuroleptics combined with psychosocial treatments to reduce relapse and compensate for skill deficits to improve cooperation in taking medication.

Question 42

Biological interventions

Answer 42

Emil Kraeplin recommended patience, disposition, and self-control, temporary not treatment, 1930s had insulin-induced comas, major risk again with illness and death. ECT was not beneficial used for mood disorders which are not helped by drugs. Heinz Lehman made chlorpromazine and helped patients think clearly, reduce, eliminate hallucinations and delusions, positive/negative/disorganized thoughts affected not as much, dopamine antagonists interfered with neurotransmitter system and serotonergic system caused a trial-and-error process. antipsychotics developed working 60-70% of time, remained treated with clozapine, risperidone, and olanzapine, 1990 had clozapine developed and promise to help those unresponsive to medications prescribed to over 3/4 of Canadians.

Question 43

Tardive dyskinesia

2) What might cause tardive dyskinesia?
3) What is akinesia?

Answer 43

Major side effect of neuroleptics, medications worked only on positive and negative symptoms, quetiapine may treat flat affect but goes away when taken properly, 7% refused due to TD, 75% refused in one week period.

2) The negative doctor-patient relations, cost, stigma, and social support contributed and produced extrapyramidal symptoms like jerks and spasms, grogginess, blurred vision, and dry mouth.
3) More common is Akinesia, expressionless face, slow motor activity, and monotonous speech, TD is involuntary movements resulting from long-term high doses of neuroleptics which is irreversible.

Question 44

TMS

Answer 44

Transcranial magnetic stimulation generates magnetic fields up to 50 times per second in skull through brain, decreased auditory hallucinations, Daskalakis and Hoffman found less promising results except for loudness.

Question 45

Psychosocial Interventions

Answer 45

Not very effective, may be harmful, recent work point to using in conjunction with medication, 19th century had moral treatment with work and religion, popular but useless, Gordon Paul and Robert Lentz in 1970s made token economy with meals and small luxuries awarded for good behaviour. Saw major improvement for inpatients, disruptive patients were fined on tokens, improved in social, self-care, and vocational skills to be discharged from hospital.

Question 46

Deinstitutionalization

2) What types of psychosocial therapies are beneficial?

Answer 46

Resulted in schizophrenics in Canada and US being involuntarily hospitalized and due to relative success of antipsychotic medications and fiscal crises ensuring cutbacks in health care.

Shut down thousands of hospitals, resulted in problems no longer receiving care and becoming homeless, women expected to care for members, became the caregiver burden, beneficial, but only a few were helped.

2) Role-play and practice skills are complex in teaching how to make friends, feedback given but unsuccessful following program. Independent Living Skills Program does this with independent living, signs of relapse are watched for, manage medications, prevent relapses. Essentially pushing to teach basic life skills once more.

Question 47

Behavioural Family Therapy

Answer 47

Classroom education on medications, side effects, communication skills, reduce negative feelings, replace harsh reactions, problem-solving skills are learnt to resolve rising conflicts.

Effects are significant in first year, less robust two years after intervention, ongoing if patient and family benefits, towards early intervention, recognized as affecting course of disorder over time, early help is critical as are medications and psychotherapy.

Question 48

Cross-cultural treatments differ

Explain how China, the Xhosa of South Africa, Native Chinese, Bali, and Africa treat schizophrenia.

Answer 48

China has anti-psychotic medications, yet 7-9% use traditional herbs and acupuncture

Xhosa in South Africa used traditional healers inducing vomiting, enemas, and slaughtered cattle to appease spirits

Native Chinese held more religious beliefs of causes and treatments compared to England translating into practice with biological, psychological, and community treatments, Chinese rely more on alternative treatments.

Supernatural beliefs among Bali lead to limited use of neuroleptics in treatment

Africa has people kept in prisons.

Question 49

Prevention, who were at the forefront of preventing schizophrenia

Which children were at higher risk? (2)

Which Other factors could prevent schizophrenia? (3)

Answer 49

Mednick and Schulsinger identified and treated children at risk for disorder, 15 was the average age of onset and were followed for 25 years determining factors which developed schizophrenia.

Children whose mothers had disorders were likely to develop schizophrenia (16%) or personality disorders (21%) in comparison to children of non-affected mothers (2-5%).

Instability of early family-rearing environment points to environmental influences triggering onset. Poor parenting placed additional strain, treatment during the prodromal stage is the primary focus where person show signs of schizophrenia, intervention investigated as means of stopping disorder or preventing relapse.