ch 9 (lesson 11): schizophrenia Flashcards
1
Q
characteristics of Schizophrenia
A
major disturbances in thought, emotion and behavior
- disordered thinking
- lack of emotional expressiveness
- inappropriate or flat emotion
- disturbances in behavior (or movement)
- disheveled appearance
typically several acute episodes and and less severe, still debilitating symptoms btwn episodes
2
Q
disordered thinking
A
- ideas not logically related
- faulty perception and attention
3
Q
what might schizophrenia result in/ disrupt
A
- can disrupt interpersonal relationships, diminish capacity to work/ live independently
- sig. increased rates of suicide/ death (12x more likely than reg population)
4
Q
prevalence of schizophrenia (men vs women, onset, ethnic)
A
lifetime prevalence: around 1%
men slightly more than women
- onset late adolescence, early adulthood. men earlier
diagnosed more in African Americans (diagnostic bias)
5
Q
DSM 5 criteria Schizophrenia
A
2 or more symptoms last atleast 1 month; one symptom has to be 1,2, or 3:
1) delusions
2) hallucinations
3) disorganized speech
4) abnormal psychomotor behavior (catatonia- staying stationary)
5) negative symptoms (blunted affect, avolition, asociality)
- functioning in work/relationships/self-care have declined since onset
- signs of disorder for atleast 6 months (some symptoms); if during a prodromal or residual phase, neg symptoms or 2 or more symptoms 1-4 in less severe forms
6
Q
three major clusters of schizophrenia symptoms
A
- positive
- negative
- disorganized
7
Q
Positive symptoms (schizophrenia)
A
- delusions
- hallucinations
8
Q
negative symptoms
A
- avoliton
- alogia
- anhedonia
- blunted affect
- asociality
9
Q
disorganized symptoms
A
- disorganized behavior
- disorganized speech
10
Q
delusions
A
(positive symptom)
- firmly held beliefs
- contrary to reality
- resistant to disconfirming evidence
11
Q
types of delusions
A
- persecutory delusions ( ex: cia planted listening device in head)
- 65% percent of schizophrenia have
- being persecuted (special)
- thought insertion (somebody putting thoughts into your head)
- thought broadcasting (others can hear your thoughts)
- outside control
- grandiose delusions
- ideas of reference (things have special meaning to you- messages)
12
Q
hallucinations
A
(positive symptom)
sensory experiences that aren’t really there
13
Q
types of hallucinations
A
- auditory (74% have this symptom)
- visual
- hearing voices
- increased levels of activity in Broca’s area (speech control)
14
Q
avolition
A
(negative symptom)
lack of interest, apathy
Neumonic: apathetic owl
15
Q
asociality
A
(negative symptom)
inability to form close relationships
16
Q
anhedonia (+ 2 types)
A
(negative symptom)
inability to experience pleasure
- consummatory pleasure
- anticipatory pleasure
17
Q
blunted affect
A
(negative symptom)
exhibits little or no affect in face or voice
18
Q
alogia
A
(negative symptom)
reduction in speech
less context, less details
19
Q
negative symptoms 2 domains
A
experience domain (avolition, asociality, anhedonia)
- motivation
- emotional experience
- sociality
expression domain (blunted affect, alogia)
- outward expression of emotion
- vocalization
20
Q
disorganized speech (formal thought disorder) (2 types)
A
(disorganized symptom)
- incoherence
- inability to organize ideas
- loose associations (derailment)
- rambles, difficulty sticking to one topic
21
Q
disorganized behavior
A
(disorganized symptom)
odd or peculiar behavior
- silliness, agitation, unusual dress
22
Q
movement symptoms
A
- catatonia
- motor abnormalities
- repetitive complex gestures (hands or fingers)
- excitable flailing
- catatonic immobility
- mantain unusual posture for long time
- waxy flexibility
- limbs can be manipulated and posed by another person
23
Q
other psychotic disorders (similar to schizophrenia)
A
- schizophreniform disorder
- brief psychotic disorder
- schizoaffective disorder
also : delusional disorder, attenuated psychosis syndrome
24
Q
schizophreniform disorder
A
- same symptoms as schizophrenia
- must include either hallucinations, delusions, or disorganized speech
- symptom duration greater than 1 month but less than 6 months
25
Brief Psychotic Disorder
symptom duration of 1 day to 1 month
- must include either hallucinations, delusions, or disorganized speech
- often triggered by extreme stress, such as bereavement
26
Schizoaffective disorder
- symptoms of both schizophrenia and mood disorder
- requires either a depressive or manic episode
- symptoms of major mood episode present for majority of the duration of the illness
27
Delusional Disorder
- delusions, no other schizophrenia symptoms
delusions may include:
- persecution
- jealousy
- being followed
-erotomania (belief that someone loves you, usually a stranger, or celebrity).
-somatic delusions
- grandiosity
28
Attenuated Psychosis Syndrome (APS)
in DSM-5, but needs further research to be included
- young "prodromal" people with mild positive symptoms that might later develop into schizophrenia)
10-30% prodromal ppl develop schizophrenia, 0.2% of general population develop it
29
Etiology of Schizophrenia- Genetic Factors (association studies and genome wide scans)
Genetically heterogenous - not likely caused by single gene
association studies-
two genes associated w schizophrenia
- DTNGP1
- NGR1
two genes associated w cognitive deficits
- COMT
- BDNF
genome-wide scans
- identified several gene mutations
- needs to be replicated
30
etiology of schizophrenia- genetic studies- behavior genetic research (family, twin, adoption studies)
family studies:
- relatives are at increased risk
- neg symptoms have stronger genetic component
twin studies
- 44% risk for MZ twins, 12% risk DZ twins
adoption studies
- increased likelihood of developing psychotic disorders
familial high-risk studies
- differing negative vs positive symptomatology (neg more genetic, pos more environmental
31
etiology of schizophrenia- neurotransmitters (dopamine theory + revision)
Dopamine theory
- disorder due to excess dopamine levels
- drugs that that alleviate symptoms reduce dopamine activity (amphetamines can induce psychosis)
Revision:
- excess # dopamine receptors, or oversensative receptors
- localized mainly in mesolimbic pathway
- mesolimbic dop. abnormalities related to POS symptoms)
- underactive dop. activity in mesocortical pathway mainly related to NEG symptoms
32
dopamine theory doesn't completely explain schizophrenia
- antipsychotics block dopamine rapidly but symptom relief takes several weeks
- to be effective, antipsychotics must reduce dopamine activity to BELOW normal levels
-other neurotransmitters involved in schizophrenia
33
other neurotransmitters involved in schizophrenia
- serotonin
- GABA
- Glutamate
- medications that target glutamate shows promise
34
Etiology or schizophrenia: brain structure and function
- enlarged ventricles
- prefrontal cortex
- temporal cortex
35
Etiology or schizophrenia: brain structure and function-- - enlarged ventricles
enlarged ventricles
- implies loss of brain cells
- correlate w/
- poor performance on cog tests
- poor premorbid (before schizophrenia) adjustment
- poor response to treatment
36
Etiology or schizophrenia: brain structure and function-- prefrontal cortex
prefrontal cortex issues
- many behaviors disrupted by schizophrenia governed by prefrontal cortex
- ppl w/ schizophrenia show impairments on neuropsychological tests of prefrontal cortex
- ppl w schiz. show low metabolic rates in prefrontal cortex
- failure to show frontal activated related to neg symptoms ( not normal activity levels)
- DISCONNECTION SYNDROME: disrupted communication among neurons due to loss of dendritic spines
37
Etiology or schizophrenia: brain structure and function-- Temporal cortex
structural and func. abnormalities in temporal cortex
- temporal gyrus
- amygdala
- anterior cingulate
- reduced grey matter and volume evident in temporal cortex
38
Etiology or schizophrenia: brain structure and function-- environmental factors (to brain)
damage during gestation or birth
- obsetrical complications rates high in patients w schizophrenia
- reduced supply of oxygen during delivery may result in loss of cortical matter
viral damage to fetal brain
- presence of parasite, toxoplasma gondii, associated w 2.5x risk of schiz.
- in finnish study, schiz. rates higher if mom had flu in 2nd trimester
39
Etiology or schizophrenia: brain structure and function-- developmental factors
may explain why symptoms appear in late adolescence but brain damage occurs early in life:
-prefrontal cortex matures in adolescence/early adulthood (which is when schiz. develops)
- dopamine activity also peaks in adolescence
- stress activates HPA system which triggers cortisol secretion
- cortisol increases dopamine activity
- excessive pruning of synaptic connections
- use of cannabis during adolescence associated w increased risk
40
Etiology or schizophrenia: psychological stress
reaction to stress:
- ppl w schiz. and 1st degree relatives more reactive to stress
- show greater decreases in pos mood and increases in neg mood
socioeconomic status
- highest rates of schiz. among urban poor
-SOCIOGENIC HYPOTHESIS- stress of poverty causes disorder
- SOCIAL SELECTION THEORY- downward drift in socioeconomic status (as generations w schiz.)
- research supports it
41
etiology of schizophrenia: family factors
Shizophrenogenic mother
- cold domineering, conflict-inducing
- no support for this theory
Communication Deviance (CD)
- hostility and poor communication
- inconclusive at this time
42
Etiology of schizophrenia- families impacting relapse
- family environment impacts relapse
- Expressed Emotion (EE)
- hostility critical comments, emotional overinvolvement
- Bidirectional association
- unusual patient thoughts --> family critical comments --> unusual patient thoughts etc/ vice versa
43
etiology of Schizophrenia: developmental studies
- use of retrospective/ "follow-back" studies
- developmental histories of children who later developed schizophrenia
- lower IQ
- boy: delinquent behavior, girls: withdrawn
- coding of home movies
- poorer motor skills
- more expression of neg emotion
44
Etiology of Schizophrenia: 3 prospective developmental studies
New Zealand study:
- cognitive deficits evident at early age
Australian study (high risk study)
- Reduced gray matter volume predicted development of psychotic disorder
North American Prodrome Longitudinal Study
- Identified factors associated w development of psychosis
- having bio relative w schiz.
- recent decline in functioning
- high levels of pos. symptoms
- high levels of social impairment
45
Treatment of Schizophrenia: medications- first gen antipsychotical meds
first-generation antipsychotic meds (neuroleptics: 50's)
- phenothiazines (Thorazine), butyrophenones (haldol), thioxanthenes (Navene)
- reduce agitation, violent behavior (positive and disorganized symptoms)
- block dopamine receptors
- little effect on neg symptoms
have extrapyramidal side effects
- tardive dyskenesia (movement tics)
- neuroleptic malignant syndrome
- text book adds: dystonia (muscle rigidity), akathesia (inability to be still)
maintenance dosages (after acute episode) to prevent relapse
46
second-generation antipsychotics
- clozapine (clozaril)
- impacts serotonin receptors
- fewer motor side effects
- less treatment noncompliance
- reduces relapse
side effects of second gen antipsychotics
- can impair immune system func.
- seizures, dizziness, fatigue, weight gain
newer meds may improve cog function:
- Olanzapine (zyprexa)
- risperidone (risperdal)
47
Clinical Antipsychotic Trials of Intervention Evectiveness (CATIE) study
- second-gen drugs NOT more effective than older, first-gen drugs
- 2nd-gen DIDN'T produce fewer unpleasant side effects
- ~ 3/4 stopped meds before end of study
2nd-gen antipsychotics serious side effects
- weight gain, diabetes, pancreatitis
disturbing trend for ppl of color:
- not prescribed 2nd gen antipsychotics
48
Psychological treatment- Patient Outcomes Research Team (PORT) treatment recommendation
- recommends meds PLUS psychosocial intervention
- Social Skills training
- teach skills for managing interpersonal situations (job application, bus schedules, make appointments)
- involves role-playing and other practice exercises, both in group and in vivo
49
psychological treatment- social skills training for schizophrenia
- teach skills for managing interpersonal situations (job application, bus schedules, make appointments)
- involves role-playing and other practice exercises, both in group and in vivo
50
Psychological treatments for Schizophrenia- Family therapy to reduce Expressed Emotion (EE)
- educate family about causes, symptoms, signs of relapse
- stress importance of meds
- avoid blaming patient
- improve family communication/ problem-solving
- encourage expanded support networks
- instill hope
51
Psychological treatments
- social skills training
- family therapy (for EE)
- cognitive behavioral therapy
- cognitive remediation training or Cognitive Enhancement therapy (CET)
- Case Management
- Residential treatment
52
Cognitive Behavioral therapy for Schizophrenia
- recognize and challenge delusional beliefs
- recognize and challenge expectations associated w neg symptoms
53
Cognitive remediation training or Cognitive Enhancement Therapy (CET
- improve attention, memory, problem solving and other cognitive-based symptoms
54
case management
multidisciplinary team to provide comprehensive services
55
residential treatment
vocational rehabilitation
56
Prodromol
The period of subclinical signs and symptoms that precedes the onset of psychosis
