ch 9 (lesson 11): schizophrenia Flashcards
characteristics of Schizophrenia
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
disordered thinking
- ideas not logically related
- faulty perception and attention
what might schizophrenia result in/ disrupt
- can disrupt interpersonal relationships, diminish capacity to work/ live independently
- sig. increased rates of suicide/ death (12x more likely than reg population)
prevalence of schizophrenia (men vs women, onset, ethnic)
lifetime prevalence: around 1%
men slightly more than women
- onset late adolescence, early adulthood. men earlier
diagnosed more in African Americans (diagnostic bias)
DSM 5 criteria Schizophrenia
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
three major clusters of schizophrenia symptoms
- positive
- negative
- disorganized
Positive symptoms (schizophrenia)
- delusions
- hallucinations
negative symptoms
- avoliton
- alogia
- anhedonia
- blunted affect
- asociality
disorganized symptoms
- disorganized behavior
- disorganized speech
delusions
(positive symptom)
- firmly held beliefs
- contrary to reality
- resistant to disconfirming evidence
types of delusions
- 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)
hallucinations
(positive symptom)
sensory experiences that aren’t really there
types of hallucinations
- auditory (74% have this symptom)
- visual
- hearing voices
- increased levels of activity in Broca’s area (speech control)
avolition
(negative symptom)
lack of interest, apathy
Neumonic: apathetic owl
asociality
(negative symptom)
inability to form close relationships
anhedonia (+ 2 types)
(negative symptom)
inability to experience pleasure
- consummatory pleasure
- anticipatory pleasure
blunted affect
(negative symptom)
exhibits little or no affect in face or voice
alogia
(negative symptom)
reduction in speech
less context, less details
negative symptoms 2 domains
experience domain (avolition, asociality, anhedonia)
- motivation
- emotional experience
- sociality
expression domain (blunted affect, alogia)
- outward expression of emotion
- vocalization
disorganized speech (formal thought disorder) (2 types)
(disorganized symptom)
- incoherence
- inability to organize ideas
- loose associations (derailment)
- rambles, difficulty sticking to one topic
disorganized behavior
(disorganized symptom)
odd or peculiar behavior
- silliness, agitation, unusual dress
movement symptoms
- 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
other psychotic disorders (similar to schizophrenia)
- schizophreniform disorder
- brief psychotic disorder
- schizoaffective disorder
also : delusional disorder, attenuated psychosis syndrome
schizophreniform disorder
- same symptoms as schizophrenia
- must include either hallucinations, delusions, or disorganized speech
- symptom duration greater than 1 month but less than 6 months
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
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
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
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
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
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
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
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
other neurotransmitters involved in schizophrenia
- serotonin
- GABA
- Glutamate
- medications that target glutamate shows promise
Etiology or schizophrenia: brain structure and function
- enlarged ventricles
- prefrontal cortex
- temporal cortex
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
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
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
Psychological treatments
- social skills training
- family therapy (for EE)
- cognitive behavioral therapy
- cognitive remediation training or Cognitive Enhancement therapy (CET)
- Case Management
- Residential treatment
Cognitive Behavioral therapy for Schizophrenia
- recognize and challenge delusional beliefs
- recognize and challenge expectations associated w neg symptoms
Cognitive remediation training or Cognitive Enhancement Therapy (CET
- improve attention, memory, problem solving and other cognitive-based symptoms
case management
multidisciplinary team to provide comprehensive services
residential treatment
vocational rehabilitation
Prodromol
The period of subclinical signs and symptoms that precedes the onset of psychosis
