Ch.16 Psychopathology Flashcards
Epidemiology
study patterns of disease in a population
Depression is more prevalent in what gender?
Females
Drug dependency is more prevalent in what gender?
Males
Alcoholism is more prevalent in what gender?
Males
Peaks for depression occurs at what age?
25 to 44 years old
Peaks for antisocial behavior occurs at what age?
25 to 44 years old
Cognitive impairment occurs especially in people of what age group?
Older than 65
What percent of the U.S. population report symptoms that match the defining features of a major psychiatric disorder.
33.33% or 1/3rd of the population.
What percent of people with Schizophrenia recover?
30-40%
Why is schizophrenia considered a “public” disorder?
B/c many who have it become homeless on our streets
What is the prevalence of Schizophrenia?
1% which is ~3 million people in the United States.
Dissociative thinking
The key symptom of schizophrenia
major impairment in logical structure and thought.
Key symptom of schizophrenia?
Dissociative thinking
Are Schizophrenia hallucinations usually visual and auditory?
No usually just auditory if some one has a visual hallucination it is usually associated with a drug such as LSP and not a schizophrenic episode.
What are the clinical features common to the varied forms of schizophrenia according to German Psychiatrist Emil Kraepelin?
Paranoia grandiose delusions abnormal emotional regulation (changes in emotion/affect) bizarre disturbances of thought auditory hallucinations
What are the associative symptoms of schizophrenia identified by Eugen Bleuler in his book “The Group of Schizophrenias”?
loosened associations
emotional disturbance
delusions (false thought)
hallucinations (auditory)
What are the clinical features common to the varied forms of schizophrenia according to German Psychiatrist Emil Kraepelin?
Paranoia grandiose delusions abnormal emotional regulation bizarre disturbances of thought auditory hallucinations
What are considered today’s symptoms of schizophrenia?
1) auditory hallucinations
2) Highly personalized delusions (false belief)
3) changes in affect (emotion)
Some investigators proposed major division of schizophrenic symptoms into what two groups?
1) Positive
2) Negative
Examples of positive symptoms in reference to schizophrenia?
hallucinations
delusions
excited motor behavior
The term negative symptoms refers to what
Behavioral functions that have been lost
The term positive symptoms refers to what
abnormal behavioral states that have been gained
What suggest that positive and negative symptoms arise from different neural abnormalities?
Positive and negative symptoms respond differently to drug treatments.
There are several kinds of schizophrenia that vary in related degree of what?
Paranoia, blunted effect, or cognitive impairment.
Role of genes in schizophrenia? All or nothing?
No instead they can simply affect the probability that an individual will develop the disorder.
Examples of negative symptoms in reference to schizophrenia?
slow and impoverished thought slow and impoverished speech emotional withdrawal social withdrawal blunted affect of emotional expression
What is Alogia?
reduced speech output, a negative symptom of schizophrenia
What is the Flat affect?
blunted emotional response, a negative symptom of schizophrenia
What is Anhedonia?
loss of pleasurable feeling, a negative symptom of schizophrenia.
What is Catatonia?
Reduced movement, a negative symptom of schizophrenia.
Is Schizophrenia an inheritable disorder?
it is partially heritable but environmental influences and developmental difficulties also play a role in the development of schizophrenia.
who has a higher risk of schizophrenia than general population?
parents and siblings of people with schizophrenia. Which supports the theory of it being partly genetic since the closer relatives share a greater number of genes.
What do they mean when they say the mode of inheritance of Schizophrenia is not simple?
It means it does not involve a single recessive or dominant gene. Rather multiple genes can play a role in the emergence of schizophrenia.
Monozygotic twins
identical; share an identical set of genes.
what type of monozygotic twins are more likely to be concordant for schizophrenia?
Monozygotic twins that share the same placenta are more likely to be concordant for schizophrenia than monozygotic twins with their own placenta.
Why can one twin with the same genetics have schizophrenia and not the other if schizophrenia partly has to do with genetics?
Genes can be expressed in different ways.
dizogotic twins
fraternal; have 1/2 their genes in common
Concordant for schizophrenia means what?
Concordant refers to when both twins in a pair express/suffer from the trait, in this case the trait being schizophrenia.
Discordant for schizophrenia refers to?
Discordant refers to when only one of a pair of twins suffers from/expresses a trait, in this case the trait being schizophrenia.
what is the percent of monozygotic twins of people with schizophrenia are concordant for the disorder?
~1/2 or 50%
What percent of dizogotic twins of people with schizophrenia are concordant for the trait?
17%
What is strong evidence of the genetic factor of schizophrenia?
The percent of concordant of schizophrenia for monzygotic twins of people with the disorder is significantly higher than the percent concordant for dizogotic twin. Monozygotic zwins are twice as closely related by genetics than dizogotic twins. Also the environmental and variables like family structure and socioeconomic stress factor would be presumably comparable for twins.
What typically tended to be the characteristics of the twin that developed schizophrenia, in twins that were discordant for the trait?
tended to be more abnormal throughout life
frequently weighed less at birth
Early developmental history including more instances of physiological distress.
during development more submissive. tearful, sensitive than the other twin and seen by the parents as more vulnerable.
In childhood impairments of motor control and other neurological signs
behavioral developmental difficulty during childhood
Cognitive development difficulty during childhood
How can an eye tracking measurements (neuropsychological test) show if you may have schizophrenia?
In an eye tracking measurement the eye movements are recorded while the eyes follow a moving target on a computer screen. These measurements are abnormal in schizophrenic patients. Schizophrenic patients tend to be unable to use normal smooth muscle movements of the eyes to follow the moving target and instead show an intrusion of rapid, jerky eye movements.
endophenotype
Behavioral or physical characteristics accompany susceptibility to a particular disorder, which may be used to identify those risks.
Genetic analyzing suggest genes influencing the development of schizophrenia are scattered across many different human chromosomes. However there have been a few genes identified that appear to be abnormal in a substantial proportion of schizophrenic cases. These genes include?
encoding for neuregulin 1 dysbindin catechol-O-meth-yltransferase (COMT) G27 disrupted in schizophrenia 1 (DISC1)
genes encoding for neuregulin 1 participatein?
NMDA, GABA and ACh receptor regulation.
abnormality identified in schizophrenics
dysbindin is a gene implicated in what?
synaptic plasticity
abnormality identified in schizophrenics
catechol-O-meth-yltransferase (COMT) is a gene involved in what?
metabolizing dopamine
abnormality identified in schizophrenics
G27 is a gene thought to contribute to what?
to glutamatergic activity.
Abnormality identified in schizophrenics
How does paternal age play a role in schizophrenia?
Older fathers are more likely than younger men to have children with schizophrenia.
Why may paternal age play a role in schizophrenia?
Perhaps the sperm of older men, which are the product of more cell divisions than the sperm of younger men, have accumulated more mutations by errors in copying the chromosomes; these mutations may increase likelihood of schizophrenia.
what are the ventricular abnormalities in patients with schizophrenia?
Many have enlarged cerebral ventricles especially the lateral ventricles.
How does duration of hospitalization and length of illness affect the size of the ventricles in schizophrenics?
It does NOT affect it at all.
How does ventricular enlargement predict the responsiveness to anti-psychotic drugs?
Patients with more enlarged ventricles tend to show poorer response to these drugs.
What happened to transgenic mice with a mutated version of the gene DISC1?
They developed enlarged lateral ventricles.
What is the significance of enlarged ventricles of schizophrenics?
Since the overall size of the brain does not increase the enlarged ventricles must come at the expense of brain tissue.
Among twins who are discordant for schizophrenia, the twin that is ill tends to have two brain structures smaller than the healthy one. what are they?
1) Hippocampus
2) Amygdala
How does the size of the ventricles and the size of hippocampus and amygdala correlated in schizophrenia?
The hippocampus and amygdala help form the walls of the lateral ventricles. Atrophy of the hippocampus and amygdala would cause enlargement of lateral ventricles and smaller hippocampus and amygdala structures. Which is what you see in schizophrenics.
Besides the hipocampus, amygdala and ventricles what other brain structures seems to be abnormal?
parahipocampal regions/cortex , entorhinal cortex, and cingulate cortex
When comparing the structure of the hippocampus of a schizophrenic to a person of the same age without the illness what were the differences discovered?
The Pyramidal cells of schizophrenic were disorganized, possibly resulting from abnormal synaptic arrangements of both the inputs and outputs of these cells. The most impaired individuals exhibited greatest disorganization.
The cellular disorganization of schizophrenia probably arises when?
during early cell development but because new neurons are made throughout life, especially in the hippocampus, abnormal neurogenesis or disordered integration of newly born cells could contribute to development of schizophrenia.
How do schizophrenics and controls differ structurally in the corpus callosum?
Schizophrenics tend to have a more accelerated loss of gray matter at adolescence than controls
What has test sensitive to frontal cortical lesions told us about schizophrenics?
Schizophrenics tend to be impaired on neuropsychological test that are sensitive to frontal cortical lesions. Raising the possibility that the frontal cortex was impaired in schizophrenics.
PET scans indicate what about schizophrenic patient’s frontal lobes?
That there is is relatively less metabolic activity in the frontal lobes compared to the posterior lobes. While in control subjects there is more-equal activation of frontal and posterior cortex.
In schizophrenic discordant twins frontal blood flow is reduced in which twin?
Only in the one with schizophrenia
Neurons in the frontal cortex of schizophrenic patients compared to controls?
the neurons in schizophrenic patients have dendrites with a reduced density of synaptic spines compared with control subjects., which may contribute to less active frontal cortex.
hypofrontality hypothesis for schizophrenia
Suggest that schizophrenia may be caused by the underactivation of the frontal lobes.
Cortical abnormalities in schizophrenics include what?
thicker corpus callosum and
altered function in this structure
lobotomy
surgical separation of a portion of the frontal lobes from the rest of the brain, as a treatment for schizophrenia.
Did lobotomies cure schizophrenia?
No, they may have made the patients easier to handle but they were rarely able to leave the mental institution.
How many lobotomies were performed in the United States?
~40,000 people. Used for almost all mental disorders not just Schizophrenia
What replaced lobotomies in 1954 as treatment for schizophrenia?
Chlorpromazine (trade name Thorazine)
Did Chlorprozamine actually work?
yes and in fact the symptoms that responded to chlorprozamine were exactly those that kept people in the mental institution.
Chlorproamazine could powerfully reduce what symptoms of schizophrenia?
Positive symptoms of schizophrenia, including: auditory hallucinations delusions disordered thinking *ONLY POSITIVE SYMPTOMS