Chapter 10: Schizophrenia Spectrum Disorders Flashcards
Schizophrenia
a chronic psychotic disorder characterized by acute episodes involving a break with reality, as manifested by such features as delusions, hallucinations, illogical thinking, incoherent speech, and bizarre behavior
Four A’s
in Bleuler’s views, the primary characteristics of schizophrenia
loose associations, blunted or inappropriate affect, ambivalence, and autism
Looseness of Associations
ideas are strung together with little or no relationship among them
Affect
the behavioral expression of emotions
First-Rank Symptoms
in Kurt Schneider’s view, the primary features of schizophrenia, such as hallucinations and delusions, that distinctly characterize the disorder
Second-Rank Symptoms
in Schneider’s view, symptoms associated with schizophrenia that also occur in other psychological disorders
Prodromal Phase
(1) stage in which the early features or signs of a disorder become apparent
(2) in schizophrenia, the period of decline in functioning that precedes the development of the first acute psychotic episodes
Acute Episode
in schizophrenia, the phase in which psychotic symptoms develop, such as hallucinations, delusions, and disorganized speech and behavior
Residual Phase
in schizophrenia, the phase of the disorder that follows an acute phase, characterized by a return to a level of functioning typical of the prodromal phase
Thought Disorder
disturbances in thinking characterized by various features, especially a breakdown in logical associations between thoughts
Neologisms
type of disturbed thinking associated with schizophrenia involving the coining of new words
Perservation
persistent repetition of the same thought or train of thought
Clanging
in people with schizophrenia, the tendency to string words together because they rhyme or sound alike
Blocking
(1) disruption of self-expression of threatening or emotionally laden material
(2) in people with schizophrenia, a condition of suddenly becoming silent with loss of memory for what they have just discussed
Catatonia
gross disturbances in motor activity and cognitive functioning
Stupor
state of relative or complete unconsciousness in which a person is not generally aware pf or responsive to the environment, as a catatonic stupor
Waxy Flexibility
feature of catatonia involving adopting a fixed posture into which people with schizophrenia have been positioned by others
Positive Symptoms
the more flagrant features of schizophrenia characterized by the presence of abnormal behavior, such as hallucinations, delusions, thought disorder, disorganized speech, and disorganized behavior
Negative Symptoms
features of schizophrenia characterized by the absence of normal behavior, negative symptoms are deficits or behavioral deficiencies, such as social-skills deficits, social withdrawal, flattened affect, poverty of speech and thought, psychomotor retardation, or failure to experience pleasure in pleasant activities
Blunted Affect
significant reduction in emotional expression
Flat Affect
absence of emotional expression
Cross-Fostering Study
method of determining heritability of a trait or disorder by examining differences in prevalence among adoptees reared by either adoptive parent or biological parents who possessed the trait or disorder in question
evidence that the disorder followed biological rather than adoptive parentage favors the heritability of the trait or disorder
Dopamine Theory
biochemical theory of schizophrenia that proposes schizophrenia involves the action of dopamine
Hippocampus
one of a pir of structures in the limbic system involved in processes of memory
Amygdala
one of a pair of structures in the limbic system involved in emotion and memory
Schizophrenogenic Mother
type of mother, described as cold but also overprotective, who was believed to be capable of causing schizophrenia in her children
research has failed to support the validity of this concept
Double-Blind Communications
pattern of communication involving the transmission of contradictory or mixed messages without acknowledgement of the inherent conflict; posited by some theorists to play a role in the development of schizophrenia
Expressed Emotions
a form of disturbed family communication in which the family members of the individual with schizophrenia have a tendency to be hostile, critical, and unspportive
Tardive Dyskinesia
movement disorder characterized by involuntary movements of the face, mouth, neck, trunk, or extremities caused by long-term use of antipsychotic medications
What is schizophrenia?
schizophrenia is among the most puzzling and disabling clinical syndromes
schizophrenia touches every facet of an afflicted person’s life
acute episodes are characterized by delusions, hallucinations, illogical thinking, incoherent speech and bizarre behavior
between episodes, people may still be unable to think clearly and may lack appropriate emotional responses to people and events in their lives
What was Emil Kraeplin’s (1856-1926) perspective on schizophrenia?
dementia praecox (losing their mental capacities before old age)
“the loss of inner unity of thought, feelings, and acting”
progressive disease process (develops early in life)
hallucinations, motor abnormalities, delusions
What was Eugen Bleuler’s (1857-1939) perspective on schizophrenia?
Four A’s: associations (jumping from one topic to another without correlation), affect (withdraw socially), ambivalence (no form of strong decisions), autism (withdraw into internal delusions)
introduced the term “schizophrenia”, “split brain”
recognized variability in the course of the disorder
What was Kurt Schneider’s (1887-1967) perspective on schizophrenia?
thought the four A’s overlapped too much with other disorders and wanted better differential criteria
first rank and second rank symptoms
What are first rank symptoms?
central to diagnosis of Sz, initially thought to be unique to Sz
ABCD: auditory hallucinations, broadcasting of thought, controlling of thought (echo, insertion, withdrawal), delusions
What are second rank symptoms?
things that are often present but not exclusively
frequently associated with Sz, but not exclusively
mood problems
non-auditory hallucinations (visual, olfactory, haptic, gustatory)
What is the prevalence of schizophrenia?
1% of the population; fifth leading cause of disability
social isolation
early adult onset, few cases spontaneously enter remission permanently
consequences can be devastating in virtually all main functional areas
Why is homelessness and victimization common in schizophrenia?
properly treated, individuals with Sz are no more harmful than members of the general population
often suspicious of family and professionals, so avoid Tx
delusions may lead to fear that medications are poison or thought control agents
medication side effects can be nasty
poor compliance with social services and out reach workers make permanency planning difficult
may be reluctant to allow others into their residence to assess safety of home environment
about 20x as likely as members of the general population to complete suicide
What are the phases of schizophrenia?
prodromal phase: deterioration of self-care
acute phase: positive symptoms start
residual phase: still have some features, retain the belief that some delusions have merit, even if they acknowledge they are false
What are major features of schizophrenia?
disturbances of thought and speech
disturbances in the content of thought
delusions of persecution, being controlled, grandeur
What are common forms of delusions?
thought broadcasting
thought insertion
thought withdrawal
What are disturbances in the form of thought?
neologisms: terms they make up that don’t make sense
preservations: keep using same phrases, words, or topics of conversation over and over
clanging: non-sensical rhyming
blocking: stopping mid-sentence
What are attentional deficiencies in schizophrenia?
hypervigilance: looking over shoulder, immediately suspicious of anyone who enters the room
What are perceptual disturbances in schizophrenia?
auditory hallucinations and self-talk (sub-vocal speech)
auditory hallucinations in 60% of cases
command hallucinations
What are the emotional disturbances in schizophrenia?
flatness of affect
inappropriate affect
often in facial expression
What are the previous subtypes of schizophrenia that are no longer in the DSM-5?
disorganized: sat around and giggled, act drunk but no motor impairment
catatonic: without movement
waxy flexibility: can be moved
rigid: can’t be moved
paranoid: term that trumped everything else
undifferentiated: features are evenly distributed between all three
What are Type I and Type II schizophrenia?
positive symptoms and negative symptoms
premorbid functioning: poorer in type II
What is the DSM-5 criteria of schizophrenia?
two (or more) of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
level of functioning in one or more areas is markedly below the level achieved prior to the onset
continuous signs of the disturbance persist for at least 6 months, may include period of prodromal or residual symptoms
schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
if there is a history of ASD or a communication disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations
What are the specifiers of schizophrenia?
first episode, currently in acute episode
first episode, currently in partial
multiple episodes, currently in acute episode
multiple episodes, currently in full remission
continuous
unspecified
with catatonia
What is the DSM-5 criteria for schizoaffective disorder?
an uninterrupted period of illness during which there is a major mood episode
delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
What are differentials of schizophrenia?
mood disorder with psychotic features
brief psychotic disorder
delusional disorder: positive symptoms in the absence of others
substance-induced psychotic disorder
schizophreniform disorder: Sz. except the time period has not been met
schizotypal personality disorder: positive symptoms
schizoid personality disorder: negative symptoms
the boundaries between these can be so unclear that many scholars have argued for the removal of separate diagnostic categories
What are the psychodynamic perspectives on schizophrenia?
primary narcissism
Harry Stack Sullivan: ego defenses are completely overwhelmed, when defense collapses fully they will revert to oral phase, perceives delusions of the Id as being real, don’t have distinction between themselves and the environment
mother-child relationships: arise from moms who do not meet the child’s emotional needs, so they retreat into themselves for social stimulation, cause social withdrawal
What are the learning perspectives on schizophrenia?
Ulmann and Krasner: arose from environment where social reinforcement is hard to come by, then they partake in unusual, attention-seeking behavior to gain reinforcement, increase behavior to increase attention
reinforcement for behaving in a manner consistent with Sz.
secondary gains: inadvertent reinforcement of bizarre behavior
What are the biological perspectives on schizophrenia?
genetic factors: cross-fostering studies
biochemical factors: dopamine theory, neuroleptic drugs
viral infections
brain abnormalities: hippocampus, amygdala
What is the research evidence supporting the diathesis-stress model?
acute stress tends to predict onset: people who have already had a psychotic break
people with COMT gene more likely to develop psychosis with cannabis
genetic liability
What is a schizophrenogenic mother?
cold, aloof, withholding affection
child withdraws, foreclosing on opportunities to socialize
retreats into a fantasy world and begins to behave according to that imagined
What is double-bind communications theory?
children being shaped to say what they think parents “want” to hear
learned that if they speak up they will get in trouble, being shaped to speak in a way the authority figure wants
incompatible with true feelings
What is communication deviance?
mimicking unclear, vague, communication modelled by others, especially parents
What are biological approaches to the treatment of schizophrenia?
antipsychotic drugs
What are the psychoanalytic approaches to the treatment of schizophrenia?
personal therapy
Freud was of the opinion that psychoanalysis was not helpful in the treatment of Sz.
What are the learning based approaches to the treatment of schizophrenia?
social skills training
lots of evidence speaking to social maladjustment
social rejection and lack of support worsen outcomes
What are the psychosocial rehabilitation approaches to the treatment of schizophrenia?
focuses on functional practical adaptation
public transportation
job skills (often in a sheltered environment)
appointment of a public guardian/trustee
What are the family intervention program approaches to the treatment of schizophrenia?
education: educate family, tell them it’s not their fault
early intervention is critical
