chapter 11 Flashcards
what is schizophrenia
A chronic, debilitating psychological disorder impacting every part of a person’s life, characterized by a break in reality that typically takes place in the form of:
- hallucinations
- delusions
- pattern of aberrant behavior
Develops during late adolescence or early adulthood
- Suddenly, within a few weeks or months
positive symptoms
negative symptoms
hallucinations
Perceptions attributed to external stimuli confused with reality
Sensory distortions such as “hearing voices” or “seeing things”
delusions
Firmly held inaccurate beliefs despite reality
Fixed, false beliefs
phases of schizophrenia
prodromal phase
acute episode
residual phase
prodromal phase
The period of deterioration preceding the onset of acute symptoms
In schizophrenia, the period of decline in functioning that precedes the first acute psychotic episode
Characterized by subtle symptoms involving unusual thoughts or abnormal perceptions (but not outright delusions or hallucinations), as well as waning interest in social activities
acute episode
The emergence of clear psychotic features
lapses in job performance or schoolwork, speech becomes vague, hoards food, collects garbage, talking to oneself on the street → increasingly bizarre behavior
residual phase
Level of functioning that was typical of the prodromal phase
Follows acute episodes
In which their behavior returns to the level of the prodromal phase
Flagrant psychotic behaviors are absent, but the person is still impaired
Difficult functioning
positive symptoms
Flagrant symptoms such as hallucinations, delusions, bizarre behavior, thought disorder
negative symptoms
Behavioral symptoms as social skills deficit and withdrawal, flattened affect, poverty of speech/thought, failure to experience pleasure, psychomotor retardation
criteria for schizophrenia
A. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition)
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)
C. continuous signs of disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms (or less ifi successfully treated) that meet Criterion A (ie., active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences)
D. schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active phase symptoms, 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
F If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated)
Disturbed thought and speech
Aberrant content of thought: delusions of thought
delusions of persecution or paranoia
delusions of reference
delusions of being controlled
delusions of grandeur
thought broadcasting
thought insertion
thought withdrawal
Delusions of persecution or paranoia
“The CIA is out to get me”
Delusions of reference
“People on the bus are talking about me”
“People on TV are making fun of me”
Delusions of being controlled
Believing that one’s thoughts, feelings, impulses, or actions are controlled by external forces such as agents of the devil
Delusions of grandeur
Believing oneself is to be Jesus
Thought broadcasting
“As I think, my thoughts leave my head on a type of mental ticker tape. Everyone around has only to pass the tape through their mind and they know my thoughts”
Thought insertion
“The garden looks nice and the grass looks cool, but the thoughts of [a man’s name] come into my mind. There are no other thoughts there, only his… He treats my mind like a screen and flashes his thoughts on it like you flash a picture”
Thought withdrawal
“I am thinking about my mother, and suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor, and there is nothing in my mind; it is empty”
thought disorder
A disturbance in thinking characterized by a breakdown in thoughts
Breakdown in:
- Organization
- Processing
- Control
Of thoughts
Attentional deficiencies
Eye movement dysfunction
and
Abnormal event related potentials
Eye movement dysfunction
Difficulty tracking a slow moving target across their field of vision
Eyes fall back and catch up in a jerky movement
Abnormal event related potentials
Abnormal brain wave patterns in response to external stimuli
Sensory ‘gating’ that suppresses does not supress does not disregard relevant stimuli
Difficulty filtering out irrelevant stimuli
Sensory overload and jumbling of sensations
Emotional disturbances
More negative and fewer positive emotions than healthy individuals
Flat affect
Less facial expressions
Perceptual disturbances
Hallucinations
- Sensory experiences in the absence of external stimulation in relation to the five senses
- Auditory are the most common (70%)
Attributed to:
- Disturbances in brain chemistry (high dopamine?)
- Inner speech/misattributed self talk attributed to external sounds
- Abnormal structure and connections in neurons
Catatonia
Three or more of the following symptoms:
- Stupor (no psychomotor activity; not actively relating to environment)
- Catalepsy (passive induction of a posture held against gravity)
- Waxy flexibility (slight, even resistance to positioning by examiner)
- Mutism (no, or very little, verbal response)
- Negativism (opposition or no response to instructions or external stimuli)
- Posturing (spontaneous and active maintenance of a posture against gravity)
- Mannerism (odd, circumstantial caricature of normal actions)
- Stereotypy (repetitive, abnormally frequent, non-goal-directed movements)
- Agitation, not influenced by external stimuli
- Grimacing
- Echolalia (mimicking another’s speech)
- Echopraxia (mimicking another’s movements)
Brief Psychotic Disorder
Applies to a psychotic disorder that last from a day to a month and is characterized by at least one of the following features: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior
Brief Psychotic Disorder
criteria
A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning
C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance or another medical condition
specify with brief psychotic disorder
With a marked stressor(s) (brief reactive psychosis):
If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture
Without marked stressor(s):
If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture
With peripartum onset:
If onset is during pregnancy or within 4 weeks
With catatonia
Schizophreniform Disorder
Consists of abnormal behaviors identical to those in schizophrenia that have persisted for at least one month but fewer than six months
Schizophreniform Disorder
criteria
A. Two or (more) of the following, each present for a significant portion of time during a 1 month period (or less is successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Negative symptoms
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional”
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness
D. The disturbance is not attributable to the physiological effects of a substance or another medical condition
Schizophreniform Disorder
specify with
With good prognostic features:
The specificer requires the presence of at least two of the following features:
- Onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity; good premorbid social and occupational functioning; and absence of blunted or flat affect
Without good prognostic features:
This specified is applied if two or more of the above features have not been present
With catatonia
Schizoaffective Disorder
Sometimes referred to as a “mixed bag” of symptoms because it includes psychotic behaviors associated with schizophrenia occuring at the same time as a major mood disorder
At some point in the course of the disorder, delusions or hallucinations occur for a period of at least two weeks without the presence of a major mood disorder
Schizoaffective Disorder
criteria
A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portion of the illness
D. The disturbance is not attributable to the effects of a substance or another medical condition
Schizoaffective Disorder
specify
Bipolar type:
This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur
Depressive type:
This subtype applies if only major depressive episodes are part of the presentation
Delusional Disorder
Applies to people who hold persistent, clearly delusional beliefs, often involving paranoid themes
Rare: 20/10,000 people during their lifetimes
Beliefs may be bizarre or may fall within a range of seeming plausibility, such as unfounded beliefs
Delusional Disorder
criteria
A. The presence of one (or more) delusions with a duration of 1 month or longer
B. Criterion A for schizophrenia has never been met
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd
D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder
Delusional Disorder
TYPES (list)
erotomanic type
grandiose type
jealous type
persecutory type
somatic type
mixed type
unspecified type
with bizarre content
Erotomanic Type
Delusional beliefs that someone else, usually a person of a higher social status such as a movie start of a political figure, is in love with you; also called erotomania
Grandiose Type
Inflated beliefs about one’s own worth, importance, power, knowledge, identity, or beliefs that one has a special relationship to a deity or to a famous person. Cult leaders who believe they have special mystical powers of enlightenment may have delusional disorders of this type.
Jealous Type
Delusions of jealousy in which the person may become convinced, without due cause, of the infidelity or his or her partner. The delusional person may misinterpret certain clues as a signs of unfaithfulness, such as spots on the bed sheets
Persecutory Type
The most common type of delusional disorder, persecutory delusions involve themes of being conspired against, followed, cheated, spied on, poisoned or drugged, or otherwise malsigned or mistreated. People with these delusions may repeatedly bring legal actions against those whom they perceive to be responsible for their mistreatment or may even commit acts of violence against them.
Somatic Type
Delusions involving the person’s physical or medical condition. People with these delusions may believe that foul odors are emanating from their bodies or that internal parasites are eating away at them.
Mixed Type
Delusions typify more than one or the other types with no single predominant theme
Unspecified Type
This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types
With bizarre content
Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences
perspectives (list)
psychodynamic
learning
social-cognitive
biological
psychodynamic perspective
Regression to a psychological state corresponding to early infancy in which the prodding of the id produces bizarre, socially deviant behavior and gives rise to hallucinations and delusions
learning
People with schizophrenia learn to exhibit certain bizarre behaviors when they are more likely to be reinforced than behaviors that would be considered normal
Social-Cognitive theorists
Modeling and selective reinforcement of bizarre behavior may explain some schizophrenic behaviors in the hospital setting
Biological
Proven genetic component → theory is combination of genes
Biochemical:
- Dopamine hypothesis
- Viral infections + Vitamin D deficiency
Brain abnormalities:
- Studies show structural abnormalities
- Loss or thinning of gray matter
- Especially in prefrontal cortex - regulating attention, organizing thoughts and behavior, prioritizing information, formulation goals
- Damage or developmental failure during prenatal development or early
Dopamine hypothesis
overactivity of dopamine in the brain is involved in schizophrenia
Viral infections + Vitamin D deficiency
Viral (flu, rubella, etc) as predisposition
Lack of vitamin D in seasons with less sun as predisposition
Family factors
- communication deviance
- Evidence shows that parents with high levels of communication deviance stand a higher than average risk of having offspring with schizophrenia spectrum disorders
- expressed emotion
- Living with high EE relative appears to impose greater stress on people who are challenged by mental disorders
communication deviance
a pattern of unclear, vague, disruptive, or fragmented communication that is often found among parents and family members of people with schizophrenia
expressed emotion
a pattern of responding to the family member with schizophrenia in hostile, critical, and unsupportive ways
treatment (list)
biomedical
learning based approach
psychosocial rehabilitation approach
family intervention programs
biomedical
Remember the 50s!
Antipsychotics
Eases intensive, flagrant behavior patterns like delusions and hallucinations
Antipsychotics
tardive dyskinesia
1st vs 2nd gen
1st gen antipsychotics
thorazine, trifluoperazine, fluphenazine, haloperidol
Prescribed less; second round; more intense; more side effects
Tardive dyskinesia
tardive dyskinesia
Involuntary movements of the face, mouth, trunk, or extremities caused by long term use
Major risk of long term use of neuroleptics
2nd gen psychotics
clozapine, risperidone, olanzapine
Family involvement plays a role! Greater accompaniment of families may require less medication
Learning based approaches
Token economy systems
Social skills training
- Increases adaptive behavior
Psychosocial rehabilitation approaches
Help people adapt more successfully to occupational and social roles in the community
Family intervention programs
Helps families cope with the burden of care, communicate more clearly, and learn more helpful ways of relating to the patient
