Chapter 11 Flashcards
what is Schizophrenia?
psychotic disorder characterized by major disturbances in though, emotion and behaviour
what are some characteristics of schizophrenia?
distorted thinking
faulty perception and attention
flat or inappropriate affect
bizarre disturbances in motor activity
what do delusions incorporate?
cultural things
when does schizophrenia usually appear?
late adolescence or early adulthood
what gender does schizophrenia appear earlier?
appears earlier in men than for women
what is the amount treated in the community?
almost half
what is the preset that commit suicide?
almost 10%
what is the percent that suffer from comorbid disorder?
50%
what is high in people with schizophrenia?
substance abuse
what does cannanbis do?
If use at early age can increase risk of schizophrenia
what is the prevalence of schizophrenia?
world wide variations around the world
incidence significantly higher in men than women (ratio = 1.4)
where are high rates of psychotic disorders?
immigrants from the caribian and Bermuda
what population has lowest prevalence rates?
asian
where are symptoms higher in auditory and visual hallucinations?
people from African nations
what counties have better recovery rates?
india
especially southern india
what does mortality rates reflect?
the seriousness of the diagnosis
what is the life expectancy of people with schizophrenia?
20-25 ears shorter than general population
what is associated with the mortality rate?
illicit drug use, lower family involvement and longer time to the initial emission of symptoms
what are the comorbid conditions?
substance abuse (37%)
depression (40%)
what helps with the corse of schizophrenia?
early treatment is vital with reductions ointment disability over the long term
when people with schizophrenia typically have acute episodes with what?
intense symptoms
what happens between schizophrenic episodes?
have less sever but still very debilitating symptoms
where are most people with schizophrenia treated in?
the community
what is sometimes necessary when treating schizophrenia?
hospitalization
what is the precent of psychotic patents with schizophrenia?
30.9%
are men or women have higher hospitalization rates in Canada?
much higher in among young men than young women (19.9% of general hospitalizations)
what are the characteristics of remission in schizophrenia?
rates vary widely across studies
slightly more than 1 in 3 have symptoms of remission
what is remission associated with?
milder initial symptoms, better premorbid functioning, earlier treatment response and shorter duration of untreated psychosis
what is there high prevalence in with schizophrenia?
anxiety disorders
what is the most prevalent comorbid condition in schizophrenia?
social anxiety
can people with schizophrenia differ from each other more than others with disorders?
yes
what is there at the empirical and conceptual levels with schizophrenia?
heterogeneity
what are the types of symptoms in schizophrenia?
positive symptom and
negative symptoms
what are positive symptoms?
presence of too much of a behaviour that is not apparent in most people
what are negative symptoms?
the absence of behaviour that should be evident in most people
what are some symptoms of positive symptoms?
disorganized speech
problems in organizing ideas and in speaking
loose associations
derailment
delusions
hallucinations
what is disorganized speech?
one of the criteria for the diagnosis
does not discriminate well btwn schizophrenia and other psychoses (mood disorders)
what are delusions?
beliefs held contrary to reality
person maybe unwilling recipient of bodily sensations or thoughts imposed by external agency
may believe their thoughts are broadcasted or transmitted
may think thoughts are being stolen from them
how many people with schizophrenia have delusions?
half of people
where else are delusions found?
seem in mania and delusional depresison
what are hallucinations?
most dramatic distortions of perception
sensory experiences in absence of stimulation
often more auditory than visual (74% with auditory)
what are symptoms of hallucinations?
hearing own thoughts though spoken by another voice
hear voices arguing
hear voices commenting on their behaviour
what are symptoms of negative symptoms?
avolition
alogia
anhedonia
flat affect
asociality
what is avolition?
lack of energy
inability to persist win what are usually routine activities
inattentive to grooming and personal hygiene
that is alogia?
poverty of speech, amount of speech, poverty of content of speech
negative though disorder
what is anhedonia?
lack of interest in recreational activities, relationships with others
symptoms and report that normally pleasurable activities are not enjoyable for them
what is flat affect
a lack of emotional expression
stare vacantly, dance flaccid , lifeless eyes
what is asociality?
few friends poor social skills, and little interest in being with others
greater shyness
childhood social troubles
why is it important to distinguish negative symptoms of schizophrenia?
can be due to some other factor
what can flat affect be a side affect of?
antipsychotic medication
what is Catatonia?
unusual increase in overall level of activity
wild flailing of limbs and great expenditure of energy similar to mania
what is catatonia immobility?
unusual postures and maintain them for long periods of time
waxy flexibility
what is waxy flexibility?
another person can move their limbs and maintain them for long periods of time
what is inappropriate affect?
laugh on hearing some died
become enraged when asked a simple question
rapid shifts from one emotional state to another
what are the impacts of delusions and hallucinations on life?
caused by considerable distress, compounded by the fact that hopes and dreams have shattered
what are cognitive impairments and avolition impacts on life?
make stable employment difficult with impoverishment and often homelessness the result
what are the social behaviours and social skills defects impact life?
lead to loss of friends and a solitary existence
what is the strongest predictor of social disability?
chronic cognitive impairment
who created the first presented his notion of demential praecox
kraepelin
what did kraepelin differentiated?
two groups pf endogenous psychoses
what are two groups of endogenous psychosis?
manic-depressive illness
dementia
what are three types of schizophrenia?
disorganized
catatonic
paranoid
what are symptoms of disorganized schizophrenia?
speech is disorganized and difficult to follow
what is catatonic schizophrenia?
immobility and wild excitement but one but one of these symptoms may presominate
what is paranoid schizophrenia?
hallucinations and delusions
incorporate unimportant events within a delusional framework
what are some characteristics of people with schizophrenia?
agitated, argumentative, angry and sometimes violent
more alert and verbal
are people with paranoid schizophrenia emotionally responsive?
yes
how are people either paranoid schizophrenia interact?
somewhat stilted, formal and intense with others
are people with paranoid schizophrenia most likely to maintain employment than people with other types of schizophrenia?
yes
what did the DSM 5 do to the classic subtypes of schizophrenia?
discontinued them and rejected alternatives to take their place
what is the major argument for for discontinuing the subtypes?
rarely used diagnostically with exception of paranoid schizophrenia
what is dimensional rating?
symptoms that enables clinicians to consider the heterogeneity in symptoms expression
does negative symptoms appear to have stronger genetic component
yes
are people who have relatives with schizophrenia are at increased risk for schizophrenia spectrum disorder?
yes
what is the ethology of schizophrenia?
90% of people who develop schizophrenia have parents who don’t have schizophrenia
btwn 60-80% don’t have a sibling with schizophrenia
what are the role of genetics?
identical twins 44.30%
fraternal twins 12.08%
among MZ twins increases when the pro bands is more severely ill
could common pathological environment could account for the concordance rates?
yes
can genes be expressed later in life?
yes, depends on the environment
what was the results of the adoption studies?
kids without contact with their biological mothers with schizophrenia were more likely to become schizophrenic than control patients
what is the etiology through molecular genetics?
5 major psychiatric disorder may all stem form several specific genetic variations
what are the 5 major psychiatric disorders?
schizophrenia, MDD, bipolar disorder, autism spectrum disorder, and ADHD
what is wrong with the cells in people with schizophrenia?
neurons have fewer synapses
what is the dopamine hypothesis?
drugs effective in treating decrease activity of schizophrenia
produces side effects similar to Parkinson’s disease caused by dopamine decrease
what are other clues provided by amphetamine psychosis?
resembles paranoid schizophrenia and exacerbates symptoms of schizophrenia
releases norepinephrine and dopamine
what wasn’t found in greater amounts in schizophrenic people?
homovanillic acid
what is homovanilic acid?
a major metabolite of dopamine
with improvements in studying neurochemical variables have led researchers to propose?
excess ot oversensitive dopamine receptors
what is the role of neurotransmitters?
newer drugs used in treating schizophrenia implicate neurotransmitters
dopamine neurons generally modulate activity of other neural systems
what do serotonin neurons regulate?
dopamine neurons in the mesolimbic pathway
what is the brain structure in schizophrenic people?
enlarged ventricles
structural problems in hippocampus
reduced volumes in basal ganglia and limbic system
reduction in grey matter in temporal and frontal regions
what does the pre frontal cortex play a role in?
behaviours such as speech, decision making and willed actions
what have MRI studies shown?
reductions in grey matter in the prefrontal cortex
what are complications while giving birth that could cause schizophrenia?
reduced supply of oxygen to brain that causes damage
can viruses invade the brain and damage other during fetal development?
yes
what times during pregnancy could having the flue cause damage to the fetus?
early to mid gestation (three fold increase)
first trimester exposer conferred a sevenfold increase risk
can childhood infection of central nervous system double the risk of adult schizophrenia?
yes
does psychological stress interact with biological vulnerability?
yes
what can increased stress do to people with schizophrenia?
increase likelihood of relapse
what is the relation btwn social class ad schizophrenia?
increased rates of schizophrenia found in central city areas inanities by people with low SES
what is the Sociogenetic hypothesis?
stressors associated with being in a low SES class may cause development of schizophrenia
what is the correlation of poor nutrition during pregnancy and schizophrenia?
poor nutrition puts increased risk for schizophrenia for the fetus
what is the socio selection theory?
during developing psychosis, may drift into poverty ridden areas of city
cognitive problems effect how much money they make
what is the schizophrenogenic mother theory?
cold and dormant, conflict inducing parents said to produce schizophrenia in her offspring
what type of family causes relapse?
expressed emotion
what dies high EE family enviros characterized by?
criticism, over involvement, hostility and low warmth
does EE increase in symptoms of schizophrenia?
increase of unusual thoughts
what are signs in children that hey will develop schizophrenia later in life?
lower IQ
boys are disagreeable
girls are passive
eloquent and withdrawn in childhood
poor motor skills and express negative affect
what are the factors associated with high risk for schizophrenia?
mothers have chronic schizophrenia
attentional dysfunction
low IQ
poor concentration
poor verbal ability
what are factors associates with low risk schizophrenia?
do not have a schizophrenic mother
what are the high risk factors associated with schizophrenia in the brain?
reduce grey matter volume
what are therapies for schizophrenia?
traditional hospital care does little to no effect
antipsychotic medication
intervening with living enviro
what does low volumes of grey matter volumes suggest?
the onset of psychotic disorders inducing schizophrenia
what is the role of impaired insight?
clients lack insight into their impaired cognition and refuse any treatment
don’t believe they have the disorder
what are early biological treatments?
1930s insulin induced comas
electroconvulsive therapy (ECT)
repetitive transcranial magnetic stimulation
what is transcranial magnetic stimulation?
non invasive approach
effect relieving symptoms of schizophrenia mainly auditory hallucinations
why were first generational antipsychotics controversial?
30-50% did not respond favourably
what was first generational anti psychotics successful in?
treating psychosis
what are the side effects of first generational anti psychotics?
dizziness, blurred vision, restlessness, and sexual dysfunction
what are extrapyramidal side effects?
dysfunction of the nerve tracts that depend from the Bain to spinal motor neurons
what does extrapyramidal resemble?
parkinson’s disease
what is dyskinesia?
abnormal motion of voluntary and involuntary muscles
what does dyskinesia do?
produce chewing movements, movements of the lips, fingers and legs
what is akathisia?
inner restlessness that can be extremely distressing an dis associated either increase risk of suicide
what neuroleptic malignant syndrome?
in 1% of cases
can be fatal
sever muscular rigidity
heart races, blood pressure increase, may lapse into coma
what does family therapy consist of?
educating clients and families about biological vulnerability, cognitive problems, signs of impending relapse, monitoring effects of anti psychotic medication
what was the drop out rate for first generational anti psychotics?
about half of people who take them quite after one year and up to 3/4 quit after 2 year
what is an example of second generational anti psychotics?
clozapine
what is clozapine?
produces therapeutic gains in many people
what was risperidone associated with?
lower length in first hospitalization and less use of inpatient beds
what are the effects of olanzapine and risperidone?
fewer motor side effects
what are psychological treatments for schizophrenia?
psychosocial treatments and cognitive behavioural interventions
what is social skills training?
designed to teach behaviours that help to succeed in wide variety of interpersonal situations
what are the main approaches for social skills training?
receiving skills
processing skills
behavioural responses in social interaction
what can family therapy do?
reduce expressed emotion
how does family therapy help reduce expressed emotion?
improve communication and problem solving skills
family learns to be less critical, less intrusive and more excepting
what typically lowers relapse over one to two years?
family therapy and medications
what was CBT assumed to be for people with schizophrenia?
assumed it would be futile to try to alter the cognitive distortions
what did beck and rector concluded about CBT?
people with schizophrenia can benefit from cognitive techniques designed to address their delusions and hallucinations
what can CBT facilitate?
motivation and engaging in social and vocational activities
how has CBT fared as a way of treating schizophrenia?
initial comparative research indicated CBT plus treatment as usual is effective as treatment as usual alone
what is associated with poor social adaptation and other defects in functional ability?
difficulties with attention and memory
what is case management assertive community treatment?
involves multidisciplinary teams, provides community services
in Canada what does the mentally ill population make a up a large proportion of?
homeless
what is persistent homelessness associated with?
male gender, younger age when homeless, past month alcohol use
what is prolonged homelessness associated with?
current substance dependance and tendency to have two other more mentaldisordetrs as determined by assessment interviews
what are contemporary trends or issues?
employment and housing
what is normally seen in hospitals in psychiatric ward?
impairment increasing with each several episodes and no return to normality
