Chapter 11 Schizophrenia Flashcards
What is the prevalence of schizophrenia
1%
What is the cost of it and why?
62.7 billion
loss of labor, medications, therapy, hospitalization
suspected 10% homeless
What is psychosis
lost of contact with reality
How was it once viewed
incurable/chronic disorder, but now it is recoverable/improvement
Who is Emil Kraeplin
German psychiatrist using the descriptive approach(focused on the description of symptoms he observed in his patients, it was simply physical deteriorations)
created the dementia praecox
What is the dementia praecox
intellectual deuteriation(brain damage) + early/premature onset
Who is Eugene Bleuler
Process approach (identify psychological processes common across schizophrenia)
Breaking of associative threads
Latent Schizophrenia
What is the breaking of associative threads
disruptive thought processes
What is the latent schizophrenia
patient has disorder in remission, isn’t showing active symptoms but they can be triggered
Where is there a higher rate
immigrants(from African countries)
African Americans,
low SES(poverty is risk factor because of high stress)
What does the higher rate highlight
impact of discrimination, environmental stress, stereotypes, and prejudice
What does DSM say about schizophrenia
2+ psychotic symptoms of which 1 must be delusions, hallucinations, or disorganized speech; and it impairs life
most commonly diagnosed and most severe
What is a brief psychotic disorder
1+ psychotic symptoms, of which at least 1 must be delusions, hallucinations, or disorganized speech between 1 day-1 month
2x more likely in women
What is a schizophreniform disorder
2+ psychotic symptoms, of which at least 1 must be delusions, hallucinations, or disorganized speech, between 1-6 months; found in more developing countries
What is delusional disorder
1+ delusions for at least one month without other odd behaviors;
Ex. Erotomania, Grandiosity, Jealousy, persecution, somatic complaints, delusions, parasitosis
What is erotomania
belief that someone is in love with them
What is Grandiosity
one has great unrecognized talent, ability, superiority
What is Jealousy
conviction one’s spouse id unfaithful
What is persecution
belief one is being conspired/plotted against
What are Somatic complaints
body odor, malformity, infestation
What are delusional parasitosis(Morgellons)
belief they are being afflicted with living organisms or other pathogens
What is Schizoaffective disorder
Psychotic + mood disorder; episode of mania/major depression, concurrent with delusions, hallucinations, or disorganized speech; psychotic symptoms persist after the mood episode ends, more in women
What is Schizophrenia major symptom categories
used to describe different classes of symptoms
What is positive symptoms
Delusions, capagras syndrome, hallucinations, thought disorder, psychomotor disturbance
What are delusions
false belief; protective misinterpretations of reality, disturbances of thought content
What some example of delusions
grandeur, external source controlling thoughts or feelings, thoughts being shared with the outside world(thought broadcasting), persecutions, you are being referred to by events that have nothing to do with you(reference), someone is stealing thoughts(thought withdrawal
What is capgras’ syndrome
Delusional existence of doubles who replace SOs, seen most in brief intense psychotic episode
What are hallucinations and the types
sensory experience in the absence of any environmental stimulus
auditory(most common, usual critical), visual, olfactory(smelling), tactile(feelings), gustatory(tasting)
What is thought disorder
disturbances in the thinking process/strange use of language
What are the types of thought disorder
blocking(interruptions in speech), loose associations(cognitive slippage; logical thought/speech), incoherent speech(word salad, disorganized and fragmented), clang associations(illogical assoications in speech baed on sound, rhyming), Neologisms(new words made with no agreed-upon meaning, inability to find real words to describe a thought)
What is a psychomotor disturbance
disturbances in motor activity; extremes in activity levels, peculiar body movements/posture, strange gestures/grimaces, excited vs. withdrawn catatonia
waxy flexibility=catatonic person can be shaped in strange positions
What negative symptoms
Avolition(inability to take action), alogia(lack of meaningful speech), asociality(lack of interest in meaningful relationships), restricted affect(little/no emotion), anhedonia(inability to experience pleasure)
What is a primary symptom
arises from disease itself
What is secondary symptoms
develops in response to the treatment
What are the risk factors for having negative symptoms
poor premorbid social functioning, restricted affect, and lack of insight into one’s condition, more common in males
What cognitive symptoms
often severe impairments, poor executive functioning(ability to organize/sequence things), inability to sustain attention, difficulty retaining learned info
What is type 1 schizophrenia
mostly positive symptoms; respond better to psychoactive medication, better functioning premorbid histories
What is type 2 schizophrenia
primarily negative symptoms, more chronic and long-term institutionalized(structural brain damage), 15-25% of schizo, more common in men
What is the DSM citerion clusters
A: 2+ for significant portion of one month; one must be 123
-delusions
-hallucinations
-disorganized speech
-disorganized/catatonic behavior
-negative symptoms
B: social/occupational dysfunction
C: 6month duration
D: Rule out other psychotic/mood disorder
E: Rule out SUD
F: if there is history of autism, diagnosed only if prominent hallucination delusions for at least 1 month
What is the 3 phases for schizo
Prodromal—–>active—–> residual
What is Prodromal Phase
right before active psychotic symptoms start; gradual deterioration of function, can be sudden, deficits in personal hygiene, odd behaviors
What is the active phase
displays psychotic symptoms; highest risk age is early 20s
What is the residual phase
After active psychotic phase, complete remission, or return to prodromal symptoms(more common); 2/3 of schizophrenics face relapses(return to active phase) occur when face with life stressors
What are favorable factors(protective)
fewer negative symptoms, history of good work performance(prior to active phase), ability to live independently, less depression/anxiety, positive peer support
What is the biology of etiology for schizophrenia
20 genes, 16% mother/son, 4% aunt/niece, 1% general population
Endophenotypes, neuro structures, neurotransmitters, Twin concordance
What are endophenotypes
quantifiable traits(working memory, executive function, sustained attention, verbal memory)
What are neurostructures
Smaller cortical structures, enlarged ventricles(the cavities containing cerebral spinal fluid), and differences in brain structure between individuals with/without schizophrenia are relatively small, usually are type 2, and don’t respond as well to medication
abnormalities may result from antipsychotic medication
What are neurotransmitters
Dopamine Excess theory(type 1 theory)= phenothiazines reduce dopamine levels, amphetamines + amphetamines psychosis: increase dopamine and can cause schizophrenic symptoms
What is the twin concordance
Less than 50%, nonshared environmental influences also play a role; diathesis stressor model=offspring that had a poor premorbid adjustment and appear to have a higher genetic risk
What are the risk/protective factors for schizophrenia
severe maternal physical abuse before 12, level of parental warmth/support, severe bullying, negative family relationships, EE
What is the expressed emotion(EE)
family theory, high levels of expressed verbal criticism + emotional overinvolvement toward schizophrenic members; high EE=likely relapse
What are the psychological risk factors
cocaine, amphetamines, alcohol, cannabis
unusual beliefs/behaviors preceding onset of psychotic symptoms
What are the sociocultural factors
earlier in men
shifts in mid 40-50, more women diagnosed(menopause), likely due to estrogen protective effects
risk factors: low parental educational level, low occupational status of father, living in poor residential areas at birth
Who is Carol Tamminga
psychosis as a learning and memory disorder
looked for a neurobiological basis for thought disorder among active schizophrenics
schizophrenics have hippocampal hyperactivity
anti-psychotic meds decrease dopamine—-> decreased hippocampal activity
exploring direct current stimulation of the hippocampus in active schizophrenics
optimal function is a combination of medication and psychosocial inteventions
What is the hippocampal hyperactivity hypothesis
leads to false memories/cognitions
hippocampus=episodic memory; consolidates/integrates facts and events
in active schizophrenics, hippocampal tissue deterioration, elevated hippocampal neural activity (compensatory), decreased hippocampal connectivity to the cortex
What is the best treatment
antipsychotic medication +psycho treatment
How good are antipsychotic medication
most effective on positive symptoms(type 1), negligible effect on negative symptoms, new drugs not confirmed to work better and are more costly
What are the extrapyramidal(side) effects of new and old drugs
symptoms: restlessness, involuntary movements, muscular tension
effects: parkinsonism(muscle tremors, shakiness), dystonia(slow contrasting movement), akathesis(motor restlessness), neuroleptic malignant syndrome(muscle rigidity), tardive dyskinesia(rhythmic tongue movement)
What are some Inpatient treatments
large group psychosocial skills training, behavior function
community group homes: behavioral transitional facilities; token economy
What does CBT do for schizophrenics
focus on reducing positive/negative symptoms+teach coping skills
What does mindfulness training do
accepting symptoms/hallucinations in a nonjudgemental manner, enhance self-control, reduce negative symptoms
How can the family help
normalize the family experience, educate family members, teach the family to cope with symptoms, strengthen communication
emotional reactions to the MI: love, loss, anger, fear
