Chapter 12 - Schizophrenia Flashcards
What is Schizophrenia?
-falls on the severe end of the psychotic disorder spectrum
-Anosognosia: inability to recognize their own mental confusion
-psychotic symptoms experienced as real or logical
What are the 4 types of symptoms?
-positive symptoms
-negative symptoms
-cognitive symptoms
-psychomotor abnormalities
What are Positive Symptoms?
-presence of unusual behaviours
-delusion: a false belief that is firmly held despite disconfirming evidence or logic
-hallucination: perception of a nonexistent or absent stimulus
What are the different types of delusions?
-persecution (most common): others are plotting against, mistreating, or trying to kill them
-grandeur
-reference (center of attention)
-control (others are controlling them)
-thought broadcasting (others can hear their thoughts)
-thought withdrawal (removing thoughts from their mind)
What are the different types of hallucinations?
-hearing = auditory (most common)
-seeing = visual
-smelling = olfactory
-touching = tactile
-tasting = gustatory
What are Negative Symptoms?
-absence of behaviours present in most people
-flat affect: reduced emotional expressiveness (face/voice/gesture)
-asociality: loss of interest in social relationships
-anhedonia: inability to experience pleasure
-avolition: lack of energy or will, profound apathy
-alogia: loss of meaningful speech (amount or content)
What are Cognitive Symptoms?
-disordered thinking, communication, speech
-loose associations: series of ideas presented with loosely apparent or unapparent logical connections
-over-inclusiveness: abnormal categorization in thinking
-word salad: random words or phrases linked together in an unintelligible manner
What are Psychomotor Abnormalities?
-catatonia: marked disturbance in motor activity - either extreme excitement or immobility
-withdrawn catatonia - extremely unresponsive
*waxy flexibility: another person can move the persons’ limbs into strange positions that they maintain for extended periods
-excited catatonia
*agitation, constant hyperactive motor activity, stereotypies
What are the DSM-5 Criteria for Schizophrenia?
-A: ≥ 2 of following during a 1-month period (at least 1 must be 1, 2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
-B: Significant decline in functioning in one or more major areas of life
-C: Continuous signs of the disturbance persist for at least 6 months (must include at least 1 month of symptoms meeting criterion A)
*specify first or multiple episodes, acute episode, partial remission, full remission
*specify with catatonia
What is the prevalence and course of schizophrenia?
-Lifetime prevalence: 1%
-Premorbid functioning: usually impaired
-Prodromal phase: onset and build up of symptoms (18-25 men; 25-30 women)
-Active phase: full blown symptoms
-Residual phase: symptoms no longer prominent, milder impairment
What are comorbid rates and other impacts of schizophrenia?
-50% have a comorbid disorder: commonly substance abuse, depression, anxiety
-High mortality rate: almost 10% die by suicide; 20 years shorter life expectancy
-Account for ~30% of stays in psychiatric hospitals
-Cognitive impairments and avolition make stable employment difficult
-Can be isolating
What are the remission rates?
-Follow-up study results: ~50-60% remission
-Factors associated with a positive outcome: female; higher levels of education, married, network of support; higher premorbid level of functioning; fewer negative symptoms; integrated and comprehensive treatment
What are the genetic factors?
-relatives of people with schizophrenia are at increased risk
-MZ concordance > DZ concordance
-children reared apart from parent with schizophrenia at increased risk
-interaction of large number of genes
-C4 allele abnormalities –> excessive pruning –> symptoms
How do neurostructures affect schizophrenia?
-enlarged ventricles (loss of brain cells –> more susceptible to schizophrenia)
-decreased cortex volume, especially prefrontal cortex
–may influence cognitive functioning (progressive loss of grey matter over time)
What are the Biochemical Factors?
-Dopamine hypothesis: schizophrenia result from excess dopamine activity
–medications that act on dopamine: antipsychotic med (Phenothiazines), L-dopa, amphetamines
-Estrogen protective against psychotic symptoms
–women more vulnerable to psychosis during low estrogen phases
What are the Psychological Factors?
-deficits in the theory of mind - can contribute to communication and interpersonal problems
-early cognitive difficulties
-negative appraisals may lead to or maintain symptoms - “it takes too much effort to try” –> Avolition
What are the Social Factors?
-exposure to abuse or early adversities (G x E – children at risk for psychosis may be more susceptible to early adverse experiences)
-psychological stress interact with biological vulnerability (greater life stress = increased onset or relapse)
-expressed emotion (EE): critical comments, statements of dislike or resentment; Emotional overinvestment or over protectiveness; High EE associated with increased relapse rate
What are the Sociocultural Factors?
-Immigration/Migration (stress/discrimination)
-Low SES, poverty, social adversities
-Culture affects how people view or interpret symptoms (mostly social explanation among African Caribbean, Bangladeshi, and West African)
-Differing views on etiology influence receptiveness to treatment approaches
-Rates & effects of expressed emotion differ across cultural groups
What is the Sociogenic and Social Selection Hypotheses?
-sociogenic hypothesis: stressors of being in a low social class may cause or contribute to the development of schizophrenia
-social selection hypothesis: people with schizophrenia may drift into low SES living areas (more support for this theory)
What are the characteristics of the Recovery Model?
-Focus on illness and deficit has shifted to one of recovery
-Learn to productively engage in important life roles
-Condition does not define the individual
What are the evidence-based treatments?
-Goal of treatment: help individual function in the community
-Holistic approach: antipsychotic medications (reduce intensity of symptoms) + psychotherapy / psychosocial treatments
What are the different kinds of antipsychotic medications (neuroleptics)?
-1st generation: conventional / typical antipsychotics (block dopamine receptors)
-2nd generation: atypical antipsychotics (act on both dopamine and serotonin receptors; greater therapeutic benefits, fewer side effects than 1st gen antipsychotics)
~1/3 do not respond to antipsychotic medications
What are the side effects of antipsychotics?
-Weight gain, restlessness, excessive sedation
-Increased risk for metabolic syndrome and cardiovascular condition
-Extrapyramidal symptoms (*especially for 1st gen meds)
-Tardive dyskinesia = involuntary and rhythmic movements of the tongue/lips
*contribute to high nonadherence; high relapse if discontinue
What are the different kinds of Psychosocial Treatments and their goal?
Teach skills to improve functioning, prevent relapse
-Cognitive-behavioral therapies
-Social skills training
-Assertive community treatment
-Family psychoeducation
-Cognitive remediation / enhancement therapy
