Chapter 12 - Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

-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

Question 2

What are the 4 types of symptoms?

Answer 2

-positive symptoms
-negative symptoms
-cognitive symptoms
-psychomotor abnormalities

Question 3

What are Positive Symptoms?

Answer 3

-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

Question 4

What are the different types of delusions?

Answer 4

-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)

Question 5

What are the different types of hallucinations?

Answer 5

-hearing = auditory (most common)
-seeing = visual
-smelling = olfactory
-touching = tactile
-tasting = gustatory

Question 6

What are Negative Symptoms?

Answer 6

-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)

Question 7

What are Cognitive Symptoms?

Answer 7

-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

Question 8

What are Psychomotor Abnormalities?

Answer 8

-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-withdrawn catatonia - extremely unresponsive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

Question 9

What are the DSM-5 Criteria for Schizophrenia?

Answer 9

-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

Question 10

What is the prevalence and course of schizophrenia?

Answer 10

-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

Question 11

What are comorbid rates and other impacts of schizophrenia?

Answer 11

-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

Question 12

What are the remission rates?

Answer 12

-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

Question 13

What are the genetic factors?

Answer 13

-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

Question 14

How do neurostructures affect schizophrenia?

Answer 14

-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)

Question 15

What are the Biochemical Factors?

Answer 15

-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

Question 16

What are the Psychological Factors?

Answer 16

-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

Question 17

What are the Social Factors?

Answer 17

-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

Question 18

What are the Sociocultural Factors?

Answer 18

-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

Question 19

What is the Sociogenic and Social Selection Hypotheses?

Answer 19

-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)

Question 20

What are the characteristics of the Recovery Model?

Answer 20

-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

Question 21

What are the evidence-based treatments?

Answer 21

-Goal of treatment: help individual function in the community
-Holistic approach: antipsychotic medications (reduce intensity of symptoms) + psychotherapy / psychosocial treatments

Question 22

What are the different kinds of antipsychotic medications (neuroleptics)?

Answer 22

-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

Question 23

What are the side effects of antipsychotics?

Answer 23

-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

Question 24

What are the different kinds of Psychosocial Treatments and their goal?

Answer 24

Teach skills to improve functioning, prevent relapse
-Cognitive-behavioral therapies
-Social skills training
-Assertive community treatment
-Family psychoeducation
-Cognitive remediation / enhancement therapy

Question 25

How do Cognitive-Behavioural Therapies work?

Answer 25

-Learn coping skills
-Help increase motivation and engagement in social and vocational activities
-Identification of negative beliefs and cognitive restructuring

Question 26

What are some examples of specific CBT treatments?

Answer 26

-Social Cognition and Interaction Training (SCIT)
-Integrated Psychological Therapy (IPT)
-Work-Focused Cognitive Behavioral Therapy

Question 27

How does Social Skills Training (behavioural therapy) work?

Answer 27

-Increase appropriate self-care behaviors (including medication adherence), conversational skills, job skills
-Learn to break down tasks to make them less overwhelming

Question 28

How does Assertive Community Treatment (ACT) work?

Answer 28

-Goal: help integrate individual into community
-Multidisciplinary team provide integrated services (e.g., medication, treatment for substance abuse, psychotherapy, vocational training, assistance with housing/employment)
-Team available 24/7

Question 29

How does Family psychoeducation work?

Answer 29

-Educating family members about schizophrenia
-Advice on monitoring effects of antipsychotic medications
-Teaching family members to cope with symptoms
-Developing skills in solving problems and managing stress
-Strengthening communication skills of all family members

Question 30

How does Cognitive remediation / enhancement therapy work?

Answer 30

-Improve cognitive deficits associated with schizophrenia
-e.g. Attention, learning, memory, processing speed