Chapter 12 - Schizophrenia and Related Disorders Flashcards
Psychosis
a loss of contact with reality
months symptoms have to be present
6 months
psychosis most common manifestation
schizophrenia
category for the disorders grouped with schizophrenia
schizophrenia spectrum disorders
prevalence of schizophrenia
1% of population
people worldwide with schizophrenia
20 million
people in US with schizophrenia
3.2 million
onset for men
23 years
onset for women
28 years
percent of people with schizophrenia that attempt suicide
25%
percent of people with schizophrenia that commit suicide
5%
downward drift theory
people with schizophrenia fall to a lower socioeconomic level or remain poor because they are unable to function effectively
3 groups of schizophrenia symptoms
positive symptoms, negative symptoms, and psychomotor symptoms
positive symptoms
excesses of thought, emotion, and behavior
negative symptoms
deficits of thought, emotion, and behavior
psychomotor symptoms
unusual movements or gestures
examples of positive symptoms
delusions, disorganized thinking and speech, heightened perceptions and hallucinations, and inappropriate affect
delusions
ideas they believe wholeheartedly but have no basis in fact
kinds of delusions
delusions of persecution, of reference, of grandeur, and of control
most common kind of delusion
delusions of persecution
delusions of persecution
believe they are being plotted against, spied on, slandered, threatened, attacked, or deliberately victimized
delusions of reference
attach special and personal meaning to the actions of others or to various objects or events
delusions of grandeur
believe themselves to be great inventors, religious saviors, or other specially empowered persons
delusions of control
believer their feelings, thoughts, and actions are being controlled by other people
disorganized thinking and speech
unable to think logically or may speak in peculiar ways
collective name for disorganized thinking and speech
formal thought disorders
examples of formal thought disorders
loose associations, neologisms, perseveration, and clang
loose associations
shift from one topic to another without any of it making sense
another term for loose associations
derailment
perseveration
repeat words and statements again and again
neologisms
made up words that typically only have meaning for those using them
clang
speak in rhymes to express oneself
word salad
random words that have no meaning
hallucinations
perceptions that a person has in the absence of external stimuli
most common kind of halluctination
auditory hallucination
auditory hallucination
hearing sounds or voices that are not real
kinds of hallucinations
auditory , tactile, somatic, visual, gustatory, olfactory
tactile hallucinations
involving touch: tingling, burning, electric shock
somatic hallucinations
feel something is happening inside their body
visual hallucinations
vague or distinct visions of people or objects
gustatory hallucinations
food or drink taste strange
olfactory hallucinations
smell odors that no one else smells
Inappropriate affect
display of emotions that are unsuited to the situation
examples of negative symptoms
poverty of speech, blunted and flat affect, loss of volition, and social withdrawal
poverty of speech also known as
alogia
poverty of speech
a reduction in speech or speech content
blunted affect
display less anger, sadness, joy, and other feelings than most people
flat affect
display no emotions at all
loss of volition also known as
avolition or apathy
loss of volition
feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action
ambivalence
conflicting feelings
social withdrawal
withdraw from social environment to devote themselves to their own ideas and fantasies
examples of psychomotor symtpoms
catatonic stupor, catatonic rigidity, catatonic posturing, catatonic excitement
catatonic stupor
stop responding to their environment, remaining motionless and silent for long stretches of time
catatonic rigidity
maintain a rigid, upright posture for hours and resist efforts to be moved
catatonic posturing
assuming awkward, bizarre positions for long periods of time
catatonic excitement
move excitedly, sometimes wildly waving their arms and legs
percent of those with schizophrenia who experience catatonia
10%
other disorders that may have catatonia
major depressive disorder and bipolar disorder
schizophrenia course
late teens and mid-thirties
three phases of schizophrenia course
prodromal phase, active phase, residual phase
prodromal phase
symptoms are not yet obvious, but deterioration is already beginning
active phase
symptoms become more apparent
active phase trigger
stress and trauma
residual phase
return to a prodromal-like level of functioning
percent of patients who recover completely from schizophrenia
25%
times when symptoms are worse
times of stress
percent of cases dominated by positive symptoms
80-85%
percent of cases dominated by negative symptoms
15-20%
name for schizophrenia focused on positive symptoms
Type I schizophrenia or excess schizophrenia
name for schizophrenia focused on negative symptoms
Type II schizophrenia or deficit schizophrenia
type of patients that were better adjusted before onset and respond to treatment better
Type I patients
diathesis-stress relationship
people with a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present
biological views of schizophrenia
genetic factors, biochemical abnormalities, dysfunction brain structures and circuitry, viral problems
genetic factors of schizophrenia
more common among relatives and defects on chromosomes 1, 2, 6, 8, 10, 13, 15, 18, 20, and 22 and on the X chromosome
concordant
if both members of a pair of twins have a particular trait
kind of twin pair with greater chance of sharing schizophrenia
identical twins
biochemical abnormality behind schizophrenia
dopamine hypothesis
dopamine hypothesis
certain neurons that use the neurotransmitter dopamine fire too often and transmit too many messages
First group of antipsychotic drugs
phenothiazines
effect of phenothiazines on schizophrenics
Parkinson’s disease- like tremors
purpose of phenothiazines
to lower dopamine activity
receptors that phenothiazines bind the most strongly to
D-2 receptors
receptors that second-generation antipsychotic drugs bind to
D-1 receptors, D-2 receptors, serotonin receptors, glutamate receptors, and GABA receptors
Schizophrenia-related circuit
prefrontal cortex
hippocampus
amygdala
thalamus
striatum
substantia nigra
pairs of structures in schizophrenia-related circuit that have low interconnectivity
substantia nigra - prefrontal cortex
striatum - thalamus
pairs of structures in schizophrenia-related circuit that have high interconnectivity
substantia nigra - striatum
thalamus - prefrontal cortex
hippocampus - prefrontal cortex
neurochemical prominent in the schizophrenia-related circuit
dopamine
viral problems
exposure to viruses before birth interferes in brain development, leading to schizophrenia
percentage of how much more schizophrenics are born in late winter
5-10%
Frieda Fromm-Reichmann’s theory
cold and un-nurturing mothers set schizophrenia in motion
mothers who cause schizophrenia in their children
schizophrenogenic mothers
cognitive-behavioral explanations for schizophrenia
operant conditioning and misinterpreting unusual sensations
operant conditioning explanation
people not reinforced for proper attention to social cues, so they pay attention to irrelevant cues more often (not much research support)
misinterpreting unusual sensations explanation
interpretation of unreal sensations distance oneself from reality (not much research support)
sociocultural views of schizophrenia
multicultural factors, social labeling, and family dysfunction
multicultural factors
rates of schizophrenia differ between racial and ethnic groups because of overdiagnosis of immigrants and special stressors tied to immigration
social labeling
features of schizophrenia influenced by the diagnosis itself, causing a self-fulfilling prophecy
Family dysfunction
schizophrenia often linked to family stress (conflict, difficulty communicating, and too critical or overinvolved parents) and high expressed emotion
Brain structure impacted by the schizophrenia-related circuit
HPA axis
HPA axis
hypothalamic-pituitary-adrenal axis
What does a dysfunctional schizophrenia-related brain circuit do to the HPA axis?
makes HPA axis highly sensitive to stressors, and leads to weaker immune system
protein that causes inflammation of brain in schizophrenics
pro-inflammatory cytokines
prevention techniques for schizophrenia
coping skills to correct oversensitive HPA axis
treatment for schizophrenia in the first half of the 20th century
institutionalization in a public hospital
goal of institutionalization
restraint and providing essentials (food, clothing, and shelter)
physician who developed institutions
Philippe Pinel in 1793
Pinel’s treatment’s name
moral treatment
state hospitals
public mental institutions established as a requirement of the law
by 1955, state hospitals had this problem
overcrowding and lack of funding
back wards
(or chronic wards) where patients who didn’t improve quickly were placed
techniques used for schizophrenics in institutions
straitjackets, handcuffs, and lobotomy
Two new approaches developed in 1950s
milieu therapy and token economy program
milieu therapy based on
humanistic principles
token economy program based on
behavioral principles
milieu therapy
give patients opportunities to exercise independence, responsibility, positive self-regard, and to engage in meaningful activities
creator of milieu therapy
Maxwell Jones
token economy program
patients rewarded when they behave acceptably and are not rewarded when they behave unacceptably
tokens can get you
food, cigarettes, hospital privileges, and other desirable items
cases where token economy is still used
community residences and in mental hospitals along with medication
antihistamines
developed to fight allergies in the 1940s
phenothiazines
group of antihistamines that were found to reduce psychotic symptoms
man who discovered chlorpromazine reduced psychotic symptoms
Henri Laborit
chlorpromazine trade name
Thorazine
first-generation antipsychotic drugs
developed in 60s, 70s, and 80s. Had many negative side effects and only reduced positive symptoms
another name for first-generation antipsychotic drugs
neuroleptic drugs
percent who feel reduction in symptoms after taking antipsychotic drug
70%
period when antipsychotic drugs kick in
weeks or up to 6 months after starting to take them
extrapyramidal effects
uncontrollable movement issues caused by first-generation antipsychotic drugs
cause of extrapyramidal effects
first-generation antipsychotic drugs target areas of brain that deal with motor control
DSM’s term for extrapyramidal effects
antipsychotic medication-induced movement disorder
Most common extrapyramidal effect
Parkinsonian symptoms
percent of people who took antipsychotic drugs that experienced muscle tremors
about half
tardive dyskinesia
extrapyramidal effect that appears a while after taking the drug
percent of people who develop tardive dyskinesia by taking antipsychotic drugs
15%
most effective second-generation antipsychotic drug
clozapine
examples of second-generation antipsychotic drugs
clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole
issue of second-generation antipsychotic drugs
1-1.5% Develop agranulocytosis, a fatal drop in white blood cells
most helpful forms of psychotherapy for schizophrenia
CBT, family therapy, and coordinated specialty care
two CBT treatments for schizophrenia
cognitive remediation and hallucination reinterpretation and acceptance
cognitive remediation
improve attention, planning, and memory through cognitive tasks
hallucination reinterpretation and acceptance
guiding patient to interpret hallucinations accurately, feel more control over their hallucinations, and reduce their delusional ideas
aim of new-wave cognitive-behavioral treatment for schizophrenia
clients become detached and comfortable observers of their hallucinations
impact of cognitive-behavioral therapies of rehospitalization rates for people with schizophrenia
50% in rehospitalization rates
family therapy
provide family members with guidance and psychoeducation on the disorder
other forms of family therapy
family support groups and family psychoeducational programs
family support groups and family psychoeducational programs
share their thoughts and emotions, provide mutual support, and learn about schizophrenia
coordinated specialty care
support clients with their cognitive issues, make sure they take their medications, and help clients find work
when should csc be applied
as early as possible
year that community programs were created
1963 with the Community Mental Health Act
Community Mental Health Act
patients with psychological disorders were to receive a range of mental health services in their communities rather than being moved to institutions far from home
number of patients in state institutions today
38,000-75,000
pattern typical for community approach
“revolving door” - patients come in and out repeatedly
a leading community approach
assertive community treatment
assertive community treatment
provides much of the same things as csc
coordinated services
coordination of the different community mental health services available to the client
community mental health centers
facilities that would supply medication, psychotherapy, and inpatient emergency care to people with sever disturbances
those who benefit most from coordination of services
clients who display both a severe mental disorder and a substance use disorder
another name for condition of having a severe mental disorder and a substance use disorder
mentally ill chemical abuse (MICA) or dual diagnosis
short-term hospitalization
stay in a mental hospital or a general hospital’s psychiatric unit for a few weeks
aftercare
a general term for follow-up care and treatment in the community
partial hospitalization
day centers that are in between full hospitalization and outpatient therapy
day centers (or day hospitals)
all-day programs in which patients return to their homes for the night
what happens in day centers
daily supervised activities, therapy, and training to improve social skills
semihospital or residential crisis center
hourses or other structures in the community that provide 24-hour nursing care for people with severe mental disorders
supervised residences
for people who don’t need hospitalization but cannot live alone/with family
examples of supervised residences
halfway houses / crisis homes / group homes
number of people who stay in halfway houses
1-2 dozen people
live-in staff of halfway houses
paraprofessionals
paraprofessionals
lay people who receive training and ongoing supervision from outside mental health professionals
philosophy of halfway houses
milieu therapy philosophy
goal of occupational training and support
employment brings companionship and order to one’s life
sheltered workshop
a supervised workplace for employees who are not ready for competitive or complicated jobs
state of occupational training in the US
not consistently available
supported employment
vocational agencies and counselors help clients find competitive jobs in the community and provide psychological support while the clients are employed
percent of people with severe psychological disorders that are not employed in the competitive job market
more than 80%
issues with community treatment
poor coordination of services and a shortage of services
percent of people a year who don’t get treated for their schizophrenia
at least 36% of people every year
poor coordination of services
the various mental health agencies in a community often fail to communicate with one another
way in which community therapists address the issue of poor coordination of services
community therapists may act as case managers
case managers
try to coordinate available services, guide clients through the community system, and help protect clients’ legal rights
key to success for a community program
effective case management
shortage of services
the number of community programs available to people with severe mental disorders falls short
economic reason for the shortage of services
plenty of funding for mental health, but it is not directed to community treatment programs
brief psychotic disorder
schizophrenia symptoms, but lasts less than a month
schizophreniform disorder
schizophrenia symptoms, but lasts 1-6 months
schizoaffective disorder
schizophrenia symptoms along with a major depressive episode or manic episode
schizoaffective disorder duration
at least 6 months
delusional disorder
delusions without other symptoms of schizophrenia for at least one month
reasons why minorities don’t get proper treatment for schizophrenia
poverty-linked factors
transportation issues
inadequate health insurance
bias
discrimination
negative attitude toward mental health services by minorities
percent who get alternate institutional care
8%
examples of alternate institutional care
nursing home
percent who are places in privately run residences that are supervised by untrained staff
18%
examples of privately run residences
foster homes, boardinghouses, and care houses
percent who live in totally unsupervised settings
34%
an example of a totally unsupervised setting that some people with schizophrenia unfortunately live in
single-room occupancy hotels (SROs) or rooming houses
out of the 565,000 homeless in US, how many have schizophrenia?
140,000
number of people with sever mental disorders in prison
440,000
percent of inmates who have schizophrenia or another severe mental disorder
20%
national interest group in US that advocates for community treatment programs
National Alliance on Mental Illness (NAMI)
year NAMI was founded
1979
shared psychotic disorder
when two or more persons share a delusion or hallucination
