Chapter 13 Flashcards
Psychosis
significant loss of contact with reality
– Hallmark of schizophrenia
Epidemiology schizophrenia
- Lifetime prevalence just under 1%
- Onset: ages 18-30
- More common and more severe in men
Delusions
are an erroneous belief that is fixed and firmly
held despite clear contradictory evidence
hallucination
A hallucination is a sensory experience that seems real
to the person having it, but occurs in the absence of any
external perceptual stimulus
– Can occur in any sensory modality
– Auditory are most common
Disorganized Speech
• Disorder in thought form
– Delusions are a disorder of thought content
• Fail to make sense even though they are using language
in a conventional way
Catatonia
• Catatonia involves almost no movement at all,
sometimes in an unusual posture
• Catatonic stupor a virtual absence of all movement and
speech
Disorganized Behavior
• Impairment of goal-directed activity
• Occurs in areas of daily functioning
– Examples: hygiene, silliness or unusual dress
Positive symptoms
excess or distortion in normal
behavior and experience
Negative symptoms
reflect an absence or deficit of
normally present behaviors
– Two domains:
– Reduced expressive behavior and Reductions in motivation or experience of pleasure
– Presence of negative symptoms is not a good sign
Avolition
the inability to initiate or persist in goal-directed activity
Reduced expressive behavior
▪ Voice, facial expression, speech
▪ Blunted or flat affect, or alogia (little speech)
Reductions in motivation or experience of pleasure
includes Avolition
Schizoaffective Disorder
- Features of schizophrenia and severe mood disorder
* Diagnostic criteria revised in DSM-5 to improve reliability
Schizophreniform Disorder
- Schizophrenia-like psychoses lasting at least 1 month but less than 6 months
- Do not warrant a schizophrenia diagnosis
Delusional Disorder
• Delusional beliefs with otherwise normal behavior
Brief Psychotic Disorder
Sudden onset of psychotic symptoms or disorganized
speech or catatonic behavior
Genetic Factors schizophrenia
• Disorders of the schizophrenia type are “familial”—tend
to run in families
– The prevalence of schizophrenia in the first-degree relatives
(parents, siblings, and offspring) is 10 percent
– Second-degree relatives who share only 25 percent of their
genes is closer to 3 percent
TWIN STUDIES
• Schizophrenia concordance rates for identical twins (28%) are
higher than those for fraternal twins or ordinary siblings (6%)
– If only genetic, the rate would be 100% between identical twins
– Genes are not the whole story
ADOPTION STUDIES
• Higher rates of schizophrenia among adopted children of
schizophrenic biological parents
other biological factors schizophrenia
Prenatal Exposures
VIRAL INFECTION
RHESUS INCOMPATIBILITY
PREGNANCY AND BIRTH COMPLICATIONS
EARLY NUTRITIONAL DEFICIENCY
MATERNAL STRESS
A Neurodevelopmental Perspective
• The stage is set for schizophrenia early in life
– Problems may not appear until the brain is mature
• Research focuses on those showing prodomal—very
early signs of schizophrenia
VIRAL INFECTION schizophrenia
• Elevated rates of schizophrenia in children born to
mothers who had been in their second trimester of
pregnancy at the time of the influenza epidemic
RHESUS INCOMPATIBILITY
• Mechanism involves oxygen deprivation, or hypoxia—risk
for schizophrenia linked to birth complications
• Rh-incompatibility between the mother and fetus may
increase the risk of brain abnormalities
PREGNANCY AND BIRTH COMPLICATIONS
• Many delivery problems (breech delivery, prolonged
labor, or the umbilical cord around the baby’s neck) affect
the newborn’s oxygen supply
EARLY NUTRITIONAL DEFICIENCY
• Schizophrenia might be caused or triggered by
environmental events
MATERNAL STRESS
• Extremely stressful event late in 1st trimester/early in 2nd
trimester of pregnancy increases schizophrenia risk
A Neurodevelopmental Perspective
• The stage is set for schizophrenia early in life
– Problems may not appear until the brain is mature
• Research focuses on those showing prodomal
prodomal
very
early signs of schizophrenia
Neurocognition: schizophrenia
• Cognitive impairment is a core feature of schizophrenia
– Apparent even before there is a diagnosable illness
Social Cognition
• Social cognition: how we recognize, think about, and
respond to social information, including the emotions and intentions of others
social cognition: schizophrenia
• People with schizophrenia show significant impairments
in social cognition
– Failure to spot the kinds of subtle (or not so subtle) social hints
– Difficulty recognizing emotion in faces and emotion being
conveyed in speech
brain volume: schizophrenia
Patients with schizophrenia have enlarged brain
ventricles
– Males more affected than females
– Indicator of a reduction in brain tissue
• Decrease in brain volume is present very early in the
illness
• Progressive brain deterioration continues for many years
affected brain areas schizophrenia
Reductions in the volume of regions in the frontal and
temporal lobes
– More specifically, in the volume of medial temporal areas: the
amygdala, the hippocampus, and the thalamus
white matter problems schizophrenia
White matter is crucially important for the connectivity of the brain
– White matter abnormalities have been shown to be correlated
with cognitive impairments
• Patients have reductions in white matter volume as well
as structural abnormalities in the white matter itself
– Abnormalities are found in first-episode patients and in people
at genetic high risk for the disorder
Brain Functioning schizophrenia
Some patients show abnormally low frontal lobe
activation (known as “hypofrontality”) when they are
involved in mentally challenging tasks
• Impaired functioning of the frontal lobes is found in
patients in the early stages of schizophrenia and in
people at high risk for developing the disorder
cytoarchitecture
the overall organization of cells
in the brain
cytoarchitecture schizophrenia
If cells fail to migrate properly, the brain’s cytoarchitecture will be compromised
– Increase in neuronal density in some areas of the brains of patients
with schizophrenia
• Abnormalities in the distribution of cells in the cortex and hippocampus
• Patients with schizophrenia are missing “inhibitory
interneurons”
– May be less able to regulate or dampen down overactivity in certain
neural circuits
Neurochemistry schizophrenia
• Alterations in brain chemistry may be associated with
abnormal states
• Dopamine: a neurotransmitter linked to schizophrenia
– Chlorpromazine blocks dopamine receptors and help patients
– Amphetamines produce excess dopamine and mimic a
psychotic state that looks like schizophrenia
– L-DOPA treated patients display psychotic symptoms
• Glutamate: an excitatory neurotransmitter
– When glutamate receptors are blocked it creates schizophrenic like symptoms
Families and Relapse schizophrenia
Expressed emotion (EE): a measure of the family
environment
• Three main elements: criticism, hostility, and emotional
overinvolvement (EOI)
• High-EE home environment more than doubles the
chance of a relapse
– Especially strong for chronically ill patients
Clinical Outcome schizophrenia
• Around 38% of patients have a favorable outcome and
can be thought of as being recovered 15 to 25 years after
development of the disorder
• Around 12 percent of patients need long-term
institutionalization
• Around one-third show signs of continued negative
symptoms
Pharmacological Approaches
FIRST-GENERATION ANTIPSYCHOTICS • Block the action of dopamine SECOND-GENERATION ANTIPSYCHOTICS • Fewer extrapyramidal symptoms OTHER APPROACHES • Researching the role of estrogen
THE PATIENT’S PERSPECTIVE
• Not all patients benefit from antipsychotic medications
• May show clinical improvement but still need help
• Side effects may lead patients to discontinue taking the
medication
• Some patients may try to avoid taking medications
because, to them, needing to take medications confirms
that they are mentally ill
Treatments and Outcomes
CASE MANAGEMENT FAMILY THERAPY PSYCHOEDUCATION SOCIAL-SKILLS TRAINING COGNITIVE REMEDIATION COGNITIVE-BEHAVIOR THERAPY
