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Psych 354 > Chapter 13 - schizophrenia > Flashcards

Chapter 13 - schizophrenia Flashcards

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1
Q

3 types of symptoms for sz?

A

pos
neg
disorganization

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2
Q

Positive symptoms: what does this mean? aka…? what are the 2 symptoms?

A
  • Excess or distortion of normal functions
  • aka psychotic symptoms
  • Hallucinations and delusions
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3
Q

hallucinations def? what do we know about the senses and the relation between them? (ie what’s most common)

A
  • Sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus
  • can be any of the 5 senses
  • AUDITORY are most common
  • often hallucinations involve more than one sense integrated
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4
Q

Delusions def?
how do they connect to other things?
often related to…?

A
  • Rigidly held inaccurate beliefs or misrepresented versions of reality
  • Can be fragmented or contradictory to other things you believe
  • very often are related to hallucinations
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5
Q

2 complications when assessing delusions?

A
  • can be difficult to figure out the ultimate truth of a variety of situations
  • need to consider cultural and religious factors
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6
Q

6 types of delusions?

A
  • persecutory
  • referential
  • somatic
  • religious
  • grandiose
  • control
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7
Q

persecutory def? ex?

A
  • people believe they’re being persecuted, attacked, or others are out to get them in some way

ex. Poisoned, followed, spied on

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8
Q

referential def? ex?

A
  • believing that something you see or hear is specifically meant to send you a message

ex. tv is talking to YOU

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9
Q

somatic def? ex?

A
  • think that something is wrong with them physically (when nothing is)

ex. cancer, organs are rotting, there’s been a chip or camera implanted in them

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10
Q

religious? ex?

A
  • delusions related to religious beliefs or figures

exs:
- they’re a deity
- god is talking to you
- devil is talking to you / trying to get you to do something

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11
Q

grandiose def? ex?

A
  • people think that they have a special role/talent/power that other people don’t

ex. they’re a famous singer / athlete / president, etc.

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12
Q

control def? ex?

A
  • someone or something is controlling you in some way

exs:
- Putting thoughts in / out of your head
- People can read your mind / see your thoughts

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13
Q

Delusions can be classified into what 2 categories? what’s the distinction?

A

“bizarre” and “non-bizarre”

bizarre: could never happen IRL

non-bizarre: could possibly happen IRL (but isn’t)

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14
Q

cotard delusion?

A

belief that you’re dead (either literally or figuratively)

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15
Q

capgras delusion?

A

belief that a loved one has been replaced by an identical looking imposter

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16
Q

What 7 considerations are important to determine when a belief becomes a delusion?

A

Degree of…
- Conviction
- Preoccupation
- Not shared by others
- Personal (vs. broad) reference
- Difficult to resist
- Behavior change
- More likely to be a delusion if their hallucinations are connected to it

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17
Q

conviction meaning?

A
  • If you offer an alternative explanation for why their delusion might be happening and they admit it could be possible, it’s not as likely to be a delusion
  • or lower on the spectrum of delusion
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18
Q

personal vs broad reference meaning?

A

I specifically am being told to do these things vs. the role of humankind is to do these things

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19
Q

Negative symptoms def? 2 main categories?

A
  • Aspects of normal behavior and social relationships that that should be present, but are absent
  1. Diminished verbal and non-verbal expression
  2. Diminished motivation and pleasure
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20
Q

Negative symptoms are considered to be more ___ than positive symptoms

A

more stable over time

positive symptoms fluctuate a lot in severity in/out of active phases of psychosis

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21
Q

What 2 symptoms fall under diminished verbal and non-verbal expression category?

A
  1. blunted affect
  2. alogia
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22
Q

Blunted affect def? how does it present? exs?

A
  • Diminished verbal and non-verbal expression of emotion
  • flat tone when speaking
  • facial expression doesn’t change
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23
Q

Alogia def? ex?

A
  • speechlessness, reduction in how much they speak
  • brief replies, 1 word answers
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24
Q

What 3 symptoms fall under the category of diminished motivation and pleasure?

A
  1. Avolition
  2. Asociality
  3. Anhedonia
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25
Q

Avolition def? ex?

A
  • lack of motivation, inability to do purposeful tasks, lack of activity in general
  • might just sit and not do anything
  • not keep up with hygiene
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26
Q

Asociality def?

A
  • social withdrawal
  • behavioral and interest level component
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27
Q

Anhedonia def?

A
  • loss of interest in things that used to be pleasurable
  • inability to predict feeling pleasure doing certain activities
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28
Q

Anticipatory vs consummatory pleasure?

A

Anticipatory: “wanting” –> pleasure from thinking ab future activities, predicted level of pleasure

Consummatory: “liking” –> in the moment pleasure from doing something

29
Q

Anhedonia in MDD vs SZ?

A

MDD:
- reduced anticipatory AND consummatory pleasure

SZ: (NEGATIVE symptoms, not depressive symptoms)
- reduced anticipatory, but NOT consummatory

30
Q

Disorganization def? 3 important symptom types?

A
  • Reflects bizarre behaviors and disturbances in thinking
  1. Disorganized speech
  2. Catatonic behavior
  3. Grossly disorg. behavior
31
Q

Disorganized speech general/less severe symptoms?

A
  • very difficult to follow
  • Conveys little, if any, meaning
  • Slip from one topic to another
32
Q

2 more severe symptoms of disorganized speech?

A
  • clanging
  • word salad
33
Q

Clanging def?

A

people put sentences together based on how the words sound/fit together/rhyme instead of the meaning/content

34
Q

Word salad def?

A

saying a lot of words, probably makes sense to them, not clear at all to the person listening

35
Q

Catatonic behavior def? symptoms?

A
  • Decreased awareness of and reactivity to environment
  • Immobility
  • Marked muscular rigidity
  • Purposeless/repetitive motor activity
36
Q

how do catatonic people react to treatment? why?

A
  • When they’re first treated, they start to experience hallucinations and delusions
  • actually an improvement
  • they were so limited by catatonic state that treatment allows for psychosis, which can then be treated later
37
Q

Disorganized behavior: def? ranges from…? distinguished from…?

A
  • behavior or affect that is inappropriate to the situation, “off” behavior
  • Ranges from childlike silliness to unpredictable violence
  • It is NOT:
    → Aimless or un-purposeful behavior
    → Agitated behavior with reason
38
Q

Cognitive impairments frequently seen in SZ? Importance/relevance?

A
  • Working memory
  • Executive functioning
  • Social cognition (ex. Theory of mind)
  • Identifying sarcasm

NOT diagnostic criteria, but they ARE treatment targets to improve daily functioning
Ex. ability to take meds and go to work

39
Q

3 phases of SZ?

A
  1. prodromal
  2. active
  3. residual
40
Q

prodromal phase characterized by?

A
  • SUBTLE / attenuated symptom
  • mostly negative symptoms
  • socially isolated
  • decline in functioning (social, occupational, familial)
  • some cognitive decline
  • peculiar behaviors and odd perceptual experiences
41
Q

residual phase characterized by?

A
  • not as extreme, similar to prodromal phase
  • still see impairment
  • fewer positive symptoms, psychosis improved
  • negative symptoms pronounced
41
Q

active phase characterized by?

A
  • threshold psychosis
  • most severe phase
  • positive symptoms
42
Q

People with onset of prodromal-like symptoms/behavior change… approx ___% convert to threshold psychosis in __-__ years?
They are called…?

A

approx 20-25% convert to threshold psychosis in 2-3 years?

Called clinical high risk for psychosis

44
Q

SZ criteria?

A

A. 2+ of the following symptoms for > 1month
1. Delusions*
2. Hallucinations*
3. Disorganized speech*
4. Disorg. / catatonic behavior
5. Negative symptoms

B. Impairment
C. Disturbance for > 6months**
D. Rule out related disorders

(at least 1 of *)
**duration can be decreased some if they respond well to treatment

45
Q

What are the 5 differential diagnoses to rule out? What aspects of the criteria do you consider?

A

Overall duration:
1. Schizophreniform disorder
2. Brief psychotic disorder

Extent of psychotic vs mood symptoms:
3. Schizoaffective disorder
4. Mood disorder w/ psychotic features

  1. Delusional disorder
46
Q

Brief psychotic disorder criteria?

A
  • 1 day - 1 month
  • Need 1+ of: delusion, hallucination, disorg speech, disorg behavior
  • RETURN to premorbid level or functioning after one month
47
Q

Schizophreniform disorder? similarities to SZ? key distinction from SZ?

A

similarities:
- Same as criteria A symptoms
- includes 3 phases
- active must be >1 month

Differences:
- lasts only 1-6 months
- impairment NOT necessary

48
Q

Mood disorder w/ psychotic features?

A
  • Psychotic symptoms only occur DURING a mood episode (mania or depression)
  • mood congruent psychosis
49
Q

Schizoaffective disorder criteria? problems?

A
  • Delusions or hallucinations for 2+ weeks in absence of mood symptoms
  • Mood symptoms present for MAJORITY of psychosis (active and residual)
  • really hard to ask people to think back and remember their symptoms
50
Q

Delusional disorder criteria?

A
  • presence of 1+ delusion with duration of >/= 1 month
  • Criterion A for schizophrenia NOT met
  • Functioning NOT markedly impaired
51
Q

Lifetime prevalence of SZ?

A

~ 1%

52
Q

Sex differences in SZ??

A

MEN tend to have…
- Higher rates
- Earlier age of onset
- Worse premorbid functioning
- A more severe course

53
Q

People with SZ are more likely to have been exposed to ___ complications?

A
  • problems in utero
  • birth complications
  • pregnancy: malnutrition, substance use, illness
  • sleep problems as baby
54
Q

2 hypotheses about SES?

A
  1. Social causation
  2. social selection
55
Q

Social causation hypothesis?

A

Negative factors related to low SES lead to development of illness

ie. low SES –> SZ

56
Q

Social selection hypothesis?

A

Due to cognitive/social impairments, those who develop the illness are less able to progress to college or high-paying jobs, drifting to a lower SES

ie. SZ –> low SES

not enough to explain SZ risk

57
Q

social/environmental risk factors?

A
  • urban living
  • migrant from other country
  • drug use, especially starting at young age
    –> cannabis by 15 = 4x more likely
58
Q

Brain abnormalities?

A
  • not one specific thing could cause it
  • commonly see abnormal structure/function in frontal cortex & limbic areas
  • reduced gray matter volume (enlarged ventricles)
  • reduced total volume
  • dysconnectivity disorder
59
Q

Dopamine hypothesis?

A
  • original: caused by excess dopamine
  • revised: caused by imbalance of dopamine system

Hyper –> positive
Hypo –> negative

60
Q

Neurodevelopmental model? Similar to what other model…?

A
  • similar to diathesis stress model
  • dopamine activity peaks in adolescence –> stressors/risk factors during adolescence related to dopamine dysregulation
  • genetic risk + early environmental factors impact brain development & increase risk of psychosis later
61
Q

Medications? developed when?

A
  • first line of treatment
  • 1st gen (traditional)
    –> 1950s
    –> yay something works
    –> lots of problems
  • 2nd gen (atypicals)
    –> 1990s
    –> alternatives, fewer problems
    –> not complete fix
62
Q

medications: problems?

A

1st:
- extrapyramidal symptoms (ie. motor neural related)
–> muscular rigidity, tremors
–> involuntary movements
- tardive dyskinesia

2nd:
- weight gain/obesity
- lower white blood cell counts

63
Q

medications: efficacy? method / how they work?

A
  • 1st/2nd gen similar efficacy
  • most effective for POSITIVE symptoms
  • Both block dopamine receptors in the cortical and limbic areas
64
Q

relapse rates after first acute psychotic episode? w/ & w/o meds?

A

w/o: 65-70% relapse
w/: 40% relapse

65
Q

High expressed emotion meaning? correlated with what?

A
  • Negative, critical and hostile attitudes and behavior on the part of the family
    AND/OR
  • Emotionally over-involved and intrusive towards patient
  • associated with higher relapse rates!
66
Q

Psychosocial treatments: 4 types of therapy? focus is on…?

A
  1. Individual therapy
  2. Assertive community treatment
  3. Family-based treatment
  4. Social skills training

Focus on long-term strategies to improve quality of life

67
Q

Family based treatment: what is it? efficacy?

A
  • improve coping skills of family members
  • educational component
  • minimize conflict & unrealistic expectations
  • delays relapse, but does not prevent it in long run
68
Q

Social skills training: for who? goals? efficacy?

A
  • for people who can avoid relapse, but still have social/occupational impairment
  • models & reinforces appropriate social behaviors
  • leads to improved social adjustment
  • no proven benefit on relapse rates

Psych 354 (10 decks)

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