Chapter 13 - schizophrenia Flashcards
1
Q
3 types of symptoms for sz?
A
pos
neg
disorganization
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
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
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
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
6
Q
6 types of delusions?
A
- persecutory
- referential
- somatic
- religious
- grandiose
- control
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
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
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
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
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.
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
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)
14
Q
cotard delusion?
A
belief that you’re dead (either literally or figuratively)
15
Q
capgras delusion?
A
belief that a loved one has been replaced by an identical looking imposter
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
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
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
19
Q
Negative symptoms def? 2 main categories?
A
- Aspects of normal behavior and social relationships that that should be present, but are absent
- Diminished verbal and non-verbal expression
- Diminished motivation and pleasure
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
21
Q
What 2 symptoms fall under diminished verbal and non-verbal expression category?
A
- blunted affect
- alogia
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
23
Q
Alogia def? ex?
A
- speechlessness, reduction in how much they speak
- brief replies, 1 word answers
24
Q
What 3 symptoms fall under the category of diminished motivation and pleasure?
A
- Avolition
- Asociality
- Anhedonia
25
Avolition def? ex?
- 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
26
Asociality def?
- social withdrawal
- behavioral and interest level component
27
Anhedonia def?
- loss of interest in things that used to be pleasurable
- inability to predict feeling pleasure doing certain activities
28
Anticipatory vs consummatory pleasure?
Anticipatory: "wanting" --> pleasure from thinking ab future activities, predicted level of pleasure
Consummatory: "liking" --> in the moment pleasure from doing something
29
Anhedonia in MDD vs SZ?
MDD:
- reduced anticipatory AND consummatory pleasure
SZ: (NEGATIVE symptoms, not depressive symptoms)
- reduced anticipatory, but NOT consummatory
30
Disorganization def? 3 important symptom types?
- Reflects bizarre behaviors and disturbances in thinking
1. Disorganized speech
2. Catatonic behavior
3. Grossly disorg. behavior
31
Disorganized speech general/less severe symptoms?
- very difficult to follow
- Conveys little, if any, meaning
- Slip from one topic to another
32
2 more severe symptoms of disorganized speech?
- clanging
- word salad
33
Clanging def?
people put sentences together based on how the words sound/fit together/rhyme instead of the meaning/content
34
Word salad def?
saying a lot of words, probably makes sense to them, not clear at all to the person listening
35
Catatonic behavior def? symptoms?
- Decreased awareness of and reactivity to environment
- Immobility
- Marked muscular rigidity
- Purposeless/repetitive motor activity
36
how do catatonic people react to treatment? why?
- 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
Disorganized behavior: def? ranges from...? distinguished from...?
- 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
Cognitive impairments frequently seen in SZ? Importance/relevance?
- 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
3 phases of SZ?
1. prodromal
2. active
3. residual
40
prodromal phase characterized by?
- SUBTLE / attenuated symptom
- mostly negative symptoms
- socially isolated
- decline in functioning (social, occupational, familial)
- some cognitive decline
- peculiar behaviors and odd perceptual experiences
41
residual phase characterized by?
- not as extreme, similar to prodromal phase
- still see impairment
- fewer positive symptoms, psychosis improved
- negative symptoms pronounced
41
active phase characterized by?
- threshold psychosis
- most severe phase
- positive symptoms
42
People with onset of prodromal-like symptoms/behavior change... approx ___% convert to threshold psychosis in __-__ years?
They are called...?
approx 20-25% convert to threshold psychosis in 2-3 years?
Called clinical high risk for psychosis
44
SZ criteria?
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
What are the 5 differential diagnoses to rule out? What aspects of the criteria do you consider?
Overall duration:
1. Schizophreniform disorder
2. Brief psychotic disorder
Extent of psychotic vs mood symptoms:
3. Schizoaffective disorder
4. Mood disorder w/ psychotic features
5. Delusional disorder
46
Brief psychotic disorder criteria?
- 1 day - 1 month
- Need 1+ of: delusion, hallucination, disorg speech, disorg behavior
- _RETURN_ to premorbid level or functioning after one month
47
Schizophreniform disorder? similarities to SZ? key distinction from SZ?
similarities:
- Same as criteria A symptoms
- includes 3 phases
- active must be >1 month
Differences:
- lasts only 1-6 months
- _impairment_ NOT necessary
48
Mood disorder w/ psychotic features?
- Psychotic symptoms _only_ occur DURING a mood episode (mania or depression)
- mood congruent psychosis
49
Schizoaffective disorder criteria? problems?
- 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
Delusional disorder criteria?
- presence of 1+ delusion with duration of >/= 1 month
- Criterion A for schizophrenia NOT met
- Functioning NOT markedly impaired
51
Lifetime prevalence of SZ?
~ 1%
52
Sex differences in SZ??
MEN tend to have...
- Higher rates
- Earlier age of onset
- Worse premorbid functioning
- A more severe course
53
People with SZ are more likely to have been exposed to ___ complications?
- problems in utero
- birth complications
- pregnancy: malnutrition, substance use, illness
- sleep problems as baby
54
2 hypotheses about SES?
1. Social causation
2. social selection
55
Social causation hypothesis?
Negative factors related to low SES lead to development of illness
ie. low SES --> SZ
56
Social selection hypothesis?
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
social/environmental risk factors?
- urban living
- migrant from other country
- drug use, especially starting at young age
--> cannabis by 15 = 4x more likely
58
Brain abnormalities?
- 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
Dopamine hypothesis?
- original: caused by excess dopamine
- revised: caused by imbalance of dopamine system
Hyper --> positive
Hypo --> negative
60
Neurodevelopmental model? Similar to what other model...?
- 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
Medications? developed when?
- 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
medications: problems?
1st:
- extrapyramidal symptoms (ie. motor neural related)
--> muscular rigidity, tremors
--> involuntary movements
- tardive dyskinesia
2nd:
- weight gain/obesity
- lower white blood cell counts
63
medications: efficacy? method / how they work?
- 1st/2nd gen similar efficacy
- most effective for POSITIVE symptoms
- Both block dopamine receptors in the cortical and limbic areas
64
relapse rates after first acute psychotic episode? w/ & w/o meds?
w/o: 65-70% relapse
w/: 40% relapse
65
High expressed emotion meaning? correlated with what?
- 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
Psychosocial treatments: 4 types of therapy? focus is on...?
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
Family based treatment: what is it? efficacy?
- improve coping skills of family members
- educational component
- minimize conflict & unrealistic expectations
- delays relapse, but does not prevent it in long run
68
Social skills training: for who? goals? efficacy?
- 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
