Chapter 13 - Schizophrenia & Related Disorders Flashcards
What is the lifetime prevalence of schizophrenia?
1%
What is psychosis?
- A state defined by a loss of contact with reality
- Could be substance-induced or caused by a brain injury
- Most psychoses appear in the form of schizophrenia
What is schizophrenia?
a psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities
What are the symptoms of schizophrenia?
- Major disturbances in thought, emotion, and behavior
- Disordered thinking
- Faulty perception and attention
- Inappropriate or flat emotions
- Disturbances in movement or behavior
- Disrupted interpersonal relationships
When is the typical onset of schizophrenia?
Late adolescence or early adulthood
Which race is schizophrenia more frequently diagnosed in?
African Americans
What are the gender differences for schizophrenia?
- slightly higher prevalence among men
- differences in age of onset
- differences in outcomes
What do symptoms affect besides the person themself?
Employability, relationships
Are the suicide and substance abuse rates high or low?
High
What are the DSM-5 symptoms for schizophrenia?
- For 1 month, individual displays two or more of the following symptoms much of the time: delusions, hallucinations, disorganized speech, grossly disorganized motor activity or catatonia, negative symptoms
- At least one of the individual’s symptoms must be delusions, hallucinations, or disorganized speech
- Individual functions much more poorly in various life spheres than was the case prior to the symptoms
- Continuous signs of the disturbance persist for at least 6 months
What are the three types of symptoms of schizophrenia?
Positive, negative, and psychomotor symptoms
What are the positive symptoms of schizophrenia?
- also called “pathological excesses”
- excess of thought, emotion, and behavior
- delusions, hallucinations, disordered thinking, inappropriate affect
What are the negative symptoms of schizophrenia?
- also called “pathological deficits”
- deficits of thought, emotion, and behavior
- avolition/amotivation, alogia, anhedonia, flat affect, asociality
What are the psychomotor symptoms of schizophrenia?
unusual movements or gestures, disorganized behavior, catatonia, and catatonic immobility
What are delusions?
Ideas that are believed wholeheartedly without any basis in fact
What are the most common delusions in schizophrenia?
Delusions of persecution (being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized)
What are delusions of reference?
Attaching special and personal meaning to the actions of others or to various objects or events
What are delusions of grandeur?
Believing you’re a great inventor, religious savior, or specially empowered
What are delusions of control?
Believing your thoughts, feelings, and actions are being controlled by other people
What are formal thought disorders?
a disturbance in the production and organization of thought
What are loose associations/derailment?
rapid shifts from one conversation to another (a formal thought disorder)W
What are neologisms?
made-up words that typically only have meaning to the person using them
What are hallucinations?
experiencing sights, sounds, or other perceptions in the absence of external stimuli
What are auditory hallucinations?
Sounds and voices that seem to come from outside of the head
What are visual hallucinations?
vague perceptions of colors, clouds, or distinct visions of people or objects
What are olfactory hallucinations?
odors that no one else smells
what are gustatory hallucinations?
food or drink tastes strange on a regular basis
what are somatic hallucinations?
feelings that something is happening inside the body
what are tactile hallucinations?
perceptions of tingling, burning, or electric-shock sensations
what is inappropriate affect?
emotions that are unsuited to the situation
What is alogia
a reduction in speech or speech content, “poverty of speech”
what is flat affect?
showing no apparent emotions
What is avolition?
lack of interest (apathy), inability to start or complete a course of action
what is catatonia?
a pattern of extreme psychomotor symptoms– catatonic stupor, rigidity, posturing, excitement
what is catatonic stupor?
when people stop responding to their environment, remaining motionless and silent for long periods
what is catatonic rigidity?
when people maintain a rigid, upright posture for hours and resist efforts to be moved
what is catatonic posturing?
when people are in awkward or bizarre positions for long periods
what is catatonic excitement?
when people move excitedly, sometimes wildly moving their legs and arms
what is the course of schizophrenia?
prodromal phase -> active phase -> residual phase
when does schizophrenia usually appear?
between the late teens and mid-30s
what is the prodromal phase of schizophrenia?
- when symptoms are not yet obvious, but deterioration is already beginning
- may withdraw socially, speak in vague or odd ways, develop strange ideas, or express little emotion
what is the active phase of schizophrenia?
- symptoms become apparent
- sometimes this phrase is triggered by stress or trauma in person’s life
what is the residual phase of schizophrenia?
- return to a prodromal-like level of functioning
- may retain some negative symptoms, but have lessening of the striking symptoms of active phase
A fuller recovery from schizophrenia is more likely in which people?
- people with good premorbid functioning
- whose disorder was triggered by stress
- with abrupt onset
- with later onset (middle age)
- who receive early treatment
what are the 2 types of schizophrenia?
Type I and type II
what is type I schizophrenia?
when disorder is dominated by positive symptoms, “excess schizophrenia” (more common)
what is type II schizophrenia?
when disorder is dominated by negative symptoms, “deficit schizophrenia”
what is schizophreniform disorder?
various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia, 1-6 months
what is brief psychotic disorder?
various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia, less than 1 month
what is schizoaffective disorder?
marked symptoms of both schizophrenia and a major depressive episode or a manic episode, 6 months or more
what is delusional disorder?
persistent delusions that are not bizarre and are not due to schizophrenia; persecutory, jealous, grandiose, and somatic delusions are common, 1 month or more
what types of factors do schizophrenia researchers focus on?
biological factors (most promising), psychological factors, & sociocultural factors
what is a diathesis-stress relationship?
- may be at work in schizophrenia
- people with a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present
what are the genetic factors of schizophrenia?
- people inherit a biological predisposition to schizophrenia
- supported by studies of relatives of people with schizophrenia, twins with schizophrenia, people with schizophrenia who are adopted, and by direct genetic research
what have family pedigree studies found about schizophrenia?
schizophrenia and schizophrenia-like brain abnormalities are more common among relatives of people with the disorder. the closer related, the more likely.
what have genetic studies found about schizophrenia?
schizophrenia could be cause by a combination of gene defects. likely not caused by one specific gene.
what is the dopamine hypothesis about schizophrenia?
certain dopamine neurons fire too often and transmit too many messages
what other neurons are involved in schizophrenia?
(dopamine), serotonin, GABA, glutamate
Which two kinds of biological abnormalities may allow genetic factors to lead to the development of schizophrenia?
biochemical abnormalities and abnormal brain structure
what is the revised dopamine theory?
a dopamine imbalance, subcortical increases and cortical decreases
what is the brain structure in schizophrenia?
- Enlarged ventricles
- Reduced activity in prefrontal cortex
- Many behaviors disrupted by schizophrenia (ex: speech, decision-making) are governed by prefrontal cortex
- Impairments on neuropsychological tests of prefrontal cortex (ex: memory)
- Low metabolic rates in prefrontal cortex
- Studies suggest that a dysfunctional brain circuit may lead to schizophrenia
- This circuit includes the prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra, among other structures
What are the congenital factors that can contribute to schizophrenia?
- Damage during gestation or birth
- Natal complication rates high in patients with schizophrenia
- Viral damage to fetal brain
- Season of birth effect (excess of winter-spring births w schizophrenia)
What are the developmental factors that can contribute to schizophrenia?
- Prefrontal cortex matures in adolescence or early adulthood
- Dopamine activity also peaks in adolescence
- Stress activates HPA system which triggers cortisol secretion
What are the psychodynamic explanations for schizophrenia?
- cold or unnurturing parents may set schizophrenia in motion (Freud)
- schizohrenogenic mothers (Fromm-Reichmann)
- self theorists suggest that biological deficiencies cause people to develop a fragmented, rather than integrated, self
what are schizophrenogenic mothers?
theorized by Frieda Fromm-Reichmann, mothers of people with schizophrenia are cold, domineering, and uninterested in their children’s needs (little research support)
what are the cognitive-behavioral explanations for schizophrenia?
- operant conditioning (the process where people learn to perform behaviors they have been rewarded for), they focus on irrelevant cues like a bird flying or the brightness of a light which are rewarded and then repeated
- misinterpretations of unusual sensations
what are the sociocultural explanations for schizophrenia?
- multicultural factors, social labeling, and family dysfunction
- more schizophrenia in African-Americans than white people
- families high in expressed emotion (criticism, disapproval, and hostility)
What is the bi-directional association for schizophrenia?
Unusual patient thoughts -> increased critical comments
Increased critical comments -> unusual patient thoughts
what is the developmental psychopathology view of schizophrenia?
Developmental histories of children who later developed schizophrenia:
- Lower IQ
- More often delinquent and withdrawn
- Poorer motor skills
- More expression of negative emotion
Applies an integrative and developmental framework
Genetic predisposition may eventually lead to schizophrenia if, over the course of the person’s development, he or she experiences significant life stressors, difficult family interactions, and/or other negative environmental factors
