Chapter 13 Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
Schizophrenia
- The startling disorder characterized by a broad spectrum of emotional dysfunctions including delusions, hallucinations, disorganized speech and behavior, and inappropriate emotions.
- Disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including hallucination, delusions, disorganized speech and behaviour and inappropriate emotions
- one of the most severe mental illnesses
- effects men more *more women then men later on in life
- no one essential symptom (ex arthur who it came and went)
Clinical description of Schizophrenia
- negative symptoms come first
- onset of positive symptoms “psychotic break”
- negative symptoms are hard to treat
- Positive symptoms dramatic but respond to medication
Course of Schizophrenia
- prodromal phase starts in high school
- 1st active phase in late teens, early 20’s
- residual phase ongoing following treatment for positive symptoms
- additional active phase from time to time if stressor
- recovery is not as good with each successive active phase
- 22% of individuals have one episode and return to premorbid functioning
Prevalence of Schizophrenia
1% of general population, equally common in both men and women, later onset in women, more commonly diagnosed in ethnic minorities
Schizophrenia: Genetic influences
Liklihood someone will develop schizophrenia if they are related to someone who has it tracks very well with genes that are shared
- 48% ID twins
- 46% if both parents have schizophrenia
- 17% dizygotic twin has schizophrenia
- 15% if one parent
- <5% if other relative
Catatonia
- alternating immobility and excited agitaiton
Hebephrenia
silly and immature emotionality
Paranoia
delusions of grandeur or persecution.
Psychotic behavior
- Unusual behaviors, usually involving delusions (irrational beliefs) and/or hallucinations.
Positive symptoms
- Delusions- delusion of grandeur (exaggerated importance), delusions of persecution- “out to get me”,
- Hallucinations- auditory most common (more activity in the Brocas area of the brain), visual, oolfactory, gustatory (taste), and tactile (touch)
- Symptoms that are added to a person’s experience.These are delusions and hallucinations.
- Overt symptoms.
Delusion
- delusion of grandeur (exaggerated importance), delusions of persecution- “out to get me”,
- Disorder of thought content.
- A belief that would be seen by most others as a misrepresentation of reality
- thinking that someone else is putting thoughts into your head
- delusions of grandeur (thinking your someone your not ex. that you can cure all hunger in the world)
- delusions of persecution common (believing others are out to get you)
- Cotards syndrom - person believes part of their body has changed
- Capgras syndrom - believes someone has been replaced by a double
Delusion of grandeur
A mistaken belief that the person is famous or powerful
Delusions of persecution
People are out to get them.
Hallucination
- sensory experience without external stimuli
- hearing, seeing, smelling, tasting, or feeling something that isn t actually present - Experiencing sensory events without the presence of stimuli. Most common is auditory.
- The experience of sensory events without any input from the surrounding environment
- Auditory most common, but can be from any sense like vision (like video)
- Say they feel bugs on them - A psychotic symptom of perceptual disturbance in which something is seen, heard, or otherwise sensed although it is not actually present.
Negative symptoms
- Avolition, Alogia, Anhedonia, and Flat Affect (absence of affect)
- Symptoms that are absent from their experience.
- Behavioural deficits
- Tend to endure beyond acute episodes
- These are behaviors/thoughts/things that are subtracted from a “normal” experience and render it abnormal
- they include emotional and social withdrawal, apathy and poverty of speech or thought
- Less outgoing symptoms such as the absence or insufficiency of normal behaviors.
Avolition
- inability to initiate and persist, lack of motivation
- Lack of energy and absence of interest in or an inability to persist in what are usually routine activities
- usually personal hygiene
- highly associated with poor outcomes compared to other symptoms
Alogia
- absence of speech
- Relative absence of speech, delayed comments or slow responses to questions
- a deficiency in the amount or content of speech.
Anhedonia
- absence of pleasure
- Lack of pleasure experienced
- Loss of interest in or a reported lessening of the experience of pleasure. Included in eating, social interactions and sexual relations. Delay in seeking treatment for schizophrenia
- Inability to experience pleasure.
Affective Flattening/ Flat affect
- No outward expression of emotion. About 2/3 experience this. Respond inside rather then outside, like wearing a mask.
- An apparently emotionless demeanor (including toneless speech and vacant gaze) when a reaction would be expected.
Disorganized speech
- (tangentiality or loose association/ derailment
Inappropriate Affect- crying when something is happy, laughing uncontrollably
Disorganized behavior- agitation and gesturing that its extreme and nonsensical, catatonic immobility and waxy flexibility - Jumping from topic to topic, speaking illogically.
- Disorganized speech, motor behaviour, and emotional reactions
- Inappropriate affect and disorganized behaviour
- Disorganized speech, motor behaviour, and emotional reactions
- Style of talking characterized by incoherence and lack of typical logic patterns, jump from topic to topic
- “associative splitting” or “cognitive slippage”
Disorganized symptom
- Disorganized speech (tangentiality or loose association/ derailment
Inappropriate Affect- crying when something is happy, laughing uncontrollably
Disorganized behavior- agitation and gesturing that its extreme and nonsensical, catatonic immobility and waxy flexibility - Variety of erratic behaviors that affect speech, motor behavior, and emotional reactions.
Disorganized Type
disrupted speech and behavior
- disjointed hallucinations and delusions
- flat or inappropriate affect
Disorganized behaviour
Disorganized Behaviour: Bizarre behaviours. Includes catatonic immobility, waxy flexibility (tendency to keep limbs in position a person puts them in ie. therapist) and hoarding
Inappropriate affect
- crying when something is happy, laughing uncontrollably
- laughing at a funeral. Bizarre behaviors.
- Emotional responses are out of context (laughs at family pet dying, mad at winning the lottery)
- An emotional display that is inappropriate for the situation.
Catatonic immobility
Disturbance of motor behavior in which the person remains motionless, sometimes in an awkward posture, for extended periods
Waxy flexibility
Rigidity, agitation, odd mannerisms
Schizophreniform disorder
- presentation of Schizophrenia, but lasts shorter than a 6 month period
- Experienced for a few months, then they can resume their normal lives. Sometimes as a result of treatment but also reasons are unknown
Schizoaffective disorder
- Presentation of both Schizophrenia and Mood disorder symptoms
- Schizophrenia and characteristics of mood disorder. Likely to not get better on their own and instead experience major life difficulties. Delusions and hallucinations must happen for atlas 2 weeks in the absence of mood symptoms
Premorbid
Before the psychotic episode
Delusional disorder
- Persistent beliefs that are not in line with reality, but don ot meet criteria for schizophrenia
- Erotomania, grandiose, jealous, persecutory, and somatic
- imagined events could happen, but are not - Beliefs that aren’t generally held by other members of society. May become isolated as suspicious of others, but tend not to have flat affect, anhedonia, or other negative symptoms
- delusional substypes are: erotomanic, grandiose, jealous, persecutory and somatic
Erotomanic type
irrational belief that one is loved by another person, usually of higher status
Grandiose type
Believing in one’s inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.
Jealous type
Sexual partner is unfaithful
Persecutory type
Believing oneself (or someone close) is being malevolently treated in some way
Somatic delusions
The person feels afflicted by a physical defect or general medical condition
Shared psychotic disorder (folie a deux)
- Develop delusions similar to that of a person who they share a close relationship with
- Condition in which people develop a delusion simply as a result of close relationships with a delusional individual
Substance-induced psychotic disorder
Psychosis caused by the ingestion of medications, psychoactive drugs, or toxins.
Psychotic disorder associated with another medical condition
Psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response, which associated with another medical condition
Brief psychotic disorder
- Delusions, hallucinations, or disorganized speech/ behavior lasting less than 1 month
- Lasts for only a few days and characterized by the presence of more positive symptoms such as delusions, hallucinations, or disorganized speech or behaviour lasting one month or less
Attenuated psychosis syndrome
- Requires further study. Patients are aware of their troubling and bizarre nature of these symptoms
prodromal phase
beginning of symptoms, often negative symptoms and some bizarre beliefs or actions
Active phase
positive symptoms are prominent and some negative symptoms
Residual Phase
negative symptoms remain after active phase has ended
Endophenotyping
Find the gene or genes that cause these difficulties
Smooth-pursuit eye movement
Eye-tracking
Hypofrontality
People with schizophrenia display a range of deficits in the prefrontal section of the brain, and this area may be less active in people with schizophrenia
Double blind communication
- communication style of conflicting messages to children (no longer supported)
Expressed emotion (EE)
- Three aspects:
-Criticism
-hostility
-Emotional Overinvolvement
(individuals that return to families that are EE are more likely to relapse) - Patients who had limited contact with their relatives did better than the patients who spent longer periods with their families.
Jane has spent the last half hour staring in the mirror. As you approach her she turns away and giggles. When you ask what she’s laughing at, she answers, but you’re having difficulty understanding what she says.
Disorganized
Drew has experienced hallucinations and bizarre delusions for the last 4 months
Schizophreniform disorder
Greg’s cognitive skills and affect are relatively intact. He, however often has delusions and hallucinations that convince him enemies are out to persecute him
Delusional Disorder
Alice usually holds an unusual posture and is sometimes seen grimacing
Catatonic
Cameron has started to hear voices and this is very disturbing to him. He told his parents and recognizes that he needs to see a mental health professional
Attenuated psychosis syndrome
Lately, Dom has become more isolated because he believes his coworkers and conspiring to get him fired. He becomes agitated whenever he sees a group of employees talking and laughing because he believes that they are plotting against him.
C - Delusional disorder
Natalie reveals to her therapist that she hears numerous voices talking to hr and giving her orders. Her doctor has just sent her to his therapist for what he believes to be a major depressive episode. She had begun to sleep all the time and contemplated suicide often
B - Schizoaffective disorder
If Shawns schizophrenia symtoms disappeared after about four months and he returned to his normal life what diagnosis might be receive
A - Schizophreniform Disorder
Elias believes the government is out to get him. He thinks agents follow him daily, monitor his calls, and read his mail. His roommate Cedric tried to convince him otherwise. After a year of this, however, Cedric began to believe the government was correct and the government was out to get him too
D - Shared Psychotic Disorder
The greatest risk of having schizophrenia is in those who have a (n) _________ or __________ with schizophrenia. Any relative with schizophrenia will make your chances of developing the disorder _______ than those of the general population
identical twin, fraternal twin, higher
Raised in a home other than that of their biological parents, adopted children of parents with schizophrenia have a __________ chance of having the disorder themselves. Children of people with schizophrenia adopted into families without schizophrenia have a __________-than-average chance of having schizophrenia
higher, higher
The likelihood of a child’s having schizophrenia is influence by the ___________ of the parent’s disorder. One may inherit a predisposition for __________________ schizophrenia that is the same or different form that of the parent.
severity, general
Setting up an elaborate ___________ in which patients are fined for disruptive or inappropriate behavior and rewarded for appropriate behavior is beneficial in hospitals
token economy
In _____________ clinicians attempt to reteach such behaviors as basic conversation, assertiveness, and relationship building to people with schizophrenia
social skills training
Aside from social skills training, two psychosocial treatments for schizophrenia, _________ (teaching family members to be supportive) and _________ (teaching meaningful jobs, may be helpful
family intervention, vocational rehabilitation
Recent studies sometimes indicate that the relationship of the neurotransmitters ______ and ___________ may explain some positive symptoms of schizophrenia
dopamine, serotonin
Because antipsychotic medications may cause serious side effects, some patients stop taking them. One serious side effect is called ___________, which may include parkinsonian symptoms.
extrapyramidal symptoms
Difficult cases of schizophrenia seem to improve with a serotonin and dopamine antagonist called __________
Olanzapine
