Chapter 14/15 Schizophrenia

Question 1

types of delusions

Answer 1

persecution
grandeur
reference (belief that random events are directed at self)
thought broadcasting (others can read thoughts)
mind reading (can read others’ thoughts)

Question 2

types of hallucinations

Answer 2

auditory (voices)
also visual, olfactory, or tactile
voices are “real” and heard outside of head
may be commanding, critical, commenting, whispering

Question 3

“Formal Thought Disorder”

Answer 3

loosely connected thoughts
digressive, associative speech
impaired logic
concreteness
neologisms
problems with selective attention (problems with thalamus)
-cannot focus on single thoughts

Question 4

main symptoms

Answer 4

hallucinations, delusions, thought process (formal though disorder), emotion, motivation, relating to others, motor behavior

Question 5

catatonia

Answer 5

motionless, frozen state, strange postures

Question 6

positive symptoms

Answer 6

hallucinations, delusions, agitation

Question 7

negative symptoms

Answer 7

loss of logical thinking
loss of coherent speech
flat, blunted affect 
anhedonia (lack of pleasure/enjoyment)
avolition (lack of goal orientation)
alogia (nothing to say in convos)
social withdrawl

Question 8

types of schizophrenia

Answer 8

Paranoid type (mostly positive symptoms)
Disorganized type (mostly negative symptoms)

Question 9

schizophrenia spectrum disorders

Answer 9

brief psychotic disorder
schizoaffective disorder
delusional disorder

Question 10

Causes of schizophrenia

Answer 10

1. loss of gray matter (
2. loss of white matter (demyelinization)
3. dilation of ventricles (fluid filled space in brain)
4. atrophy of hippocampus (memory)
5. thalamus irregularities (sensory gating deficit)
6. shrinkage/inactivity of frontal lobes
7. temporal lobe abnormalities (hearing)
8. thinner corpus callosum
9. neuropsychological testing shows impairments
10. soft neurological signs (facial tics, motor skills, negative
    emotional expressions on face, low social
    competence, problems w/attn)
11. EEG abnormalities
12. eye movement abmormalities
    >handedness (no preference)
    >fingerprints (fewer ridges)
    >final neruonal trimming/ pruning abnormalites)
13. Biochemical abnormalities
    >overactivity of dopamine receptors (meth/cocaine)
    >blockage of serotonin receptors (LSD)
    >diminished glutamate activity (PCP)
14. Father older than 50
15. Maternal psychological stress (3-4th month of
    pregnancy)
16. Maternal nutrition (affects grandchild)
17. pregnancy/birth complications
18. exposure to virus (beginning-middle pregnancy)

Question 11

Etiology

Answer 11

genetics
viral infections
neurodevelopment
stress/trauma factors  
(Diathesis-Stress model)

Question 12

Obsolete Etiological Theories

Answer 12

Masturbation (throughout 19th cent.)
Schizophrenogenic mother (cold, distant mothers 1940-60’s)
Double Bind
Thomas Szasz (mental illness is myth)
R.D. Laing (sane response to insane world)

Question 13

Treatment

Answer 13

1. Hospitalization in state institutions
2. Medical treatments prior to antipsychotics
   >hydrotherapy, insulin coma, lobotomy, electroconvulsive)
3. Antipsychotic Medication
4. Comprehensive Treatment on Mult. levels

Question 14

older antipsychotic drugs

traditional

Answer 14

> block dopamine receptors and improve + symptoms

>thorazine, prolixin (injectible, less side effects, haldol)

Question 15

side effects of older antipsychotic drugs

Answer 15

stiffness of posture and tremors
shuffling gait
stiffening of neck and jaw
mask-like face
decreased spontaneity
restlessness
dry mouth, blurred vision
impaired sexual funtioning
sedation weight gain
Tardive Dyskinesia (involuntary movements of tongue/mouth)

Question 16

Risk factors for Tardive Dyskinesia

Answer 16

female
genetics
elderly
Hx of head injury
Hx of street drug use
length of time drug was taken
dosage

Question 17

Newer Antipsychotic Drugs

non-traditional

Answer 17

Work on D2, D1, and D4 dopamine circuits
work on serotonin system and other neurotransmitters
action more specific

Question 18

advantages of newer antipsychotics

Answer 18

fewer side effects
treat + and - symptoms
some mood stabilizing properties

Question 19

history of newer antipsychotics

starting in early 1990’s

Answer 19

Closaril
Rispderal (injectable)
Zyprexa (injectable, enormous weight gain)
Seroquel
Geodon
Abilify (injectable)

Question 20

side effects of newer antipsychotics

Answer 20

> agranulocytosis (lowered white blood cells in white bone
marrow, only clozaril)
sedation (clozaril, zyprexa, seroquel)
weight gain (worse than older, mostly Clozaril/Zyprexa)
higher risk for diabetes (zyprexa)

Question 21

Comprehensive Treatment on Mult. Levels

Answer 21

1. Antipsychotic Mediation
2. counseling/case management
3. social skill/communication training (socialization opps)
4. life skill training
5. supportive training
6. occupational therapy/supportive work
7. family counseling
   >educate
   >reduce self-blame
   >reduce “expressed emotion” (criticism, hostility, emotional over involvement)

Question 22

Schizophrenia prevalence

Answer 22

lifetime==1%
onset==late teens-mid 20’s (acute vs. chronic)
course==deterioration w/ each episode, treatable
gener== 1:1 overall
**women more likely 1st diagnosis after age 40
**men more likely 1st diagnosis under age 25