Chapter 14 Flashcards
What are the two core features of psychosis?
- Loss of contact with reality
- Delusions and hallucinations.
What disorder is characterized by psychosis and affects all major areas of functioning?
Schizophrenia.
What disorders fall under the Schizophrenia Spectrum and Other Psychotic Disorders?
-Schizophrenia
-Schizophreniform Disorder
-Schizoaffective Disorder
-Delusional Disorder
-Brief Psychotic Disorder
-Schizotypal Personality Disorder
What did Emil Kraepelin contribute to the concept of schizophrenia?
-> differentiated two groups of psychoses:
1. Manic-depressive illness
2. Dementia praecox
->Identified catatonia, hebephrenia, and paranoia as symptoms with a shared progressive deterioration
What term did Eugen Bleuler propose in 1908, and what does it mean?
- Proposed term schizophrenia
-A term derived from the Greek words for split (skhizein) and mind (phren)
- Associative splitting of the basic functions of personality (lose contact with reality not personality itself)
-“Breaking of associative threads”
What did Bleuler mean by “breaking of associative threads”?
A disruption in the links between thoughts, emotions, and actions.
Define Hallucinations and delusions
H:
seeing or hearing things that others do not
D:
having beliefs that are unrealistic, bizarre, and not shared by others in the same culture
What are the three major categories of schizophrenia symptoms?
- Positive Symptoms
- Negative Symptoms
- Disorganized Symptoms
What defines positive symptoms in schizophrenia?
Excess or distortion of normal behavior, such as delusions and hallucinations.
What % of people people with schizophrenia experience hallucinations, delusions, or both?
60-80%
What are some common delusions in schizophrenia?
Grandeur: Belief of being powerful/famous
EX. I can control whether, I’m god
Persecution: Belief that others are out to get you
EX. the actors in the TV are spying on my and will report me to NASA
Cotard’s syndrome: person believes parts of their body are missing, or that they are dying, dead, or don’t exist (rare)
Capgras syndrome: Belief a loved one has been replaced by a double
What are hallucinations, and which type is most common in schizophrenia?
Sensory experiences without input; auditory hallucinations are most common.
-Associated with listening to own thoughts
What brain area is associated with auditory hallucinations?
Abnormal activation of the primary auditory cortex.
What defines negative symptoms in schizophrenia?
Absence or insufficiency of normal behavior in areas such as speech, affect, and motivation (A behavior should be present but isn’t)
(less common than positive symptoms).
List key negative symptoms.
- Avolition: inability to initiate/persist in activities
- Alogia: absence of speech; brief replies (amount and content of speech)
- Anhedonia: lack of pleasure experienced
- Asociality: lack of interest in social interactions
- Affective flattening: no open reaction to emotional situations (lack of emotional expressiveness)
What are disorganized symptoms in schizophrenia?
Erratic behaviors affecting speech, emotion, and movement.
What is disorganized speech (formal thought disorder)?
(aka formal thought disorder) reflects a disturbance in thinking, which can impact how a person communicates (incoherence/word salad, loose associations, neologism)
EX. call a Panda “fluffy”, create new words, jump from topic to topic, word salad = “how have you been recently?” “No, I got a head of lettuce”
What is catatonia in the context of schizophrenia?
Motor dysfunction that ranges from agitation to immobility
e.g., waxy flexibility
->keeping body and limbs in the position they are put in by someone else
What is an example of inappropriate affect in schizophrenia?
Laughing or crying at inappropriate times.
How many core symptoms are required for a schizophrenia diagnosis? What are they?
At least 2 or more of the following (present for 1 month):
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized/catatonic behavior
- Negative symptoms
→ At least one must be: delusions, hallucinations, or disorganized speech
How long must signs of disturbance be present for a schizophrenia diagnosis?
6 months, including 1 month of active symptoms.
What is schizophreniform disorder?
people who experience the symptoms of schizophrenia for fewer than six months
What defines schizoaffective disorder?
people who have symptoms of schizophrenia and who also exhibit the characteristics of mood disorders such as depression and bipolar disorder.
Presence of delusions or hallucinations for *2 or more weeks in the absence of a major mood episode
What is delusional disorder?
A persistent belief contrary to reality without other schizophrenia features. Types:
Erotomanic
(think someone is into them EX. I’m in a relationship with Tom Brady and he send me messages thru the TV)
Grandiose
Jealous
Persecutory
Somatic
What is brief psychotic disorder?
-people with one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behavior over the course of less than a month, followed by full recovery (don’t usually relapse)
What is attenuated psychosis syndrome?
A set of early, milder symptoms that may indicate the beginning of a psychotic disorder, such as schizophrenia. (act as a warning signal)
What are the three stages of psychosis development?
- Prodromal stage
a. Starting to see symptoms - Acute/active stage
a. Experience full blown symptoms - Residual stage
a. The calm after the big storm
How many people worldwide are affected by schizophrenia?
24 million or 1 in 300 people
What are the annual prevalence rates in BC and Canada?
BC: 1.1%
Canada: 0.9%
Do men and women get schizophrenia at the same rate?
Yes, but onset differs:
Men: early adulthood
Women: later, with increasing age
How much shorter is the life expectancy for people with schizophrenia?
10–15 years shorter
What factors predict earlier death in schizophrenia?
Illicit drug use
Low family involvement
Delayed treatment
Medication noncompliance
Suicide
When does schizophrenia typically begin?
Late adolescence to early adulthood.
What percentage go through a prodromal stage before full diagnosis?
Up to 85%
Can schizophrenia relapse after treatment?
Yes — relapse is common even after early intervention.
What is the general course of schizophrenia?
Involves acute episodes followed by periods of less severe but still very debilitating symptoms
Is schizophrenia found across all cultures?
Yes — it is universal
Which region has the lowest prevalence of schizophrenia?
Asia
Why might schizophrenia outcomes be better in poorer countries?
More family/community support
Less medicalization
Alternative coping strategies
What symptoms have stronger genetic links?
Negative symptoms
Is Schizophrenia inheritable?
- Children of parents with schizophrenia likely to have it too
- Predisposition may be inherited
What did twin studies show?
Identical twins: 44.3% concordance
Fraternal twins: 12.1% concordance
Who were the Genain quadruplets?
Identical quadruplets who all developed schizophrenia — shared genes & environment, but different symptoms & onset.
What do adoption studies suggest?
Genetics matter, but a healthy environment reduces risk.
How do genes and environment interact in schizophrenia?
Genes create vulnerability, which can be triggered by environmental stressors during key developmental periods.
Which chromosomes are linked to schizophrenia?
1, 2, 3, 5, 6, 8, 10, 13, 20, 22
What are the three most studied genetic regions?
Chromosome 8 (NRG1)
Chromosome 6 (DTNBP1)
Chromosome 22 (COMT)
What is a possible biological marker for schizophrenia?
Eye-tracking deficit (issues with smooth pursuit)
What are quantitative trait loci (QTLs) in relation to schizophrenia?
Genes located on different chromosomes contributing to variation in severity of symptoms.
What is the dopamine theory of schizophrenia?
Schizophrenia is linked to overactivity of dopamine, especially D2 receptors.
What evidence supports the dopamine hypothesis?
->Neuroleptics reduce dopamine and relieve symptoms
->Cause Parkinson-like side effects
->L-Dopa and amphetamines (dopamine agonists) induce or worsen symptoms
What role does striatal D2 receptor overactivity play? What is the role of prefrontal D1 receptor deficiency?
D2: May cause positive symptoms of schizophrenia.
D1: May contribute to negative symptoms (e.g., flat affect, withdrawal).
What structural brain differences are found in people with schizophrenia?
-Reduced grey matter in frontal/temporal lobes and reduced volume in basal ganglia and limbic structures
-Enlarged lateral and third ventricles (esp. in males)
-Hypofrontality – reduced activity in frontal lobes (linked to negative symptoms)
What prenatal infections are linked to schizophrenia risk?
- Prenatal exposure to influenza during pregnancy = more likely hood to develop disorder later in life
- A parasite, Toxoplasma gondii
How does stress influence schizophrenia risk? (Sociogenic hypothesis & Social selection hypothesis)
Higher rates in low SES areas
Sociogenic hypothesis: stress of poverty causes symptoms
Social selection hypothesis: schizophrenia causes downward drift
What family dynamics were once thought to cause schizophrenia?
- Schizophrenogenic: mothers with cold, dominant, rejecting nature may cause schizophrenia in their children
- Double bind nature of the family situation: communicating conflicting messages so kid can’t securely connect with their mother
- These two theories are no longer supported and have caused guilt in parents who believe their actions contributed to the development of schizophrenia in their kids
What is Expressed Emotion (EE)?
- disapproval, animosity, intrusiveness
- Predictor of relapse (families with high EE contribute to higher relapse)
What is a challenge when treating people with Schizophrenia?
Many clients lack insight into their disorder and resist intervention (don’t believe they have a disorder)
What was insulin coma therapy?
->the practice of inducing a coma with large dosages of insulin (though it would reset the brain)→ up to three quarters of the schizophrenics treated showed significant improvement.
->now obsolete due to risks (coma, death)
How does ECT (Electroconvulsive Therapy) work?
Induces seizures via electric shocks; minimally effective for schizophrenia
What is a frontal lobotomy?
Destruction of frontal lobe areas to treat symptoms; introduced by Egas Moniz
What are neuroleptics and what do they target?
-> dopamine antagonists
->block dopamine D2 receptors to reduce positive symptoms
What are common side effects of neuroleptics?
Extrapyramidal symptoms (Parkinson-like so tremors of the fingers, a shuffling gait, drooling)
Dystonia: muscle rigidity
Akathisia: restlessness
Tardive dyskinesia: involuntary mouth movements (10–20% of long-term users); sucking, lip-smacking, and chin-wagging motions.
Neuroleptic malignant syndrome: fever with muscle rigidity, can be fatal
What is the difference between first-gen and second-gen antipsychotics?
First-gen (e.g., Chlorpromazine): effective for positive symptoms
Second-gen (e.g., Clozapine): fewer side effects, reduce both positive and negative symptoms, affect serotonin as well
What is TMS (Transcranial Magnetic Stimulation) used for?
Briefly reduces auditory hallucinations
Is psychoanalysis helpful for schizophrenia?
No — it’s often ineffective or harmful.
What is behavioral family therapy?
Educates families
Improves communication
Teaches problem-solving
-> Shown to reduce relapse when ongoing
What is a token economy?
A behavioral system to encourage independence and daily skills
What is social skills training?
-helps people with schizophrenia learn the necessary social skills needed to navigate life
- Focuses on 3 key areas: Social cognition (receiving skills), Processing skills, and Behavioral responses in social interactions
- Often combined with other treatments like family therapy
How does CBT help with schizophrenia?
Effective for treating delusions and depression symptoms
Why is early intervention important?
->Improves long-term outcomes
-> Important for managing schizophrenia effectively
-> Raise awareness about psychosis thru education
How do schizophrenia treatments vary across cultures?
May involve herbal medicine, acupuncture, imprisonment, oral rituals, or ancestor worship
How can schizophrenia be prevented or its severity reduced?
->Identify/treat at-risk children
->Address unstable home environments
->Intervene during prodromal stages
