Chapter 14:Psychosis Flashcards
German psychiatrist Emil Kraepelin (1899) provided what stands today as the most enduring description and categorization of schizophrenia. Two of Kraepelin’s accomplishments are especially important. What are they?
- he combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders (catatonia, paranoia, hebephrenia, dementia praecox)
- distinguished dementia praecox from what was then called manic-depressive illness (bipolar disorder)
__________ is a Disorder of movement involving immobility or excited agitation
catatonia
Silly and immature emotionality (a characteristic of some types of schizophrenia) is called ___________.
hebephrenia
________ is a Person’s irrational beliefs that he or she is especially important (delusions of grandeur) or that other people are seeking to do him or her harm.
paranoia
_______ ________ is a Latin term meaning “premature loss of mind,” an early label for what is now called schizophrenia, emphasizing the disorder’s frequent appearance during adolescence.
dementia praecox
Kraepelin’s contemporary Eugen Bleuler (1908), a Swiss psychiatrist who introduced the term ____________.
schizophrenia
Separation among basic functions of human personality (e.g., cognition, emotion, perception) that is seen by some as the defining characteristic of schizophrenia is called _________ _________.
Associative Splitting
________ is a Term used to characterize many unusual behaviours, although in its strictest sense it usually involves delusions and hallucinations.
psychosis
psychosis usually involves _______ and ______.
- delusions
- hallucinations
TRUE or FALSE: Schizophrenia is not one of the disorders that involves psychosis
FALSE: Schizophrenia IS one of the disorders that involves psychosis
TRUE or FALSE: people with a schizophrenia diagnosis are far less likely to commit future violent crimes than those with a history of violent crime but no schizophrenia diagnosis
TRUE
what is the difference between positive symptoms, negative symptoms, and disorganized symptoms when it comes to schizophrenia?
- Positive symptoms generally refer to symptoms around distorted reality
- Negative symptoms involve deficits in normal behaviour in such areas as speech, affect, and motivation
- Disorganized symptoms include rambling speech, erratic behaviour, and inappropriate affect
More overt symptoms, such as delusions and hallucinations, displayed by some people with schizophrenia are called _______ ______.
positive symptoms
Between ___-__% of people with schizophrenia experience hallucinations and approximately ___% experience delusions.
- 60 to 80%
- 70%
__________ is a Psychotic symptom involving disorder of thought content and presence of strong beliefs that are misrepresentations of reality
delusion
Name three types of delusions from the textbook.
- Delusions of Persecution (believes that others are out to get them)
- Cotard’s Syndrome (the person believes a part of his or her body (e.g., the brain) has changed in some impossible way)
- Capgras Syndrome (the person believes someone he or she knows has been replaced by a double)
_________ is a Psychotic symptom of a perceptual disturbance in which things are seen or heard or otherwise sensed although they are not real or actually present.
Hallucination
What type of hallucination is the most common form experienced by people with schizophrenia?
Auditory hallucinations
List two existing theories for why someone might experience auditory verbal hallucinations.
- They’re not hearing the voices of others, but are listening to their own thoughts or their own voices and cannot recognize the difference.
- They arise from abnormal activation of the primary auditory cortex (increased metabolic activity)
Less outgoing symptoms, such as flat affect and poverty of speech, displayed by some people with schizophrenia, are called ________ _________.
Negative symptoms
Approximately ___% of people with schizophrenia display negative symptoms.
60%
_______ is the inability to initiate and persist in activities.
Avolition
Avolition is also known as _______.
apathy
Out of all schizophrenia symptoms (both positive or negative), which symptom was more highly associated with poor outcome ?
Avolition
_______ refers to the relative absence of speech
Alogia
How may a person with Alogia respond to questions?
- brief replies
- little content
- uninterested in the conversation
_________ is the Inability to experience pleasure.
anhedonia
Why is anhedonia clinically meaningful symptom of schizophrenia?
it relates to a delay in seeking treatment for schizophrenia
Lack of interest in or motivation for social interactions; a preference for solitary activities is called _____.
Asociality
patients who have poor social or interpersonal functioning before the development of their psychosis also have greater levels of ________ ________and greater _______ _______ at the time of their admission to a schizophrenia treatment program.
- negative symptoms
- social impairment
_____ ______ is an emotionless demeanour (including toneless speech and vacant gaze) when a reaction would be expected.
Flat Effect
Approximately _____-______ of people with schizophrenia exhibit flat effect.
Two-thirds
List 4 negative symptoms of schizophrenia.
- Asociality
- Anhedonia
- Alogia
- Avolition
________ __________ are the least understood symptoms of schizophrenia that include erratic behaviours that affect speech, motor behaviour, and emotional reactions
Disorganized symptoms
_________ ______ is a Style of talking often seen in people with schizophrenia that involves incoherence and a lack of typical logic patterns.
Disorganized Speech
Emotional displays that are improper for the situation is called the ______ ________.
inappropriate effect
______ ________ is the Disturbance of motor behaviour in which the person remains motionless, sometimes in an awkward posture, for extended periods of time
catatonic immobility
catatonic immobility is also known as _____ _______
waxy flexibility
To receive a diagnosis of schizophrenia, a person needs to display how many symptoms and for how long?
two or more symptoms for one month
NOTE: At least one of the symptoms must include delusions, hallucinations, or disorganized speech
________ ________ is a Psychotic disorder involving the symptoms of schizophrenia but lasting less than six months
Schizophreniform disorder
_________ ______ is a Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder`
Schizoaffective disorder
The Psychotic disorder featuring a persistent belief contrary to reality but no other symptoms of schizophrenia is called _______ ________.
Delusional disorder
List the five delusional subtypes (JPEGS)
- erotomanic
- grandiose
- jealous
- persecutory
- somatic
An __________ delusion is someone’s mistaken belief that a higher-status and unsuspecting person is in love with him or her.
erotomanic
The ________ type of delusion involves believing in one’s inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
grandiose
A person with the ________ type of delusion believes a sexual partner is unfaithful.
jealous
The __________ type of delusion involves the person believing that they (or someone close to them) are being malevolently treated in some way.
persecutory
With the ________ type of delusion, the person feels afflicted by a physical defect or general medical condition.
somatic
How do delusions from delusional disorder differ from the delusions found in people with schizophrenia?
- in delusional disorder the imagined events could be happening but aren’t (e.g., mistakenly believing you are being followed)
- in schizophrenia, the imagined events are not always possible (e.g., believing your brain waves broadcast your thoughts to other people around the world).
______ _______ ______ is a Psychotic disturbance in which an individual develops a delusion similar to that of a person with whom he or she shares a close relationship.
folie à deux
folie à deux is also called ___________ _________ __________.
shared psychotic disorder
It is believed that among those people with disorders of psychosis in general, between ____-_____% are thought to have delusional disorder
2-8%
The average age of a person with delusional disorder’s first admission to a psychiatric facility is between ____ and ____
35 and 55
Does delusional disorder affect males or females more?
females
Psychosis caused by the ingestion of medications, psychoactive drugs, or toxins is called _______-__________ ________ ________.
substance-induced psychotic disorder
Psychotic disorder due to another ________ ______ is characterized by hallucinations or delusions and that is the direct result of another physiological disorder, such as _______ or _____ _____.
- medical condition
- stroke
- brain tumor
Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behaviour, but lasting less than one month is called ____ _________ ____________
brief psychotic disorder
brief psychotic disorder often occurs in a reaction to a ________.
stressor
_________ _______ ________ is a Disorder involving the onset of psychotic symptoms such as hallucinations and delusions, which puts a person at high risk for schizophrenia
attenuated psychosis syndrome
TRUE or FALSE: Schizophrenia and schizotypal personality disorder aren’t genetically related as part of a schizophrenia spectrum.
FALSE: Schizophrenia and schizotypal personality disorder may possibly be genetically related as part of a schizophrenia spectrum.
__________ is a major problem for individuals living with schizophrenia
Loneliness
TRUE or FALSE: First Nations people living both on and off reserve have almost double the acute care hospitalization rates for schizophrenic/psychotic disorders that Canadians of non-Indigenous identity have
TRUE
Schizophrenia is seen in ____-____% of the general population
0.2 to 1.5 percent
People with schizophrenia tend to live ___-____ years less than average, partly because of the higher rate of _______ and _______ among people with schizophrenia
- 10 to 15
- suicide
- accidents
TRUE or FALSE: Cases of schizophrenia in Canada is on the rise
FALSE: the incidence of schizophrenia in Canada may be on a slight but steady decline
The all-cause mortality rate of Canadians living with schizophrenia was almost ______ times that of Canadians not living with schizophrenia
three
When it comes to schizophrenia between men and women, there is a difference between the sexes in age of onset. Explain.
- For men, the likelihood of onset diminishes with age, but it can still first occur after the age of 75.
- The frequency of onset for women is lower than for men until age 36, when the relative risk for onset switches, with more women than men being affected later in life
When it comes to schizophrenia, who is more likely to have favourable outcomes, men or women?
women
In regards to development, when do the most severe symptoms of schizophrenia first occur?
in late adolescence or early adulthood
Up to ____% of people who later develop schizophrenia go through a prodromal stage
85%
__________ ________ is a Period during which some symptoms appear but before development of full symptoms.
prodromal stage
Once schizophrenic symptoms begin to appear, it can take anywhere from ___ years to around ____ years before a person at high risk (e.g., mild positive symptoms, decline in functioning) meets the full criteria for a psychotic disorder.
- two
- ten
TRUE or FALSE: People with schizophrenia have a poorer prognosis than those with most of the other disorders we describe in this book—including a high risk of suicide—although a significant number of individuals can experience long periods of recovery
TRUE
Are outcomes of schizophrenia better in not so wealthy countries or wealthy countries?
not so wealthy countries
Do Black people or White people receive the diagnosis or schizophrenia more often?
Black people, due to bias and stereotyping
TRUE or FALSE: The course and outcome of schizophrenia is similar globally
FALSE: The course and outcome of schizophrenia vary from culture to culture
What are some important things to note when it comes to schizophrenia running in the family?
- The more severe the parent’s schizophrenia, the more likely the children were to develop it also
- there appears to be some familial risk for a spectrum of psychotic disorders related to schizophrenia
- the risk of having schizophrenia varies according to how many genes an individual shares with someone who has the disorder
- a good home environment reduces the risk of schizophrenia
- genes can be passed onto children but the parents not show the disorder themselves
____% of children of nonschizophrenic parents develop schizophrenia
1.7%
Children of people with schizophrenia adopted into families without schizophrenia have a ________ than average chance of having schizophrenia.
higher
The greatest risk of having schizophrenia is in those who have an ______ ______ with schizophrenia.
identical twin
One of the most enduring yet still controversial theories of the cause of schizophrenia involves the neurotransmitter _______.
dopamine
when drugs are administered that are known to increase dopamine (agonists), schizophrenic symptoms ________; when drugs that are known to decrease dopamine activity (antagonists) are used, schizophrenic symptoms tend to ________. Taking these observations together, researchers theorized that schizophrenia in some people was attributable to __________ dopamine activity.
- increases
- diminish
- excessive
List 3 pieces of evidence that contraindicate the theory that schizophrenia is caused by excessive dopamine.
- A significant number of people with schizophrenia are not helped by the use of dopamine antagonists.
- Although the neuroleptics block the reception of dopamine quite quickly, the relevant symptoms subside only after several days or weeks, much more slowly than researchers would expect.
- These drugs are only partly helpful in reducing the negative symptoms (e.g., flat affect, anhedonia) of schizophrenia.
What is the functionality and structure of the brain like in people with schizophrenia?
- excessive stimulation of striatal dopamine receptors (These cells control movement, balance, and walking)
- deficiency in the stimulation of prefrontal receptors (believe this may cause avolition)
- alterations in prefrontal activity involving glutamate transmission
- unusually large lateral and third ventricles in people with schizophrenia (more often in men and women)
- deficient activity in a particular area of the frontal lobes, the dorsolateral prefrontal cortex
One hypothesis suggests that schizophrenia may have come about due to a _____ ____ 200 years ago.
viral infection
Why type of in utero events may be associated with schizophrenia?
- prenatal exposure to influenza
- prenatal brain damage as shown in finger ridges
There is a theory that schizophrenia came about due to a parasite called ______ ______
Toxoplasma gondii
Stress and schizophrenia
- stress of urban living may precipitate onset
- high number of stressful life events in a short amount of time
- Being born in the winter increases chances of having schizophrenia by 5-8%
- lower socioeconomic status is a risk factor (sociogenic hypothesis)
- may experience a downward social drift into the lower social classes (social selection hypothesis)
at one time the term _______________ was used to describe a mother whose cold, dominant, and rejecting nature was thought to cause schizophrenia in her children
schizophrenogenic
According to an obsolete, unsupported theory, the practice of transmitting conflicting messages that was thought to cause schizophrenia is called _______ _______.
double bind
________ _______ is Hostility, criticism, and overinvolvement demonstrated by some families toward a family member with a psychological disorder
expressed emotion
Expressed emotion can often contribute to a schizophrenic person’s ________.
relapse
Family communications involving high levels of expressed emotion are characterized by which four characteristics?
- intrusiveness
- high levels of emotional response
- negative attitude toward the illness on the part of family members
- low tolerance and unrealistic expectations of the patient
TRUE or FALSE: Expressed Emotion is universal across cultures
TRUE
What were some earlier forms of treatment for schizophrenia?
- insulin induced coma
- electroshock therapy
The psychiatrist Heinz Lehmann is credited by many with introducing ________ medications for the treatment of schizophrenia to North America.
neuroleptic
How do neuroleptic medications help treat schizophrenic patients?
- They help people think more clearly and reduce or eliminate hallucinations and delusions.
- They work by affecting the positive symptoms (delusions, hallucinations, agitation) and to a lesser extent the negative and disorganized symptoms.
Are neuroleptics dopamine agonists or antagonists?
antagonists
What were the earliest neuroleptic drugs called?
conventional antipsychotics
Newer neuroleptic medications include _______, _______, and __________.
- clozapine
- olanzapine
- risperidone
What are the benefits of newer neuroleptic medications?
- can reduce the severity of long-standing tardive dyskinesia
- may be more effective in reducing both negative and positive symptoms
- may be helpful in improving cognitive functioning
- tend to have fewer serious side effects than the conventional antipsychotics
What is the biggest reason as to why neuroleptic medications don’t work?
patients don’t routinely take their medication
List five reasons as to why schizophrenic patients may be noncompliant for taking their medication
- negative doctor-patient relationships
- stigma
- cost of medication
- poor social support
- negative side effects from the medications
What are some of the side effects from neuroleptic medications?
- extrapyramidal/parkinson symptoms, including:
- Akinesia (expressionless face, slow motor activity, and monotonous speech)
- Tardive Dyskinesia ( involuntary movements of the tongue, face, mouth, or jaw, protrusions of the tongue, puffing of the cheeks, puckering of the mouth, and chewing movements)
- Akinesia (expressionless face, slow motor activity, and monotonous speech)
Tardive dyskinesia seems to result from ______ term use of ______ doses of antipsychotic medication and is often _________.
- long
- high
- irreversible
Studies have shown that ___-___% of all patients treated with antipsychotics develop tardive dyskinesia, with lower risk for younger people: only ___-___% percent of young people taking this medication display tardive dyskinesia, with the risk _______over time.
- 20 to 50%
- 3 to 5%
- increasing
Researchers hoped that compliance rates of taking schizophrenic medication would improve with the introduction of ________ medications, for they would only need to take it once every ___-____ weeks.
- injectable
- 2-4 weeks
innovative treatment for the hallucinations experienced by many persons with schizophrenia is __________ ___________ ________. Why is it that this helps?
- transcranial magnetic simulation
- interrupts the normal communication temporarily to that part of the brain
TRUE or FALSE: TMS was generally effective in treating the auditory hallucinations
FALSE: TMS can modestly improve auditory hallucinations but its effects last less than one month
What are the psychosocial interventions for schizophrenia?
- adequate community supports
- reteach basic social skills
- ensure families reduce levels of EE via behavioural family therapy
- vocational rehabilitation (ie. supportive employment)
- CBT
It is increasingly becoming recognized that ______ ________ can be important in affecting the course of the disorder over time.
early intervention
What are the five key elements of early intervention when it comes to Schizophrenia?
- Reduction of duration of untreated psychosis through education
- Assessment and the context of care: building a therapeutic alliance
- Family engagement and support
- Comprehensive, phase-specific, individualized treatment
- Prolonged engagement to sustain gains
TRUE or FALSE: Schizophrenia treatments vary across culture to culture
TRUE
What are two strategies for preventing schizophrenia?
- identify and treat children who may be at risk for getting the disorder later in life
-treat persons in the prodromal stages of the disorder
approximately ____% of the children born to parents who have schizophrenia are likely themselves to develop the disorder.
17%
What does the latin definition of schizophrenia?
“split mind”
