Chapter 14: Schizophrenia Flashcards
What are the truths behind the common misconceptions of schizophrenia?
- Not a “split personality” as in two identities, but a “split mind” and shattered personality
- Not a violent disorder per se
What is the lifetime prevalence of schizophrenia?
1% of the world’s population
When is the onset of schizophrenia?
Usually late teens to mid 20s
Acute onset vs. chronic onset of schizophrenia. Which has better prognosis?
- Acute = suddenly appearing psychotic symptoms w/ good premorbid adjustment
- Chronic = slow process of steady deterioration without periods of remission and poor premorbid adjustment
- Better prognosis = acute
What course does schizophrenia take?
- Deterioration w/ each episode
- Treatable, but no cure
What is the gender ratio of schizophrenia? Exceptions?
1: 1
- More younger males (under 25) first diagnosed than younger females
- More older women (40+) first diagnosed than older men
When are the majority of males and females diagnosed with schizophrenia?
When under 25 years old
List the main symptoms of schizophrenia.
- Perception = hallucinations
- Thought content = delusions
- Thought processes = formal thought disorder
- Emotion
- Motivation
- Relating to others
- Motor behavior
Describe the hallucinations symptom of schizophrenia.
- Involuntary sensory experiences w/o sensory stimulation and not related to external stimuli
- Mostly auditory (hearing voices), but sometimes also visual, olfactory, tactile
- Voices are realistic and heard outside of one’s head
- Voices may be commenting, critical, commanding, whispering
Describe the delusions symptom of schizophrenia.
-False belief systems that are fixed and not open to change even when evidence contradicts them —> called “bizarre” if not derived from ordinary experience
What are the most common delusions of schizophrenia?
- Persecution = paranoia
- Grandeur = grandiosity
- Reference = belief that random events are directed at oneself
- Thought broadcasting = belief that others can hear/read one’s thoughts
- Delusions of mind reading = belief that one is able to read others’ thoughts
Describe Formal Thought Disorder as a symptom of schizophrenia.
Disordered thinking manifested by:
- loosely connected thoughts
- digressive, associative speech (doesn’t seem to make sense)
- impaired logic (cause and effect are reversed or inconsequential)
- concreteness (inability to abstract of understand figurative speech)
- neologisms (making up new words that don’t exist in one’s language)
- probs w/ selective attention (inability to distinguish important from unimportant)
Describe the emotional symptoms of schizophrenia.
- Agitated manic affect
- Inappropriate affect
- Flat, blunt affect
Describe the motivational symptoms of schizophrenia.
- Loss of interest
- Loss of enjoyment (anhedonia)
- Loss of goals (avolition)
- Loss of drive
Describe the relational symptoms of schizophrenia.
- Social withdrawal
- Loss of social skills
List the motor behavior symptoms of schizophrenia.
- Purposeless motor acts, tics, mannerisms
- Agitation, pacing
- Catatonia (motionless, frozen state, strange postures)
- Loss of complex coordination, left-right confusion
What are the positive symptoms of schizophrenia?
- Hallucinations
- Delusions
- Agitation
What are the negative symptoms of schizophrenia?
- Loss of logical thinking (formal thought disorder)
- Loss of coherent speech)
- Flat, blunt affect
- Anhedonia
- Avolition
- Alogia (having nothing to say in convos)
- Social withdrawal
What makes positive symptoms better than negative symptoms of schizophrenia?
Positive symptoms are easier to treat w/ meds and generally suggest a better prognosis
What is the DSM-V criteria for schizophrenia?
- At least 2/5 of the following symptoms must be present, whereby at least one needs to be delusions, hallucinations, or disorganized thinking
1. Delusions
2. Hallucinations
3. Disorganized thinking (speech)
4. Grossly disorganized or abnormal motor behavior
5. Negative symptoms - Significant deterioration of functioning in one or several areas (work, relations, self care)
- Continuous signs of disturbance persist for at least 6 months
- Symptoms not caused by substance use or a medical condition
What are the types of schizophrenia?
- Paranoid
- Disorganized
What is the main difference between paranoid and disorganized schizophrenia?
- Paranoid = prominent symptoms are mostly positive
- Disorganized = prominent symptoms are mostly negative
Describe paranoid schizophrenia.
- Delusions of persecution or grandeur
- Auditory hallucinations
- Paranoia-related fear, anger, hostility
- Cognitive skills remain relatively intact (no formal thought disorder)
- Responds relatively well to antipsychotic medications
- Likely to refuse meds and other treatment
Describe disorganized schizophrenia.
- Formal thought disorder
- Social withdrawal
- Flat or inappropriate affect
- Anhedonia, avolition, alogia
- Bizarre mannerisms
- Regressed behavior (childlike, immature)
- Inappropriate social behaviors (peeing, masturbating in public)
- Disintegration of personality
- May experience hallucinations
- No organized delusional system
- Early onset
- Poor premorbid adjustment
- Chronic course with likely brain damage
- Poor prognosis
What are the phases of schizophrenic illness?
- Prodromal phase
- Psychotic phase
- Resitual state
Define the prodromal phase of schizophrenic illness.
Approaching psychotic phase
Define the psychotic phase of schizophrenic illness
Full symptoms
Define the residual state of schizophrenic illness
- Remaining symptoms after episode
- No active delusions or hallucinations
- Similar to schizotypal personality disorder
What is brief psychotic disorder? Symptoms?
- Same symptoms as schizophrenia
- Symptoms last less than a month
What is schizoaffective disorder?
- Criteria met for both major mood disorder (bipolar I or II, or MDD) and schizophrenia
- Psychosis for at least 2 weeks w/o simultaneous mood symptoms
What is delusional disorder?
- Delusions are only psychotic symptom
- No mood symptoms, no hallucinations, no negative symptoms
Is schizophrenia one disorder or a group of disorders? Explain.
- A group of disorders –> schizophrenia spectrum
- Overlap w/ other disorders
- Differing degrees along spectrum
Is there one or several causal factor(s) of schizophrenia?
Multiple factors that accumulate
What are the abnormalities associated w/ schizophrenia? What symptoms does each produce?
- Biological = structural, biochemical, electrical
- Structural = mostly cause negative symptoms (chronic or disorganized schizophrenia)
- Biochemical = positive symptoms
How does schizophrenia affect gray matter in the brain? Course?
- Progressive loss of gray matter
- Parietal cortex –> temporal lobe –> frontal lobes
How does schizophrenia affect white matter of the brain?
- Progressive loss of white matter in temporal region
- Demyelinization
- Correlated w/ poor social functioning
How does schizophrenia affect the ventricles?
Dilation of ventricles = enlargement of fluid-filled spaces in brain –> shrinking of surrounding brain tissue
How does schizophrenia affect the hypocampus?
- Atrophy of hypocampus
- Probs w/ memory
How does schizophrenia affect the thalamus?
- Thalamus irregularities
- Sensory gating deficit
- Sensory overload
How does schizophrenia affect the frontal lobes?
Shrinking, underactive
How does schizophrenia affect the temporal lobe?
- Temporal lobe abnormalities
- w/ hearing voices
How does schizophrenia affect the corpus callosum?
- Thinner
- Fewer fibers connecting hemispheres –> less integration of R/L sides of brain
What impairments does neuropsychological testing show about schizophrenia?
- Memory
- Attention
- Concentration
- Problem solving
- Abstraction
What are examples of soft neurological signs?
- L/R confusion
- Difficulty detecting 2 simultaneous touches to body w/ one’s eyes closed (report only one touch)
When comparing videos of children who later would develop schizophrenia to videos of their normal siblings, the affected child showed what symptoms?
- More motor abnormalities, less coordinated
- More facial ticks like blinking
- More negative emotional expressions in face
- Lower social competence
- More probs w/ attention
How does schizophrenia affect eye movement?
Abnormalities in tracking, blink rate, reflexes
What are the neurodevelopmental abnormalities of schizophrenia?
- Handedness
- Fingerprints
- Final neuronal trimming/pruning abnormalities
How does schizophrenia affect handedness?
Schizophrenics less often have clear hand preference than the general population
How does schizophrenia affect fingerprints?
- Fingerprints different in identical twins when one has schizophrenia
- Few ridges, less complex
How does schizophrenia affect neuronal trimming/pruning?
Final neural trimming/pruning takes places in late teens/early 20s and involves frontal lobes (around same time as onset of schizophrenia)
How does schizophrenia affect the dopamine system?
- Over-reactivity of dopamine receptors in schizophrenic brain
- Methamphetamines and cocaine are dopamine agonists –> creates positive symptoms
- Dopamine inhibits release of glutamate
How does schizophrenia affect the serotonin system? Role of LSD?
- LSD can cause psychotic symptoms (break w/ reality, visual hallucinations, depersonalization, etc.)
- LSD mimics serotonin molecules –> blocks serotonin receptors
How does schizophrenia affect the glutamate system? Role of PCP?
- Schizophrenia is associated w/ diminished glutaminergic activity, especially in the hippocampus and the anterior cingulate cortex
- PCP is a glutamate antagonist –> produces both positive and negative symptoms
How is schizophrenia related to the age of the father (sperm donor)?
Fathers over the age of 50 are 3x more likely to have kids w/ schizophrenia than dads under 25 years old
How is schizophrenia related to maternal psychological stress?
- Critical time period = 3-4th month of pregnancy
- If death of close relative in this period of pregnancy, it results in a 67% increase of schizophrenia in the child
- Increase of maternal stress hormones passed on to fetus
How is schizophrenia related to maternal nutrition?
Critical period during first trimester of pregnancy makes child more prone to schizophrenia
What pregnancy/birth complications contribute to schizophrenia?
Low birth weight, oxygen loss, etc.
How does exposure to virus contribute to schizophrenia? When does this occur?
- Beginning to middle of pregnancy
- Virus doesn’t cross placenta and isn’t directly responsible for abnormal brain development in the fetus
- Virus mobilizes the mother’s immune system, produces antibodies, and antibodies cross the placenta barrier and react w/ fetal brain antigens
- Immunological response that disrupts the development of the fetus’s critical brain structures
Describe the genetic predisposition of schizophrenia?
- Schizophrenia is not a “genetic” disorder
- What is inherited is a vulnerability to factors playing a role in developing the illness
- One’s genetic makeup controls how sensitive we are to certain aspects of the environment
- Genes can be turned on or off in response to environmental conditions
How are multiple genes involved in schizophrenia?
Multiple pathways and the gene overlap may account for the different forms of schizophrenia and the various schizophrenia spectrum disorders
What fraction of individuals w/ schizophrenia have a known fam history of the disorder in their first or second degree relatives?
1/3
How do gene mutations play a role in schizophrenia? What are genetic glitches? What do they cause?
- 3-4 times more nonspecific genetic glitches were found in schizophrenic patients
- Genetic glitches = DNA duplications or omissions in the genetic code that influence how neuronal circuits get sculptured
- This can lead to signals not getting filtered out –> creates hallucinations, thought problems, general “overload”
What is the probability of developing schizophrenia in the general population?
1%
What is the probability of developing schizophrenia as a spouse?
2%
What is the probability of developing schizophrenia as a first cousin?
2%
What is the probability of developing schizophrenia as a nephew/niece?
4%
What is the probability of developing schizophrenia as a sibling?
9%
What is the probability of developing schizophrenia as a fraternal twin?
17%
What is the probability of developing schizophrenia as an identical twin?
48%
What is the probability of developing schizophrenia as the offspring of one schizophrenic parent?
13%
What is the probability of developing schizophrenia as the offspring of 2 schizophrenic parents?
46%
What did the Finnish Adoption Study (2004) reveal about children w/ one schizophrenic parent?
- Adopted into high stress non-schizophrenic family = 37% developed schizophrenia
- Adopted into low stress non-schizophrenic family = 6% developed schizophrenia
- Raised by schizophrenic parent = 17% developed schizophrenia
What are the current etiologies of schizophrenia?
- Genetics
- Viral infections
- Neurodevelopment
- Stress/trauma factors
What are the obsolete etiological theories?
- Masturbation = brain rot
- Schizophrenogenic mother = cold, distant mothers cause schizophrenia in their children
- Double bind = contradictory (Catch 22) communication patterns in families create schizophrenia in children –> putting kids in position to make decisions in which there are bad consequences for both choices
- Thomas Szasz = fake disease, myth of mental illness
- R.D. Laing = existentialist anti-psychiatrist; schizophrenia is a sane response to an insane world
What are the different kinds of hallucinations?
- Tactile = tingling, burning, electric shock sensations
- Somatic = something happening inside body
- Visual = vague perceptions of colors, clouds, or distinct visions of people or objects
- Gustatory = regularly find that their food/drink tastes strange
- Olfactory = smell odors that no one else does
What did Sigmund Freud believe about schizophrenia? What did he specialize in?
- Schizophrenia was a “brain disorder” –> not amenable to psychoanalytic treatment
- Specialized in treatment of neuroses
Who was Frieda Fromm-Reichmann? What did she believe?
-Schizophrenia was caused
by “schizophrenogenic” mothers (bad parenting)
In which racial group(s) is schizophrenia more common? Hypotheses?
- More common (overrepresented) in African Americans & Hispanic Americans
- Economically disadvantaged
How does schizophrenia differ in developing countries vs. developed countries?
- Course and outcome
- Developing countries have better recovery rates
- Developing countries more likely to recover from disorder
- Developing countries less likely to experience continuous or episodic symptoms, display impaired social functioning, require heavy antipsychotic drugs, require hospitalization
- Developing countries seem to provide more family and social support –> more relative and friends to help care for individuals, act less judgmental, critical, hostile
What are expressed emotions? How does it affect schizophrenia?
- Criticism, disapproval, hostility expressed in a family
- Individuals in recovery are 4x more likely to relapse if they live w/ such a fam than if they live w/ one low in expressed emotion
