Chapter 6 - Schizophrenia Flashcards
1
Q
Broad definition of schizophrenia
A
- Psychotic disorder with major disturbances in thought, emotion, behaviour
- Disordered thinking in which ideas are not logically related
- Faulty perceptions and attention
- Flat/inappropriate affect
- Bizarre disturbances in motor activity
2
Q
How to diagnose schizophrenia
A
- No essential symptom
- Heterogeneity in patients
3
Q
In which ways does the course of schizophrenia varies?
A
- Onset: sometimes childhood, often young adult, sometimes later in women
- Number of acute episodes (many or 1)
- Symptoms between episodes (residual or severe, or chronic)
- Treatment (in the community or hospitalized)
4
Q
Comorbidity
A
Often comorbid with personality disorders (avoidant, paranoid, dependent, anti-social), also substance use disorders, depression and anxiety
5
Q
Positive symptoms
A
Too much behaviour
- Hallucinations
- Delusions
6
Q
Acute psychosis refers to
A
Positive symptoms
7
Q
Delusions
A
- Erroneous beliefs despite clear contradictory evidence
- Anbormal thought content (bizarre)
- Usually involves misinterpretation of perceptions/experience
- Found among more than 1/2 people with SZ
- Are found in other diagnoses (mania, delusional depression)
8
Q
Types of delusions
A
- Persecution (tormented, followed, ridiculed, spied on, etc, leave or hide)
- Reference (environmental cues specifically directed to them)
- Body control (Body/actions manipulated by someone/something)
- Grandeur (being famous/important)
- About one’s thoughts
9
Q
Delusions about one’s thought (types)
A
- Insertion (thoughts were inserted in their brain)
- Withdrawal (thought were taken away from them)
- Broadcasting (people outside can hear their toughts)
- Reading (people can read their thoughts)
10
Q
Syndromes about delusions
A
- Capgras’ syndrome (a person has been replaced with an imposter, or they are their own double)
- Cotard’s syndrome (one has lost body parts or has died)
11
Q
Hallucinations
A
- Most dramatic distortions of experience
- Sensory experiences without stimulation
- Auditory are most frequent
12
Q
Types of voices heard
A
- Their own thoughts spoken by someone else
- Hear voices arguing
- People commenting on behaviour
13
Q
What are disorganized symptoms
A
- Inappropriate affect
- Disorganized speech (rare but hallmark)
14
Q
Inappropriate affect
A
Emotional responses out of context
Shift rapidly from one state to another
Rare, but important
15
Q
Disorganized speech
A
Formal Thought Disorder
thoughts are disorganized, include loose associations and incoherence
16
Q
Loose associations
A
when people are talking they are skipping to another subject which seems totally unrelated (but for them, it seems like they are talking about the same thing since the beginning)
17
Q
Incoherence
A
Speech that is impossible to follow
18
Q
Catatonia (not + or -)
A
Several motor abnormalities
Gesture repeatedly, unusal increase in movements
19
Q
Catatonic immobility
A
Adopting unsual postures and maintaining them for long periods of time
20
Q
Waxy flexibility
A
Another person can move the person’s limbs into strange positions that they will maintain for extended periods
21
Q
Negative symptoms
A
Avolition Alogia Anhedonia Flat Affect Asociality
22
Q
Avolition
A
Lack of energy and seeming absence of interest in routine activities
Inattentive to grooming, personal hygiene
Difficulty persisting at work/school/household chores and spend most time doing nothing
23
Q
Alogia
A
Poverty of speech (amount of speech reduced) or of content of speech (amount of speech is ok, but conveys little information)
24
Q
Anhedonia
A
Inability to experience pleasure
Lack of interest in recreational activities, sex, relationships
Awareness of this symptoms
25
Flat affect
No stimulus can elicit an emotional response - no face expressions, no voice expressions
Refers ONLY to outward expression, not to internal feelings which are intact
26
Asociality
Impaired social relationships
| Social anxiety is commonly comorbid
27
5 SZ subtypes
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Paranoid
Disorganized (hebephrenic)
Catatonic
Undifferentiated
Residual
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28
Paranoid SZ
Delusions/frequent auditory hallucinations (typically persecutory/grandiose)
Usually organized around a theme
40% of cases
No disorganized speecch, catatonic behaviour, flat affect
Good prognosis
29
Disorganized SZ (hebephrenic)
Disorganized speech, behaviour, flat/inappropriate affect
No catatonia
Hallucinations/delusions don't have a theme
Poor premorbid personality
Poor prognosis
Early/gradual onset
30
Catatonic SZ
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Psychomotor disturbance (motoric immobility, exessive motor activity, extreme negativism/mutism, posturing, echolalia or exhopraxia)
Rare in industrialized countries
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31
Echolalia
Repeating words
32
Echopraxia
Echolalia but for movements
33
Undifferentiated SZ
Symptoms, but unmet criteria for Paranoid, Disorganized, or Catatonic
60% of cases
Catchall category
34
Residual SZ
At least 1 episode of SZ, but no longer prominent positive/disorganized symptoms
Continued negative symptoms
35
Argument to remove subtypes in DSM-5
Rarely used diagnostically, except paranoid
Too much variability in the symptoms
Instead included dimensional rating
36
Alternative approach to the subtypes
Proposes to make categories based on performance on neuropsychological tests
1. Normative (intact cognition)
2. Executive (impairment on Card Sorting Test)
3. Executive-motor (deficits in card sorting and motor functioning)
4. Motor (deficits only in motor functioning)
5. Dementia (pervasive and generalized cognitive impairment)
37
Genetic variability of SZ
Concordance rates in MZ is 15-65%, 3-14% in DZ (increases when more severe)
Polygenic
Share genetic variability with MDD, bipolar, ASD and ADHD
Biological parents + likely to have it than adoptive, for SZ patients
38
Enlarged ventricles in SZ
Reduced grey matter in temporal and frontal regions, basal ganglia
Seen in twins; not genetic
Can be detected at 1st episode
Causes impairment
39
Hypofrontality in SZ
Reduced resting metabolism in PFC
PFC activity accompanied iwth temporal gyrus activity = auditory hallucinations
Reduced PFC response in Card Test
40
Dopamine hypothesis for SZ
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1st: excessive dopamine activity (dismissed)
Evidence was (L-DOPA (drug) can induce psychotic symptoms, amphetamines also can, antipsychotics are dopamine antagonists)
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More likely: excessive D2 (dopamine) receptors
41
What is behind the negative/positive symptoms (dopamine hypothesis)
Negative: dopamine neurons under-active in PFC
Positive: release of mesolimbic dopamine neurons from inhibitory control
42
Glutamate hypothesis
Reduced glutamate transmission
PCP and ketamine (glutamate antagonists) can induce psychosis
Reduced activity of receptors (NMDA) leads to neuronal death in certain areas (could explain enlarged ventricles)
43
Combined glutamate/dopamine hypothesis
+D2 receptors = -Glutamate = less NMDA activity (=enlarged ventricles)
Serotonin; also implicated (regulate dopamine neurons in mesolimbic pathway)
44
Prenatal risk factors
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Viral infection (no real evidence)
Nutritional deficiency (low birth weight)
Gene-environment interaction
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45
Psychosocial factors
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High stress sensitivity
Urban living / immigration (big stressor)
More common in people with low SES
Communication deviance/problems
Expressed Emotion in household
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46
Sociogenic hypothesis
Being in a low SES brings many stressors, which can then lead to the development of schizophrenia
47
Social drift hypothesis (social selection theory)
Developing schizophrenia may make people drift into lower SES neighborhoods because they can't hold the stress of maintaining their older lifestyle
48
Which is true: sociogenic or social drift hypothesis?
An egg/chicken situation: to answer it, are the fathers of people with schizophrenia also having the disease? Yes = evidence in favour of the sociogenic hypothesis, no = evidence for other hypothesis
Not many fathers were found to be from lower SES, supporting social drift
49
What is expressed emotion (EE)
Criticism, Hostility, Emotional overinvolvment from the relatives of a SZ patient
Increases form 13 to 50% the risk of relapse in the 1st year when the person comes back from the hospital in a high EE household
Causal or reactive? Both
50
Schizophrenogenic mother
cold, dominant and conflict-inducing mother that is said to produce schizophrenia in her kids (hypothesis; not supported)
Disturbed rearing environment could also be a risk factor, but it can also be a response to the illness of the child
51
Pre diagnosis signs of SZ in childhood
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Pre-diagnosis signs of Schizophrenia in childhood:
Lower IQ
Girls were passive
Boys were disagreeable
Delinquent and withdrawn
High-risk method, unreliable data
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52
Risk factors in childhood for positive and negative symptoms
Difference between history of positive and negative symptoms schizophrenia
Positive: history of family instability, foster homes, etc
Negative: pregnancy and birth complications
53
First generation antipsychotic medication
Dopamine antagonists (D2 receptors)
Chlopromazine (Thorazine), haloperidol (Haldol)
Effective on positive symptoms mostly
Side effects
54
APA guidelines for treatment
1. Antipsychotic medication
2. Treatment of comorbid disorders (esp. Depression and substance abuse)
3. Psychological treatment (therapy)
55
Dystonia (side effect of 1st gen antipsychotics)
Muscle rigidity
56
Akathisia (side effect of 1st gen antipsychotics)
unable to stay still
57
Dyskinesia (side effect of 1st gen antipsychotics)
Abnormal motion of muscles, producing chewing movements and movements of lips, fingers, legs
58
Tardive dyskinesia (side effect of 1st gen antipsychotics)
involuntary lip smacking, chewing, sucking movements
59
Neuroleptic malignant syndrome (side effect of 1st gen antipsychotics)
severe muscular rigidity and fever, can be fatal
60
Second generation antipsychotics
Less side effects
Clozapine (works on treatment-resistant SZ), Risperidone
Effective on + and - symptoms
Better compliance since less side effects
61
Family therapy for SZ
Reduce EE
Provide communication skills
Education on illness
Lower expectations on the patient
62
Social skills training for SZ
Learn skills in specific domains: employment, relationship, self-care, conversation, etc
Break down tasks = less overwhelming
Not necessarily improve global functioning
63
Psychodynamic therapy for SZ
Requires patient to gain insight into the role that the past played in current problems
Long term, often not realistic
64
CBT for SZ
Goal: decrease symptoms intensity, relapse and social difficulties through "reality checks"
Reduces positive symptoms
65
Cognitive enhancement therapy (CET) for SZ
Cognitive-enhancement therapy (CET): computer training in attention, memory, problem solving, and social-cognitive skills - helps with deficits induced by the disorder - protects against grey matter loss in the brain
66
Assertive Community Treatment (ACT) for SZ
team of case managers that help people get in contact with the services they need
67
Kraepelin's descriptions of SZ
Kraepelin: dementia praecox (manic-depressive illness was another type of psychosis)
Early onset: praecox
Intellectual deterioration: dementia (not the same as old-age dementia)
68
Bleuler's description of SZ
Bleuler: believed that it did not necessarily have an early onset, and that it did not necessarily led to dementia
Replaced the name with schizophrenia
Tried to find a common denominator between all the categories/symptoms - the "breaking of associative threads"
69
Historical prevalence of SZ
Hard to consider the historical prevalence since the definition for the disorder has been everchanging
In the US, the prevalence increased in the 1930s
Kasanin: added the term "schizoaffective psychosis" to describe instances of schizophrenia
US clinicians diagnosed schizophrenia whenever delusions or hallucinations were present
Personality disorders were also often diagnosed as schizophrenia
People with acute onset of schizophrenia and a rapid recovery were diagnosed as having schizophrenia
70
Other issues in SZ
Homeless mentally ill
Obtaining employment and housing
Destigmatization
71
Old treatments for SZ
Insulin-induced coma
Lobotomies - leucotomies
Today - TMS
72
Current prevalence / gender / life expectancy for SZ
12-month prevalence 0.33%
People affected by it have 20yrs lower life expectancy
4 men for 1 women
