Chapter 9 Flashcards
Misconceptions of Schizophrenia
- Schizophrenics are violent: most are not
- Schizophrenia is split personality: Schizophrenia derived from Greek term for “split mind” refers to the split in reality experienced not a split in personality
Schizophrenia
A chronic psychotic disorder characterized by disturbed behavior, thinking, emotions, and perceptions.
Psychosis
- The hallmark of schizophrenia
- A significant loss of contact with reality (ex. weather is at the door)
Heterogeneity
- Schizophrenia is characterized by heterogeneity
- People with the disorder differ from one another in symptoms, background, response to treatment, ability to live outside hospital care, etc.
Prevalence of Schizophrenia
Schizophrenia affects about 1% of the U.S. population and about 0.3% to 0.7% of the global population.
About 24 million people worldwide and
Approximately 300,000 Canadians
Peak age to get Schizophrenia
early to middle 20s for men and the late 20s for women.
Prodromal and Residual Phases
Prodromal Phase – The period of gradual deterioration.
Residual Phase – The phase that follows an acute phase, characterized by a return to the level of functioning of the prodromal phase; not actively psychotic. Flagrant psychotic behaviors are absent, but the person is still impaired by significant cognitive, social, and emotional deficits.
Diagnostic Features of Schizophrenia
- affects a wide range of psychological processes involving cognition, affect, and behavior.
- psychotic behaviors must be present at some point during the course of the disorder and signs of the disorder must be present for at least 6 months.
Positive symptoms of schizophrenia
- reflect an excess or distortion in a normal repertoire of behaviour and experience such as delusions, hallucinations, disorganized speech, disorganized behaviour, and/or a break with reality
- symptoms that are added due to the disorder, things that weren’t there before
Negative symptoms of schizophrenia
- reflect an absence or deficit of behaviours that are normally present such as flat or blunted emotional expressiveness, alogia, and/or avolition
- affect the person‘s ability to function in daily life
Common types of delusions
- Persecutory delusions (e.g., “The CIA is out to get me”)
- Referential delusions (“People on the bus are talking about me”)
- Somatic delusions (believing that one’s thoughts, feelings, impulses, or actions are controlled by external forces, such as agents of the devil)
- Delusions of grandeur (having grand but illogical plans for saving the world)
- Thought broadcasting — believing one’s thoughts are somehow transmitted to the external world so that others can overhear them
- Thought insertion — believing one’s thoughts have been planted in one’s mind by an external source (ex. Oh I really want a pizza, no wait that’s the pizza company putting that idea in my head)
- Thought withdrawal — believing that thoughts have been removed from one’s mind (ex. think of an ex you havent thought of in a while, oh someone must not want me to think of him)
Hallucinations
Sensory perceptions occurring in the absence of external stimuli that become confused with reality.
Hallucinations can involve any of the senses.
Common types of hallucinations
Auditory hallucinations (“hearing voices”) are most common, affecting about three of four schizophrenia patients Tactile hallucinations (such as tingling, electrical, or burning sensations). Somatic hallucinations (such as feeling like snakes are crawling inside one’s belly).
Causes of hallucinations
- remains unknown.
- Disturbances in brain chemistry are suspected and the neurotransmitter dopamine is implicated.
- Auditory hallucinations may be a form of inner speech that for unknown reasons becomes attributed to external sources rather than to one’s own thoughts
Thought disorder
A disturbance in thinking characterized by the breakdown of logical associations between thoughts.
Flat affect
observed by the absence of emotional expression in the face and voice
Alogia
a deficit or reduction in communication
Avolition
lack of motivation; inability to initiate and persevere in activities
Catatonia
People with schizophrenia may become unaware of the environment and maintain a fixed or rigid posture—even bizarre, apparently strenuous positions for hours as their limbs become stiff or swollen.
Waxy flexibility
allowing others to move their body and limbs and then maintaining new position
DSM-5 Diagnostic Criteria for Schizophrenia
- 2or more of the following over a 1 month period:
- Delusions*
- Hallucinations*
- Disorganized speech*
- Grossly disorganized or catatonic behavior
- Negaive symptoms
- 1 of the criteria has to be a positive symptom (*)
- Difficulties in social functioning, work, or self-care
- Symptoms continuous for at least six months
- The disorder is not contributed to substance use or another medical condition, and is not better explained by a different psych disorder
Endophenotypes
Measurable processes or mechanisms not apparent to the naked eye, which are the means by which an organism’s genetic code comes to affect its observable characteristics or phenotypes.
Investigators are exploring possible endophenotypes in schizophrenia, including disturbances in brain circuitry, deficits in working memory, impaired attentional and cognitive processes, and abnormalities in neurotransmitter functioning.
Psychodynamic Perspectives on Schizophrenia
Schizophrenia represents the overwhelming of the ego by primitive sexual or aggressive drives or impulses arising from the id.
These impulses threaten the ego and give rise to intense intrapsychic conflict.
Under such a threat, the person regresses to an early period in the oral stage, referred to as primary narcissism.
Learning Perspectives on Schizophrenia
From this perspective, people with schizophrenia learn to exhibit certain bizarre behaviors when these are more likely to be reinforced than normal behaviors.
Social-cognitive theory on Schizophrenia
these theorists suggest that modeling of schizophrenic behavior can occur within the mental hospital, where patients may begin to model themselves after fellow patients who act strangely.
Genetic Factors of Schizophrenia
First-degree relatives of people with schizophrenia have about a ten times greater risk of developing schizophrenia than general population.
Maternal twins and offspring of 2 schizophrenic people are closer to 50% chance of getting schizophrenia
Epigenetic mechanisms that turn genes on and off may be critical
Event-related potentials (ERPs)
- brain wave patterns that occur in response to external stimuli like sounds and flashes of light.
- can be broken down into various components that emerge at different intervals following the presentation of a stimulus.
- Schizophrenia patients show reduced levels of later-occurring ERPs which are believed to be involved in the process of focusing attention on a stimulus in order to extract meaningful information
The leading biochemical model of schizophrenia
the dopamine hypothesis, posits that schizophrenia involves an overreactivity of dopamine transmission in the brain.
Neuroleptics
antipsychotic drugs that block dopamine D2 receptors and target just the positive symptoms
Communication deviance (CD)
- a pattern of unclear, vague, disruptive, or fragmented communication that is often found among parents and family members of schizophrenia patients.
- speech that is hard to follow and from which it is difficult to extract any shared meaning
- parents of schizophrenia patients tend to have higher levels of CD
Expressed Emotion
- form of disturbed family communication
- a pattern of responding to the schizophrenic family member in hostile, critical, and unsupportive ways
- Schizophrenia patients from high EE families stand a higher risk of relapsing than those with low EE (more supportive) families.
- High EE relatives typically show less empathy, tolerance, and flexibility than low EE relatives.
The diathesis–stress model and Schizophrenia
views the development of schizophrenia in terms of an interaction or combination of a diathesis, or genetic predisposition to develop the disorder, and stressful life factors, especially environmental stress that exceeds the individual’s stress threshold or coping resources.
Environmental stressors may include psychological factors, such as family conflict, child abuse, emotional deprivation, or loss of supportive figures, as well as physical environmental influences, such as early brain trauma or injury
Tardive dyskinesia (TD)
A disorder characterized by involuntary movements of the face, mouth, neck, trunk, or extremities and caused by long-term use of antipsychotic medication. (the shakes)
atypical antipsychotics
Second generation of antipsychotic drugs that have largely replaced the earlier generation of antipsychotics and have the advantage of carrying fewer neurological side effects and a lower risk of TD
Cognitive Behavioural Therapy and Schizophrenia
- Usually used in combo with drugs
- Focuses on four principal problems
Emotional disturbance: Psychotic symptoms (e.g., hallucinations, delusions), Social disabilities, Risk of relapse - Treatment includes how to interpret environmental events, how to respond to social cues, practice dealing with particular positive symptoms
3 Learning-based therapies used for schizophrenia
- Selective reinforcement of behavior, such as providing attention for appropriate behavior and extinguishing bizarre verbalizations through withdrawal of attention.
- Token economy, in which individuals on inpatient units are rewarded for appropriate behavior with tokens, such as plastic chips, that can be exchanged for tangible reinforcers such as desirable goods or privileges.
- Social skills training, in which clients are taught conversational skills and other appropriate social behaviors through coaching, modeling, behavior rehearsal, and feedback.
Brief psychotic disorder
A psychotic disorder lasting from a day to a month that often follows exposure to a major stressor such as a job loss.
Schizophreniform disorder
A psychotic disorder lasting less than 6 months in duration, with features that resemble schizophrenia just to a lesser extent
Delusional disorder
Applies to people who hold persistent, clearly delusional beliefs, often involving paranoid themes but don’t see many of the other symptoms
Erotomania
A rare delusional disorder in which the individual believes that he or she is loved by someone, usually someone famous or of high social status and no one else can have him/her.
Schizoaffective disorder
A type of psychotic disorder in which individuals experience both severe mood disturbance and features associated with schizophrenia. The mood disorder makes it different enough.
