Chapter 9 Flashcards
What are the negative symptoms of schizophrenia?
Experiential negative symptoms:
- Avolition/Apathy: Lack of motivation and lack of interest in daily activities
- Anhedonia: diminished capacity to anticipate and experience pleasurable emotions
- Asociality: lack of interest in social interactions; leads to social withdrawal
Expressive negative symptoms:
- Alogia: difficulty speaking or a reduced desire to speak
- Affective flattening: A lack of emotional expressivity and facial expression
Disorganized behaviour and motor symptoms of schizophrenia
Disorganized behaviour: problems initiating or sustaining appropriate goal-directed behaviour
Abnormal motor behaviour:
- Catatonia: causes people to engage in purposeless, repetitive behaviours like clapping, going silent, or maintaining a bizarre posture.
- Wavy flexibility: someone stays in a position someone else puts them in
Cognitive symptoms of schizophrenia
Impairments in cognitive functions:
- memory
- attention
- learning
- processing speed
- problem solving
These symptoms are separate from positive and negative symptoms and often persist even after treatment
Positive symptoms of schizophrenia—Hallucinations
Hallucinations: abnormal perceptual experiences that occur without the stimuli needed for it
- Auditory Hallucinations—hearing sounds or voices that other people cannot hear
- Command Hallucinations—the voices command the person to do something
- Visual Hallucinations—seeing partially formed images that may disappear upon interaction with them
- Tactile Hallucinations—feeling sensations on your body, producing fear
- Somatic Hallucinations—feeling sensations in the internal body
- Gustatory Hallucinations—tasting things you cant actually taste
These hallucinations occur in the context of a clear sensorium: a clear state not clouded by drugs, fatigue or other conditions
Positive symptoms of schizophrenia—Delusions
Delusions: fixed, false, unfounded beliefs subject to extreme belief perseverance
- Persecutory Delusions: belief that one is being conspired against
- Grandiose Delusions: belief that one possesses special powers/knowledge
- Religious Delusions: unfounded beliefs regarding rigid themes ad can often involve the person taking on the role of a religious icon
- Somatic Delusions: beliefs that one’s body is changing
- Referential Delusions: a belief that common events, objects or individuals hold a personally relevant meaning to the affected individuals—like its a special message to them
Bizarre Delusions: completely impossible experiences
Non-Bizarre Delusions: could occur in reality but rare
Positive symptoms of schizophrenia—Thought Disorder and Disorganized speech
Thought disorder and disorganized speech: disorganized linguistic communication through either verbal or written means; hard to understand
- Loosening of associations: when speech switches from topic to topic with little connection between them
- Tangentiality: response doesn’t match the topic
- Perseveration: person becomes fixated on a specific word or idea and repeats it over and over
- Circumlocution: yapping, dancing around the answer
What is a neologism? What is a word salad?
A form of thought disorder where people use words that are completely made up or real words that are out of place contextually
Word salad: completely incoherent speech
Describe the Diathesis-Stress Model of schizophrenia
Etiology
General: schizophrenia comes from an interaction between biological vulnerability (predisposition) and environmental stressors.
As the extent of the predisposition goes up, the threshold of stress goes down.
Describe the Neurodevelopmental Model of schizophrenia
Etiology
General: suggests that schizophrenia is the result of a long-term process of atypical brain development; multiple risk factors accumulate over time.
Influences: these factors accumulate gradually
1. Prenatal: genetics, prenatal infections, prenatal malnutrition
2. Early developmental delays: Motor/speech delays, social difficulties, cognitive deficits, early MH issues
3. Social stressors: experiences like bullying etc
4. Additional MHds: Anxiety, depression etc
Describe biological factors of schizophrenia—the dopamine hypothesis and its mechanism
Schizophrenia results from abnormally high levels of dopamine in the subcortical regions of the brain
Mechanism (Aberrant salience): assigning too much importance to innocuous stimuli.
1. Too much dopamine causes neurons to have a lower threshold of excitation
2. This causes them to fire in response to innocuous stimuli
3. To make sense of these stimuli, positive symptoms develop
Describe biological factors of schizophrenia—neurobiological findings
- Structural abnormalities in the brain occur in 25% of schiz
(e.g., reduced grey matter in the temporal and frontal lobes) - Reduced activation of the frontal regions occurs in 50%
Describe the Psychological Factors that contribute to schizophrenia—Neurocognition
We can use neuropsychological tests to measure brain function in schizos; while an indirect measure, it provides us a basis to make assumptions regarding brain functioning
Neurocognitive impairments are very common in schizos; may be associated with schizo but it’s not significant enough to cause the disorder.
Describe the Psychological Factors that contribute to schizophrenia—social cognition
Social cognition: cognitive abilities necessary for understanding the social world
- Schizos are bad at understanding others’ emotions
- Bad at mental state inference
Describe the Psychological Factors that contribute to schizophrenia—cognitive biases
Biases in how info is processed.
Delusions are associated with cognitive biases:
1. schizos jump to conclusions without enough evidence
2. schizos do hella belief perseverance
Hallucinations are associated with cognitive biases:
1. Source monitoring bias: ppl misattribute internal stimulation (song stuck in your head) to an external source (song actually playing on a speaker)
Describe the Psychological Factors that contribute to schizophrenia—social factors
Social defeat theory: chronic exposure to negative social exp leads makes the dopaminergic system more active, thereby increasing the risk for schizophrenia
Describe the 4 phases of schizophrenia
- Premorbid Phase: No symptoms yet, but risk factors may be present.
- Prodromal Phase: Early warning signs, such as social withdrawal and subtle cognitive changes.
- Active Phase: Full symptoms appear, including hallucinations and delusions.
- Stable Phase: Symptoms lessen, but negative symptoms and relapses may continue.
Differ functional recovery from personal recovery
Functional Recovery: ability to regain function in life
Personal Recovery: experience of regaining confidence
Treatments for schizophrenia: Antipsychotics
Antipsychotics:
- Typical Antipsychotics: Dopamine antagonists
- Reduce positive symptoms - Atypical Antipsychotics: Dopamine antagonists and dopamine agonists
- Reduce positive symptoms with more side effects
Treatments for schizophrenia: Psychosocial Treatment
Psychosocial treatments focus on skills training and therapy to support functional recovery and address the impact of symptoms on daily life
- Psychotherapy: helpful combined with medication
- Skills training: helps improve ability to manage everyday tasks (self-care, communication). Improves community functioning
Treatments for schizophrenia: CBT for psychosis (CBTp)
CBTp is a form of CBT adapted to treat positive symptoms and reduce distress.
- reduces severity of symptoms
- improves functional abilities
Helpful in the early stages
Treatments for schizophrenia: Cognitive Remediation ****
Aimed at improving neurocognitive impairments that commonly occur in individuals with schizophrenia
Three main therapeutic elements:
1. Computerized cognitive training: computerized exercises that become progressively more difficult to promote neuroplasticity
2. Strategy Monitoring: developing new cognitive strategies to address challenges
3. Functional Generalization: transferring the cognitive strategies learned through training to real-life scenarios
Treatments for schizophrenia: Family therapy and psychoeducation
Integrates family support into recovery, aiming to improve family dynamics:
Strategies:
1. Psychoeducation abt schiz and its symptoms
2. Crisis intervention skills
3. Problem-solving strategies
4. Communication skills training
Focuses on two levels of goals:
1. Patient-level goals: improving overall recovery for schizo
2. Family-level goals: reducing distress, improving relationships, and addressing the burden of caregiving
What is Expressed Emotion (EE)?
A measure of the emotional climate within families; related to relapse risk in schizophrenia
Treatments for schizophrenia: Skills training (3 areas)
Focuses on teaching practical skills necessary for daily living
Skills training programs target various areas:
1. Social skills training: enhancing interpersonal abilities
2. Functional skills training: teaches essential daily living skills necessary for independent living
3. Vocational rehabilitation: helps people develop job-specific skills
