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Abnormal Psychology > Chapter 9 - Schizophrenia > Flashcards

Chapter 9 - Schizophrenia Flashcards

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1
Q

What does schizophrenia mean

A

Split mind

  • psychotic disorder, loss of contact with reality
  • most severe debilitating
  • most patients unable to care for themselves
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2
Q

Stats on schizophrenia

A
  • 10-20% of homeless
  • 40-60% live w family
  • begins early in life (16-25)
  • Suicide rates 8-10%
  • 2x as common as Alzheimers
  • 5x as common as MS
  • 300x as common as Cystic fibrosis
  • 1/100 ppl diagnosed, 300k in canada
  • 1/12 hospital beds
  • $6.85 billion annually in Canada
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3
Q

Groups of symptoms of schizo

A

1) Disordered thinking (speech)
2) Delusions (false beliefs)
3) Hallucinations
4) Disorganized motor behaviour (gross disorganized or catatonic)
5) Negative symptoms

1-4: Positive symptoms

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4
Q

Details of disordered thinking symptoms

A
  • Formal thought disorder (form/style not content)
  • Inchoherence - word salad
  • Neologisms - new (neo) words (logos)
  • loose associations
  • perseveration (stuck in one line of thinking - Wisconson card sort task
  • thought blocking
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5
Q

Details of delusions symptoms

A

Types

  • Reference (things have special significance)
  • grandeur
  • control (controlled by external)
  • persecution
  • somatic

Thought insertion
thought broadcasting
thought withdrawl (others removing thoughts frm head)

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6
Q

Most common form of hallucination

A
  • auditory
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7
Q

two types of disorganized motor behaviour

A

1) Disorganized - pacing, agitated, strange dress, talking,

2) Catatonic - waxy flexibility

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8
Q

Describe Negative symptoms

A
  • Alogia - poverty of speech (a - lack of; logia - speech)
  • anhedonia
  • flat affect
  • avolition - lack of motivation
  • social withdrawl (one of the first signs)
  • these are less responsive to antipsychotic meds
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9
Q

Name the positive symptoms of schizo

A
  • disordered thinking
  • delusions
  • hallucinations
  • disorganized motor behaviour
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10
Q

Define Alogia, Anhedonia, Avolition

A

Alogia - poverty of speech
Anhedonia - loss of enjoyment of pleasurable activities
Avolition - lack of motivation

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11
Q

Phases of Schizophrenia

A

Prodromal -> Active -> Residual

  • Prodromal: clear deterioration of functioning
  • Residual: attenuated symptoms following active phase
  • tends to be episodic
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12
Q

Diagnostic criteria for active phase

A
  • at least one month
    1) 2 or more symptoms
  • delusions, hallucinations, diorganized speech, gross disorganized or catatonic behaviour, negative symptoms
  • or -
    2) 1 symptom if
  • bizarre delusion; or, auditory hallucination of voice keeps a running commentary, or two or more voices conversing

Bizarre: impossible
Non-bizarre: could possibly be true (plot to be killed by neighbour)

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13
Q

Diagnostic criateria for schizophrenia

A
  • active phase at least 1 mos
  • all phases at least 6 months

If less than 6 months:

  • Brief psychotic disorder (<1 mos)
  • schizophreniform disorder (1-6 mos)
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14
Q

Subtypes of schizophrenia

A

1) Paranoid type
2) Disorganized
3) Catatonic
4) Undifferentiated
5) Residual

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15
Q

Which subtype has best and worst prognosis

A

Best: paranoid
Worst: disorganized

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16
Q

Features of paranoid subtype

A
  • delusions, auditory hallucinations (only)
  • no disorganized speech, behaviour or affect
  • most common, least severe
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17
Q

Features of disorganized subtype

A
  • disorganized speech, behaviour

- inappropriate affect

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18
Q

Features of Catatonic subtype

A
  • immobile, waxy flexibility, mutism, posturing, grimacing, echolalia, echopraxia,
  • behaviour excitement, agitation
  • more common in less developed countries, was more common 50 yrs ago in N America
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19
Q

Difference between Echolalia and Echopraxia

A
  • echolalia (repeat back others SAY)

- echopraxia (imitate BEHAVIOURS)

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20
Q

Undifferentiated subtype

A

doesn’t meet criteria for paranoid, disorganized, catatonic

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21
Q

Residual subtype

A
  • negative symptoms, attenuated positive symptoms

- no delusions, hallucinations, disorganized speech or behaviour

22
Q

Prognosis rates of schizophrenia

A
  • severity reduces with aging
  • 22% one episode only, complete recovery
  • 35% several episodes,normal functioning between
  • 8% several episodes, never return to normal between
  • 35% continual deterioration, reduced functioning between episodes

Shortened life-span (10 yrs reduction)

  • infectious diseases, circulatory disease
  • 8-10% suicide
23
Q

Prevalence rates of schizophrenia

A
  • 1% of population
  • men = women
  • men (15-24), women (25-34)
  • men more severe
  • similar rates around world
  • different symptoms around world
  • better recovery in developing countries (better social family networks) than in developed countries
  • more common in lower SES (Social drift theory)
24
Q

List other psychotic disorders

A

1) Mood disorder with psychotic features
2) brief psychotic disorder (<1 mos)
3) Schizophreniform disorder (1-6mos)
4) Schizzoaffective disorder
5) delusional disorder (erotomanic, grandios, persecutory, somatic)
6) Shared psychotic disorder (folie a deux)
7) Substance-induced psychotic disorders

25
Q

Why is mood disorder w psychotic features tough to diagnose

A
  • manic episode (mood) tough to distinguish frm schiz
26
Q

Describe schizoaffective disorder

A
  • all symptoms, but also symptoms of major depression or mania
  • 2 weeks of psych symptoms w no mood symptoms
27
Q

Difference between paranoid and delusional disorder

A
  • delusional disorder has non-bizarre disorder
28
Q

Role of genetics

A
  • MZ concordance is 48%
  • offspring w two schizo parents 47%
  • DZ concordance drops to 17%
  • polygenic (many genes)
  • epigenetics: environment/experiences influence whether genes are turned on
29
Q

Describe dopamine hypothesis

A
  • dopamine: movement, cognition (memory, attention, prob solving), motivation, pleasure, sociability
  • excess of dopamine in following areas:
    1) Nigrostriatal - i.e. basal ganglia
    2) Mesolimbic - limbic system, reward pleasure
    3) Mesocortical - frontal lobes, motor areas
  • can be due to too much dopamine or too many receptors
30
Q

Which receptors respond, which react to antipsychotic meds

A

Benefit: D2 receptors - positive symptoms (delusions, hallucinations)

Worse: D1 receptors - negative symptoms (inadequate receptor binding)

31
Q

Evidence of dopamine hypothesis

A
  • effects of antipsychotic drugs

- effects of drugs that increase dopamine (amph, cocaine, L-dopa)

32
Q

Other neurotransmitters possibly involved in schizo

A
  • norepinephrine, glutamate, serotonin, GABA
33
Q

Describe the neurophysiology of schizophrenia

A
  • enlarged lateral ventricles

- cortical atrophy - esp frontal and temporal lobes, basal ganglia

34
Q

Describe the four areas of the brain involved in schizophrenia, and their general functions

A

1) Frontal lobe - executive functions, avolition, personality change, working memory
2) Left temporal lobe - thought disorder, bizarre language, memory, selective attention
3) Right temporal lobe - flat affect, aprosodia, poor discrimination of facial emotion
4) Basal ganglia - fine motor control: rocking, pacing, stereotyped movements

35
Q

What is aprosodia

A

unable to interpret meaning from tone of voice

36
Q

Describe antipsychotic meds

A

1) traditional (50’s-60s)
- chlorpromazine, haloperidol
- reduce positive symptoms
- block dopamine receptors
2) Atypical antipsychotics (90’s)
- Clozapine, Risperidone, Olanzapine
- target serotonin & dopamine
- fewer side effects
- long term mtce, high relapse

37
Q

Describe typical side-effects of antipsych meds

A
  • weight gain, anxiety, insomnia, dry mouth, constipation, low blood pressure, sex dysf
  • blurred vision, drowsy
  • parkinson tremors, rigidity (due to lack dopamine in Basal ganglia)
  • diabetes
  • tardive dyskinesia
  • Clozapine: immune suppression, weekly blood checks
38
Q

Define bizarre delusions

A

clearly implausable and not understandable, do not derrive from everyday experiences

39
Q

Type of schizophrenia in video

A

undifferentiated

40
Q

Define Tardive dyskinesia

A
  • loss of motor control from long-term antipsych use.
  • usually irreversable
  • due to brain’s new dopamine production
41
Q

Describe the psychosocial stress factors in psych

A

1) Stress
- diathesis/stress model
2) Family communication patterns
- expressed emotion
- critical comments, hostility, emo overinvolvement, lack of warmth
- increased risk of relaps (70% w hi family emo relapse)
3) Social class
- neg assoc w SES
- sociogenic theory
- social drift hypothesis

42
Q

Describe sociogenic theory, describe social drift hypothesis

A

Sociogenic: stress + poverty -> schizo
- diathesis stress model,

Social Drift hyp: those who are vulnerable get stuck in cycle. not that low ses causes vulnerable
- perpetuates thru kids

43
Q

Epigenetics (rat studies)

A
  • social environment affect regulation, expression, function of genes
    Rats:
  • maternal care (licking, grooming, nursing)
  • experession of genes in hippocampus
  • regulation of stress response (HPA Axis)
  • differences in reactivity to stress later in life

Humans:
- gene expression similar to childhood abuse, neglect

44
Q

Finnish study results

A
  • dramatic increase in schizo expression when adopted in to brutal environment
45
Q

Psychosocial treatments

A
  • aimed at relieving triggers
  • Family Therapy
  • Social skills training - group therapy
  • stress management training
  • CBT - targets deficits in social interaction. How u see ppl around you
46
Q

CBT vs Supportive counseling

A
  • CBT stronger for positive and negative over supportive

- CBT for negative symptoms + antipsych meds for positive symptoms

47
Q

What makes schizo different than other disorders

A
  • heterogeneity (variety of symptoms, background, treatment response)
  • tough to predict how affected, prospects, or course of disorder
48
Q

Types of markers and endophenotypes

A

Endophynotypes: vulnerability marker

1) Cognitive marker: reveals deficits in attention, working memory
2) Eye tracking - deviations from stimulus path

49
Q

What is hypokrisia

A
  • biological diathesis occurs througout brain,
  • not single gene tho
  • causes cognitive slippage - scrambled info
50
Q

Define schizotype

A
  • primary cognitve slippage and

- aversive drift (social withdrawl and disinterest)

51
Q

Examples of neuropsych tests

A
  • Wisconson card sorting - perseverate

- FAS techniqe: name words that begin with …

Abnormal Psychology (6 decks)

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