Chapter 9 - Schizophrenia Flashcards
What does schizophrenia mean
Split mind
- psychotic disorder, loss of contact with reality
- most severe debilitating
- most patients unable to care for themselves
Stats on schizophrenia
- 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
Groups of symptoms of schizo
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
Details of disordered thinking symptoms
- 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
Details of delusions symptoms
Types
- Reference (things have special significance)
- grandeur
- control (controlled by external)
- persecution
- somatic
Thought insertion
thought broadcasting
thought withdrawl (others removing thoughts frm head)
Most common form of hallucination
- auditory
two types of disorganized motor behaviour
1) Disorganized - pacing, agitated, strange dress, talking,
2) Catatonic - waxy flexibility
Describe Negative symptoms
- 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
Name the positive symptoms of schizo
- disordered thinking
- delusions
- hallucinations
- disorganized motor behaviour
Define Alogia, Anhedonia, Avolition
Alogia - poverty of speech
Anhedonia - loss of enjoyment of pleasurable activities
Avolition - lack of motivation
Phases of Schizophrenia
Prodromal -> Active -> Residual
- Prodromal: clear deterioration of functioning
- Residual: attenuated symptoms following active phase
- tends to be episodic
Diagnostic criteria for active phase
- 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)
Diagnostic criateria for schizophrenia
- 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)
Subtypes of schizophrenia
1) Paranoid type
2) Disorganized
3) Catatonic
4) Undifferentiated
5) Residual
Which subtype has best and worst prognosis
Best: paranoid
Worst: disorganized
Features of paranoid subtype
- delusions, auditory hallucinations (only)
- no disorganized speech, behaviour or affect
- most common, least severe
Features of disorganized subtype
- disorganized speech, behaviour
- inappropriate affect
Features of Catatonic subtype
- 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
Difference between Echolalia and Echopraxia
- echolalia (repeat back others SAY)
- echopraxia (imitate BEHAVIOURS)
Undifferentiated subtype
doesn’t meet criteria for paranoid, disorganized, catatonic
Residual subtype
- negative symptoms, attenuated positive symptoms
- no delusions, hallucinations, disorganized speech or behaviour
Prognosis rates of schizophrenia
- 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
Prevalence rates of schizophrenia
- 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)
List other psychotic disorders
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
Why is mood disorder w psychotic features tough to diagnose
- manic episode (mood) tough to distinguish frm schiz
Describe schizoaffective disorder
- all symptoms, but also symptoms of major depression or mania
- 2 weeks of psych symptoms w no mood symptoms
Difference between paranoid and delusional disorder
- delusional disorder has non-bizarre disorder
Role of genetics
- 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
Describe dopamine hypothesis
- 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
Which receptors respond, which react to antipsychotic meds
Benefit: D2 receptors - positive symptoms (delusions, hallucinations)
Worse: D1 receptors - negative symptoms (inadequate receptor binding)
Evidence of dopamine hypothesis
- effects of antipsychotic drugs
- effects of drugs that increase dopamine (amph, cocaine, L-dopa)
Other neurotransmitters possibly involved in schizo
- norepinephrine, glutamate, serotonin, GABA
Describe the neurophysiology of schizophrenia
- enlarged lateral ventricles
- cortical atrophy - esp frontal and temporal lobes, basal ganglia
Describe the four areas of the brain involved in schizophrenia, and their general functions
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
What is aprosodia
unable to interpret meaning from tone of voice
Describe antipsychotic meds
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
Describe typical side-effects of antipsych meds
- 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
Define bizarre delusions
clearly implausable and not understandable, do not derrive from everyday experiences
Type of schizophrenia in video
undifferentiated
Define Tardive dyskinesia
- loss of motor control from long-term antipsych use.
- usually irreversable
- due to brain’s new dopamine production
Describe the psychosocial stress factors in psych
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
Describe sociogenic theory, describe social drift hypothesis
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
Epigenetics (rat studies)
- 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
Finnish study results
- dramatic increase in schizo expression when adopted in to brutal environment
Psychosocial treatments
- 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
CBT vs Supportive counseling
- CBT stronger for positive and negative over supportive
- CBT for negative symptoms + antipsych meds for positive symptoms
What makes schizo different than other disorders
- heterogeneity (variety of symptoms, background, treatment response)
- tough to predict how affected, prospects, or course of disorder
Types of markers and endophenotypes
Endophynotypes: vulnerability marker
1) Cognitive marker: reveals deficits in attention, working memory
2) Eye tracking - deviations from stimulus path
What is hypokrisia
- biological diathesis occurs througout brain,
- not single gene tho
- causes cognitive slippage - scrambled info
Define schizotype
- primary cognitve slippage and
- aversive drift (social withdrawl and disinterest)
Examples of neuropsych tests
- Wisconson card sorting - perseverate
- FAS techniqe: name words that begin with …
