Chapter 9: Schizophrenia Flashcards
1
Q
What are the main characteristics of schizophrenia?
A
- positive symptoms
→ hallucinations and delusions - negative symptoms
→ emotional withdrawal and lack of motivation - overall adverse changes in thought, perception, emotion, and motor behaviour, and a feeling of depersonalization
- heterogeneity
2
Q
What is heterogeneity?
A
- variability and diversity of clinical and biological features seen in schizophrenia
3
Q
What is the lifetime risk of developing schizophrenia?
A
- 1%
4
Q
When is schizophrenia most frequently manifested?
A
- 20 and 40 years of age
5
Q
What is the gender difference in schizophrenia?
A
- equal risk
- men display symptoms earlier and more severely
6
Q
What is the prognosis of individuals with schizophrenia?
A
- less likely to complete education
- less likely to maintain a job
- more likely to develop additional psychiatric problems (depression, alcohol abuse)
7
Q
What has been the historical view of schizophrenia?
A
- existed under other names and description, such as madness or lunacy
- auditory hallucinations, which occur in about 70% of schizophrenia patients, were rarely described in cases prior to the 1700s
- extremely rate until the late eighteenth century
- speculated that industrialization and environmental changes may be related to this emergence
8
Q
What are the phases of schizophrenia over a lifetime?
A
- premorbid phase
→ no symptoms or impaired social competence
→ mild cognitive disorganization or perceptual distortion
→ anhedonia
→ mild and recognized only in retrospect - prodromal phase
→ subclinical symptoms may emerge
→ negative symptoms
→ withdrawal or isolation, irritability, suspiciousness, unusual thoughts, perceptual distortions, and disorganization
→ onset of overt schizophrenia (delusions and hallucinations) may be sudden (over days or weeks) or slow and insidious (over years).
- middle/active phase → positive symptoms → symptomatic periods episodic (with identifiable exacerbations and remissions) or continuous → functional deficits tend to worsen → treatment and relapse
- late illness/static/residual phase
→ illness pattern may be established
→ disability may stabilize or even diminish
9
Q
What are the three main symptom clusters in schizophrenia?
A
- positive
- negative
- cognitive (sometimes subdivided into the two above)
10
Q
What are positive symptoms?
A
- additions to mental life in excess of normal function
- include more obvious symptoms of psychosis
→ hallucinations, delusions, disordered thought, grossly disorganized catatonic behaviour
11
Q
What are hallucinations?
A
- false perception in the absence of any relevant sensory stimulus
- aka sensing something that isn’t there
- can occur in any sense modality
→ auditory and tactile most commonly occurring
→ visual generally only during early stages
12
Q
What are delusions?
A
- false beliefs that have no basis in reality
→ usually involve misinterpretation of perceptions or experiences
→ held with extraordinary conviction and subjective certainty
→ not affected by rational argument or evidence to the contrary
- most commonly persecutory → referential (thinking something refers to you, "the TV is talking to me" etc.) → somatic → religious → grandiose
13
Q
What is disorganized speech?
A
- nonsensical speech often signals the presence of thought disorder
- shows loosening of associations and logical connections between ideas or words
14
Q
What are negative symptoms?
A
- feature of schizophrenia showing behavioural deficits, a lack of normal functioning
→ sparse speech and withdrawal → affect flattening → avollition → anhedonia → alogia → asociality
15
Q
What is affect flattening?
A
- lack of emotional expression and response
16
Q
What is avolition?
A
- lack of initiation of goal-directed behaviours
17
Q
What is alogia?
A
- restrictions in fluency and productivity of thoughts and speech
18
Q
What is grossly disorganized behaviour?
A
- motor symptom of schizophrenia
- difficulty in goal-directed behavior (leading to difficulties in activities in daily living)
- unpredictable agitation or silliness
- social disinhibition, or behaviors that are bizarre to onlookers
- purposelessness distinguishes them from unusual behavior prompted by delusional beliefs.
19
Q
What is catatonic behaviour?
A
- motor symptom of schizophrenia
- marked decrease in reaction to the immediate surrounding environment
→ motionless and apparent unawareness
→ rigid or bizarre postures
→ aimless excess motor activity.
20
Q
What is waxy flexibility?
A
- state wherein a person’s limbs and posture can be “moulded” into different positions
21
Q
What are examples of cognitive impairments resulting from schizophernia?
A
- Disorganized thought process
- Disorganized speech → incoherence → loose associations → neologisms → poor verbal fluency (word salad) → excessive concreteness
- impaired attention and information processing
→ problems concentrating - impaired vigilance in executive functioning → prioritizing and impulse control
22
Q
What are the three forms of disorganized thought in schizophrenia?
A
- Thought insertion
→ belief that thoughts from other people are being inserted into one’s mind - Thought withdrawal
→ belief that thoughts have been removed from one’s mind by an outside agency - Thought broadcasting
→ belief that one’s thoughts can be heard by others
23
Q
What are neologisms?
A
- words a person makes up that have meaning only for that person
→ often part of a delusional system
