Chapter 9 - Schizophrenia Flashcards
Heterogeneity
Tendency for people with disorder to differ from each other in symptoms, family, personal background, response to treatment and ability to live outside the hospital
What is the first formal onset of first episode of schizophrenia?
development of psychotic/positive symptoms
What is the age onset?
15-45 years of age
How do the symptoms show up?
can be gradual or abrupt
what is the gender differences in developing the disorder
equal rates in both men and women
if disorder develops after 45 years of age, more common in women
is schizophrenia a relapsing disorder?
yes, and tends to be chronic
What groups is schizophrenia most common in?
lower socio-economic groups - developing countries
ratio of recovery
1/7 patients
positive symptoms
exaggerated, distorted adaptions of normal behaviour
what are examples of psychotic/positive symptoms
hallucinations, delusions, thought and speech disorder, catatonic behaviour, grossly disorganized
negative symptoms
absence or loss of typical behaviours and experiences
what are examples of negative symptoms
avolition, alogia, anhedonia, associality
avolition
loss of motivation
alogia
speaking loss
anhedonia
inability to feel pleasure/lack of emotional responsiveness
hallucination
Perception like experiences that occur without external stimuli - auditory is most common
delusions
Fixed beliefs that don’t change even in light of conflicting evidence
persecutory delusions
paranoid delusions - individuals believe that they are being pursued or targeted for sabotage, ridicule, or deception (ex. strangers on street are undercover agents)
referential delusions
a belief that events, objects, or other individuals have personality relevant meaning (ex. songs that a DJ is playing have special meaning in life)
somatic delusions
perception of a change or disturbance in personal appearance or bodily function (ex. aliens in body causing headaches)
religious delusions
unusual religious experiences or beliefs (ex. Satan is leaving messages for me via TV)
grandiose delusions
possession of special or divine powers, abilities, or knowledge (ex. “I have the power to change the course of history”)
affective flattening
negative symptom - a lack of emotional expressiveness, failing to convey any feeling in their face, tone of voice, or body language
what symptoms are involved with schizophrenia?
1) delusions
2) hallucinations
3) disorganized speech
4) grossly disorganized or catatonic behaviour
5) negative symptoms - ex. alogia, anhedonia, avolition etc.
how long must these symptoms be present?
1 month active period - 1 out the 3 symptoms (delusions, hallucinations, disorganized speech) and the other can be anything - total of two, and a total of 6 month period with disturbance inclusive of 1 month active period
disease markers
biological or behavioural traits or features of an individual that reliably reflect the presence of a medical or psychiatric disease or a predisposition to develop such a disease
endophenotypes
Stable and enduring trait of the disorder that occurs before the onset of symptoms ex. Eye tracking and deficits on performance tests in schizophrenics
Schizophrenogenic
the unsupported theory that cold and rejecting behaviour causes schizophrenia
collective unconscious
the concept that symbols and myths are shared among people in a culture but remain beneath awareness - ex. swinging penis
social drift
the tendency for people vulnerable to schizophrenia to “drift” down to lower social and economic levels
hypokrisia
biological diathesis that occurs throughout the brain making nerve cells abnormally reactive to incoming stimulation
cognitive slippage
information is disorganized, incoherent, and “scrambled”
aversive drift
in Meehl’s theory, the tendency for people with a genetic predisposition for schizophrenia to be perceived negatively and subjected to personal rejection, leading progressively to social withdrawal and alienation
schizotype
suffer from “primary” cognitive slippage, difficulty feeling pleasure, social alienation, and other consequences of aversive drift
vulnerability
diathesis - hereditary
disorder-promoting events
stress - environmental
neuropsychological tests
activate and depend on frontal region of brain - impairment on this test supports hypothesis that frontal brain is defective in the disorder
FAS technique
20-25 words that began with F,A,S in 3 one minute trials - results showed that schizophrenic patients produced fewer words than healthier people
Wisconsin Card Sorting Test
shown 4 key cards and patient is asked to match each card out of a deck of cards to a key card - results showed is easier for healthy people and schizophrenic patients make more mistakes and frequent mistakes
brain structure in schizophrenics (CT/MRI)
larger ventricles, reduced grey matter volumes
blood flow in schizophrenics (PET/fMRI)
less reduced blood flow or metabolism in the frontal region when engaged in a mental “activation” task
Paul Meehl
hypokrisia , cognitive slippage, aversive drift - brain is overstimulated (too much info) causing info to be unorganized and then it interferes with how important/rewarding you find relationships
Daniel Weinberger
biological vulnerability and surging stress hormones - person could inherit genetic defect that creates vulnerability for the disorder, also believed it was possible that subtle brain injuries during fetal development or birth could become a diathesis
diathesis - stress model
genetic vulnerability/predisposition (diathesis) interacts with the environment/life events (stressors) to trigger behaviours or psychological disorders
Elaine Walker
people with biological vulnerability for schizophrenia cannot cope with the effects of surging stress hormones on brain chemistry and begin to develop symptoms and clinical illness
dopamine receptors hypothesis
dopamine is central to schizophrenia - antipsychotic drugs reduce symptoms by blocking dopamine receptors since dopamine increases activity
insulin-coma
a seizure and loss of consciousness induced by administration of insulin
psychosurgery
use of brain surgery to alter behaviour especially in relation to psychiatric disorders
frontal lobotomies
the surgical cutting of connecting fibres within the frontal brain
how does biological treatment help?
control/manage symptoms, less time in hospitals, few relapses, better life functioning
where does biological treatment fall short?
discontinuation of medication, side effects, not helpful in providing occupational/daily living skills or social support
what four elements did CBT focus on
1) emotional disturbances
2) psychotic symptoms
3) social disabilities
4) risk of relapse
CBT theory
emotional and behavioural disturbances are influenced by subjective interpretation of life and illness experiences
what is done in CBT therapy
patients are taught how to interpret correctly relevant environmental events and how to respond appropriately to social cues while interacting and communicating with other people
results of CBT
gains in their psychosocial functioning, motivation and experienced reduced positive symptoms
social skills training
learning-based intervention model for the development of practical social skills in schizophrenics - effective with younger patients
CBBST
individual or group based treatments
family therapy
conceptualizes the patient as a member of a family system and tailors treatment to the family as a whole
prodrome
period before the appearance of psychotic symptoms when vulnerable adolescents often become withdrawn and suspicious
Schizoaffective disorders
co-occurence of a major mood episode with schizophrenic symptoms (2 or more)
how long must the delusions/hallucinations be present for in schizoaffective disorder?
2 weeks without the mood symptoms, mood symptoms are present for the majority of the total time meeting criteria for schizophrenia
how long should the symptoms be present in schizoaffective disorders?
1 month period
what is one symptom that must be present in schizoaffective disorders?
pervasive low mood
what gender is schizoaffective disorders more common in?
females
cannabis and psychosis
use is associated with twice the higher risk of psychosis
what are the four psychotic disorders?
delusional disorder, brief psychotic disorder, schizophrenia, schizoaffective disorder
how long must delusional disorder symptoms be present
1 month without any other psychotic symptoms
what are some other categories that need to be met for delusional disorder
- behaviour is not bizarre
- has never had schizophrenia
- if mood symptoms are present, they are brief compared to duration of delusions
what are the delusional disorder types
erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified, with bizarre content
gender differences for delusional disorder
equally common in men and women, more prevalent in older adults
which type of delusional disorder type is the most common
persecutory
what is the most common delusional disorder type in males
jealous
brief psychotic disorder symptoms
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior
how long must the symptoms for brief psychotic disorder be present
from 1 day to a month - can occur after a severe stressor or during/after pregnancy
gender differences for brief psychotic disorder
twice as common in women
average age onset for brief psychotic disorder
mid-thirties, more common in developing ocuntries
Bizzare delusion
Clearly implausible, not understandable, not related to real world content
Disorganized or catatonic behaviour
Ranges from child like silliness to unpredictable agitation
Catatonic behaviour - negativism
Outcomes of brief psychotic disorder
High risk of relapse and usually excellent outcome
What happens if schizophrenics don’t have an insight on their disorder?
Non-adherence to medication, relapse, involuntary treatment, aggression, poor course of illness
What is more associated with increased risk of aggression for schizophrenia?
Young makes, past history of violence, non-adherence to treatment, substance abuse, impulsivity
Schizophrenia and age expectancy
10-25 years shorter lifespan for schizophrenics and 2-3x higher mortality rate than general population
Causes of excess mortality in schizophrenia
1) physical illness is common but are detected later and treated poorly
2) antipsychotic medications have negative side effects
3) unhealthy lifestyle ex. Smoking
4) lifetime suicide risk
Cognition remediation training
Targets cognitive skills (ex. Memory, attention), medium range effect that are maintained over time
