Chapter 9: Schizophrenia Flashcards
Schizophrenia (term translate as )
schizo: split
phrenia: mind
Schizophrenia
Influences the way a person thinks, feels, and behaves
Disordered thinking
Ideas not logically related
Faulty perception and attention
Lack of emotional expressiveness
A blunted affect
Mood incongruent affect – the way a person feels is not the way they feel
Disturbances in movement or behavior
Widespread disruptions in life:
Maintaining jobs, living independently, having close relationships
Onset typically in late adolescence/early adulthood
Men diagnosed at a slightly earlier age
Often experience several acute episodes with less severe symptoms between episodes
Three major clusters of symptoms:
Positive : hallucinations and delusions, an addition to what normally experience in life
Negative :taking away things normally experience in life. Subtracting it
Disorganized : seen a lot in verbal communication, person appears to be very confident in what they are talking about, jumping from one sentence to the next
Delusions
-types of delusions
-a Positive Symptom
Beliefs contrary to reality
Firmly held despite disconfirming evidence
Types of delusions: Thought insertion Thought broadcasting Feelings or behaviors are controlled by external force Grandiose delusions Ideas of reference
Hallucinations
-a Positive Symptoms
Sensory experiences in the absence of sensory stimulation
Most often auditory and visual
Hearing thoughts spoken by another voice
Voices arguing or commenting on behavior
People who have auditory hallucinations may misattribute their own voice as someone else’s voice
Negative Symptoms
behavioral deficits in motivation, pleasure, social closeness, and emotion expression
Endure beyond an acute episode
Have profound effects on the lives of people with Schizophrenia
Strong predictor of a poor quality of life
Representing two domains:
Motivation and pleasure: Motivation, emotional experience, sociality
Expression domain: Outward expression of emotion, vocalization
5 Types of Negative Symptoms ***
Avolition: Lack of motivation; apathy
Asociality: Little interest in being around others and close relationships
Anhendonia: Inability to experience pleasure
Appears to be in anticipating pleasure, not experiencing pleasure in the presence of pleasurable things
Blunted affect: Lack of outward expression of emotion
Alogia: Significant reduction in speech
Avolition def
Avolition: Lack of motivation; apathy
a type of negative symptom
Anhendonia:
Anhendonia: Inability to experience pleasure
Appears to be in anticipating pleasure, not experiencing pleasure in the presence of pleasurable things
-a negative symptom
Disorganized speech (formal thought disorder)
Disorganized speech (formal thought disorder)
- Problems in organizing ideas and in speaking coherently
- Loose associations (derailment)
- Difficulty sticking to one topic
Neologism
-falls under the loose associations of disorganized speech.
a word that does not exist – makes it up
(it sounds like a made up word haha)
disorganized symptoms
disorganized speech and disorganized behavior
Disorganized behavior
Difficulty organizing behaviors and conforming to community standards
- Catatonia
- Peculiar, increased, repeated gestures or immobility
- Seldom seen today due to effective medications
DSM-5 Criteria: Schizophrenia
Two or more of the following symptoms for at least 1 month; one symptom should be either 1, 2, or 3:
(1) delusions
(2) hallucinations
(3) disorganized speech
(4) disorganized (catatonic) behavior
(5) negative symptoms (diminished motivation or emotional expression)
Functioning in work, relationships, or self-care has declined since onset
Signs of disorder for at least 6 months; or, if during a prodromal or residual phase, negative symptoms or two or more of symptoms 1-4 in less severe form
Do you need negative symptoms present to give a dx of schizophrenia?
YES
Medications: First-Generation Antipsychotics
Reduce positive and disorganization symptoms
Little or no effect on the negative symptoms
- 30% of people don’t respond
- Many stop quit due to side effects
Maintenance dosages help to prevent relapse
*Side Effects
Sedation, dizziness, restlessness, sexual dysfunction
Extrapyramidal side effects (e.g., tremors, shuffling gait)
Tardive dyskinesia
Medications: Second-Generation Antipsychotics
Equally as effective as first-generation at reducing positive symptoms and disorganization
Modestly more effective at reducing negative symptoms
More effective at improving cognitive functioning
Also produce unpleasant side effects: Weight gain
Associated with other serious health concerns (e.g., Type 2 diabetes)
Many people also stop taking these medications
African Americans often do not receive these medications
Medications: Evaluation of Drug Treatments
A Review of over 60 years of clinical trials:
Just over half of people with schizophrenia had a minimal response compared to placebo
-Only 23% had a good response
*Even though these drugs work better than placebo, they do not work well for many people
More work is needed to develop better medications for schizophrenia
Psychological Treatments of schizophrenia
Patient Outcomes Research Team (PORT) treatment recommendation:
Social Skills Training
Family Therapy
Psychological Treatments: Social Skills Training
Teach skills for managing interpersonal situations
- Completing a job application
- Reading bus schedules
- Make appointments
Involves role-playing and other practice exercises, both in group and in vivo
Associated with fewer relapses, better social functioning, and a higher quality of life
Psychological Treatments: Family Therapy
Goal: reduce expressed emotion
Components common across family therapies for schizophrenia:
Education about schizophrenia
Information about antipsychotic medications
Blame avoidance and reduction
Communication and problem-solving skills within family
Social network expansion
Instilling hope
Psychological Factors: Families and Relapse
*Family environment impacts relapse
- Expressed Emotion (EE)
- Hostility, critical comments, emotional overinvolvement
- Associated with greater relapse
- Cultural differences in the impact of EE
Psychological Factors: Family Factors
*Schizophrenogenic mother
Cold, domineering, conflict-inducing parent causes schizophrenia
No support for this theory
*Family relationships do not cause schizophrenia, but may influence course of the illness
E.g., unclear communication, high levels of conflict
Plausible that these factors are a response to having a family memory with schizophrenia
Psychological Treatments: Cognitive behavioral Therapy
Recognize and challenge delusional beliefs
Reduces negative symptoms
Challenging belief structures tied to low expectations for success and pleasure
Currently most effective treatment
Cognitive-behavioral social skills training (CBSST)
Combines social skills training and cognitive behavioral therapy
Focuses on reducing symptoms and improving functioning
The earlier treatment begins the better
Other Psychological Treatments
- Cognitive remediation or cognitive training
- Include hours of computer-based training in attention, memory, and problem solving
- Associated with a reduction in symptoms and an improvement in everyday functioning
*Psychoeducation
Educate people about their illness
Effective in reducing relapse and rehospitalization and increasing medication compliance
*Residential treatment
Vocational rehabilitation
Residents learn marketable skills thereby increasing community functioning
Brain Structure and Function: Enlarge Ventricles
Implies loss of brain cells
Correlated with:
Poor performance on neuropsychological tests
Poor functioning prior to onset of disorder
Poor response to medication treatment
Not specific to schizophrenia
Brain Structure and Function: Factors Involving Prefrontal Cortex
Plays a role in speech, decision making, emotion, goal-directed behavior
Reduction in gray matter and overall volume
Antipsychotic may contribute to loss
Poorer performance on neuropsychological tests designed to tap into functions of prefrontal region
Lower glucose metabolism when performing neuropsychological tests
Less activation associated with more severe negative symptoms
Behavioral Genetics Research : family studies
-are positive or negative symptoms have a stronger genetic component?
- Relatives at increased risk
- Risk increases as genetic relationship becomes closer
*Negative symptoms have stronger genetic component
- Incidence highest among children with both parents with a schizophrenia or bipolar disorder diagnosis
- Suggests some shared genetic vulnerability
- The role of environment cannot be discounted
. In schizophrenia research, prodrome refers to
a) neurobehavioral functioning in the disorder.
b) positive symptomatology in the disorder.
c) intellectual functioning in the disorder.
d) the period before a person meets diagnostic criteria for schizophrenia but nonetheless shows some symptoms.
d) the period before a person meets diagnostic criteria for schizophrenia but nonetheless shows some symptoms.
A recent review of 37 longitudinal studies of people after their first episode of schizophrenia found that
a) psychosocial treatments predicted no benefit above and beyond medication.
b) medication was useless in treating the disorder over long periods of time.
c) the combination of medication and psychosocial treatment predicted the best outcome.
d) medication alone predicted the best outcome.
c) the combination of medication and psychosocial treatment predicted the best outcome.
Lifetime prevalence of schizophrenia
~1%
for schizophrenia : t/f substance use, suicide, and mortality rates are high
true Substance use, suicide, and mortality rates are high
schizophrenia and gender
Affects men slightly more often than women
schizophrenia and race
Diagnosed more frequently in African Americans
May reflect bias among clinicians
T/F ASD is very predictive of who develops PTSD
FALSE ASD is not very predictive of who develops PTSD
Less than half develop PTSD within 2 years
PTSD and gender
1.5 to 2 times more likely in women
Consistent with gender ratio in other anxiety disorders
May be related to different life circumstances of women
Alogia:
-a negative symptom of schizophrenai
Alogia: Significant reduction in speech
Domains of Negative symptoms of expression
Representing two domains:
Motivation and pleasure: Motivation, emotional experience, sociality
Expression domain: Outward expression of emotion, vocalization
PORT
Patient Outcomes Research Team (PORT) treatment recommendation:
Medication PLUS psychosocial intervention
Social skills training, cognitive behavior therapy, and family-based treatments
Combined treatment is associated with:
Lower rates of relapse and treatment discontinuation
Greater improvements in functioning
Effects of high dose of alcohol (how much is this)
Effects of high dose (.08 blood alcohol content) of alcohol:
Significant motor impairment
Difficulty monitoring errors and making decisions
People at the legal limit of alcohol may make poor decisions about driving and not realize they are making mistakes
- If hoarding symptoms develop as part of schizophrenia, hoarding disorder ________
A. should not be diagnosed.
B. probably will be considered instead.
C. must be listed as a co-morbid diagnosis.
D. should not be diagnosed unless the individual is particularly unaware of the problem.
A. should not be diagnosed.
True or False? Hoarding Disorder is commonly comorbid with Obsessive-Compulsive Disorder.
TRUE
-how idk
people with BDD: how do they look at their body
Instead of looking at the whole, they examine one feature at a time
when was DID first put in the DSM
Increased rates since 1970s
Appearance of DID in popular culture
DSM-III (1980) defined DID for the first time
T/F in illness anxiety disorder a mild somatic symptom may be present
TRUE: No more than mild somatic symptoms are present (no significant somatic symptoms)
somatic symptom disorder vs illness anxiety disorder
Generally speaking, people with somatic symptom disorder do complain of physical symptoms. People with illness anxiety disorder usually do not have physical symptoms, or if symptoms are present, they are mild.
(google)
- The drug disulfiram helps people abstain from drinking alcohol by
a. causing alcoholic drinks to taste bitter.
b. interfering with the body’s metabolism of alcohol.
c. making people allergic to alcohol.
d. reducing the pleasurable feelings that are associated with alcohol.
b. interfering with the body’s metabolism of alcohol.
- Which of the following is an example of the agonist substitution type of treatment for
substance abuse?
a. The use of methadone to treat heroin addiction
b. A nicotine patch or nicotine gum to treat addiction to cigarette smoking
c. Both of these
d. Neither of these
c. Both of these
Jessica spends much of her day counting or saying certain words to herself. When she is not doing this, she is checking whether she left her doors unlocked. These symptoms illustrate ________
compulsions.
obsessions.
both obsessions (the counting and saying words) and compulsions (the checking).
neither obsessions nor compulsions.
compulsions.
When a person incorporates unimportant events within a delusional framework and reads personal significance into trivial activities of others, it is called
a) grandiose delusions.
b) hallucinations.
c) ideas of reference
d) absence of logic.
) ideas of reference
Sensory experiences in the absence of any relevant stimulation from the environment are called
a) delusions.
b) ideas of reference.
c) hallucinations.
d) flights of thought.
c) hallucinations.
- Among women seeking plastic surgery, approximately __________ percent meet the criteria
for diagnosis with body dysmorphic disorder.
a) 1-2
b) 3-4
c) 5-7
d) 8-10
c) 5-7
