Exam 3: Schizophrenia Flashcards
Prevalence
1%, m=f
Psychotic Disorder
thinking an emotions are so impaired that there is a loss of contact with reality; for example, not being able to tell if a sound is real or a hallucination
Delusions
fixed beliefs that are not shared by others and cannot be changed
Hallucinations
major distortions in perception; can occur with any sense, but auditiory is most common
Loose Association
common thinking disturbance in schizophrenia, characterized by rapid shifts from one topic of conversation to another;
Positive Symptoms
things that aren’t there in normal/baseline behavior: delusions, hallucinatons, disorganized thought/speech (loose association), abnormal motor behavior (no reaction to events, rigid posture, unpredictable aggression); often fluctuate
Negative Symptoms
emotional lack of expression, lack of motivation, apathy; tend to be more stable
Schizophrenic Spectrum: Schizophrenia
signs of disturbance for 6 mo+, 2 groups of symptoms for 1 mo+
Schizophrenic Spectrum: Schizophreniform
signs of disturbance from 1-6 mo+
Schizophrenic Spectrum: Brief Psychotic Disorder
sudden onset, <1 month, no negative symptoms
DSM Criteria
2 or more symptoms for at least 1 month (one must be from the first three): delusions, hallucinatons, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms; requires an mpairment in major area of functioning, and symptoms have been present for at least 6 months
Negative symptom: alogia
person says very little when they talk, when they do speak, it has little content
Negative symptom: avolition
lack of motivation/interest
Negative symptom: anhedonia
lack of pleasure
Negative symptom: flat affect
lack of expression of emotion
Negative symptom: psychomotor
awkward movements, odd gestures, rigidity, over excitement
Type I Schizophrenia
positive symptoms; overattention
Type II Schizophrenia
negative symptoms; underattention
Prodromal Phase
precedes active phase; categorized by deterioration in functioning and change in personality; onset is difficult to date accurately, and length of phase varies
Active Phase
positive symptoms are frequent; onset could be a stressor
Residual Phase
symptoms similar to prodromal phase; positive symptoms can be present, but are often milder; negative symptoms are often still present
Higher rates of schizophrenia are seen in…
low socioeconomic urban areas
Social Drift Hypothesis
(Explains low SES) reduced ability to work due to schizophrenia leads to a drift into poverty
Environmental Hypothesis
(Explains low SES) higher levels of stress contribute to people who are genetically predisposed
Comorbidity
Anxiety Disorders (PTSD 29%, Panic 15% OCD 23%), Depression (50%), Substance Abuse (50-60%), higher rate of suicide
Marijuana
worsens positive symptoms
Nicotine
90% of people with schizophrenia smoke; form of self-medication; nicotine affects dopamine, which improves some cognitive function, specifically attention and spatial working memory
Life expectancy
much shorter than general population, potentially due to poor environments and health problems
Aggression and violence
majority are not more violent than average; more common in younger males, people with higher impulsivity, and a history of violence; violence could potentially be attributed to substance abuse; violence is typically directed at family members; more likely to be victims, not aggressors
Age of Onset
later adolescence/early adulthood; males 21-23, females 27-28; rare in childhood and after 45
Gender patterns
females respond better to meds, spend less time in hospitals, and have better social interactions
Prognosis Patterns: most likely to succeed
females with acute onset, better premorbid functioning, supportive family environment, available programs, and no substance abuse
Prognosis “Rule of Thirds”
1/3 improve significantly, 1/3 stay the same (episodic relapses, lapse in functioning), 1/3 are severely and chronically disabled
Historical Perspective: Bleuler
Schizophrenia term (1908): splits between associations in thoughts and emotions
Historical Perspective: Freud
thought it involved some sort of regression, but did not treat any patients
Historical Perspective: Fromm-Reichman
Schizophrenogenic Mother (1948): a cold, domineering mother that is simultaneously overprotective can cause schizophrenia; appears to be self-sacificing, but uses child to satisfy own needs
Historical Perspective: Bateson
Double-Bind Family Communication (1956): people who are important to you who send conflicting verbal and nonverbal messages in situations that are inescapable can cause relapse; children cannot avoid displeasing their parents because nothing they do is right
Historical Perspective: RD Laing
Radical Psychiatry (50-60’s): schizophrenia isn’t a disease, it’s a “sane way of dealing with an insane world;” someone with a difficult life needs to do this to give their life meaning
Behavioral View
operant conditioning and reinvordement: people who are not reinforced for their attention to social cues will stop attending to them; causes more bizarre responses which are given attention
Revealed Differences Approach
family is given an issue to discuss that they previously disagreed on and told to reach agreement; 3 patterns emerge: 1) more conflict 2) more communication difficulties 3) more critical, yet over-involved
Expressed Emotion (EE)
combination of criticism and emotional over-involvement; relapse rates are higher with higher EE (stressor, not causal)
Cognitive View
cognitive deficits: attention (selective and sustained), verbal learning, memory, executive function, spatial working memory, processing speed (frontal lobe)
Biological View
genetic predisposition; negative symptoms may have higher heritability; fathers over 50 when child is born have higher risk; MZ: 50% DZ: 17%; offspring of MZ’s have higher risk, whether it was the twin with schizophrenia or not; adopted children still higher with biological parent
Smooth Pursuit Eye Movement
majority have irregular pursuit/more extraneous eye movements, relatives have worse scored than control groups
Sensory Gating
ability to filter out auditory signals is worsened
Diathesis-Stress Model
includes both environmental and biological factors, interactive model; biological vulnerability and environmental factors (prenatal or postnatal stressors) interact lead to disease; typically high rate of exposure to abuse
Dopamine Theory
Indirect evidence of increased dopamine: drugs can create Parkinsonian side effects, and bind to the same receptors as DA; amphetamine psychosis looks a lot like schizophrenia
Revised Dopamine Hypothesis
excess of DA receptors, or oversensitized DA receptors; backed by brain scans, brain autopsies, and animal studies
Problems with Dopamine Hypothesis
Timing: drugs can block receptors within hours, but symtpoms are not affected for weeks
Drugs affect positive symptoms, but not negative ones
Mesolimbic Pathway
ventral tegmental area (midbrain) to limbic system (amygdala): leads to positive symptoms and excess dopamine activity
Mesocortical Pathway
ventral tegmental area to frontal lobe, specifically prefrontal cortex: affects negative symptoms; underactive dopamine neurons in profrontal cortex fail to inhibit DA neurons in the limbic system
Serotonin
newer drugs affect this, often a moderating neurotransmitter, can regulate dopamine neurons in the mesolimbic pathway
Glutamate
also plays a moderating role, low levels of glutamate affects levels of DA
GABA
may contribute
Neuroimaging/Brain Structure
reduction in frontal lobe function, less connectivity between frontal and parietal lobes; enlarged ventricles (more cerebrospinal fluid) = less brain tissue (affects 1/3); less gray matter in frontal and temporal lobes, fewer dendrites, no reduction of neurons (may be more densely packed); causes unknown
Childhood indicators
subtle differences in childhood behavior and cognition; more involuntary movements than average
Why adolescents?
maturation of prefrontal cortex, more DA activity in the brain, new synapses formes, excessive pruning (getting rid of synapses we do not need)
Prenatal and Birth Risk Factors
poor nutrition, vitamin D deficiency, maternal infection, birth complications (reduced oxygen)
First Generation Antipsychotics: Major Tranquilizers
Phenothiazines: (Thorazine) block DA receptors (D2), work better at controlling positive symptoms
Haldol is a similar drug
Adverse Affects of 1st Generation Drugs
sedation, low blood pressure, constipation, urinary problems, dry mouth, blurred vision
Extrapyramidal Side Effects of 1st Generation Drugs
Parkinsonian symptoms (muscle tremors, muscular rigidity, lack of facial expression)
dystonia (involuntary muscle contractions)
akathesia (restlessness)
occur within days of starting medication
Tardive Dyskinesia: 1+ year after starting meds, involuntary, tic-like contractions, doesn’t always disappear; 10-20% develop this, high risk: high dose, long term, type II, 55+, female, mood disorder
2 types: Breakthrough (usually not reversible)
Withdrawal (less likely to be permanent)
Second Generation Atypical Antipsychotics: Clorazil
Affects D4 and serotonin receptors, few extra-pyramidal symptoms, helped negative symptoms
Adverse effects: weight gain, sedation, increased risk of diabetes, low blood pressure, seizures
Agranulocytosis: drop in white blood cells; affects young, f>m)
Second Generation Atypical Antipsychotics: Resperidone
Affects serotonin more than others, weaker blocker of DNA, less adverse effects but affects acne, bone density, and sexual function
Second Generation Atypical Antipsychotics: General
affects fewer D2 receptors, more D1, D4, and serotonin
Effectiveness: 1st gen vs. 2nd gen
2009 meta-analysis: only 4 2nd gen drugs proved to be more effective, Clozapine was #1
Adverse Effects: 1st gen vs. 2nd gen
extra-pyramidal effects occur mostly in high-potency 1st gen drugs (Haldol and Risperidone)
Short term vs. long term
Short term: most people on meds do better than those who aren’t
Long term: those on meds do worse than those who aren’t
Need to consider length of use and patient characteristics
Social Skills Training
problem solving, group work, geeral social skills, interacting with others, using schedules, applying for jobs, etc.; especially used for negative symptoms
Family Therapy
reduces hospitalization; teaches family about the disease and medication, increases problem solving and communication, teaches family not to blame the patient, helps both family and patient; can be used with individual therapy
Supportive Counseling
supports and coaches the client
Cognitive/Behavioral Therapy
reduces hospitalization by 50%; helps with interpretation of symptoms and coping with them
Acceptance & Commitment: rather than trying to stop abnormal cognitions, patient accepts them and tries to learn from them
Cognitive Enhancement Training: addesses attention and memory problems with practice
Living situations
many are placed in homes with untrained supervisors, or are barely supervised at all
Hospitalization in the Past
prior to 1950’s, there were no treatments so patients were just put in hospitals
Milieu Therapy
humanistic; people will do better if they are treated with respect and given responsibilities
Token Economy
still used today; based on operant conditioning; people work on behaviors like self-care or social skills and get tokens for good behavior that they can spend on objects or priviledges; needs to be individualized to work well
Hospitals Today
mostly short-term hospitalization for people in acute phase in danger of hurting themselves or others; purpose is to stabilize them and work out medications
Community Mental Health Act
1963: goal of getting people out of hospitals and provide a network of services to them; created community mental health centers; only partial short-term hospitalization with day treatments, sheltered workshops, job training and halfway houses; works well when all services are available and coordinated; more treatment in rural areas
How has community treatment failed?
40-60% a year do not recieve treatment, shortage of beds for people who do need hospitals, shortage of community mental health centers, shortage of day programs, residences, and sheltered workshops
Community Mental Health Act Funding
most money goes to medications, SSI Disability income, patients with less severe illnesses
Why has community treatment failed?
funding is not going to schizophrenia, therapists prefer to work with milder illnesses because they are easier to treat and more likely to improve, constrained by zoning laws, or people want the services, but not near their homes
Homelessness and Prisons
1/3 of homeless people have mental illnesses, more than 1/2 of inmates have mental illnesses; substance abuse is an issue
Social Policy
it is expensive to keep people in jail, and people in prisons/hospitals cannot work
