Exam 3.1 Flashcards
How is schizophrenia characterized?
- Extreme obscurity in perception, thought processes, actions, and sense of self
What is psychosis?
Significant loss of contact with reality
What is démence précoce?
- Early classification for schizophrenia
- Benedict Morel
- Mental deterioration at an early age
What is dementia praecox?
- Early classification for schizophrenia
- Latin version of Morel’s term
- Describes a group of conditions related to early-life mental deterioration
- Suspicion of others, hallucinations,
apathy/indifference, withdrawn behavior, and
inability to work/function normally
- Suspicion of others, hallucinations,
How was the diagnostic term “schizophrenia” created?
- Eugen Bleuer (1911)
- “schizo”: to split or crack
- “phren”: mind
- Disorganization of thought; discrepancies in coherence between thoughts and emotions
- Internal “split” within intellect and emotion
- Internal “split” between intellect and external reality
What is the average lifetime prevalence of schizophrenia?
0.7%
What is the difference between males and females, in regard to symptom severity in schizophrenia?
- Males usually have more severe symptoms
- Females have better projected long-term outcomes
When do most cases of schizophrenia initially occur in life?
Late adolescence, Early adulthood
What are groups that are more susceptible to schizophrenia?
- Those with a parent with schizophrenia
- Those with older fathers at time of birth
- Those with a parent that works as a dry cleaner
- 1st and 2nd generation immigrants
- Particularly black Caribbean, black African
counties
- Particularly black Caribbean, black African
What is the common onset of schizophrenic symptoms, and what is the difference between males and females?
- Onset often occurs from 18-30 years old
- Men: more likely to have early age of onset
- Women: onset is more likely between ages 20-24
What is positive-symptom schizophrenia?
Symptoms that have been added; reflect distortions in a typical pattern of behavior and experience
- Ex. Delusions, hallucinations, disorganized
thinking
What is negative-symptom schizophrenia?
An absence of or deficit in behaviors that are typically present
- Reduced expressive behavior (blunted and flat affect, alogia–very little speech)
- Reductions in motivations/experience of pleasure
What is avolition?
Inability to pursue goal-oriented activities
What is anhedonia?
Diminished ability to experience pleasure
What is a delusion?
Belief that is held despite there being evidence of the contrary
What are common delusions?
- External source(s) controlling thoughts, feelings, or actions
- Private thoughts are being broadcasted to others
- External source(s) planting thoughts in brain
- External source(s) extracting thoughts
- Neutral event has special meaning (ex. television, radio)
- Bodily changes (ex. bowels not working)
What is a hallucination?
Any sensory experience that seems real to the person having it but is from a nonexistent stimulus
- Increased activity in Broca’s area
How was the word hallucination created?
Hallucinere, or Allucinere: “wander in mind”, “idle talk”
Can healthy minds experience hallucinations?
Yes, if under enough stress and drink lots of caffeine
How does disorganized speech manifest in schizophrenia?
- Disorganization of thought form
- Person seems to be using correct semantic and syntax rules but fails to make sense to the listener(s)
- Often includes made up words (ex. detone)
How does disorganized behavior manifest in schizophrenia?
- Disruption in executive behavior
- Can manifest in a variety of ways
- Impairment in routine daily functioning (ex. work,
self-care, social relations) - Unusual/eccentric appearance
- Impairment in routine daily functioning (ex. work,
What is catatonia?
Catatonic stupor: Individual displays lack of movement and speech, may hold unusual posture for a period of time
- Aspect of disorganized behavior in schizophrenia
What is Schizoaffective Disorder?
- “Hybrid” diagnostic category
- Describes people with features of both schizophrenia and mood disorder
- Subtypes based on different unipolar and bipolar
conditions
- Subtypes based on different unipolar and bipolar
What are the mood symptoms like in a schizoaffective diagnosis?
Mood symptoms meet the major mood episode criteria and are present for 50% of total duration of condition
- Speculation allows for increased reliability and
decreased number in people that are diagnosed
What is the long-term outlook for those with schizoaffective disorder, in comparison to schizophrenia?
Long-term outcome is better for those with schizoaffective disorder
What is Schizophreniform Disorder?
Category for those that have schizophrenia-like psychoses that last for less than 6 months
What is Delusional Disorder?
Individuals have beliefs that are considered false and obscure, but can behave normally
- Behavioral deterioration and performance
deficiencies are rarely visible externally
What is Erotomania?
- Subtype of delusional disorder
- Delusion involves love and obsession for someone–usually of higher status (ex. celebrities, serial killers)
What is Brief Psychotic Disorder?
- Sudden onset of psychotic symptoms, disorganized speech, or catatonic behavior
- Usually only lasts a few days before individual returns to normal functioning
- May never have an episode again
- Often triggered by stress
What are the genetic factors associated with schizophrenia?
- Genetic predisposition
- Prenatal conditions
- Candidate genes
- Endophenotypes
What blood-relation has the highest predisposition to schizophrenia?
Monozygotic/Identical twins
What are candidate genes in schizophrenia?
Genes involved in processes considered deviant in schizophrenia
- Chromosome 22
- COMT gene
- Involved in dopamine metabolism
- Some variants make those with the gene
susceptible to psychotic behavior as adults if
cannabis is used during adolescence
How are prenatal exposures associated with the development of schizophrenia?
- Pregnant mothers with infections or conditions that attack the immune system can increase the risk for schizophrenia/schizo-similar disorders
- Pregnant mothers with influenza is correlated to increased risk of schizophrenia or schizo-similar disorders
- Weak correlation
- Maternal stress and nutritional deficiency can cause pregnancy and birth complications
What is the Neurodevelopmental Perspective of schizophrenia?
- Risk for developing the condition later in life can be increased if there are certain genes activated early in life/during the prenatal period
- Genes can be activated by harmful environmental
variables (ex. polluted air)
- Genes can be activated by harmful environmental
- Presentation of symptoms may not occur until the brain has matured or until another thing triggers them
How is “preschizophrenia” observed?
Abnormalities in motor functioning; Less positive expressions and more negative expressions
What percent of individuals with schizophrenia do not have a first or second generation relative with the disorder?
89%
What is the prodromal stage?
Very early, low-level symptoms of schizophrenia
What is Attenuated Psychosis Syndrome?
Mild psychotic symptoms that do not qualify for schizophrenia
How is neurocognition affected in schizophrenia?
- Cognitive impairment
- Poor performance on cognitive tests
- Impairments in basic and higher-level processing
- Eye-tracking participants with schizophrenia and
50% of first-degree relatives showed impairments
(even if they do not have the disorder themselves)
- Sensory gating difficulties
How is loss of brain volume associated with schizophrenia and schizo-similar disorders?
- Gray matter
- Enlarged brain ventricles
- Also characteristic in Alzheimer’s, Huntington’s, and chronic alcoholic issues
- Also characteristic in monozygotic twins, in which
only one twin has schizophrenia and both are
shown to have same brain changes
- Brain changes worsen over time
- “Dementia praecox”
What areas of the brain are affected by schizophrenia?
- Prefrontal cortex
- Temporal lobes
- Amygdala
- Hippocampus
- Thalamus
How are disruptions among white matter in the brain associated with schizophrenia?
- White matter is critical for brain connectivity
- Disruptions can result in issues for how well cells of the nervous system function
- Abnormal connectivity between brain regions can explain hallucinations
How is white matter important for brain functioning?
Nerve fibers that are covered in a myelin sheath acts as an insulator, increasing the speed and efficiency of the conduction between nerve cells
What is hypofrontality?
Abnormally low frontal lobe activation
What is cytoarchitecture?
The structural arrangement of neurons in the nervous system
What are the common ages for head injuries increasing the likelihood of developing schizophrenia?
11-15
What is the Dopamine Hypothesis?
States that characteristic symptoms of schizophrenia can be attributed to abnormally high levels of dopamine in dopamine receptors
- Neurons that transmit dopamine fire too easily and
too often
Positive symptoms of schizophrenia can be attributed to hyperactivity of dopamine D2 receptor neurotransmission in subcortical and limbic brain regions
Negative symptoms of the disorder can be attributed to hypofunctionality of dopamine D1 recepter neurotransmission in the prefrontal cortex
What is aberrant salience?
Dysregulated dopamine can cause individuals to pay more attention to non-important stimuli
How is neurochemistry affected in schizophrenia?
- Dopamine
- Too much is being synthesized and released into
the synapses
- Too much is being synthesized and released into
- Glutamate (NMDA receptors)
- Low levels of activity in glutamate receptors
How is PCP and Ketamine associated with the NMDA/Glutamate receptors?
They block glutamate receptors and cause symptoms similar to schizophrennia
What are the psychosocial and cultural factors associated with schizophrenia?
- Family environments
- Urban living
- Immigration
- Cannabis abuse (especially during young adolescence)
- Diathesis-Stress Model
How are family environments associated with schizophrenia symptoms?
- Expressed emotion between family can help predict relapses
- Stress can worsen symptoms with increased cortisol levels
How did treatment for schizophrenia evolve from before the 1950’s to the 1980’s?
- Pre-1950’s: Straightjackets, electroconvulsive therapy
- 1950’s: First-generation antipsychotics introduced
- 1980’s: Second-generation antipsychotics introduced
What are the probabilities of success in treatment of schizophrenia?
- 38% have favorable treatment outcome
- No known cure
- Condition reduces life expectancy
How has estrogen become associated with the treatment of schizophrenia?
It is suggested estrogen has antipsychotic effects
- Can reduce positive symptoms of schizophrenia
- Can delay/prevent the onset of schizophrenia
Why is there a need for new medication for schizophrenia?
Most medications have negative side effects
What are helpful psychosocial approaches to treating schizophrenia?
- Case management
- Family therapy
- Psychoeducation
- Social skills training
- Cognitive remediation
- CBT
- Exercise
What is the purpose of cognitive remediation?
Intended to help patients’ cognitive functioning, such as memory, attention, verbal skills, etc.
What is an acute psychotic break?
Delusion that lasts for less than 3 months
How long must psychosis last to be considered schizophrenia?
6+ months
Why are men more commonly diagnosed with schizophrenia than women?
Women tend to have less severe forms of schizophrenia and usually have more depressive symptoms, leading them to be diagnosed with other disorders
What are the most common hallucinations?
Auditory hallucinations
What is catatonic stupor?
An immobile, expressionless, coma-like state
What are genome-wide association studies?
A large-scale analysis of genomes of a certain phenotype/disease that is common
- Is intended to find genetic markers that correlate with the phenotype/disease
What is expressed emotion (EE)?
Negative communication patterns found among relatives of individuals with schizophrenia that often can help cause relapses
- Criticism, hostility, and emotional overinvolvement
What do antipsychotics do in the brain?
Block dopamine D2 receptors
What are common side effects of 1st generation antipsychotics?
Drowsiness, dry mouth, weight gain, motor difficulties
What are common side effects of 2nd generation antipsychotics?
Drowsiness, weight gain, diabetes, sometimes dangerous drop in white blood cells
True/False: Paranoia is considered a positive symptom of schizophrenia
False
What neurotransmitters are most importantly implicated in schizophrenia?
Dopamine and glutamate
In men, there is a peak in new cases of schizophrenia between what ages?
20-24
In the asylum video, when the man and woman talked about their murders, what was the most obvious difference between them?
The woman was emotional, while the man showed no emotion
Individuals with schizophrenia experience what physical detriment over time?
Loss of brain volume
True/False: Autonomic arousal decreases in patients with schizophrenia
False
What kind of psychoactive substance causes effects similar to symptoms of paranoid schizophrenia?
Amphetamines
Who was the guest speaker that is diagnosed with schizophrenia?
Trey Forbes
Excessive use of cocaine in a time span of 8-10 days can result in the development of what condition?
Bipolar I
What first-generation antipsychotic blocks dopamine receptors?
Chlorpromazine/ “Thorazine” (1952)
What are some examples of second-generation antipsychotics?
Clozapine, Risperdal, Seroquel, Abilify, Latuda
