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1
Q

Comorbidity and schizophrenia

A
  • Comorbid with variety of other disorders, especially depression and substance abuse/ dependency
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2
Q

Social drift

A

The tendency for people with schizophrenia to drift down to lower social and economic levels

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3
Q

Cost schizophrenia

A

About 6.85 billion annually in Canada

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4
Q

3 phases of schizophrenia

A
  1. Prodromal phase
  2. Active phase
  3. Residual phase
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5
Q

Prodromal phase

A
  • obvious deterioration in functioning, development of schizotypal personality disorder
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6
Q

Active phase

A

Symptoms such as hallucinations, delusions, disorganized speech

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7
Q

Residual phase

A

Similar to the prodromal phase

Hallucinations, delusions, etc. Improve

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8
Q

Positive symptoms

A

Abnormal additions to mental life, including the hallucinations, delusions, and disordered thoughts frequently experienced by schizophrenia patients (hallucinations, delusional belief, disorganized symptoms)

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9
Q

Hallucinations

A

False perceptions occurring in the absence of any relevant stimulus. Auditory hallucinations are the most common, but they may occur with any sensory modality.
- associated with other symptoms (delusions)

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10
Q

Delusional belief

A

Idiosyncratic, unreasonable,rigidly held beliefs defended by the patient against all evidence

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11
Q

Disorganized symptoms

A

Disorganized speech,including loose associations, tangentiality, perseveration

Bizarre behaviour including catatonia, unpredictable movements (motor symptoms), incongruity of affect and behaviour, grossly disorganized behaviour

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12
Q

Loosening of association

A

Loss of logical or conventional connections between ideas or words; shifts quickly from one topic to another

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13
Q

Catatonic behaviour

A

Rigid body positions assume by people with schizophrenia

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14
Q

Negative symptoms

A

Deficits and loses in normal functioning

  • Affective and emotional disturbances (affective flattening and anhedonia)
  • apathy, avolition, alogia (social withdrawal, indecisiveness, poverty of thought content, thought blocking)
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15
Q

Affective flattening

A

Lack of emotional expression and response

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16
Q

Anhedonia

A

A loss of pleasure or interest in almost all activities or a lack of reactivity to usually pleasurable events

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17
Q

DSM-5 classification schizophrenia A.

A

A. Two (or more) of the following, each present for a significant portion of the time during a one month period (or less if successfully treated). At least 1 must be 1,2, or 3

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized such as catatonic behaviour
  5. Negative symptoms (affective flattening, alogia, or avolition)
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18
Q

DSM-5 classification schizophrenia B-F

A

B. Level of functioning in one or more areas is markedly below the level achieved prior to onset
C. Continuous signs disturbance persist for at least 6 months. This period must include at least 1 month symptoms that meet criterion A
D. Schizoaffective disorder and depressive or bipolar disorder must be ruled out. If they have been present must be for a small minority duration
E. Not attributable to physiological effects of a substance (drug, medication, or other medical condition
F. History autism/ communication disorder, hallucinations/ delusions must be present for at least 1 month

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19
Q

Lifetime prevalence schizophrenia

A

Between .5 and 1%

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20
Q

Incidence schizophrenia

A

1 per 10,000 per year

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21
Q

Mean age onset schizophrenia

A

Between 20-35

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22
Q

Mean duration of schizophrenia

A

15 years

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23
Q

Is prevalence schizophrenia equal in men and women?

A
  • men and women experience the disorder equally
  • men experience symptoms 4-5 years earlier than women, are more likely to exhibit negative symptoms and to have a chronic, deteriorating course
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24
Q

Genetic contribution

A

The influence of genes on the development of a mental illness or disorder

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25
Q

Epigenetics

A

The study of modifications of gene expression that are caused by mechanisms other than changes in the underlying DNA sequence

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26
Q

Schizophrenia study genomics discoveries

A
  • many genes involved govern the functioning of neurotransmitters such as dopamine and glutamate
  • the strongest findings concern chromosome 6, which is heavily involved in immune functioning
  • many alleles that indicate high risk for schizophrenia also indicate high risk for bipolar disorder
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27
Q

Schizophrenia as a neurodevelopmental disorder?

A

Recent research found allele mutations, deletions and duplications might play a role in schizophrenia

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28
Q

Neuropsychological testing indicates that most people with schizophrenia are:

A

Cognitively impaired and may have a low IQ

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29
Q

Brain imaging reveal diffuse brain pathology in schizophrenia. Of note are:

A
  • abnormally reduced frontal brain volumes and frontal brain blood flow
  • abnormalities in the left temporal lobe, which is strongly connected to the frontal lobes, the amygdala, and the hippocampus
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30
Q

Dopamine hypothesis

A
  • he theory that dopamine plays a major role in schizophrenia
  • studies drugs either inhibit dopamine (antipsychotics) and observations many drugs stimulate dopamine cause hallucinations
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31
Q

Other neurotransmitters and schizophrenia

A
  • dopamine
  • serotonin
  • glutamate (lower levels in prefrontal cortex and the hippocampus)
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32
Q

Etiology schizophrenia- developmental factors

A
  • most people diagnosed with schizophrenia show problems in childhood
  • pregnancy and birth complications including prolonged labour, preterm delivery, low birth weight, and fetal distress may play a role
  • proportion children at risk shoe early signs of motor impairment, cognitive limitations, social withdrawal, and aggression
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33
Q

Etiology psychosocial factors schizophrenia

A
  • occurs more often in low SES
  • emergence and surge schizophrenia coincided with industrial revolutions and increased urbanization under very poor conditions
  • associated with urban living
  • developmental factors (which influences which?)
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34
Q

Cognitive problems and schizophrenia

A
  • impaired problem solving
  • memory deficits
  • impaired learning and word recall
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35
Q

Research supported subtypes schizophrenia

A
  • impaired problem solving
  • memory deficits- memory impaired
  • cognitively impaired
  • cognitively normal
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36
Q

Diathesis

A

A predisposition or vulnerability for the development of an illness or disorder

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37
Q

Hypokrisia

A

In Meehl’s theory, the reduced selectivity with which nerve cells respond to stimuli, especially as seen in schizophrenia

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38
Q

Meehl’s theory

A
  • biological diathesis (Hypokrisia) caused by single gene
  • expression gene affected by other genetic characteristics and psychosocial circumstances leads to cognitive slippage
  • cognitive slippage + aversive drift = schizotypia
  • moderator characteristics such as intelligence, artistic talent, and personality traits likely influence functioning and may lead to emergence of full blown schizophrenia
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39
Q

Cognitive slippage

A

The mental consequences of Hypokrisia, namely loss of integrated thinking and coherent mental life

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40
Q

Aversive drift

A

In Meehl’s theory, the tendency for people with a genetic predisposition for schizophrenia to be perceived negatively end subjected to personal rejection, leading progressively to social withdrawal and alienation

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41
Q

Schizotype

A

A person experiencing cognitive slippage and aversive drift

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42
Q

Expressed emotions (EE)

A

Negative or intrusive attitudes and behaviours directed at the patients (associate in relapse in diagnosed patients)

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43
Q

Integrated theories

A

Interaction between genetics and psychosocial factors probably best explain schizophrenia

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44
Q

Markers

A

Individual characteristics that would predict a person’s vulnerability to schizophrenia (continuous performance test, eye tracking dysfunction, Wisconsin card scoring test)

45
Q

Disease markers

A

Markers that occur in virtually all people with the illness

46
Q

Continuous performance test (CPT)

A
  • participants observe a string of numbers and are asked to respond whenever two identical numbers occur together
47
Q

Endophenotypes

A

Characteristic deficiencies that underly an observable symptom and have a genetic component; a heredity characteristic that is normally associated with some condition, but is not a direct symptom of that condition

48
Q

Antipsychotic medication

A
  • phenothiazines
  • reduce severity mostly of positive symptoms
  • 25% show no improvement, 30-40% show mild improvement
  • side effects: extra pyramidal symptoms (EPS), tardive dyskinesia (TD)
49
Q

Extra pyramidal effects

A

Severe side effects of the major tranquilizer a

50
Q

Tardive dyskinesia

A

Strange muscular movements such as eye twitching and tongue thrusting

51
Q

Maintainence medication

A

90% relapse if not on antipsychotics, 40% if taking them

52
Q

Atypical antipsychotics:

A
  • cause fewer side effects and maybe more effective for positive and negative symptoms
  • target mostly serotonin system
53
Q

Types treatment schizophrenia

A
  • family oriented aftercare
  • social skills training
  • community based treatment
  • cognitive-behavioural treatment
  • institutional programs
54
Q

Heterogeneity

A

The variability and diversity of clinical and biological features seen in schizophrenia; the tendency for people with the disorder to differ from each other in symptoms, family and personal background, response to treatment, and ability to live outside the hospital
- makes predictions difficult

55
Q

Masters & Johnson human sexual response cycle

A

Sexual excitement
Plateau
Orgasm
Resolution

56
Q

Refractory period

A

Shortly after ejaculation men are unresponsive to sexual stimulation

57
Q

Heel singer Kaplan the human sexual response cycle

A

Desire, excitement, orgasm

Desire primarily psychological component to sexual response

58
Q

Classification sexual dysfunction

A
  • recurrence of problems over 6 months and clear distress or interpersonal difficulty
    (Not diagnosed if element satisfaction,if not distressed or not coming harm to others)
  • must not be explained by other disorders, substance abuse, or general medical conditions
59
Q

Lifeline sexual dysfunction

A

Person has always experienced the problem

60
Q

Acquired sexual dysfunction

A

If dysfunction is a fairly recent onset

61
Q

Generalized sexual dysfunction

A

Apparent with all partners and even during solitary sexual activity (across all situations)

62
Q

Situational sexual dysfunction

A

The problems are only apparent in one situation (ex with spouse, only during masturbation)

63
Q

Sexual arousal and desire phase disorders

A
  • male hypo active sexual disorders
  • female sexual interest/ arousal disorder
  • erectile disorder
64
Q

Male hypoactive sexual desire disorder

A

Client describes persistently or recurrently deficient (or absent) sexual/ erotic thoughts or fantasies and desire for sexual activity

65
Q

Female sexual interest/ arousal disorder

A

A sexual dysfunction characterized by a woman’s persistent or recurrent inability to attain or maintain arousal until competition of her sexual activity

66
Q

Erectile disorder

A

Difficulties obtaining erection, maintaining and/ or marked decrease erectile rigidity

67
Q

Orgasmic phase disorders

A

Delayed ejaculation
Female orgasmic disorder
Premature orgasm

68
Q

Delayed ejaculation

A

Marked delay in ejaculation or a marked infrequency or absence of ejaculation, which is present in about 75-100% of sexual occasions

69
Q

Female orgasmic disorder

A

Presence of either marked delay in, marked infrequency of, or absence of orgasm; or markedly reduced intensity of orgasmic sensations in about 75-100 percent of sexual occasions

70
Q

Dysapeurnia

A

Difficult/ painful sexual intercourse

71
Q

Vaginismus

A

A sexual dysfunction characterized by persistent involuntary contraction of the muscles in the outer third of the vagina upon attempts at penetration by the penis, preventing it from occurring

72
Q

Epidemiological issues of sexual dupes function disorders

A
  • fairly common
  • treatment sought mostly for erectile disorder, female orgasmic disorder, premature orgasm (premature ejaculation in men))
  • sexual desire problems have become more frequent
  • age affects sexual functioning
73
Q

Biological factors sexual dysfunction

A
  • role hormones in sexual desires
  • erectile dysfunction is in part related to vascular dysfunction
  • tobacco, alcohol, marihuana can affect arousal and sexual function
  • SSRIs can cause delayed ejaculation and orgasmic dysfunction
  • neurological disorders can cause erectile dysfunction
  • neurological disorders, pelvic disease, hormonal dysfunctions can interfere with vaginal swelling, lubrication
74
Q

Social factors sexual dysfunction

A
  • culture
  • childhood socialization
  • women born recent decades report fewer orgasmic problems
  • women with orgasmic disorder are less lie joy talk about sex, hold negative attitudes about masturbation, and feel more guilt about sex
75
Q

Psychological factors sexual dysfunction

A
  • performance anxiety
  • relationship factors
  • assertiveness problems, lack social skills, discomfort about sex
  • previous harmful experiences
76
Q

Treatment sexual dysfunctions

A
  • sensate focus and scheduling time for sexual activity
  • cognitive restructuring and education
  • communications training
  • biological treatments, including mechanical devices, injections of neurotransmitters, PDE5 inhibitors
77
Q

Paraphilias

A

Sexual arousal associated with atypical stimuli;
Intense, persistent sexual interest other tha sexual interest in genital stimulation, or proper story findings with phenotypically normal, physically mature, consenting human partners

78
Q

Typical symptoms Paraphilias

A
  • sexual fantasies are strong, long standing, unusual, and very persistent
  • fantasies usually do not involve reciprocal loving with an adult partner
  • themes of aggression, revenge, hostility may dominate fantasies
  • compulsion, lack of flexibility
79
Q

Men with Paraphilias fall in many categories:

A
  • timid, submissive, socially inept
  • aggressive, domineering, rigid, self-indulgent
  • confused, disorganized, sometimes mentally ill or intellectually deficient
80
Q

Fetishic disorder

A

Recurrent and intense sexual arousal from either the use of no living objects, or q highly specific focus on non-genital body part(s)

81
Q

Transvestic disorder

A

A person who cross-dresses- wears the clothing associated with the opposite sex- to produce or enhance sexual excitement

82
Q

Sexual sadism

A

A sexual preference toward inflicting pain or psychological suffering on others and can be consider either a sexual variant or a sexual offence

83
Q

Sexual masochism

A

Describes individuals who enjoy experiencing pain or humiliation from another individual

84
Q

Hypoxyphilia (autoerotic asphyxia or asphyxiophilia)

A

Deliberate induction of unconsciousness by oxygen deprivation, chest compression, strangulation, enclosing heads in plastic bags etc.

85
Q

Paraphilias disorders involving sexual desires that can constitute criminal offences

A
  • exhibitionist
  • voyeuristic
  • frotteuristic
  • pedophilic
86
Q

Exhibitionist disorder

A

Involves exposure of the genitals to an unsuspecting person

87
Q

Voyeuristic disorder

A

Secretly looking at naked people

88
Q

Frotteuristic disorder

A

Touching or rubbing against a no consenting person for the purpose of pleasure

89
Q

Pedophilic disorder

A

Describes recurrent fantasies or behaviours involving sexual activity with prepubescent children

90
Q

Difference between child molesters and pedophiles

A
  • pedophilia consists in the experience of recurrent intense sexual,y arousing fantasies and urges involving sexual activity with a prepubescent child (exclusively attracted children)
  • child molesters: adult heterosexual males who usually have one or more adult relationships and also interact sexually with children and/ or teenagers
91
Q

Most victims are

A

Girls

92
Q

Most common contact is

A

Genital fondling

93
Q

Do child mole store usually know the perpetrator or is it a stranger?

A

Usually know; most incidents occur in the child’s home or the perpetrator’s home

94
Q

Incestuous relationships

A

Take place between blood relatives or step relatives

95
Q

About half the men who sexually abuse their children

A

Are also abusing children outside the family

96
Q

Sexual assault

A

Any sexual act, from sexual touching to full penetration, that is performed without the victims consent

97
Q

Rape

A

A non consensual sexual penetration by force, threat, or when the victim is incapable of giving consent

98
Q

Rape and sexual assault

A
  • 6% report being raped, 21% report having been sexually assaulted
  • victims usually know the perpetrators
  • recidivism rates high. 25% recommit after 5-10 years in prison
  • rape motivated partially by aggression and partially by sexual arousal, many do so with intention of hurting, humiliating, and degrading the victims
99
Q

Epidemiology Paraphilias

A
  • people who exhibit one form of Paraphilia often exhibit others
  • most Paraphiliacs are men
100
Q

Biological factors Paraphilia

A
  • poorly understood, some evidence hormonal (testosterone) dysfunction and temporal lobe dysfunction
101
Q

Freud’s courtship theory

A

4 phases of Sexual interactions:

  1. Looking for and appraising a potential partner (voyeurism)
  2. Posturing and displaying oneself to partner (exhibitionist)
  3. Tactile interaction with partner (frotteuristic)
  4. Sexual intercourse
    - fixation at any stage produces sexual offending (rape)
102
Q

Theories rape & sexual assault

A
  • Freud’s courtship theory
  • feminist theory
  • integrative theories
  • failure to achieve intimacy combined poor social skills
  • reinforcement provided by sexual pleasure, empowerment, high risk taking
103
Q

Paraphilias treatment

A

Aversion therapy
Cognitive- behavioural therapy
Hormone therapy

104
Q

Gender identity disorder

A
  • characterized by a firm conviction that one is a member of the opposite sex
  • feelings of belonging to the other gender arise early in childhood
  • rare, more common in children than adults: 3% boys, 1% girls
105
Q

Dimensions of gender

A
  • chromosomal
  • gonadal
  • prenatal hormone
  • internal organs
  • external genital appearance
  • gender identity
106
Q

Gender role

A

The collection of those characteristics that society defines as masculine or feminine

107
Q

When the biological variables are consistent, but discordant with the person’s sense of self

A

GID occurs

108
Q

Gender identity disorder treatment

A
  • psychotherapy is important to explore gender issues only

- sex reassignment surgery

Abnormal psychology (3 decks)

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