Final Flashcards
Comorbidity and schizophrenia
- Comorbid with variety of other disorders, especially depression and substance abuse/ dependency
Social drift
The tendency for people with schizophrenia to drift down to lower social and economic levels
Cost schizophrenia
About 6.85 billion annually in Canada
3 phases of schizophrenia
- Prodromal phase
- Active phase
- Residual phase
Prodromal phase
- obvious deterioration in functioning, development of schizotypal personality disorder
Active phase
Symptoms such as hallucinations, delusions, disorganized speech
Residual phase
Similar to the prodromal phase
Hallucinations, delusions, etc. Improve
Positive symptoms
Abnormal additions to mental life, including the hallucinations, delusions, and disordered thoughts frequently experienced by schizophrenia patients (hallucinations, delusional belief, disorganized symptoms)
Hallucinations
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)
Delusional belief
Idiosyncratic, unreasonable,rigidly held beliefs defended by the patient against all evidence
Disorganized symptoms
Disorganized speech,including loose associations, tangentiality, perseveration
Bizarre behaviour including catatonia, unpredictable movements (motor symptoms), incongruity of affect and behaviour, grossly disorganized behaviour
Loosening of association
Loss of logical or conventional connections between ideas or words; shifts quickly from one topic to another
Catatonic behaviour
Rigid body positions assume by people with schizophrenia
Negative symptoms
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)
Affective flattening
Lack of emotional expression and response
Anhedonia
A loss of pleasure or interest in almost all activities or a lack of reactivity to usually pleasurable events
DSM-5 classification schizophrenia 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
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized such as catatonic behaviour
- Negative symptoms (affective flattening, alogia, or avolition)
DSM-5 classification schizophrenia B-F
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
Lifetime prevalence schizophrenia
Between .5 and 1%
Incidence schizophrenia
1 per 10,000 per year
Mean age onset schizophrenia
Between 20-35
Mean duration of schizophrenia
15 years
Is prevalence schizophrenia equal in men and women?
- 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
Genetic contribution
The influence of genes on the development of a mental illness or disorder
Epigenetics
The study of modifications of gene expression that are caused by mechanisms other than changes in the underlying DNA sequence
Schizophrenia study genomics discoveries
- 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
Schizophrenia as a neurodevelopmental disorder?
Recent research found allele mutations, deletions and duplications might play a role in schizophrenia
Neuropsychological testing indicates that most people with schizophrenia are:
Cognitively impaired and may have a low IQ
Brain imaging reveal diffuse brain pathology in schizophrenia. Of note are:
- 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
Dopamine hypothesis
- he theory that dopamine plays a major role in schizophrenia
- studies drugs either inhibit dopamine (antipsychotics) and observations many drugs stimulate dopamine cause hallucinations
Other neurotransmitters and schizophrenia
- dopamine
- serotonin
- glutamate (lower levels in prefrontal cortex and the hippocampus)
Etiology schizophrenia- developmental factors
- 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
Etiology psychosocial factors schizophrenia
- 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?)
Cognitive problems and schizophrenia
- impaired problem solving
- memory deficits
- impaired learning and word recall
Research supported subtypes schizophrenia
- impaired problem solving
- memory deficits- memory impaired
- cognitively impaired
- cognitively normal
Diathesis
A predisposition or vulnerability for the development of an illness or disorder
Hypokrisia
In Meehl’s theory, the reduced selectivity with which nerve cells respond to stimuli, especially as seen in schizophrenia
Meehl’s theory
- 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
Cognitive slippage
The mental consequences of Hypokrisia, namely loss of integrated thinking and coherent mental life
Aversive drift
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
Schizotype
A person experiencing cognitive slippage and aversive drift
Expressed emotions (EE)
Negative or intrusive attitudes and behaviours directed at the patients (associate in relapse in diagnosed patients)
Integrated theories
Interaction between genetics and psychosocial factors probably best explain schizophrenia
Markers
Individual characteristics that would predict a person’s vulnerability to schizophrenia (continuous performance test, eye tracking dysfunction, Wisconsin card scoring test)
Disease markers
Markers that occur in virtually all people with the illness
Continuous performance test (CPT)
- participants observe a string of numbers and are asked to respond whenever two identical numbers occur together
Endophenotypes
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
Antipsychotic medication
- 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)
Extra pyramidal effects
Severe side effects of the major tranquilizer a
Tardive dyskinesia
Strange muscular movements such as eye twitching and tongue thrusting
Maintainence medication
90% relapse if not on antipsychotics, 40% if taking them
Atypical antipsychotics:
- cause fewer side effects and maybe more effective for positive and negative symptoms
- target mostly serotonin system
Types treatment schizophrenia
- family oriented aftercare
- social skills training
- community based treatment
- cognitive-behavioural treatment
- institutional programs
Heterogeneity
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
Masters & Johnson human sexual response cycle
Sexual excitement
Plateau
Orgasm
Resolution
Refractory period
Shortly after ejaculation men are unresponsive to sexual stimulation
Heel singer Kaplan the human sexual response cycle
Desire, excitement, orgasm
Desire primarily psychological component to sexual response
Classification sexual dysfunction
- 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
Lifeline sexual dysfunction
Person has always experienced the problem
Acquired sexual dysfunction
If dysfunction is a fairly recent onset
Generalized sexual dysfunction
Apparent with all partners and even during solitary sexual activity (across all situations)
Situational sexual dysfunction
The problems are only apparent in one situation (ex with spouse, only during masturbation)
Sexual arousal and desire phase disorders
- male hypo active sexual disorders
- female sexual interest/ arousal disorder
- erectile disorder
Male hypoactive sexual desire disorder
Client describes persistently or recurrently deficient (or absent) sexual/ erotic thoughts or fantasies and desire for sexual activity
Female sexual interest/ arousal disorder
A sexual dysfunction characterized by a woman’s persistent or recurrent inability to attain or maintain arousal until competition of her sexual activity
Erectile disorder
Difficulties obtaining erection, maintaining and/ or marked decrease erectile rigidity
Orgasmic phase disorders
Delayed ejaculation
Female orgasmic disorder
Premature orgasm
Delayed ejaculation
Marked delay in ejaculation or a marked infrequency or absence of ejaculation, which is present in about 75-100% of sexual occasions
Female orgasmic disorder
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
Dysapeurnia
Difficult/ painful sexual intercourse
Vaginismus
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
Epidemiological issues of sexual dupes function disorders
- 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
Biological factors sexual dysfunction
- 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
Social factors sexual dysfunction
- 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
Psychological factors sexual dysfunction
- performance anxiety
- relationship factors
- assertiveness problems, lack social skills, discomfort about sex
- previous harmful experiences
Treatment sexual dysfunctions
- sensate focus and scheduling time for sexual activity
- cognitive restructuring and education
- communications training
- biological treatments, including mechanical devices, injections of neurotransmitters, PDE5 inhibitors
Paraphilias
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
Typical symptoms Paraphilias
- 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
Men with Paraphilias fall in many categories:
- timid, submissive, socially inept
- aggressive, domineering, rigid, self-indulgent
- confused, disorganized, sometimes mentally ill or intellectually deficient
Fetishic disorder
Recurrent and intense sexual arousal from either the use of no living objects, or q highly specific focus on non-genital body part(s)
Transvestic disorder
A person who cross-dresses- wears the clothing associated with the opposite sex- to produce or enhance sexual excitement
Sexual sadism
A sexual preference toward inflicting pain or psychological suffering on others and can be consider either a sexual variant or a sexual offence
Sexual masochism
Describes individuals who enjoy experiencing pain or humiliation from another individual
Hypoxyphilia (autoerotic asphyxia or asphyxiophilia)
Deliberate induction of unconsciousness by oxygen deprivation, chest compression, strangulation, enclosing heads in plastic bags etc.
Paraphilias disorders involving sexual desires that can constitute criminal offences
- exhibitionist
- voyeuristic
- frotteuristic
- pedophilic
Exhibitionist disorder
Involves exposure of the genitals to an unsuspecting person
Voyeuristic disorder
Secretly looking at naked people
Frotteuristic disorder
Touching or rubbing against a no consenting person for the purpose of pleasure
Pedophilic disorder
Describes recurrent fantasies or behaviours involving sexual activity with prepubescent children
Difference between child molesters and pedophiles
- 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
Most victims are
Girls
Most common contact is
Genital fondling
Do child mole store usually know the perpetrator or is it a stranger?
Usually know; most incidents occur in the child’s home or the perpetrator’s home
Incestuous relationships
Take place between blood relatives or step relatives
About half the men who sexually abuse their children
Are also abusing children outside the family
Sexual assault
Any sexual act, from sexual touching to full penetration, that is performed without the victims consent
Rape
A non consensual sexual penetration by force, threat, or when the victim is incapable of giving consent
Rape and sexual assault
- 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
Epidemiology Paraphilias
- people who exhibit one form of Paraphilia often exhibit others
- most Paraphiliacs are men
Biological factors Paraphilia
- poorly understood, some evidence hormonal (testosterone) dysfunction and temporal lobe dysfunction
Freud’s courtship theory
4 phases of Sexual interactions:
- Looking for and appraising a potential partner (voyeurism)
- Posturing and displaying oneself to partner (exhibitionist)
- Tactile interaction with partner (frotteuristic)
- Sexual intercourse
- fixation at any stage produces sexual offending (rape)
Theories rape & sexual assault
- 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
Paraphilias treatment
Aversion therapy
Cognitive- behavioural therapy
Hormone therapy
Gender identity disorder
- 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
Dimensions of gender
- chromosomal
- gonadal
- prenatal hormone
- internal organs
- external genital appearance
- gender identity
Gender role
The collection of those characteristics that society defines as masculine or feminine
When the biological variables are consistent, but discordant with the person’s sense of self
GID occurs
Gender identity disorder treatment
- psychotherapy is important to explore gender issues only
- sex reassignment surgery
