L10: schizophrenia Flashcards
what is schizophrenia
a brain disorder affecting how ppl think, act, feel and perceive.
- deprives rational thought
- impacts perception
what is the defining feature of schizophrenia?
psychosis
- possibly with hallucinations and/or delusions
what are hallucinations?
stimuli inconsistent with objective reality
-ie. hearing voices no one else can hear
what are delusions?
fixed false beliefs that are inconsistent with objective reality
what is the prevalence of Schizophrenia ?
- M : F = 1.4:1
- generally agreed upon worldwide.
what population has the lowest lifetime prevalence of Schizophrenia?
Asian populations
lifetime prevalence of schizophrenia + schizophrenic disorders
0.55 + 1.45, respectively
Prevalence in Canada
~1%
Why is prevalence higher in Canada? (2 theories)
- higher prevalence of people who immigrate = likely relates to stress
- Less sunlight = low VitD in pregnancy = prenatal risk factor.
age of onset for schizophrenia
- late teens to mid 30s
- early to mid 20s for MEN
- late 20s for WOMEN
course of schizophrenia?
from healthy, normal functioning to more ill.
- gradual onset of subsyndromal symptoms.
what is prodromal period?
when subsyndromal symptoms begin to arise - before the onset of full schizophrenia.
- perhaps capture this state + intervene before schizophrenia arises.
chidhood onset? yay or nay?
possible but unlikely
late onset - when? characterized by?
after 40yoa
- psychotic symptoms + paranoia
co-morbidity?
50% have another psychiatric disorder.
- 50% use substances ie. cigarettes.
- others have anxiety, ocd depression
how many commit suicide?
10%
why do people use substances with schizophrenia?
biological effects of nicotine.
- give a lift, break down antipsychotics = more energy.
cognitive deficits in schizophrenia?
often precede psychosis + remain stable
is there a reliable way to predict the course of schizophrenia?
no reliable way.
- some improve, few recover.
- most require support + are chronically ill.
- some have exacerbations + remissions.
- some progressively deteriorate.
what features may relate to good prognosis?
- late onset
- acute onset
- (+) premorbid social, sexual, work histories
- mood disorder symptoms
- married
- family history
- good support system
- (+) symptoms
what features may relate to poor prognosis?
- young onset
- insidious onset
- poor premorbid social, sexual, work histories
- withdrawn, autistic behaviour
- single, poor support systems
- family history of schizophrenia
- negative symptoms
- perinatal trauma
psychiatric hospitalization of schizophrenics??
31% are with schizophrenia
5 elements required for diagnosis?
H(u)SB(a)ND Hallucinations Speech disorganization Behaviour disorganization Negative symptoms Delusions
what is diagnosis based on?
psychiatric history
mental status exam
clinical diagnosis
– no lab test/imaging
strategy to get psychiatric history?
get full psychiatric assessment
- thorough, objective assessment of life + mental state
what is psychosocial backgroun?
gender, life experiences
5 S’s of history of presenting illness?
Situation Stressors Symptoms Safety (suicide/homicide/self harm) Substance use
what are the elements of a Psychiatric history?
- psychosocial background
- history of presenting illness
- medical history
- family history
- medical psych history (diagnoses, treatments, hospitalizations, suicide attempts)
- medications
- social and personal history.
elements of social + personal history?
birth (prenatal experience may increase schizophrenia)
- development
- family
- school
- abuse
- work
- relationship
- supports
- legal
what is acute onset often related to?
ingestion of substance
why are relapses important in prognosis?
each time you relapse, you come back to “normal” worse off + clozer to a schizophrenic episode.
major risk factors in schizophrenia?
place/time of birth
- infection
- prenatal elements
- obstetric conditions.
what are positive symptoms?
presence of too many behaviours not found in most people (added behaviours)
- hallucinations, speech + behaviour disorganization, delusions
what are negative symptoms?
absence of behaviours found in most people (lost something)
- 5A’s.
what are hallucinations?
false perceptions that feel real, without sensory input
- most are auditory (hear voices or thoughts of others)
contrast hallucinations and illusions?
h: false perception - no sensory input
I: miscerception of real sensory input.
describe what disorganized speech may be like?
tangential, mocking others, lack of connectedness, quickly changes topics
- reflection of thought pattern in mind
what is Linear thought form?
completes given idea before moving on to the next.
what is circumstantial thought form?
moves on to related topics but eventually returns to original topic
what is tangential thought form?
moves on to related topics but never returns to original topic
what is “Loosening of associations” thought form
no logical connection between sequence of thoughts
what is “word salad” thought form
no logical connection between words
what is “flight of ideas” thought form
rapid movement from topic to topic without completing each train of thought
perseveration?
persistent inappropriate repetition of same thoughts
what are delusions?
fixed false beliefs
what are persecutory delusions?
paranoid that others will persecute them, threaten them, conspire against them
what are referential delusions?
neutral event that’s not meant to have special meaning, does.
what are grandiose delusions
narcissistic-type delusions
what are erotomanic delusions
thoughts that never stop
what are nihilistic delusions
nothing exists, everything is false/imposter.
somatic delusions?
feeling in the body that isn’t real
thought withdrawal delusion?
someone taking thoughts out of your mind
thought insertion delusion?
thoughts didn’t originate from you; someone adding thoughts to your head.
= compensatory behaviours.
what are delusions of control?
belief that dont have control over own body.
what are the 5 A’s of negative symptoms?
Anhedonia Avolition Alogia Asociality Affective flattening
what is anhedonia
lack of interest/enjoyment.
- looks like depression.
what is avolition
lack of motivation to initiate purposeful activities
what is alogia
lack of speech
what is asociality
lack of interest in social interactions
what is affective flattening
lack of facial expression
course of (+) and (-) and cognitive symptoms?
(+): diminish with age
(-): persist with age
cognitive: affect memory + problem solving
what is catatonia?
unusual movements in the body
- inability to move/rigid. no logical connection to this.
morel + idea about schizophrenia
- demence precoce: mental deterioration that began in adolescence
kraepelin + idea about schizophrenia?
dementia precox: schizophrenia pre-cursor, chronic + deteriorating.
manic depression: psychotic symptoms that come and go
bleuler + idea about schizophrenia?
named it.
- split mind: split btw real and not real.
- didn’t believe it had to be early onset
- didn’t believe it progressed to dementia
what are prefrontal lobotomies?
disrupting neural connections from prefrontal cortex to stop schizophrenia
- reduced difficult behaviours, left blunted behaviours
DSM-IV : 5 subtypes of schizophrenia?
paranoid disorganized catatonic undifferentiated residual
DSM-5 changes in diagnosis of schizophrenia
subtypes eliminated bc limited diagnostic stability, low reliability, poor validity.
no identifiable/consistent treatment among the subtypes.
is schizophrenia a continuum or category
continuum for many symptoms
genetic etiology of schizophrenia
- evidence for over 100 genes
- genetic data suggests schizophrenia, depression, bipolar, autism + adhd share genetic similarities.
prevalence of schizophrenia when MZ twin has schizophrenia?
47%. very much heritable. perhaps other factors impact too.
genetics: relatives of schizophrenics at greater risk for?
greater risk for Cluster A PDs, especially schizotypal PD
– suggests schizotypal is phenotype of schizophrenia genotype
what are endophenotypes?
variable expression of traits that are aspects of a symptom/disorder
(ie. psychosis is combo of prepulse inhibition + sensory gating + others)
what is prepulse inhibition?
ability to inhibit startle response
what is sensory gating
filtering unnecessary sensory information
DA and psychosis?
too much DA from excess release, excess receptors or hypersensitive receptors = psychosis.
dopamine agonists?
stimulants = cocaine, amphetamines
- induce psychosis
dopamine agonists?
antipsychotics, reduce psychosis
Da and parkinsons
too little Da activity
- nigrostriatal da pathway controls + regulates movement
- Da antagnosists can induce parkinsons.
risk/benefit to antipsychotics?
- safety, lucidity, increase quality of life
- decrease physical health, + side effects
adherence of antipsychotics?
low. 50% quit within 1st year, 75% quit within 2 years.
what are side effects of antipsychotics
- sedation, weight gain, diabetes
- dystonia (muscle rigidity)
- akathisia : motor restlessness
- tardive dyskinesia: involuntary repetitive movements
- neuroleptic malignant syndrome: excessive DA blockage can be fatal..
what are some serotonin agonists?
psychedelics:
LSD
psilocybin mushrooms
DMT
what are serotonin antagonists
antipsychotics
seroqual = sedation, neuroleptic syndromes
brain differences in schizophrenics
ventricles enlarged
pfc: reduced volume + metabolism
- decreased synapses
relapse of schizophrenia?
medication noncomplianse most associated w relapse. = vicious cycle, deterioration with relapse
- long acting injectable forms improve compliance. side effects more tolerable
homelessness of schizophrenics?
hard to quantify.
- in US, small proportion of homeless are mentally ill, but many schizophrenics are homeless.
- in canada, large proportion of homeless are mentally ill.
risk factors for homelessness with schizophrenia?
male, substance use, comorbid conditions
employment of schizophrenics?
desire to work, benefit from working (self-esteem, purpose, income)
- hesistant to hire.
vocational interventions are?
integrating mental health team + supported employment team
- work together with person
social skills training intervention?
teach behaviours to function in variety of settings
- help adapt better to situations
- taught the basic of interactions
family as intervention tool?
family psychoeducation lowers risk of relapse.
- when families express emotions heatedly, but learn to deal with that , relapse decreases
CBT as intervention?
- effectiveness is similar to medication
- ID triggers/responses and come up with strategies to cope.
- reduce stress + arousal = reduce stress-diathesis model
overall purpose of cbt?
question core beliefs and cognitive distortions
effect of CBT?
decreased (+) symptoms: severity, hospitalization + relapse
- decreased (-) symptoms: greater mood, motivation + enagagment
what is assertive community treatment?
community based, multidisciplinary treatment teams.
10:1, provide housing, meds, employment
outcomes of assertive community treatment?
reduces admissions, improves functioning, quality of care.
- does not decrease cost of care
what is cognitive remediation
skills to compensate for cognitive deficits
- drills to strengthen memory, problem solving skills, social-cognitive skills
= moderate improvement of cog performance
