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239 - final > L10: schizophrenia > Flashcards

L10: schizophrenia Flashcards

1
Q

what is schizophrenia

A

a brain disorder affecting how ppl think, act, feel and perceive.

  • deprives rational thought
  • impacts perception
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2
Q

what is the defining feature of schizophrenia?

A

psychosis

  • possibly with hallucinations and/or delusions
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3
Q

what are hallucinations?

A

stimuli inconsistent with objective reality

-ie. hearing voices no one else can hear

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4
Q

what are delusions?

A

fixed false beliefs that are inconsistent with objective reality

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5
Q

what is the prevalence of Schizophrenia ?

A
  • M : F = 1.4:1

- generally agreed upon worldwide.

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6
Q

what population has the lowest lifetime prevalence of Schizophrenia?

A

Asian populations

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7
Q

lifetime prevalence of schizophrenia + schizophrenic disorders

A

0.55 + 1.45, respectively

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8
Q

Prevalence in Canada

A

~1%

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9
Q

Why is prevalence higher in Canada? (2 theories)

A
  1. higher prevalence of people who immigrate = likely relates to stress
  2. Less sunlight = low VitD in pregnancy = prenatal risk factor.
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10
Q

age of onset for schizophrenia

A
  • late teens to mid 30s
  • early to mid 20s for MEN
  • late 20s for WOMEN
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11
Q

course of schizophrenia?

A

from healthy, normal functioning to more ill.

- gradual onset of subsyndromal symptoms.

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12
Q

what is prodromal period?

A

when subsyndromal symptoms begin to arise - before the onset of full schizophrenia.
- perhaps capture this state + intervene before schizophrenia arises.

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13
Q

chidhood onset? yay or nay?

A

possible but unlikely

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14
Q

late onset - when? characterized by?

A

after 40yoa

- psychotic symptoms + paranoia

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15
Q

co-morbidity?

A

50% have another psychiatric disorder.

  • 50% use substances ie. cigarettes.
  • others have anxiety, ocd depression
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16
Q

how many commit suicide?

A

10%

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17
Q

why do people use substances with schizophrenia?

A

biological effects of nicotine.

- give a lift, break down antipsychotics = more energy.

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18
Q

cognitive deficits in schizophrenia?

A

often precede psychosis + remain stable

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19
Q

is there a reliable way to predict the course of schizophrenia?

A

no reliable way.

  • some improve, few recover.
  • most require support + are chronically ill.
  • some have exacerbations + remissions.
  • some progressively deteriorate.
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20
Q

what features may relate to good prognosis?

A
  • late onset
  • acute onset
  • (+) premorbid social, sexual, work histories
  • mood disorder symptoms
  • married
  • family history
  • good support system
  • (+) symptoms
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21
Q

what features may relate to poor prognosis?

A
  • 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
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22
Q

psychiatric hospitalization of schizophrenics??

A

31% are with schizophrenia

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23
Q

5 elements required for diagnosis?

A 
H(u)SB(a)ND
Hallucinations
Speech disorganization
Behaviour disorganization
Negative symptoms
Delusions
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24
Q

what is diagnosis based on?

A

psychiatric history
mental status exam
clinical diagnosis
– no lab test/imaging

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25
Q

strategy to get psychiatric history?

A

get full psychiatric assessment

- thorough, objective assessment of life + mental state

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26
Q

what is psychosocial backgroun?

A

gender, life experiences

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27
Q

5 S’s of history of presenting illness?

A 
Situation
Stressors
Symptoms
Safety (suicide/homicide/self harm)
Substance use
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28
Q

what are the elements of a Psychiatric history?

A
  • psychosocial background
  • history of presenting illness
  • medical history
  • family history
  • medical psych history (diagnoses, treatments, hospitalizations, suicide attempts)
  • medications
  • social and personal history.
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29
Q

elements of social + personal history?

A

birth (prenatal experience may increase schizophrenia)

  • development
  • family
  • school
  • abuse
  • work
  • relationship
  • supports
  • legal
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30
Q

what is acute onset often related to?

A

ingestion of substance

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31
Q

why are relapses important in prognosis?

A

each time you relapse, you come back to “normal” worse off + clozer to a schizophrenic episode.

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32
Q

major risk factors in schizophrenia?

A

place/time of birth

  • infection
  • prenatal elements
  • obstetric conditions.
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33
Q

what are positive symptoms?

A

presence of too many behaviours not found in most people (added behaviours)

  • hallucinations, speech + behaviour disorganization, delusions
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34
Q

what are negative symptoms?

A

absence of behaviours found in most people (lost something)

- 5A’s.

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35
Q

what are hallucinations?

A

false perceptions that feel real, without sensory input

- most are auditory (hear voices or thoughts of others)

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36
Q

contrast hallucinations and illusions?

A

h: false perception - no sensory input

I: miscerception of real sensory input.

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37
Q

describe what disorganized speech may be like?

A

tangential, mocking others, lack of connectedness, quickly changes topics

  • reflection of thought pattern in mind
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38
Q

what is Linear thought form?

A

completes given idea before moving on to the next.

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39
Q

what is circumstantial thought form?

A

moves on to related topics but eventually returns to original topic

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40
Q

what is tangential thought form?

A

moves on to related topics but never returns to original topic

41
Q

what is “Loosening of associations” thought form

A

no logical connection between sequence of thoughts

42
Q

what is “word salad” thought form

A

no logical connection between words

43
Q

what is “flight of ideas” thought form

A

rapid movement from topic to topic without completing each train of thought

44
Q

perseveration?

A

persistent inappropriate repetition of same thoughts

45
Q

what are delusions?

A

fixed false beliefs

46
Q

what are persecutory delusions?

A

paranoid that others will persecute them, threaten them, conspire against them

47
Q

what are referential delusions?

A

neutral event that’s not meant to have special meaning, does.

48
Q

what are grandiose delusions

A

narcissistic-type delusions

49
Q

what are erotomanic delusions

A

thoughts that never stop

50
Q

what are nihilistic delusions

A

nothing exists, everything is false/imposter.

51
Q

somatic delusions?

A

feeling in the body that isn’t real

52
Q

thought withdrawal delusion?

A

someone taking thoughts out of your mind

53
Q

thought insertion delusion?

A

thoughts didn’t originate from you; someone adding thoughts to your head.
= compensatory behaviours.

54
Q

what are delusions of control?

A

belief that dont have control over own body.

55
Q

what are the 5 A’s of negative symptoms?

A 
Anhedonia
Avolition
Alogia
Asociality
Affective flattening
56
Q

what is anhedonia

A

lack of interest/enjoyment.

- looks like depression.

57
Q

what is avolition

A

lack of motivation to initiate purposeful activities

58
Q

what is alogia

A

lack of speech

59
Q

what is asociality

A

lack of interest in social interactions

60
Q

what is affective flattening

A

lack of facial expression

61
Q

course of (+) and (-) and cognitive symptoms?

A

(+): diminish with age
(-): persist with age
cognitive: affect memory + problem solving

62
Q

what is catatonia?

A

unusual movements in the body

- inability to move/rigid. no logical connection to this.

63
Q

morel + idea about schizophrenia

A
  • demence precoce: mental deterioration that began in adolescence
64
Q

kraepelin + idea about schizophrenia?

A

dementia precox: schizophrenia pre-cursor, chronic + deteriorating.

manic depression: psychotic symptoms that come and go

65
Q

bleuler + idea about schizophrenia?

A

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
66
Q

what are prefrontal lobotomies?

A

disrupting neural connections from prefrontal cortex to stop schizophrenia
- reduced difficult behaviours, left blunted behaviours

67
Q

DSM-IV : 5 subtypes of schizophrenia?

A 
paranoid
disorganized
catatonic
undifferentiated
residual
68
Q

DSM-5 changes in diagnosis of schizophrenia

A

subtypes eliminated bc limited diagnostic stability, low reliability, poor validity.
no identifiable/consistent treatment among the subtypes.

69
Q

is schizophrenia a continuum or category

A

continuum for many symptoms

70
Q

genetic etiology of schizophrenia

A
  • evidence for over 100 genes

- genetic data suggests schizophrenia, depression, bipolar, autism + adhd share genetic similarities.

71
Q

prevalence of schizophrenia when MZ twin has schizophrenia?

A

47%. very much heritable. perhaps other factors impact too.

72
Q

genetics: relatives of schizophrenics at greater risk for?

A

greater risk for Cluster A PDs, especially schizotypal PD

– suggests schizotypal is phenotype of schizophrenia genotype

73
Q

what are endophenotypes?

A

variable expression of traits that are aspects of a symptom/disorder
(ie. psychosis is combo of prepulse inhibition + sensory gating + others)

74
Q

what is prepulse inhibition?

A

ability to inhibit startle response

75
Q

what is sensory gating

A

filtering unnecessary sensory information

76
Q

DA and psychosis?

A

too much DA from excess release, excess receptors or hypersensitive receptors = psychosis.

77
Q

dopamine agonists?

A

stimulants = cocaine, amphetamines

  • induce psychosis
78
Q

dopamine agonists?

A

antipsychotics, reduce psychosis

79
Q

Da and parkinsons

A

too little Da activity

  • nigrostriatal da pathway controls + regulates movement
  • Da antagnosists can induce parkinsons.
80
Q

risk/benefit to antipsychotics?

A
  • safety, lucidity, increase quality of life

- decrease physical health, + side effects

81
Q

adherence of antipsychotics?

A

low. 50% quit within 1st year, 75% quit within 2 years.

82
Q

what are side effects of antipsychotics

A
  • sedation, weight gain, diabetes
  • dystonia (muscle rigidity)
  • akathisia : motor restlessness
  • tardive dyskinesia: involuntary repetitive movements
  • neuroleptic malignant syndrome: excessive DA blockage can be fatal..
83
Q

what are some serotonin agonists?

A

psychedelics:
LSD
psilocybin mushrooms
DMT

84
Q

what are serotonin antagonists

A

antipsychotics

seroqual = sedation, neuroleptic syndromes

85
Q

brain differences in schizophrenics

A

ventricles enlarged

pfc: reduced volume + metabolism
- decreased synapses

86
Q

relapse of schizophrenia?

A

medication noncomplianse most associated w relapse. = vicious cycle, deterioration with relapse

  • long acting injectable forms improve compliance. side effects more tolerable
87
Q

homelessness of schizophrenics?

A

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.
88
Q

risk factors for homelessness with schizophrenia?

A

male, substance use, comorbid conditions

89
Q

employment of schizophrenics?

A

desire to work, benefit from working (self-esteem, purpose, income)
- hesistant to hire.

90
Q

vocational interventions are?

A

integrating mental health team + supported employment team

- work together with person

91
Q

social skills training intervention?

A

teach behaviours to function in variety of settings

  • help adapt better to situations
  • taught the basic of interactions
92
Q

family as intervention tool?

A

family psychoeducation lowers risk of relapse.

- when families express emotions heatedly, but learn to deal with that , relapse decreases

93
Q

CBT as intervention?

A
  • effectiveness is similar to medication
  • ID triggers/responses and come up with strategies to cope.
  • reduce stress + arousal = reduce stress-diathesis model
94
Q

overall purpose of cbt?

A

question core beliefs and cognitive distortions

95
Q

effect of CBT?

A

decreased (+) symptoms: severity, hospitalization + relapse

- decreased (-) symptoms: greater mood, motivation + enagagment

96
Q

what is assertive community treatment?

A

community based, multidisciplinary treatment teams.

10:1, provide housing, meds, employment

97
Q

outcomes of assertive community treatment?

A

reduces admissions, improves functioning, quality of care.

- does not decrease cost of care

98
Q

what is cognitive remediation

A

skills to compensate for cognitive deficits
- drills to strengthen memory, problem solving skills, social-cognitive skills

= moderate improvement of cog performance

239 - final (5 decks)

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