L6 - Schizophrenia

Question 1

What is Psychosis + what is it characterised by?

Answer 1

Umbrella term for a state of mind characterised by:
- Loss of touch with reality in
key ways
- Clusters of symptoms (e.g. hallucinations, delusions etc.)

Question 2

How are psychosis and Sz linked?

Answer 2

Sz is proposed to be a specific form of psychosis

Question 3

According to the DSM-5 diagnosis of Sz, how many and what symptoms have to be present?

Answer 3

2 symptoms

• Delusions
• Hallucinations
• Disorganised speech
• Very abnormal motor
  activity, incl. catatonia
  (motionless)
• Negative symptoms e.g., volition (reduced goal-directed activity due to decreased motivation)

Question 4

Which of these symptoms are core symptoms and why?

Answer 4

Delusions
Hallucinations
Disorganised speech

Core because at least 1 of them have to be present for Sz to be diagnosed

Question 5

What are the 2 types of delusions and what’s the difference?

Answer 5

Grandeur –> delusion that the person is more important that they are e.g., believing their the second coming of Christ

Persecution –> a false belief that others are intentionally trying to cause harm, despite evidence of this being false

Question 6

What is dysfunction?

Answer 6

another symptom of Sz, characterised by functioning worse in various life spheres before the symptoms arose

Question 7

What else is needed for Sz to be diagnosed?

Answer 7

1 month of intense symptomology and the individual must continue to display some degree of impaired functioning for at least 5 additional months

Question 8

Why is Sz hard to diagnose?

Answer 8

Sz is very heterogeneous –> different for different people

Question 9

What are positive symptoms of Sz?

Answer 9

Excesses of/ bizzare additions to normal thoughts, emotions. and behaviours e.g., hallucinations

Question 10

What are negative symptoms of Sz?

Answer 10

Deficits in normal thought, emotions or behaviours e.g., change in eating habits

Question 11

How does Sz typically develop?

Answer 11

3 stages:

1) Promodal –> symptoms not yet obvious but individual is beginning to deteriorate e.g., slow withdrawal from normal life)

2) Active –> symptoms are more apparent, need for help and treatment + first episode of psychosis

3) Residual –> positive symptoms start to deteriorate and negative symptoms reduct, functioning may improve but poor functioning may be present

Individuals can go back and forth between the active and residual stages

Question 12

What is the peak age onset of SZ spectrum disorders?

Answer 12

ages 20-29 yrs

Question 13

What are the causes/ predictors of SZ?

Answer 13

• Hospitalisations
• Negative symptoms
• Relapses
• Social and occupational functioning

Question 14

What are the gender differences in Sz?

Answer 14

2x higher in males than females

Some evidence that negative symptoms are more common in men

Affective symptoms are more prevalent in women

Early onset in males

Women tend to have better long term prognosis
* Higher rate of remission
* Lower risk of
hospitalisation
* Better response to
medication

Question 15

What is the issue with research into gender differences in Sz?

Answer 15

Evidence is inconsistent

Question 16

What was the median 12-month and median lifetime prevalence rate for SZ (based on meta analysis)?

Answer 16

4.03 per 1000
7.49 per 1000

Question 17

What are the study limitations for studies examining the prevalence of Sz?

Answer 17

Study design
Geographic region
Time of reassessment
Study quality

Question 18

What are the 3 treatment types of SZ?

Answer 18

• Early intervention teams
• Care programme approach
• Individually tailored programme of treatment

Question 19

What are the 4 stages of CPA and what do they do?

Answer 19

Assessment - health and social needs assessed

Care plan - plan created to meet health and social needs

Key worker appointed - key worker, usually a social worker or nurse, who is the 1st point of contact with other members of the Community Mental Health Team (CMHT)

Reviews - treatment regularly reviewed and if needed, changes to the care plan agreed.

Question 20

What is voluntary and compulsory detention used for?

Answer 20

more serious/ acute episodes where people can be compulsorily detained at a hospital under the Mental Health Act (2007)

Question 21

What is the medication used to treat Sz?

Answer 21

Antipsychotics

Question 22

What are antipsychotics?

Answer 22

A drug that’s considered the 1st line of treatment for sz

Replaced the initial use of ECT/ lobotomies (highly invasive + potentially fatal)

Question 23

How do antipsychotics work?

Answer 23

block the effect of dopamine on the brain

Question 24

What are the side effects of antipsychotics?

Answer 24

• Drowsiness
• Weight gain, particularly
  some atypical
  antipsychotics
• Blurred vision
• Constipation
• Lack of sex drive
• Dry mouth

Question 25

What is CBTp and what does it do?

Answer 25

Cognitive Behavioural Therapy for psychosis

Targets and challenges some symptoms of psychosis (e.g., attentional, attributional, reasoning bias)

Challenged and trained to change these patterns of thought

Question 26

What does family intervention therapy do?

Answer 26

Aims to modify the family dynamic in many ways, mainly to identify problems and solve them rather than aggravating symptoms

Families often play a key support role

Question 27

What does arts therapy do?

Answer 27

designed to promote a creative and safe expression of experiences –> shown to alleviate negative symptoms

Question 28

What does research into the efficacy of therapy show?

Answer 28

40/53 studies reduced positive symptoms more than inactive control

Question 29

To what extent is Sz biological?

Answer 29

n = 31,524 twin pairs showed a concordance rate of 33% in Mz twins and 7% in Dz twins

No specific gene found that could cause Sz

However, an imbalance of dopamine (neurotransmitter) in the brain can cause the symptoms of Sz

Question 30

What are the comorbidity (2 or more diseases at once) rates for Sz and with which MH issues?

Answer 30

Depression: 23-57%
PTSD: 29%
OCD: 23%
Substance abuse: 47%

Question 31

How is Sz triggered by substance use?

Answer 31

Regular psychotic drug use is related to the development of psychotic symptoms

Question 32

What particular drug is related to Sz?

Answer 32

Cannabis - widely used illicit drug used by Sz sufferers + effects the release of dopamine

Increased risk of Sz among cannabis users vs non-users

Some studies have shown that regular cannabis use alters brain maturational processes, resulting in small white-matter volume.

Question 33

What are non-biological risk factors?

Answer 33

• Depressive and other non-
  psychotic experiences
• Urbanicity (growing up in an
  urban environment)
• Socioeconomic status
• Social dysfunction
• Being single
• Unemployment
• Life events
• Lower level of education + IQ
• Childhood trauma

Question 34

What are the social risk factors for Sz?

Answer 34

Those who suffered adversity (difficult or unpleasant situation) were 3x more likely to experience psychosis

Those raised in a city are 2-3x more likely to diagnosed

If you’re in an urban area you’re more likely to have access to cannabis use, group position, social adversity, exclusion and discrimination.

Area-level risks like population density, social fragmentation and deprivation, air pollution.