L6 - Schizophrenia Flashcards
What is Psychosis + what is it characterised by?
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.)
How are psychosis and Sz linked?
Sz is proposed to be a specific form of psychosis
According to the DSM-5 diagnosis of Sz, how many and what symptoms have to be present?
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)
Which of these symptoms are core symptoms and why?
Delusions
Hallucinations
Disorganised speech
Core because at least 1 of them have to be present for Sz to be diagnosed
What are the 2 types of delusions and what’s the difference?
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
What is dysfunction?
another symptom of Sz, characterised by functioning worse in various life spheres before the symptoms arose
What else is needed for Sz to be diagnosed?
1 month of intense symptomology and the individual must continue to display some degree of impaired functioning for at least 5 additional months
Why is Sz hard to diagnose?
Sz is very heterogeneous –> different for different people
What are positive symptoms of Sz?
Excesses of/ bizzare additions to normal thoughts, emotions. and behaviours e.g., hallucinations
What are negative symptoms of Sz?
Deficits in normal thought, emotions or behaviours e.g., change in eating habits
How does Sz typically develop?
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
What is the peak age onset of SZ spectrum disorders?
ages 20-29 yrs
What are the causes/ predictors of SZ?
- Hospitalisations
- Negative symptoms
- Relapses
- Social and occupational functioning
What are the gender differences in Sz?
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
What is the issue with research into gender differences in Sz?
Evidence is inconsistent
What was the median 12-month and median lifetime prevalence rate for SZ (based on meta analysis)?
4.03 per 1000
7.49 per 1000
What are the study limitations for studies examining the prevalence of Sz?
Study design
Geographic region
Time of reassessment
Study quality
What are the 3 treatment types of SZ?
- Early intervention teams
- Care programme approach
- Individually tailored programme of treatment
What are the 4 stages of CPA and what do they do?
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.
What is voluntary and compulsory detention used for?
more serious/ acute episodes where people can be compulsorily detained at a hospital under the Mental Health Act (2007)
What is the medication used to treat Sz?
Antipsychotics
What are antipsychotics?
A drug that’s considered the 1st line of treatment for sz
Replaced the initial use of ECT/ lobotomies (highly invasive + potentially fatal)
How do antipsychotics work?
block the effect of dopamine on the brain
What are the side effects of antipsychotics?
- Drowsiness
- Weight gain, particularly
some atypical
antipsychotics - Blurred vision
- Constipation
- Lack of sex drive
- Dry mouth
What is CBTp and what does it do?
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
What does family intervention therapy do?
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
What does arts therapy do?
designed to promote a creative and safe expression of experiences –> shown to alleviate negative symptoms
What does research into the efficacy of therapy show?
40/53 studies reduced positive symptoms more than inactive control
To what extent is Sz biological?
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
What are the comorbidity (2 or more diseases at once) rates for Sz and with which MH issues?
Depression: 23-57%
PTSD: 29%
OCD: 23%
Substance abuse: 47%
How is Sz triggered by substance use?
Regular psychotic drug use is related to the development of psychotic symptoms
What particular drug is related to Sz?
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.
What are non-biological risk factors?
- 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
What are the social risk factors for Sz?
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.
