lecture 10- Psychotic disorders ( schizophrenia) Flashcards
what is psychosis
Extreme impairment in several areas of functioning o Clarity of thought o Emotional response o Communication o Understanding reality o Behaviour * Severely interfere with normal life * Psychotic symptoms are observed in many other conditions o Schizophrenia (and subtypes) o Bipolar disorder o Severe depression o Alcohol and drug abuse o Withdrawal from alcohol/recreational drugs
name some aspects of schizophrenia on the DSM
A. (Characteristic symptoms) Two or more of following … at least one must be 1, 2 or 3:
o Delusions
o Hallucinations
o Disorganised speech
o Grossly disorganised or catatonic behaviour
o Negative symptoms
* B. For significant proportion of time … level of functioning … markedly below pre-onset functioning
* C. Signs of disturbance must persist for at least 6 months (with some variations according to profile)
* D. Schizoaffective disorder and depressive/bipolar disorder with psychotic features has been ruled out
* E. …is not attributable to psychological effects of a substance or another medical condition
name the positive symptoms of schiz
delusions
hallucinations
explain some aspects of delusions - a positive symptom
Firmly held (erroneous) beliefs o Distorted reasoning o Misinterpretation of perception * Delusion of control * Delusion of reference * Erotomania * Grandiose delusion * Persecutory delusion * Religious delusion
explain the different types of hallucinations- a positive syptom
Distortions or exaggerations of perception
o Perceiving sensations that are not apparent to others
* But are vivid, substantial, and real to the patient
o Can relate to any of the senses
* Most commonly auditory
* Followed by visual
o But can also relate to other senses
* Olfactory – smell
* Taste
* Tactile/body sensations
* Auditory hallucinations (most commonly)
o Hearing voices that no-one else can hear
* May be heard as conversations between other people
* Or may be directed at the patient
o Voices may comment on patient’s behaviour
* Often menacing or intimidating
* Voices may even ‘issue commands’ or warn of danger
* Visual hallucinations
o Seeing things that no-one else can see
* May be distinct, such as people or objects
* Or may be vague perceptions of colour and sha
name and explain negative symptoms of hallucinations
Affective flattening
o Reduction in range and intensity of emotional expression
* Alogia
o Poverty of speech
* Avolition
o Reduction or difficulty with goal-directed behaviour
* Other social dysfunction impairments
o Reduced energy
o Lack of motivation
o Poor hygiene
o Problems functioning at school, work, or other activities
o Moodiness (including severe mood swings)
describe disorganised speech
Patient’s inability to think clearly and respond appropriately
* Most commonly associated with irregular speech
o Talking in sentences that do not make sense
o Rambling loose associations
o Using nonsense words
o Speaking incoherently
* Can also be related to behaviours
o Odd movements
o Disorganised actions
o Catatonia
list some causes of schizophrenia
veral causal explanations have been suggested
o Schizophrenia is strongly linked to biological causes
* But, environmental triggers are also likely to be needed
o Some of the most strongly associated causes:
* Genetics
* Obstetric events
* Infections
* Brain structure and function
* Neurochemistry
* Substance misuse/withdrawal – as discussed earlier
* Social explanations and life experiences
* Cognition
explain some genetic explanations for schiz
Schizophrenia tends to (somewhat) run in families
o Risk of schizophrenia about 10% if parent has the illness
* General population risk is 1%
o Risk in monozygotic twins is 11-14% (quite low)
* Against 1-4% in dizygotic twins
* BUT 60% of pts do not have any other family member with psychotic disorder
o AND genetic predisposition does not always lead to illness
* Probable that inherited genes make a person vulnerable to schizophrenia
o But environmental factors act on vulnerability to trigger illness
describe some social explanations of schi
Risk for schizophrenia increases with number of adverse social factors experienced in childhood (Wicks et al 2005) * Some key social risk factors (e.g. see Mueser & McGurk, 2004; Jarvis, 2007) o Birth events (maternal illness, etc) o Physical or sexual abuse in childhood o Poverty o Lower social class o Social deprivation o Migration and racial discrimination o Relationships o Urbanicity
explain some cognitive causes of schi
Interaction between neurobiological, environmental, cognitive, and behavioural factors (Beck & Rector 2005; Kuipers et al 2006)
o Brain structure abnormalities may predispose illness
* And environmental stressors may provide trigger
o But cognitive interpretations guide maladaptive behaviour
o Delusions could be due to cognitive biases
* Such as negative external attributions
o And inappropriate behaviour
* Such as jumping to conclusions
o Hallucinations may be result of attention biases
describe (Thornicroft et al 2004) study on the social impacts of schiz
European study explored personal impact (Thornicroft et al 2004) o Poorer personal outcomes * Higher rates of unemployment * More likely to be single * Greater use of welfare benefits o Poorer quality of life * Anxiety/depression * Alcohol/substance abuse * Poor social life * Health factors (side effects of medication etc) * Poor personal care and hygiene * Labelling and stigma * Social deprivation
explain how schiz affects functional impairment
While social deprivation might be potential cause
o It is also a consequence
* Schizophrenic people often live in poor urban areas
o But did that cause the illness?
* Or did the illness cause a drift towards social deprivation?
o Social causation hypothesis (Hollingshead & Redlich 1958)
* Those in lower classes suffer greater levels of stress
* More likely to trigger predisposition
o Social drift hypothesis (Wender et al 1973)
* Those with schizophrenia cannot gain employment
* “Drift down” to the lower classes
explain the social cognition impairment of chiz
Social cues (verbal and non-verbal) involve perception:
o Processing others’ emotional facial expression
o Recognition of familiar social situations
* Theory of mind (ToM)
o Recognition of others’ intentions and thoughts
* Depends on interpreting non-verbal social cues
o Schizophrenia pts impaired in ToM (Brüne 2005)
* Often measured using ‘faux pas’ recognition tests
* Schizophrenia also associated with other cognitive dysfunctions (Rodriguez-Sanchez et al 2008)
o Information processing (esp. abstract)
o Executive function and problem-solving
o Speed of processing
explain the burden of schizophrenia
Burden
* Schizophrenic pts represent sig burden to society (Awad & Voruganti 2008)
o On caregivers – family & friends
o Economic costs
o Hospitalisation
o Psychosocial support
o State benefits
o Lost production
* But most research focuses on family burden
o Emotional, psychological, physical and economic impact
o Distress, shame, embarrassment, guilt, self-blame
Family (and/or friends) burden
* Burden of care often focuses on two constructs
o Objective burden
* Effects on the household
* Taking care of daily tasks
* Family dynamics
* Loss of social activities
* Effect on leisure time and/or career
* Finances
o Subjective burden
* Caregivers’ perceptions of that burden
* How they cope with objective burden
* Recent research focuses on determining factors
* Schizophrenia and family burden (Gutiérrez-Maldonado et al 2005)
o Burden of caring for schizophrenic person associated with:
* Reduced quality of life
* Sig impact health and functioning of caregivers
o Higher levels objective and subjective burden ð
* High expressed emotion ð
* Increases risk of schizophrenia relapse in patient
o Distress and dissatisfaction from burden:
* Perceived losses in carer’s life
* Lost opportunities because of caring for patient
* Stigma concerning schizophrenia
* Financial problem`
