lecture 11 Flashcards
Schizophrenia Spectrum and Other Psychotic Disorders
How is Schizophrenia defined
Chronic mental illness with positive symptoms (delusions, hallucinations, disorganized speech and behavior), negative symptoms, and cognitive impairment
What are the ABCDEF characteristics of Schizophrenia
A) Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be
delusions, hallucinations or disorganized speech:
* Delusions
* Hallucinations
* Disorganized speech (e.g., frequent derailment or incoherence)
* Grossly disorganized or catatonic behavior
* Negative symptoms (i.e., diminished emotional expression or avolition)
B) Since onset, level of functioning in work, interpersonal functioning, or self-care is markedly below level achieved prior to onset
C) Persistence for at least 6 months, which includes at least
one month of Criterion A symptoms and may include
prodromal or residual periods, in which only 1 negative
symptom or two Criterion A symptoms are present in an
attenuated form
D) Schizoaffective and depressive or bipolar disorder with psychotic features have been ruled out
E) Symptoms are not attributable to the physiological effects
of a substance or another medical condition
If there is a history of autism spectrum disorder or a
communication disorder of childhood onset, the additional
diagnosis of schizophrenia is made only if prominent
delusions or hallucinations, in addition to other required
symptoms of schizophrenia, are also present for at least
one month
What is involved in the schizophrenic positive symptom; hallucinations
- Sensory experiences in the absence of any relevant
stimulation from the environment - Auditory hallucinations more common than visual, which includes:
- Hearing one’s thoughts spoken by another voice
- Hearing voices arguing
- Hearing voices comment on one’s behaviour
What is involved in the schizophrenic positive symptom; Delusions
Beliefs contrary to reality and firmly held despite
disconfirming evidence
- Grandiose delusions: exaggerated sense of self-importance
- Ideas of reference: reading personal significance
into the trivial activities of others - Thought insertion: believing that one’s thoughts are not their own, but have been inserted by an external force
- Thought withdrawal: believing one’s thoughts have
been taken from their minds - Thought broadcasting: believing that others can
know what one is thinking - Persecution: believing that someone is harming or trying to harm oneself or loved ones
- Erotomatic: believing that another person is in love
with the individual - Jealous: believing that one’s spouse or lover is unfaithful
- Somatic: believing that one’s bodily function or appearance is grossly abnormal
- Believing an external force controls their feelings or
behaviours - Believing the people around them have been replaced by imposters
What is involved in the schizophrenic negative symptom; disorganised behaviour/behavioural deficits
Behavioural deficits in motivation, pleasure, social
closeness and emotional expression, including:
- Avolition: inability to initiate and persist in activities - More motivated by goals that reduce boredom as opposed to those about autonomy, building skills, knowledge, etc
- Anhedonia: lack of pleasure - Reduction in anticipatory pleasure not consummatory
pleasure - Asociality: lack of interest in social interactions
- Alogia: significant reduction of speech
- Affective flattening/Blunted affect: lack of emotional
expression
What is involved in the schizophrenic disorganised symptom; disorganised speech
- Erratic speech and emotions that prevents listeners from
understanding - Loose associations: ideas which are disjointed by still
related - Derailment: ideas so disorganized there appears to be no meaningful connections
What is involved in the schizophrenic disorganised symptom; disorganised behaviour
- Inability to organize behaviour so that it conforms with community standards
- Catonia: abnormality of movement that may involve
repetitive or purposeless overactivity, catalepsy
(resistance to passive movement), or waxy flexibility
(can move a person’s limbs into positions that will be
held for long periods)
What are the two cognitive deficits associated with schizophrenia
Neurocognition = attention, concentration, memory, speed of processing, executive functioning
Social cognition = emotion recognition, theory of mind
What are the 3 phases of Schizophrenia
Prodromal = early stage often not recognized until after the
illness has progressed
Active/Acute = this phase is the most visible as people
experience the positive symptoms of psychosis
Residual = a period when individuals have fewer obvious
symptoms, but some symptoms are still present
What is Schizophreniform Disorder
“Schizophrenia” that lasts between 1 - 6 months
- generally good functioning among patients whom can resume normal lives
What is brief Psychotic Disorder
Positive symptoms of schizophrenia and/or disorganized speech or behaviour
- lasts less than 1 month
- has the briefest duration of all psychotic disorders
- typically precipitated by trauma or stress
What is Schizoaffective Disorder
It is “Schizophrenia” + a major mood episode (manic or
depressive)
- Psychotic symptoms must also occur outside the mood
disturbance for at least two weeks
- Prognosis is similar for people with schizophrenia
- Such persons do not tend to get better on their own
What is Delusional Disorder
Key feature = delusions
- Does NOT include other positive symptoms or negative or disorganized symptoms
- Functioning is generally not impaired beyond the impact of
believing the delusion
- Prognosis is better than with schizophrenia
Why cant we solely look at a person’s symptoms when diagnosing them with a disorder?
Psychotic symptoms can occur for a range or reasons, not only as part of their mental disorder, but also other factors such as symptoms resulting from substance use, the medications they are on, or any medications they may be on
What is the prevalence of Schizophrenia
1% overall
- equally common in males and females
- can emerge at any time but typical onset occurs in late adolescence or early adulthood (can still occur during childhood, its just extremely rare)
What is the morbidity of Schizophrenia
- Chronic
- Most suffer moderate-to-severe impairment –> e.g. Only 21.5% employed over a 12mos period, 85% are dependent on government assistance, and 42%-63% will abuse drugs and alcohol
- life expectancy = less than average (5% due by suicide)
How do biological factors influence Schizophrenia
- Genetic risk is the main driver for the development of
schizophrenia –> Accounts for about 81% of the risk - Risk increases with genetic relatedness –> E.g., having a twin with schizophrenia incurs greater risk than having an uncle with schizophrenia
- Negative symptoms seem to have a stronger genetic
component than positive symptoms - Adoptees have a high risk for developing schizophrenia if a
biological parent has schizophrenia, but risk is lower than for children raised by their biological parent with
schizophrenia (therefore, Healthy environment is a protective factor) - Schizophrenia if partially caused by overactive dopamine –> PET and SPECT studies show that excess dopamine drives positive and disorganized symptoms however many neurotransmitters are
likely involved including Glutamate, NMDA, GABA - Reduction in grey matter and overall volume of prefrontal
cortex –> causes less activation of the prefrontal cortex and therefore greater severity of negative symptoms
How do environmental factors influence Schizophrenia
Stress
* Delivery complications
* Starvation
* Maternal infections during pregnancy
* Cannabis use
* Low SES
* High expressed emotion
What are the treatment options for Schizophrenia
Often includes a combo of short-term hospital stays,
medication, and psychosocial treatment
What are the medication options of treatment for Schizophrenia
Antipsychotics (AKA neuroleptics)
* First-generation medications - e.g. chlorpromazine, haloperidol
- Extrapyramidal adverse effects are common which resemble the symptoms of Parkinson’s disease)
- Tardive dyskinesia - Mouth muscles involuntarily make sucking, lipsmacking motions (permanent side effect)
- Second-generation medications - e.g. aripiprazole, clozapine, olanzapine, risperidone
- Mechanism of action differs from first-generation
meds - Weight gain side effect
**However compliance with medication is often a problem due to aversion to side effects, financial cost and poor relationships with doctors
What are the psychosocial options of treatment for Schizophrenia
- Social skills training
- Family therapies
- Psychoeducation about schizophrenia
- Blame avoidance reduction
- Communication and problem-solving training
- Social network expansion
- Cognitive remediation = Computer-based training in attention, memory, and
problem-solving
There are token economies on inpatient units which utilise strategies such as rewarding adaptive behaviours
What is case management in regards to schizophrenia
- Involves connecting people with the services they need
- Hold together and coordinate the range of medical and psychological services that individuals need
How can Schizophrenia be prevented
- Identify at-risk children
- Foster supportive, stable environments
- Offer additional treatment at prodromal stages, including
social skills training
