Lecture 12: Psychotic Disorder Part 2 Flashcards
Cognitive impairment in Schizophrenia (4)
- Attention
- Working memory
- Learning
- Executive functioning
There seems to be cognitive deficits in ______ of people with schizophrenia which suggests genetic influence
Relatives
Biological mediators of Schizophrenia (7)
HINT for first 3: There are volume deficits in 3 areas
- Volume deficits in amygdala
- Volume deficits in hippocampus
- Volume deficits in frontal lobe
- Enlargement of ventricles
- Decreased 5HT2A receptors
- Neurons in cortex and hippocampus are smaller in size
- Increased D2 Receptors
What type of neurotransmitter receptor is a 5HT2A receptor?
A type of serotonin receptor
What type of neurotransmitter receptor is a D2 receptor?
A type of dopamine receptor
Some studies suggest that brain volume progressively ______ across the lifespan for people with schizophrenia
Decreases
The dopamine hypothesis (2) for schizophrenia! This talks about the activations of certain areas in the brain
- OVERACTIVATION of Mesolimbic dopamine pathway (MDP) causing POSITIVE symptoms
- UNDERACTIVATION of Mesocortical dopamine pathway causes NEGATIVE and COGNITIVE symptoms
The dopamine hypothesis originated from the use of _______ ________
Antipsychotic medication
The mechanism of action for most antipsychotic medication is to act as a ___ ____ _____
Dopamine receptor antagonist
Receptor antagonist
- A molecule that BINDS to a receptor
- which BLOCKS neurotransmitters or neuromodulators
- from binding to the receptor
- which INTERRUPTS neurotransmission
Antipsychotic medication _____ dopamine receptors and _______ the overactive MDP in people with schizophrenia
BLOCKS
DOWNREGULATES
Additional support for the dopamine hypothesis is that stimulants like methamphetamine which act as dopamine receptor agonists can cause _______
psychosis
Receptor agonist
- A molecule that BINDS to a receptor
- STIMULATING it
- And INCREASING neurotransmission
Additional support for the dopamine hypothesis is that ______ _____ show higher levels of dopamine and higher density of D2 receptors in the _____
Postmortem studies
Striatum
One problem with using dopamine antagonists to treat schizophrenia is that while it helps ______ positive symptoms, it can make negative symptoms worse by ________ the mesocoritcal dopamine pathway
REDUCE
DOWNREGULATING
Stress activates the ____ ____ which releases ______ in the bloodstream
HPA axis
Cortisol
Cortisol has been shown to increase activity of __________ ______ which maybe trigger the onset of schizophrenia in _____ _____ _______
Dopaminergic circuits
Genetically vulnerable people
People with schizophrenia seem to have lower rates of reproduction so how did it persist? Why wasn’t it selected out?
What’s the deflationary answer
Deflationary answer: People with schizophrenia have lower rates of reproduction in modern societies but more in ancestral societies
People with schizophrenia seem to have lower rates of reproduction so how did it persist? Why wasn’t it selected out?
What are the 2 adaptionist answers?
- People with schizophrenia contributed to group survival by adopting the role of shamans/other religious leaders that contributed to group cohesion and fitness
- People with schizophrenia usually have relatives with schizotypal traits (atypical cognition andd behaviors) like creativity which can be beneficial
People with schizophrenia seem to have lower rates of reproduction so how did it persist? Why wasn’t it selected out?
What is the non-adaptionist answer?
Women with schizophrenia tend to have a psychotic episode later in adulthood, giving them a period of average reproductive success
Rates of schizophrenia have found to be higher among what demographic?
African American people
Researchers have debated how to interpret the schizophrenia findings (2)
- Results reflect a real phenomenon
- Results are spurious
If the assumption of SZ rates among AA are real then it might be due to: (3)
- Genetic causes eg. Gene linkages that are risk factors for psychosis appear more in genomes of AA
- Environmental causes eg. Prenatal malnutrition that might disproportionately affect AA communities
- Sociocultural factors eg. Discrimination and racisms that disproportionately affect AA and causes traumatic stress which is a risk factors for SZ
If the assumption of SZ rates among AA are spurious then it might be due to: (3)
- Cognitive biases/stereotype of clinicians conducting assessments
- Differences in psychotic system-presentation across racial/ethinic groups
- Diagnostic procedures at low-income community mental health clinics that disproportionally serve AA compared to procedures at higher income hospital that disproportionately server other racial/ethnic groups
Currently is there enough evidence to say wither higher reported rates of SZ among AA are attributable to factors that make it a real discrepancy?
NO!
Some cognitive scientists have argues that the mind is largely _____ in its organization
Modular
Mental module: part of the mind that is: (3)
- Domain specific
- Informationally encapsulated
- Other properties that we don’t need to worry about
Domain specificity
Each module processes one type of information
Informational encapsulation
Information processing of one module is unavailable to other modules with the exception of a narrow range of inputs and outputs between modules
Example of informational encapsulation
The müller-layer illusion ~ short and long lines with arrows inwards and one outwards
Some cognitive scientists believe that visual perception and belief formation are ____ _____ _____ that don;t have access to eachothers information processing
Separate mental modules
Some scientists also believe that while ____ ____ processing occurs, little ____ _____ processing occurs in normal human perception and cognition
Bottom-up
Top-down
“Bottom-up” processing
Information that flows from perception to cognition
Example of bottom up processing
Alone, outside at night, you see a dark figure and then believe you’re in danger
“Top-down” information processing
Information processing that flows from cognition to perception
Example of top down processing
Alone, outside at night, you believe you’re in danger and so perceive a shadow as a person
Powers et al (2016) argue that hallucinations are an example of ____ _____ __________
Top down processing
Evidence for the hallucinations = top down processing include? (4)
- People who hallucinate are more susceptible to sensory conditioning
- Content of hallucinations tends to be mood-congruent (perception affected by emotion)
- Illusory pattern perception is common in non-clinical population (perception affected by prior belief)
- Hallucinations aren’t limited to people with psychotic disorders but also loved ones after bereavement. (perception affected by emotion and belief)
Sensory conditioning
False perception of a stimulus that has been previously associated (through conditioning) with another stimulus
In sensory conditioning preception is affected by ______/______ which is a _____ state
Expectation/association
Cognitive
Mood-congruent
Related to mood
When hallucinations are mood-congruent, perception is affected by ______ which is a _____ state
Emotion
Cognitive
When hallucinations are based on illusory pattern perception (eg. People’s belief about the stock market trending downwards) perception is affected by ____ ____, which is a _____ state
Prior belief
Cognitive
When hallucinations are after bereavement, perception is affected by _____ (eg. ______) and _______ (e.g. the lost person survives in an afterlife)
Emotion eg. Sadness
Belief
What’s Bayes theorem
P(A|B) = P(B|A) x P (A) / P (B)
Explain/Read: P(A|B) = P(B|A) x P (A) / P (B)
The probability of A, given that B is trueis equal to the
product of the probability of B given that A is true
multiplied by the probability of A
divided by the probability of B
Use the Bayes Theorum to explain the probability you have COVID given that you have a cough
The probability you have COVID given that you have a cough is equal to
The probability that you would have a cough if you have COVID
Multiplied by the probability that you have COVID (local rates of covid)
Divided by the probability that you just have a cough in general (for any reason)
In psychotic disorders people tend to have impaired _______ reasoning
Bayesian
A client with a psychotic disorders believed that his roommate was tampering with his computer because he was having recurrent Zoom connection difficulty. He thought this was highlight probable because (3)
- He overestimated the probability that tampering would result in connection difficulty
- He overestimated the probability of how much computer tampering by roommates exists in the world
- He underestimated the probability of Zoom connection difficulty
The primary treatment of Schizophrenia and schizoaffective disorders people tend is with ______ ________. Typically these are ______ _________.
Antipsychotic medication
Dopamine antagonists
Examples of dopamine antagonists used to treat schizophrenia
- Clorazil
- Abilify
Primary treatment of bipolar disorder is done with ______ ________ for example. _____ or _______
Mood stabilizers like Lithium or Depakote
Secondary treatment of schizophrenia and other psychotic disorders is with _______ and ____ ________
Psychotherapy and case management
Psychotherapy and case management typically includes (3)
- Psychoeducation about psychosis
- open conversations about delusions and hallucinations
- Methods to help reduce and manage delusions and hallucinations
What are some methods to help reduce and manage delusions and hallucinations (8)
- Follow a daily schedule that provides consistent structure
- Reduce unexpected events
- Reduce stress caused by work/relatinoship conflict
- increase social support and social services
- Help process stigma and loss of previous life goals
- Help develop new life goals
- Practice social skills
- Individual and/or group psychotherapy
People with schizophrenia and other psychotic disorders often have _______ and _______
Comorbid anxiety and depression
More specifically people with schiziphrenia and other psychotic disorders often have Comorbid anxiety and depression i.e., (2)
- A hyperactive threat/avoidance system and/or
- A hypoactive reward/approach system
Because people with schizophrenia and other psychotic disorders often have Comorbid anxiety and depression, they benefit from interventions that (2)
- Decrease activity of the threat/avoidance system
- Increase activity of the reward/approach system
