Lecture 3 Schziophrenia Flashcards
What does Dementia praecox mean? (by Emil Kraeplin)
Dementia of young people
According to Eugene Bleuler what were the four core disturbances of Schizophrenia (splitting of the mind)?
Affect
Ambivalence
Associations (changes in thoughts)
Preference for fantasy over reality
How prevalent is schizophrenia?
Approximately 1% prevalence in general population
What is the peak age of onset of schizophrenia for males and females?
Males: 15-25 yrs
Females: 25-35 yrs
Is schizophrenia associated with a lower lifespan? True or False?
True
Is schizophrenia the most expensive of all mental disorders? True or False?
True.
Direct treatment costs
Low employment rate
Public assistance costs
What are the characteristic symptoms of schizophrenia?
A. Individual needs to have TWO or MORE during 1 month and at least one of the symptoms needs to be 1, 2, or 3 below.
- Delusions (fixed beliefs that are not open to change in light of conflicting evidence)
- Hallucinations (sensory experiences that aren’t real)
- Disorganised speech (frequent derailment or
incoherence in speech) - Grossly disorganised or catatonic behaviour
(1-4 are positive symptoms - the addition of something unusual to normal types of behaviours)
- Negative symtpoms (absence of typical types of behaviours)
- Affect flattening (reduced emotional expression)
- Alogia (impoverished thinking - seen through diffs in
speech) - Avolition (lack of motivation)
What are the other criteria for schizophrenia?
B. Social Occupational Dysfunction - often loss of jobs,
difficulty studying
C. Duration: continuous signs for 6 months
D. Schizoaffective & Mood Disorder (individual SHOULD NOT meet this criteria in order to be diagnosed with schizophrenia - EXCLUSION CRITERIA)
E. Substance/general Medical Condition (individual SHOULD NOT meet this criteria in order to be diagnosed with schizophrenia - EXCLUSION CRITERIA)
F. Relationship to Autism Spectrum Disorder or
communication disorder (if person already diagnosed
with these disorders, they can receive a diagnosis for
schizophrenia as well, so long as they do have
prominent delusions or hallucinations over at least a
month period.
What are the two things needed for Criterion D to be marked Yes?
1) no major depressive or manic episodes have
occurred concurrently with the active-phase symptoms
OR
2) if mood episodes have occurred during active-phase
symptoms, they have been present for a minority of
the total duration of the active and residual periods of
the illness.
Characteristic symptoms
What are the 3 most common delusions?
Delusions (disturbances in CONTENT of thought)
Persecutory delusions - belief that one is going to be harmed, harassed and so forth by an individual, organisation or other group)
Referential delusions - belief that certain gestures, comments, environmental cues, and so forth are directed at oneself
Grandiose delusions - belief that you have exceptional abilities, wealth or fame
Characteristic symptoms
What are the 5 loosening of associations? Disorganised speech (disturbances in production and organisation of thought)
Neologism: making up words
Perseveration: repeating particular phrases or words/sounds
Word salad: using a mixture of words that don’t make sense together
Circumstantiality: beginning to make a point, going on track a little bit, then veering off track to less important points but then eventually COMING BACK TO ORIGINAL POINT.
Tangentiality: talking about one thing, go off on a tangent, and u never come back to ur original point.
Characteristic symptoms
What are hallucinations and what senses are involved?
Disturbances of Perception
Hallucinations - Percept like experience occurring in the absence of appropriate stimulus and not under voluntary
Auditory (Most common and hearing voices) Visual Olfactory Gustatory Tactile
Sometimes voices can be pleasant
Characteristic symptoms
Disturbances in Affect
Expression of outward emotion
Restricted affect (Least severe)
Blunted affect (or affect flattening) - indifferent to their surrounding
Flat affect (Most severe) - complete absence of emotional expression
Characteristic symptoms
Disturbances in Psychomotor Behaviour
Collectively called Catatonia
- Catatonic stupor: incredibly slow, deliberate
movements
Catatonic rigidity: being ‘stuck’ in certain postures
What are positive symptoms of schizophrenia?
“extra unusual” behaviours
Delusions
Hallucinations
Loose associations (Speech problems)
Disorganised behaviour
What are negative symptoms of schizophrenia?
“taking away of normal behaviours”
Flat affect: taking away variation in normal emotional expression
Apathy: Lethargy, not wanting to do things
Social withdrawal
Poor attention
What are schizophrenia specifiers?
To be used after 1-year duration
Extra info. about how the disorder is presented in a particular individual.
Catatonia can also act as a specifier
- Catatonia is marked psychomotor disturbance which may involve stupor, rigidity, excitement or posturing
How is the severity of the primary symptoms of psychosis (Delusions, Hallucinations, Disorganised speech, Abnormal psychomotor behaviour, and Negative symptoms) assessed?
Current severity (past 7 days) is assessed on a 5 point scale where 0 - not present to 4 - present and severe
What are the characteristics of Type 1 schizophrenia?
Sudden onset
Normal intellect
No brain damage
No negative symptoms
Good drug response (or medication)
What are the characteristics of Type 2 schizophrenia?
Slower onset
Intellectual deterioration
Brain abnormality
Prominent negative symptoms
Poor drug response
What are the three course phases of schizophrenia and in what order?
Prodromal phase
Active phase
Residual phase
What happens in the prodromal phase?
Where there is a gradual and obvious deterioration in role functioning. Social withdrawal, stopping activities they would typically do.
Marks a CHANGE IN HIS PERSONALITY
symptoms of prodromal phase include peculiar behaviours (talking to urself in public), unusual perceptual experiences, outbursts of anger, increased tension, and restlessness.
Social withdrawal, indecisiveness, and lack of willpower are often seen during the prodromal phase.
What happens in the active phase?
The active phase is where we see the psychotic symptoms such as hallucinations, delusions, and disorganised speech.
They become really out of touch with reality, and believing that those experiences are real.
What happens in the residual phase?
The residual phase is where those main psychotic symptoms are no longer present, but often the negative symptoms are still there, so withdrawing from others.
At this point most dramatic symptoms of psychosis have improved, but the person continues to be impaired in various ways.
What does it mean if schizophrenia has different potential courses of the phases?
The courses of schizophrenia is VERY VARIABLE how the schizophrenia course looks like for different individuals
What is the prognosis of schizophrenia?
~ 20-30% are able to lead “normal” lives
~ 20-30% experience moderate symptoms
~ 40-60% remain significantly impaired
List the good outcome predictors
The dominance of positive symptoms - delusions, hallucinations are more associated with GOOD OUTCOMES
Good premorbid (period of time before diagnosis) adjustment
No family history of schizophrenia
Sudden onset
(identifiable) Precipitating stress
Good response to medication
Positive symptoms
Later age of onset
Female gender
List the bad outcome predictors
Negative symptoms are more likely to have an impact on life and living.
Poor premorbid adjustment Family history of schizophrenia Slow onset No precipitating stress Poor response to medication Negative symptoms Early age of onset Male gender
Name and describe other psychotic disorders?
Schizophreniform Disorder
- Duration at least 1 month but less than 6 months
- Impaired social/occupational functioning not required
- Essentially SHORTER form of schziophrenia
Schizoaffective Disorder
- Symptoms fall on the boundary between schizophrenia
and mood disorders
- Prominent episode of mood disturbance concurrent
with Criterion A schizophrenia symptoms
- Delusions/hallucinations for at least 2 weeks in absence
of prominent mood disturbance
- Overlap of schizophrenia with mood disorder
Delusional Disorder
- Person experiences one or more delusions and never
meets Criterion A of Schizophrenia
- They are preoccupied for at least one month with delusions that are not bizarre (things that could actually happen to you)
Brief Psychotic Disorder
- Sudden onset of at least one: delusions, hallucinations,
disorganised speech, disorganised/catatonic behaviour
- Lasts at least one day but less than month and full
return to premorbid functioning
- This most commonly happens to a very stressful event
How does neuroleptic work?
Decreases dopamine and results in calm behaviour
Schizophrenogenic mother
The mother of the person with schizophrenia is blamed for the development. (NO SUPPORT)
What has expressed emotion (Psychosocial factors) been useful for?
Expressed emotion has become important when we’re looking for how to prevent relapse
What is expressed emotion referring to?
Very high levels of
criticism
hostility
emotional over-involvement … within families.
A person with schizophrenia is 3.7 times more likely to relapse if living in a High vs. a Low EE family
Expressed emotion is low specificity meaning it is not only specific to schizophrenia
