lecture 7 + ch10

Question 1

what % of population has schizophrenia

Answer 1

1%

Question 2

schizophrenia disorder GENERAL SYMPTOMS + WHAT IT IS

Answer 2

group of disorders that range in severity and have similar features including reality distortion

criteria/symptoms:
- need 2+ symptoms for a significant portion of time during a 1 month period, and one of these symptoms MUST BE EITHER positive symptoms (1 and 2) OR cognitive symptoms
- impairment for at least 6 months
1. delusions
2. hallucinations
3. cognitive symptoms
4. psychomotor abnormalities
5. negative symptoms

Question 3

positive symptoms

Answer 3

involve unusual thoughts or perceptions that are new to the person

Question 4

delusions

Answer 4

false beliefs that are firmly and consistently held despite disconfirming evidence

they are POSITIVE symptoms

Question 5

list and explain the common delusion themes

Answer 5

common themes:
- grandeur (belief u r famous/powerful)
- persecution (belief others are plotting against u)
- thought broadcasting (belief that others can hear ur thoughts)
- thought withdrawal (belief someone/something is inserting thoughts into your mind (or removing))

Question 6

halluciniations

Answer 6

POSITIVE symptom

perception of a nonexistent or absent stimulus

can involve one or more of the following sensory modalities:
- auditory
- visual
- tactile
- smells

Question 7

what is the most common hallucination

Answer 7

auditory

Question 8

cognitive symptoms

Answer 8

disordered thinking, communication and speech

can be:
- speaking in unintelligible manner
- difficulty with abstractions like “ppl who live in a glass house shouldnt throw stones”
- overinclusiveness ( we would group similar things together, but schizos categorize stimuli differently and would group them all together)
- memory + attention issues

Question 9

psychomotor abnormalities

Answer 9

disorganized behaviour

Question 10

catatonia

Answer 10

a psychomotor abnormality symptom

lack of responsiveness to environment, weird body movements/postures, strange gestures

Question 11

differentiate bw excited and withdrawn catatonia

Answer 11

excited: disorganized behavior, agitation, hyperactivity

withdrawn: unresponsiveness, long periods of mutism

Question 12

negative symptoms

Answer 12

inability or decreased ability to initiate actions or speech, express emotions, or feel pleasure

tend to be more stable and persistent than positive symptoms

linked to poorer prognosis

Question 13

examples of negative symptoms

Answer 13

avolition (not able to start goal directed behaviours)

alogia (lack of meaningful speech)

anhedonia (reduced ability to experience pleasure)

diminished emotional expression (reduced display of emotions, involving facial expressions, voice intonation, gestures etc)

Question 14

course of schizophrenia

Answer 14

premorbid phase
- during childhood
- evidence of atypical functioning but dont reach threshold of schizophrenia criteria so they go unnoticed

prodromal phase
- build up of more deficits
- but still go unnoticed

psychotic phase
- first psychotic episode in late adolescence and early adulthood

stable/residual phase
- positive symptoms decrease
- negative symptoms increase

Question 15

evolutionary cause of schizo

Answer 15

Tim crow
- development of language associated w development of schizo
- incomplete hemispheric dissociation bw thought and speech

jonathan burns
- disorder of the social brain
- schizo result from trade offs at diff stages in human evolution (ex: lengthier period for brain maturation vs lengthier time in which things can go wrong)

Question 16

developmental causes of schizo

Answer 16

typically starts in adolescence, but may show earlier signs

schizo is a neurodevelopmental disorder. what happens to fetus in utero influences brain development and thus the changes in brain occuring during adolescence

environemntal factors may also influence the developing social brain (cannabis use, early life issue)

Question 17

do genes cause schizo?

Answer 17

strong genetic component but also gene x environment interaction

Question 18

brain structure cause of schizo (biological)

Answer 18

larger ventricles

reduced volume in specific areas

general loss of brain volume

Question 19

brain activity cause of schizo (biological)

Answer 19

cognitive network dysfunction and executive functioning

Question 20

neutransmitter cause of schizo (biological)

Answer 20

neurotransmitters:

L-dopa produces schizo-like effects in ppl with parkinsons disease

amphetamines produce symptoms similar to those of acute paranoid shcizo in ppl without schizo

phenothiazines reduce schizo symptoms

all of these act on dopamine levels! –> schizo generally speaking = too much dopamine

Question 21

original dopamine hypothesis for schizo

Answer 21

too much dopamine (but this is wrong cuz not all ppl show high dopamine)

Question 22

original glutamate hypothesis

Answer 22

too little glutamate

Question 23

dopamine-glutamate hypothesis

Answer 23

dopamine and glutamate dysregulation in different brain regions

in frontal cortex: underactivity of dopamine
- normally, dopamine increases cell firing and glutamate would strenghten those signals
- in schizos, too little glutamate decreases those signals which leads to dopamine underactivity

in the basal ganglia, there is overactivity of dopamine:
- normally dopamine would decrease cell firing rate and glutamate would increase the firing rate
- in schizos, too little glutamate to regulate the dopamine, so there is too much dopamine activity

Question 24

psychological cause of schizo

Answer 24

cognitive attributes, dysfunctional beliefs, etc may predispose ppl to developing psychotic symptoms

Question 25

social causes of schizo

Answer 25

not a major cause but it can increase risk

childhood exposure to traumatic events

increased risk of relapse associated w high expressed emotion (EE)
- negative communication pattern (criticism for example): this is because…(watch lec)

Question 26

true or false; immigrant groups have the highest rates of schizo in western europe

Answer 26

true

this is bc there are actual differences in the disorder (stress associated w migration=risk factor)

also bc there is clinical bias, where clinician doesnt know that prior experience of immigrant w discrimination can lead to “healthy paranoia”

Question 27

family intervention treatment for schizo

Answer 27

emotional support

psychoeducation

modify poor beliefs about schizo

improve coping + communication

involve everyone in relapse prevention plan

Question 28

CBT treatment for schizo

Answer 28

develop therapeutic alliance

understand clients interpretation of past and present events

develop alt explanations of symptoms

educate client abt the role of stress

Question 29

what is the 1st generation (typical) treatment for schizo

Answer 29

chlorpromazine, haloperidol

they block dopamine receptors

reduce agitation, positive symptoms, but no impact on cognitive and negative symptoms

several side effects like tardive dyskinesia (involuntary movement)

less expensive

Question 30

what is 2nd generation treatment for schizo (atypical)

Answer 30

risperidone, olanzapine, seroquel

diff mode of action on dopamine receptors

reduces positive, negative and cognitive symptoms

less side effects but more expensive

Question 31

is there a genetic relationship between delusional disorder and schizo?

Answer 31

yes! its strong

Question 32

delusional disorder

Answer 32

persistent delusions that are not accompanied by other unusual or odd behaviours (other than those related 2 delusional theme)

delusions must persist for 1 month

common themes:
- erotomania (belief that someone else is in love w them)
- grandiosity (belief that u have so much talent or special abilities)
- persecution (belief you are being conspired against)
- somatic complaints (think they r malformed, are infested by insects or parasites)

Question 33

brief psychotic disorder

Answer 33

diagnosis requires the presence of at least 1 psychotic symptom that continues for at least 1 day but lasts less than 1 month

• often a full return to normal functioning after the episode

onset usually followed by significant stressor, but not always

Question 34

9% of people who seek help for first time psychotic symptoms are experiencing

Answer 34

brief psychotic disorder

Question 35

schizophreniform disorder

Answer 35

2+ psychotic symptoms that last bw 1-6 months

shares characteristics w schizophrenia

1/3 recover in 6 months, while 2/3 develop schizophrenia or schizoaffective disorder

Question 36

schizoaffective disorder

Answer 36

demonstrates psychotic symptoms (meets criteria for schizophrenia) AND symptoms of major depressive or manic episode that continue majority of time that psychotic symptoms r present

psychotic features must continue for minimum 2 weeks after depressive or manic episode has subsided

2 subtypes; bipolar subtype and depressive subtype

Question 37

what do the chances of recovery for a schizophrenic person depend on?

Answer 37

timing of intervention:
- if you catch it in premorbid or prodromal stage, higher chance bc you can prevent first psychotic episode

also the more psychotic episodes they have the more the chance to recover reduces

access to social support increases chances of recovery

stigma reduces changes of recovery

Question 38

what is a RARE but possible course of schizophrenia?

Answer 38

single psychotic episode followed by a full recovery

OR

single psychotic episode with no recovery, so they cannot function in life anymore

Question 39

explain the charlie chaplin illusion for normal ppl and for schizophrenics

Answer 39

normally, we would see the back of the mask and it would not look hollow due to the illusion of the facial features. we use top down processing of what we know about faces and assume that the back of the mask is a face and protruding, even though its hollow.

schizophrenics see the back of the mask as hollow because they use too much bottom up processing and not enough top down processing.