lecture 7 + ch10 Flashcards
what % of population has schizophrenia
1%
schizophrenia disorder GENERAL SYMPTOMS + WHAT IT IS
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
positive symptoms
involve unusual thoughts or perceptions that are new to the person
delusions
false beliefs that are firmly and consistently held despite disconfirming evidence
they are POSITIVE symptoms
list and explain the common delusion themes
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))
halluciniations
POSITIVE symptom
perception of a nonexistent or absent stimulus
can involve one or more of the following sensory modalities:
- auditory
- visual
- tactile
- smells
what is the most common hallucination
auditory
cognitive symptoms
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
psychomotor abnormalities
disorganized behaviour
catatonia
a psychomotor abnormality symptom
lack of responsiveness to environment, weird body movements/postures, strange gestures
differentiate bw excited and withdrawn catatonia
excited: disorganized behavior, agitation, hyperactivity
withdrawn: unresponsiveness, long periods of mutism
negative symptoms
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
examples of negative symptoms
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)
course of schizophrenia
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
evolutionary cause of schizo
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)
developmental causes of schizo
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)
do genes cause schizo?
strong genetic component but also gene x environment interaction
brain structure cause of schizo (biological)
larger ventricles
reduced volume in specific areas
general loss of brain volume
brain activity cause of schizo (biological)
cognitive network dysfunction and executive functioning
neutransmitter cause of schizo (biological)
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
original dopamine hypothesis for schizo
too much dopamine (but this is wrong cuz not all ppl show high dopamine)
original glutamate hypothesis
too little glutamate
dopamine-glutamate hypothesis
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
psychological cause of schizo
cognitive attributes, dysfunctional beliefs, etc may predispose ppl to developing psychotic symptoms
social causes of schizo
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)
true or false; immigrant groups have the highest rates of schizo in western europe
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”
family intervention treatment for schizo
emotional support
psychoeducation
modify poor beliefs about schizo
improve coping + communication
involve everyone in relapse prevention plan
CBT treatment for schizo
develop therapeutic alliance
understand clients interpretation of past and present events
develop alt explanations of symptoms
educate client abt the role of stress
what is the 1st generation (typical) treatment for schizo
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
what is 2nd generation treatment for schizo (atypical)
risperidone, olanzapine, seroquel
diff mode of action on dopamine receptors
reduces positive, negative and cognitive symptoms
less side effects but more expensive
is there a genetic relationship between delusional disorder and schizo?
yes! its strong
delusional disorder
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)
brief psychotic disorder
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
9% of people who seek help for first time psychotic symptoms are experiencing
brief psychotic disorder
schizophreniform disorder
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
schizoaffective disorder
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
what do the chances of recovery for a schizophrenic person depend on?
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
what is a RARE but possible course of schizophrenia?
single psychotic episode followed by a full recovery
OR
single psychotic episode with no recovery, so they cannot function in life anymore
explain the charlie chaplin illusion for normal ppl and for schizophrenics
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.
