module 6 Flashcards
prodromal symptoms
- emerging symptoms that come before the first psychotic episode
- experience changes in cognition and behaviour
- may last for a few weeks or slowly worsen over several years
- first stage of schizophrenia and occurs before any noticeable psychotic symptoms appear
- 75% of people that have been diagnosed with schizophrenia go through this prodromal stage
examples of prodromal symptoms
- non-specific symptoms
- social isolation
- anxiety
- irritability
- changes to one’s normal routine
- sleep problems
- neglecting personal hygiene
- mild or poorly formed hallucinations
- lack of motivation
- difficulty concentrating
- erratic behaviours
active symptoms
- intense delusions, hallucinations, fully disorganized speech, etc
- when an individual experiences a psychotic episode
residual symptoms
- symptoms that remain after a full psychotic episode
- the psychotic episode has ended and individual continue to experience symptoms with impact similar to the prodromal stage
- no positive symptoms like hallucinations, delusions or disorganized speech
residual symptoms examples
- lack of motivation
- low energy
- depressed mood
- social withdrawal
- difficulty concentrating
- reduced or absent facial expression (flat affect)
- flat or monotone voice
positive symptoms
- hallucinations and delusions are positive symptoms
- positive symptoms tend to decrease over time, possible due to natural age related decreases in dopamine
hallucinations as positive symptoms
- experience of sensory events without input from external reality
- auditory: may include voices, sounds or commands
- visual: shadows or ghost-like images
- almost 40% of people have experienced a hallucination
delusions as positive symptoms
- incredibly strongly held beliefs that appear irrational to any reasonable person
- 5 subtypes of delusions
1. grandeur/grandiose
2. persecutory
3. erotomatic
4. jealous
5. somatic
grandeur/grandiose delusions
having a great talent or insight, or making some discovery
persecutory delusions
being cheated, spied upon, poisoned, harassed or obstructed
erotomatic delusions
someone else loves you
jealous delusions
lover/spouse is unfaithful
somatic delusions
- involving bodily functions/sensations
- beliefs that something is wrong with them; can also feed into hallucinations
- capgras syndrome: believing that everyone around you has been replaced by imposters
disorganized symptoms
- disorganized speech
- inappropriate affect
- grossly disorganized behaviour
- catatonia
disorganized speech as a disorganized symptom
- illogical speech while jumping from topic to topic
- tangential speech: when individuals go off on tangents and their replies to questions tend to be totally irrelevant
- loose associations/derailment: having spontaneous speech with an inability to stay on topic but there are minimal, hard to find, logical connections between thoughts
inappropriate affect as a disorganized symptom
- expressing emotions do not match the context
- e.g. laughing at a funeral
grossly disorganized behaviour as a disorganized symptom
- largely disorganized behaviour
- childish/silly behaviour
- unpredictable agitation
- hoarding and collecting odd items
catatonia as a disorganized symptom
- waxy flexibility: individuals in a catatonic state are almost as if their bodies are made of soft wax that you can bend into positions
- pacing, stereotyped behaviours
- echolalia: repeating back or mimicking sounds you hear
negative symptoms
- avolition/apathy
- alogia
- anhedonia
- affective flattening/flat affect
- asociality
avolition/apathy as a negative symptoms
- little interest in daily functions including hygiene
- inability to initiate or persist in activities
alogia as a negative symptom
little use of speech or interest in conversation
anhedonia
little interest in pleasurable activities
affective flattening/flat affect
lack of emotional expression
asociality as a negative symptom
little interest in socializing and poor social skills
criteria A for a psychotic episode and schizophrenia
- criteria A defines active psychosis
- two or more of the following during a one month period:
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behaviour
5. negative symptoms - at least one of either delusions, hallucination or disorganized speech must be present
schizophrenia criteria
- level of functioning has deteriorated below what was seen before onset
- continuous sign of the disorder must be present for at least 6 months either in prodromal, active or residual states
- rates are equal between men and women
- life prevalence = 0.3%-1%
schizoaffective disorder
- experience an active psychosis (criteria a), concurrent with mood episode (mania or major depressive) to receive a diagnosis
- hallucinations or delusions must have occurred outside of mood episodes as evidence of a mood disorder outside of a psychotic episode
- mood episode occurs throughout the majority of the active and residual periods
- similar negative prognosis as schizophrenia
- rates are higher in women than men because women are more likely to have depression
- life% = 0.3%
schizophreniform disorder
- active psychosis (criteria a) for at least one month but deterioration in functioning lasts less than 6 months
- less impairment of functioning
- often serves as a provisional diagnosis while we wait to see if it develop into schizophrenia
- effects men and women equally
- occurs much more in developed countries
- life prevalence: 0.1%-1%
brief psychotic disorder
- experience one or more of the following for at least 1 day, but for less than 1 month:
- delusions
- hallucinations
- disorganized speech
- may also experience catatonia
- you can only be diagnosed retrospectively; after the symptoms have remitted
- symptoms present for less than one month
- twice as common in men
- life% = 0.1%-0.5%
delusional disorder
- must experience one or more delusions for 1 month or longer
- apart from the impact of the delusions, functioning is not impaired and behaviour is not odd
- does not meet criteria for schizophrenia, though hallucinations may be present but they must fit within the delusional themes and more not be prominent
- delusions tend to not be as bizarre as in schizophrenia
and are of things that can happen in real life such as being followed, poisoned, infected, loved at a distance, being deceived by a spouse or lover - function must better than those with schizophrenia or schizoaffective and have less impairment and have no negative symptoms
- life% = 0.2%
psychological models - etiology
- stress
- families
psychological methods - stress etiology
- stress has a bidirectional relationship with psychosis and relapse
- stressful events can precede relapse
- can trigger subsequent psychotic episodes
- symptoms cause people to drop in socioeconomic status
- social support from non-family can improve outcomes
psychological methods - family etiology
- may see symptoms as intentional
- attitudes towards loved ones with schizophrenia tend to be negative
- expressed emotion such as criticism, animosity and intrusiveness
- individuals with families with high expressed emotion can trigger a relapse quicker
- in latin american families, criticism had no effect on relapse but lack of warmth did
- in african american families, expressed emotion decreased relapse
- this could be because expressed emotion was experienced as compassion and more openness by the individual
psychological methods and treatments - historical treatments
- psychoanalytic/psychodynamic
- token economy
psychoanalytic/psychodynamic as a historical treatment
- have historically been harmful
- schizophrenogenic mothers: moms who were characterized as cold, rejecting and overprotective caused their kids to have schizophrenia
token economy as a historical treatment
- involve rewarding someone for positive behaviour to get them to continue positive behaviour while punishing negative behaviour
- formerly used in psychiatric hospitals
psychological models and treatments - modern treatments
- community resources
- clinicians
- first episode clinics
community resources as a modern treatment
individuals may be connected with life coaches, peer groups, recreational therapists
clinicians as a modern treatment
- help clients detect relapse, manage medications, and deal with stress
- teach to deconstruct complex social skills and model healthy social skills (e.g. how to make a friend, how to give feedback)
- initial positive results tend to fade when treatment is done
first episode clinics as a modern treatment
- the earlier you can intervene in an illness the more likely you are the decrease relapses
- provide individuals and family with psychoeducation
- targets those who have experienced their first active phase episode
- connect with support systems and community resources
- prescribe correct medications, offer therapy, help with medication compliance
psych. models and treatments - behavioural family therapy
- classroom-type psychoeducation for family members to help understand the disorder
- may include some training in expressed emotion
- effective in the short-term and helpful while they are in treatment, but tend to decline when family members leave treatment
psych. models and treatments - becks CBT
- targets negative symptoms along with the same lines as CBT for depression since symptoms are similar (i.e. automatic thoughts)
- targets positive symptoms with very gentle questioning of beliefs with evidence
- provides a sense of self-control
- can lead to significant improvements that appear to last although many tend to require more significant interventions due to the nature of the disorder
age of onset for psychotic disorders
- late teens to late twenties
- men = early twenties
- women = late twenties
psychotic disorders as neurodegenerative disorders
- not supported by research
- most have moderate to severe levels of impairment and levels of functioning that stay stable through life after the first episode is experienced
- positive symptoms may sometimes decrease in severity with age
- men tend to have the worst outcomes prognosis wise
differences in prevalence of psychotic disorders cross-culturally
usually members of minority or marginalized groups are more likely to be forced into hospitalization and given injections as well as receive the worst treatment
bio models and treatment etiology
- genetic contribution
- dopamine
- glutamate
- brain structure
- viral infection
bio models etiology - family studies as a genetic contribution
parents who have more severe forms of schizophrenia predisposes their children broadly to psychotic disorders
bio models etiology - twin studies as a genetic contribution
identical twins are more at risk of having schizophrenia, followed by fraternal twins who are slightly more at risk then siblings due to shared in utero environment and upbringing
bio models etiology - adoption studies as a genetic contribution
individuals can still be at risk of developing schizophrenia/psychotic disorder if their bio parents had schizophrenia but being adopted into healthy environments can delay the onset and decrease severity of the disorder
bio models etiology - genes and cannabis as a genetic contribution
- 10% of the population is a carrier for some genes
- most people who smoke cannabis don’t become psychotic, however use during sensitive periods (i.e. teen years) can increase chances of onset within a specific group with specific genetic profiles
bio models etiology - dopamine as a genetic contribution
- individuals with schizophrenia have excessive stimulation of D2 receptor sites and under stimulation of D1 receptor sites
- d2 sites are located in the basal ganglia and tend to be associated with positive or disorganized symptoms
- d1 sites are located in the prefrontal cortex in our limbic system and tend to be associated with negative symptoms
bio models etiology - glutamate as a genetic contribution
- under stimulation of NMDA receptor sites
- PCP and ketamine are NMDA antagonists and block glutamate
- related to positive and negative symptoms
bio models etiology - brain structure as a genetic contribution
- proposed 3 points of brain structure as causes of schizophrenia:
- enlarged ventricles
- decreased frontal lobe activity
- 22q deletion syndrome
brain structure as a cause of schizophrenia - enlarged ventricles
- enlarged ventricles cause schizophrenia because researchers have found through brain dissection that a lot of people with schizo. have them
- however this could be due to atrophied brain areas, brain areas that never fully developed or prenatal influenza
brain structure as a cause of schizophrenia - decreased frontal lobe activity
- linked to negative symptoms
- could be the result of viral infections
brain structure as a cause of schizophrenia - 22q deletion syndrome
- rare genetic disorder where children are born with 1 copy of chromosome 22 that is missing a segment that includes anywhere between 30-40 genes
- have a 25-33% chance of developing schizophrenia making it the most common genetic risk factor for the development of schizophrenia
- also often born with heart defects, increased chance of learning and cognitive disabilities
bio models etiology - viral infection as a genetic contribution
2nd trimester prenatal influenza has been linked to schizophrenia
bio models & treatments - conventional antipsychotics
- work for about 60-70% of clients with the intention to prevent relapse as much as possible while mitigating symptoms
- can cause severe side effects that make medication compliance difficult
- can cause extrapyramidal symptoms & tardive dyskinesia, grogginess, difficulty thinking, weight gain, sexual issues & blurred vision
extrapyramidal symptoms
e.g. parkinsons, expressionless face, slow movements, monotone speech and spasms
tardive dyskinesia
- results in excessive eye blinking, protrusions of the tongue, puffing of cheeks, or chewing movements
- 3-5% will develop these symptoms within 5 years and they may be irreversible
- longer someone is on the meds the higher likelihood they will develop it
bio models & treatments - newer antipsychotics
- fewer side effects, work as well if not better
- though they can technically cause similar side effects it is less common
- may work on both positive and negative symptoms
