Problem 8 Flashcards
Psychosis
Inability to tell the difference between what is real + what is not
Schizophrenia
Refers to a psychotic disorder that involves a breakdown in the relation between
a) thought
b) emotion
c) behaviour
–> that leads to faulty perception + inappropriate actions and feelings and a withdrawal from reality + personal relationships
Prevalence of Schizophrenia ?
- 0.5-2% general pop. prevalence
- Develops in late adolescence/ early adulthood
- Slight ethnic differences may occur due to differences in socioeconomic status
There are 3 types of Schizophrenic symptoms.
Name them.
- Positive symptoms
- -> adding qualities
a) Delusions
b) Hallucinations
c) Disorganized thought or speech
d) Catatonic behavior
- Negative symptoms
- -> loosing qualities
a) affective flattening
b) alogia
c) avolition
- Cognitive deficits
a) attention
b) WM
c) abstract thinking
Delusion
Positive symptom
Refer to ideas that an individual believes are true but are highly unlikely
–> often impossible
Winning the lottery might be a highly unlikely event as well.
Why is this nonetheless a self deception and not a delusion ?
Where are the crucial differences between the two ?
- Self deceptions are possible, delusions are not
2. People holding self deceptions know their beliefs may be wrong, delusional people will insist on their views
Persecutory delusion (Positive symptom)
Believing that you are being watched by people you know
ex.: FBI, Professor at school
Delusion of reference
Positive symptom
Believing that random events or comments by others are directed at you when they are not
ex.: comments of a politician at directed at none other than you
Grandiose delusions (Positive symptom)
Believing that one is a special being that possesses special powers
ex.: most intelligent on earth
Delusion of thought insertion
Positive symptom
Believing that ones thoughts are being controlled by outside forces
Hallucinations
Positive symptom
Refer to unreal perceptual experiences
–> may be consistency with delusions
Auditory hallucination
Postitive symtom
Consist of voices speaking to the individual through his thoughts or somewhere outside
–> most common schizophrenic hallucination
Visual hallucination
Positive symptom
Consists of seeing things that aren’t there
ex.: seeing a ghost (that may talk to the individual)
–> 2nd most common, often accompanied by auditory H.
Tactile hallucination
Positive symptom
Involves the perception that something is happening outide the persons body
ex.: bugs are crawling up the back
Are there any cultural differences when it comes to hallucinations and delusions ?
Yes,
The specific content of the hallucinations or delusions vary from culture to culture
BUT: form of these symptoms remain similar, thus it can be diagnosed reliably across cultures
Disorganized thought/Speech
Formal thought disorder
Refers to the disorganized thinking, by slipping from one topic to the next, where the second one is totally unrelated
–> loosening of associations/derailment, “Word salad”
Men with schizophrenia tend to show more severe deficits in language than women.
Why ?
Language is controlled more bilaterally in women
–> as it is more localized in men their deficits are larger
Catatonic disorganized behavior
Positive symptom
Unpredictable + apparently untriggered agitation
- Catatonia
- -> unresponsiveness to environment - Negativism
- -> lack of response to instructions - Mutism
- -> complete lack of verbal/motor responses - Catatonic excitement
- -> purposeless & excessive motor activity for no apparent reason
Is disorganized behavior that occurs in response to delusions + hallucinations and reflects unresponsiveness to the world
–> becoming wildly agitated for no reason
Affective flattening
Negative symptom
Refers to a severe reduction or absence of affective responses to the environment
ex.: no body language, immobile face
Alogia
Negative symptom
Refers to a reduction in speaking
ex.: no initiation of speech, brief answers
Avolition
Negative symptom
Inability to complete tasks and being rather disorganized, careless + unmotivated
e.g.: work, school, home
People with schizophrenia show deficits in basic cognitive processes.
Name them.
- WM
- -> holding + manipulating info, thus more difficult to ignore irrelevant info and making connections between relevant ones - Attention span
- -> early marker of the risk for schizophrenia
Prodromal vs residual symptoms
Prodromal
–> present before people go into acute phase of schizophrenia
Residual
–> present after they emerge from acute phase
=> during these phases people may have unusual but not delusional beliefs, milder version
Prognosis of Schizophrenia
- 50-80% of people who have previously been hospitalized, will be so again
- Life expectancy is 10 years shorter
- Suffer from infectious diseases for unclear reasons
- No progressive detoriation
- -> stabilization within 5-10 years with no relapse
Gender differences in Schizophrenia ?
- Onset is earlier for men than women
- Women show milder negative symptoms, social adjustment, are hospitalized less
–> differences are not yet understood
Schizoaffective disorder
DSM IV
Is a mix of schizophrenia + mood disorders
Brief psychotic disorder
DSM IV
Showing a sudden onset of
a) delusions
b) hallucinations
c) disorganized speech or behavior
BUT: only having it for less than a month + no functional impairment
Delusional disorder
DSM IV
Having delusions lasting at least 1 month regarding situations that could occur in real life
ex.: being followed, poisoned, deceived by a spouse
–> no impairment of everyday life
Shared psychotic disorder
DSM IV
Having a delusion that develops from a relationship with another person who already has delusions
ex.: woman thinking she is pregnant convincing the husband
Structural + functional brain abnormalities
- Enlarged ventricles
- -> suggests deterioration in other brain tissue - Lower volume density of neurons in
a) PFC
- -> less active, connects to the other regions mentioned
b) temporal lobe
c) basal ganglia
d) limbic area
- Hippocampus
Dopamine theory
- Excessive dopamine activity in mesolimbic pathway
- -> positive symptoms - Usually low dopamine activity in PFC
- -> thus negative symptoms - Other neurotransmitters also play a role
- -> interaction between serotonin + dopamine may be crucial - Abnormalities in levels of GABA
Which key role does stress play in the life of a schizophrenic person ?
May be the trigger to new episodes in people with the disorder
BUT: cannot cause it in people who lack a vulnerability to it
Expressed emotion
Families who are over-involved/overprotective + hostile at the same time will increase the risk of relapse for the ill family member
Cognitive factors contributing to schizophrenia
Schizophrenic people try to conserve their already limited cognitive resources, by using biases/schemas to understand the load of info they receive
–> delusions arise as a consequence of trying to explain different phenomena
Biological treatment options
- Electroconvulsive therapy
- -> little effect - Phenothiazines
- -> antipsychotic drug, reduce the positive symptoms but not negative, have major side effects (=Tardive dyskinesia) - Atypical antipsychotics
- -> more effective as they treat both symptoms, w/o side effects
Psychological/Social treatment options
Involve helping schizophrenic people
- reduce stress
- improve family interactions
- learn social skills
- cope with the impact it has on their lives
Tardive dyskinesia
Refers to an irreversible neurological disorder characterized by involuntary movements of the face, jaw etc
Comprehensive treatment program
Combines drug therapy with psychological + social therapies
–> significantly reduces relapse
A study compared people having AVH with and without psychotic features.
They then established 4 characteristics that together could accurately predict the presence or absence of a psychotic disorder in individuals.
Name them.
- Negative emotional valence of the AVHs content
- -> most predictive power - Higher frequency
- Less control over AVHs
- Later age at onset
–> Seen in schizophrenic individuals
Which cognitive biases are essential in the pathogenesis of Schizophrenia ?
- JTC
- -> gathering little info before arriving at strong conclusions
BUT: individuals are unaware of their hastiness; think they are indecisive
- Incorrigibility
- -> persistence + stubbornness - Blaming others
- -> attributional style - Reduced memory vividness
- -> over-confident in wrong memories - ToM deficits
- -> inability to infer others intentions
Metacognitive training for schizophrenia
MCT
Targets the specific biases involved in the pathogenesis of schizophrenia, by combining
a) Psychoeducation
b) cognitive remediation
c) CBT
–> goal is to
- raise the participants awareness of these distortions
- make them critically reflect on them
- teach them problem solving skills
Frontal lobe model
- Hypo-frontality
- -> have reduced frontal to posterior blood flow - WM abnormalities
- -> basis for other cognitive deficits - Decreased activation of ACC
- -> for errors + conflict
Temporal lobe model
- Left hemispheric overactivation model
- -> showing less lateralisation during verbal tasks + greater left hemispheric activation during spatial task - Hippocampus abnormalities
- -> reduced hippocampal + abnormally increased frontal activation
BUT: Meds possibly restore it
Schizotypal disorder
Having all symptoms of schizophrenia
BUT: more moderate + not loosing ease of reality
Schizophrenie form
Having all symptoms of Schizophrenia
BUT: only more than a month but less 6 months + more functional impairment
Fronto-temporal network dysfunction
Refers to the integrated model of the temporal lobe + frontal lobe models
–> suggests that schizophrenic patients have dysfunctions in both regions
Somatic hallucination (positive symptom)
Refers to the perception that something is happening inside the body
e.g. worms are eating the person’s testines
