Psychosis & Schizophrenia Flashcards
1
Q
Psychoses/Schizophrenia Features
A
MAIN FEATURES
RISK/PROTECTIVE FEATURES
- BIOLOGICAL (GENETIC/BIOCHEM/NEURO)
- PSYCHO-SOCIAL (DEPRIVATION/FAMILY ISSUES/LONG-TERM STRESS)
2
Q
P/S: Media Representation
A
- psychosis/psychotic = anti-social/schizophrenia = “split-personality”; WRONG/MISLEADING/JUDGEMENTAL/DAMAGING misconceptions!; only lead to stigma/social isolation
- even “positive” media representation still glorifies/makes it into an egoistical tragedy (ie. ‘A Beautiful Mind’)
- psychosis = loss of “shared” reality
- schizophrenia = split real/imaged mind
3
Q
P/S: Statistics
A
- 8% of all homicide convictions in England/Wales during 18 months contacted mental healthy services in previous year
- 25% of these diagnosed w/schizophrenia; most had personality disorder/alcohol or drug misuse
- schizophrenics no more prone to criminal violence than general public
- 10% of schizophrenics commit suicide
4
Q
PF: Main Features
A
- loss of socially perceived/shared awareness of reality due to: SCHIZOPHRENIA (?) DRUG MISUSE SEVERE DEPRESSION NEUROLOGICAL INJURY
5
Q
SF: Main Features
A
- delusional beliefs (aka. misinterpretation of reality); ie. believing neighbour is mind-controlling them/people on TV are sending special messages/thoughts can be broadcasted
- hallucinations (ie. hearing voices commenting/arguing/directing; often terrifying)
- withdrawal states (ie. avolition = loss of energy/absence of daily interest)
6
Q
Schizophrenia Diagnosis
A
- SYMPTOM GROUPS (POSITIVE/NEGATIVE)
- MAIN FORMS
- ICD-10 DIAGNOSTIC CRITERIA
7
Q
SD: Symptom Groups (Positive)
A
- “excess cognition”
- PICCHIONI & MURRAY (2007); most common include:
- insight lack
- auditory hallucinations = 97%
- delusional reference = 74%
- suspiciousness = 66%
- flatness of effect = 66%
- thought alienation = 52%
- out-loud thoughts = 50%
8
Q
SD: Symptom Groups (Negative)
A
- “deficits in behaviour”
- IE. avolition/alogia (speech poverty)/anhedonia/flat effect (fake outward expression)
9
Q
SD: Main Forms
A
DISORGANISED:
- speech content disordered; bizarre associations
- disorganised behaviour incongruent to social cues
CATATONIC:
- apathy/withdrawal/immobility w/islands of excitement/agitation; experience sometimes recalled
PARANOID:
- (persecutory) delusion prominent (ie. reference = random convo snippets refer to them); hallucinations; 1/100 across culture rate
10
Q
SD: ISD-10 Diagnostic Criteria
A
+/=1 MOST OF MONTH:
- thought echo/insertion/withdrawal/broadcast
- control/perception delusions regarding body/actions/sensations
- hallucinatory voices w/running commentary/patient discussion OR sourced in patients body
- persistent bizarre/culturally inappropriate delusions
+/=2 MOST OF MONTH:
- daily hallucinations + delusions
- incoherent/irrelevant speech
- catatonic behaviour (ie. stupor/posturing)
- negative symptoms (ie. apathy/incongruous mood)
11
Q
SF: Biological Factors (Genetic)
A
- genetic risk on range of disorders related via shared neuro-chemical underpinnings
- GOTTESMANN & SHIELDS (1972); twin studies concordance; MZ = 42%; DZ = 9%; re-analysis showed negative symps more linked than positive; interaction w/environment leads to variance
- HESTON (1966); adoptee studies; greater schizophrenia risk w/diagnosed schizophrenic birth mothers even if kids raised in alternative environment
12
Q
SF: Biological Factors (Genetic) Examples
A
- PICCHIONI & MURRAY (2007); schizophrenia as multifactorial; greatest risk = positive family history; general pop lifetime risk = <1%; 6-5% in first relatives; 40% in MZ twins; many common, small-effect risk genes exist; interaction w/environment past critical threshold may trigger development
- CARDNO et al (2002); twins (one diagnosed schizophrenic/schizoaffective manic); 47 MZ; 89 DZ SS; statsig genetic correlations of syndromes; common/specific genetic contribution; relaxed diagnostic hierarchies showed overlap in genes w/RDC (research diagnostic criteria) and syndromes
13
Q
SF: Biological Factors (Biochemical)
A
- symptoms triggered by chemical imbalances due to possible genetic risk/injury/drug intake (or combo)
- ie. Parkinson’s; control/initiation issue; related w/brain area linked to dopamine activity; treatment risks hallucinations
- schizophrenia = excess dopamine; symptoms lesson via psychotropic meds inhibiting dopamine
14
Q
SF: Biological Factors (Neurochemical)
A
- YOON et al (2013); schizophrenic brain systems; excess activity in substantia nigra; decreased activity in prefrontal cortex; diminished functional connectivity between them suggests un-synced communication; high connectivity between substantia nigra + striatum = high schizophrenic psychosis
- HADDARD et al (2016); chlorpromazine (antipsych med); induced calmness w/o sedation prior to surgery so psychiatry link; controversial work of doctors treating maniacs/schizophrenics w/it; effective results
15
Q
PF: Biological Factors (Biochemical)
A
- MURRAY et al (2017); cannabis as paranoia cause; prevented cases via cannabis illegality= 8-24% (country dependant; opposite USA public policy; legalisation = increased consumption/potency
16
Q
SF: Psycho-Social Factors (Deprivation)
A
- highest likelihood in low socio-economic groups; poor housing/low income/overcrowding/homelessness/environmental hazards/uncertainty/lack of opportunities)
17
Q
SF: Psycho-Social Factors (Long-Term Stress)
A
- more common w/less control over decisions/processes governing life
- triggered via stressful life events (ie. bereavement/job loss/divorce/relationship end/significant transitions)
- work/education act as buffers
18
Q
SF: Psycho-Social Factors (Family Issues)
A
- “expressed emotion”; INSUFFICIENT for independent onset, but likely relapse trigger; occurs prior
- reactive to deterioration manifested by newly developing psychotic disorder rather than family traits
- can maintain schizophrenia (ie. critical comments (“… see, she’s always like that…”)
- 10% = low EE household relapse
- 58% = high EE household relapse
19
Q
SF: Psycho-Social Factors (Long-Term Stress) Example
A
- PICCHIONI & MURRAY (2007); 5% South London black men schizophrenia link; no biochemical/gene/drug risk; source found in social stress of racism
- high schizophrenia rates in immigrant kids; not reflected in kids of home country; environmental/social factors implicated; small immigrant population = increased schizophrenia risk
20
Q
S-M/PM: Genetically/Neuro/Socio-developmental Continuum (Example)
A
- MURRAY et al (2017); common small-effect genes shared w/autism/learning disability; neuro-developmental genetic risk continuum; schizophrenic polygenic risk scores reflect polygenic loading; genetic variants associated w/schizophrenia impact on brain/cognitive development
- risk genes influencing upstream factors render midbrain dopamine neurons vulnerable to dysregulation via socio-developmental risk factors; downstream influencers amplify dysregulation effect
21
Q
S-M/PM: Developmental Risk Factor Model
A
- MURRAY et al (2017); neuro-developmental factors interact w/adverse social/drug risk factors; lead to neuro/social cognition/neural network deficits
- increase scholastic difficulty/a-sociality/isolation risk; rebranded as primary negative symptoms
- increased deviance drug abuse/victimisation exposure risk = dysregulated dopamine release; salience assigned to perceptions
- social adversity exposure biases cognitive schema to excessively interpret experiences via paranoia
VICIOUS CYCLE: - stress = increased dopamine dysregulation = stress via psychotic experiences = further dopamine release = hardwired psychotic interpretation
22
Q
Schizophrenia Medical/Psychological Models
A
DEVELOPMENTAL RISK FACTOR MODEL
GENETICALLY/NEURO/SOCIO-DEVELOPMENTAL CONTINUUM
23
Q
S-M/PM: Genetically/Neuro/Socio-developmental Continuum
A
- genetic risk normally distributed; polygenetic risk may be manageable w/precision medicine
- “probable” viral infection risk (ie. in-utero)
- drug intake risks brain development
- social disadvantage/family environment/stress history risk
- ALL MIXING = NOT disease entity but bio/psycho/social condition w/influential factors
24
Q
Psychosis/Schizophrenia Treatments
A
MEDICAL SERVICES SOCIO-BEHAVIOURAL - CBT - FAMILY THERAPY - "CONTINUUM OF EXPERIENCE"
25
PT: Medical Services
- historical institutions of "no treatment"
- 1930-50s; ineffective/damaging "treatments" (ie. psychosurgery/electro-convulsive therapy (ECT))
- neuroleptics in 1950s; block dopamine via positive symptom reduction; "calming"; BUT negative symptoms untouched/frightening parkinsonism effects = discontinuation/resistance
- FIRST/SECOND GENERATION PSYCHOTICS
26
PT-MS: First Generation Psychotics & Side Effects
- ANTICHOLINERGIC: blurred vision/dry mouth/urinary retention/weight gain/sexual dysfunction/cardiotoxicity
- EXTRAPYRAMDIAL: pseudoparkinsonism/akathisia (inability to be still)/dystonia (twisting muscles)/reduced seizure threshold/postural hypotension/hyperprolactinaemia (increased stress hormone production)
27
PT-MS: Second Generation Psychotics & Side Effects
- OLANZAPINE: weight gain/sedation/glucose intolerance/hypotension
- RISPERIDONE: hyperprolactinaemia/hypotension/sexual dystfunction/extrapyramidal side effects (high dosage)
- AMISULPIRIDE: hyperprolactinaemia/insomnia/extrapyramidal side effects
- QUETIAPINE: hypotension/dyspepsia (indigestion)/drowsiness
- CLOZAPINE: hypersalivation/constipation/reduced seizure threshold/hypotension/tachycardia (increased heart rate)/pyrexia (increased temp)/weight gain/glucose intolerance/nocturnal enuresis (involuntary nightly urination)
28
PT-SB: Family Therapy
- risk of "revolving door" management (aka. being sent from helpline to helpline to helpline...)
- FAMILY THERAPY (FT); prevents relapse; educative/collaborative/constructive method of reducing confrontational EE
- reduced stress = reduced relapse
- FALLOON et al (1982); 18 in FT/control; EE lowered = FT; 2 FT relapsed; 9 control relapsed
29
PT-MS: Rare Serious Clozapine Side Effects
- neutropenia (93%); low white blood cells
- agranulocytosis (0.8%); extremely low white blood cells
- thromboembolism; blood clots in veins
- cardiomyopathy; heart muscle disease (tenses)
- myocarditis; heart muscle disease (reduces pump ability)
- aspiration pneumonia; food/saliva/liquid/vomit breathed into lung airway
30
PT-SB: Family Therapy (Process)
- changing family behaviour during episode
- speaking normally/slowly/clearly (ie. "let's sit down and talk")
- obvious observational statements (ie. "you're angry/confused/afraid; please tell me why")
- avoid patronising/authoritative speech (ie. "you're always such a child/you'll do as I say")
- avoid intense physical contact (ie. standing over/close to them; too much emotion on your part doesn't help)
- avoid shouting/criticism; if you're being ignore, other "voices" are likely being louder
31
PT-SB: "Continuum of Experience"
- ROMME et al (1993); 700 people responded on TV programme; 400 heard "voices"; 350 struggled to cope; 100 coped well
- differences of "voices" included: positive messages/less commanding/selective listening/communication w/others
32
PT-SB: CBT
- self-monitoring for medication use
- noticing symptoms= assessing optimum support
- investigates belief content/voice source; ie: paranoia/persecution in gay man from orthodox religious background
- modifying belief strength (ie. asking for physical evidence)
- managing/answering "voices" (ie. if not expelled, can be manipulated into positive reminders of chores, etc.)
33
ST-SB: CBT (Example)
- LANCET (2014); CBT as effective alternative to antipsychotic drugs (high discontinuation rate due to side effects/lack of effect); schizophrenics assigned CBT and drugs or drugs alone; mean positive/negative symptoms constantly lower in CBT + drugs group; statsig results showed CBT + drug combo much better than drugs alone.
34
SUMMARY
- multiple potential schizophrenia causes
- schizophrenia probably group of conditions sharing some outward symptoms
- experience/support required for understanding/coping of client/relatives via family therapy/CBT
- medical treatments must be developed further w/less side effects
- interventions should be earlier/better targeted at reducing initial distress, improving outcomes
- more long-term social solutions required (ie. equality of opportunity/human rights preservation)
