PSYU3337 Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
What is schizophrenia?
Cognitive and emotional dysfunctions including delusions, hallucinations, disorganized speech or inappropriate emotions.
Positive symptoms of schizophrenia
Excesses and distortions confined to an acute episode of schizophrenia
- Hallucinations: sensory experience in the absence of any relevant stimulation
–> auditory most common (74% of individuals with schizophrenia will experience auditory hallucinations)
- Delusions: beliefs that are contrary to reality, and firmly held despite disconfirming evidence
–> 65% of individuals with schizophrenia may suffer from delusions
What are the different types of delusions
Grandiose: exaggerated sense of self importance
Ideas of reference: reading personal significance into the trivial activities of others
Thought insertion: believing that one’s thoughts are not their own, but have been inserted by an external force
Thought withdrawal: believing one’s thoughts have been taken away from their minds
Thought broadcasting: believing that others can know what one is thinking
Persecution: believing that someone is harming or trying to harm yourself
Erotomatic: believing that another person is in love with you
Jealous: believing that one’s spouse is unfaithful
Somatic: believing that one’s bodily function is abnormal
What are the negative symptoms of schizophrenia?
behavioural deficits in motivation, pleasure, social closeness and emotional expression.
- Avolition: inability to initiate and persist in activities (more motivated by goals that reduce boredom as opposed to those about autonomy, building skills, knowledge)
- Anhedonia: lack of pleasure (reduction in anticapatory pleasure)
- Asociality: lack of interest in social interactions
- Alogia: significant reduction of speech
- Affective flatterning: lack of emotional expression
Disorganised symptoms of schizophrenia
Disorganised speech: erratic speech and emotions that prevent listeners from understanding
- loose associations
- derailment
Disorganised behaviour: inability to organize behaviour so that it conforms with community standards
Catonia: abnormality of movement that may involve repetitive or purposeless overactivity, catalepsy (resistance to passive movement) or waxy flexibility
Cognition - schizophrenia
Cognitive deficits are common and start prior to onset of schizophrenia
Worsen at the time of first presentation and then stabilize
Neurocognition deficits: attention, concentration, memory, speed of processing, executive functioning
Socail cognition: emotion recognition, TOM
3 Phases of Schizophrenia
Prodromal: early stage often not recognized (85% of people will experience this - occurring 1-2 years before serious symptoms begin)
Active/ acute: phase is most visible due to experiencing positive symptoms
Residual: individuals have fewer obvious symptoms
Criteria in the DSM for Schizophrenia
A) Two+ present for a significant amount of a 1 month period (there has to be at least one of the first 3)
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behaviour
- negative symptoms
B) level of functioning is below level prior to onset
C) persist for at least 6 months, including at least 1 month of criterion A symptoms
D) schizoaffective, depressive and bipolar disorder have been ruled out
E) not attributable to the psychological effects of a substance
F) if history of ASD, additional diagnosis only if delusions or hallucinations are prominent
What is schizophreniform disorder?
Schizophrenia that lasts for a shorter amount of time (between 1-6 months)
- associated with relatively good functioning and most patients resume normal lives
What is brief psychotic disorder?
Positive symptoms of schizophrenia and/or disorganized speech or behaviour
lasts < 1 month
briefest duration of all psychotic disorders
precipitated by trauma / stress
Schizoaffective disorder
Is schizophrenia plus a major mood episode (manic or depressive)
Psychotic symptoms must also occur outside the mood disturbance for at least 2 weeks.
Do not tend to get better by themselves
Delusional disorder
Key feature = delusions
Does NOT include other positive, negative or disorganized symptoms.
Functioning not impaired beyond the impact of the delusion.
What is the prevalence and causes of schizophrenia?
Prevalence = 1% of the population
Can emerge at any time, and most suffer moderate-to-severe impairment, and 50% will abuse drugs and alcohol.
Biological causes:
- genetic risk = accounts for 81% of risk, multiple genes likely involved
- risk increases with genetic relatedness
- negative symptoms have a stronger genetic component than positive symptoms
- BUT healthy environment is a protective factor (gene-interaction)
- dopamine (come back to this)
Environmental
- stress
- delivery complications
- starvation
- maternal infections
- cannabis use
- low ses
Biological influence of dopamine with schizophrenia
Schizophrenia (positive and disorganized symptoms) is partly caused by overactive dopamine (but glutamate, NMDA and GABA are also implicated)
Enlarged ventricles are common (loss of brain cells) however not specific to schizophrenia and not causal.
Reduction in grey matter and overall volume of PFC, with less activation of the prefrontal cortex –> related to greater severity of negative symptoms
Treatment of schizophrenia
- short term hospital stays, medication, psychosocial treatment
- first generation medications (neuroleptics) targeted reducing positive symptoms, blocking dopamine receptors –> but they had extrapyramidal adverse effects and tardive dyskinesia
- second generation medications are not targeting dopamine receptors
- psychosocial treatment
- case management
