Schizophrenia Flashcards
Psychosis Terminology:
Positive Sxs
Atypical excesses (not a part of normal experience) i.e. hallucinations, delusions, etc.
Psychosis Terminology:
Negative Sxs
Absence of normally occurring behaviors, i.e. lack of speech (alogia, amotivation, asociality) etc.
Up to 60% of those with Schizophrenia have strong neg. Sxs.
Neg. Sxs are frequently first Sx of illness.
Psychosis Terminology:
Hallucinations
Perception not based on external stimuli
Psychosis Terminology:
Illusion
Misperception of an external stimuli
Psychosis Terminology:
Delusion
False belief maintained despite strong evidence to the contrary
Psychosis Terminology:
Delusions can either be:
______ or _______
Bizarre - can never possibly occur
Non-bizarre - could potentially occur (but aren’t occurring now)
Psychosis Terminology:
Specific types of delusions:
Ideas of reference
Incorrectly believe external events are occurring for or with specific reference to oneself
Psychosis Terminology:
Specific types of delusions:
Thought broadcasting
Delusion that one’s thoughts are being broadcast out loud for others to hear
Psychosis Terminology:
Specific types of delusions:
Thought insertion
Delusion that some of one’s thoughts have been inserted in one’s mind by others
Psychosis Terminology:
Loose associations/derailment
Person’s ideas slip from one topic to another - at best obliquely related to one another
Psychosis Terminology:
Neologism
a made-up word used by the person
Psychosis Terminology:
Clanging
words are strung together based on sound similarity (vs. meaning)
Psychosis Terminology:
Word salad/Incoherence
a mixture of words and phrases that lack logical coherence
this disturbance occurs within clauses, whereas with loose associations is between clauses
Psychosis Terminology:
Poverty of content
person speaks but conveys little content
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Alogia
impoverished speech and thought
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Avolition
inability to initiate and persist in goal-directed activities
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Affect
refers to emotions
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Blunted affect
affective expression is reduced in intensity
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Flat affect
an absence of affective expression
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Inappropriate affect
affective content does not match the situation or content of what is being said
Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Anhedonia
inability to experience pleasure from activities that usually produce pleasurable feelings
Schizophrenia Course:
Prodromal phase
the period leading up to the full blown Dx characterized by increase in Sxs and increase in adjustment problems
Schizophrenia Course:
Residual
phase of the illness after remission of the florid active Sxs
Schizophrenia - DSM-5 Diagnostics:
A. More than 2 Sxs each present for a significant portion of time during a 1 month period (less if successfully treated). (Most crucial criteria)
5 Domains
At least 1 of which must be (1), (2), or (3).
- Delusions
- Hallucinations
- Disorganized speech
(freq. derailment or incoherence) - Grossly disorganized or catatonic behavior
- Negative Sxs
Schizophrenia - DSM-5 Diagnostics:
B. For a significant portion of time since onset, level of functioning in more than 2 major areas (e.g., work, interpersonal, self-care) is markedly ________ prior to onset.
below level
if onset during childhood there is a failure to achieve expected levels of functioning
Schizophrenia - DSM-5 Diagnostics:
C. Continuous signs persist for _____
more than 6 months
The 6 months MUST include at least 1 month of active Sxs (less if actively treated) (active = meets criteria A)
AND
Rest of time may be prodromal or residual
Note: during prodromal or residual phase, disturbance may be manifested only as -
1. negative Sxs
OR
2. more than 2 criteria A Sxs present in an attenuated form (odd beliefs vs. delusions)
Schizophrenia - DSM-5 Diagnostics:
D. Schizoaffective Dx and Depressed or Bipolar Dxs with psychotic features have been ruled out b/c…
No major depressive or manic episodes during acute phase
OR
If mood episodes occur during active phase, they represent only a minor to total duration of the active and residual periods of the Dx.
Schizophrenia - DSM-5 Diagnostics:
E. Disturbance not attributable to ______ or other ________
substance or other medical condition
Schizophrenia - DSM-5 Diagnostics:
F. If Hx of ASD or a Communication Dx with childhood onset, additional Dx of schizophrenia ONLY MADE IF….
Prominent hallucinations or delusions, in addition to other required Sxs of schizophrenia are also present for more than 1 month (or less if successfully treated)
Schizophrenia - DSM-5 Specifiers:
Hx specifiers:
Episodes
Remissions
- first episode
- multiple episodes
- continuous
- acute = Sx criteria fulfilled
- full or partial remission
Schizophrenia - DSM-5 Specifiers:
Catatonia specifier:
Reactivity to environment
-Marked decrease in reactivity to the environment
present in several Dxs - psychotic, mood, and ASD
Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Extreme reactions S/M A
stupor/mutism or agitation
Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Repetitive behaviors E E S S
- echolalia (repeating speech)
- echopraxia (repeating actions)
- staring
- stereotypies (repeated motor behaviors with no goal)
Schizophrenia - DSM-5 Specifiers:
Catatonia specifier:
Behaviors that don’t mach the situation
- mannerisms
- grimaces
Schizophrenia - DSM-5 Specifiers:
Catatonia specifier:
Motoric
- posturing
- catalepsy (maintains a posture against gravity then slowly sinks back into resting state
- waxy flexibility (maintains posture against gravity and resists repositioning)
- negativism (resistant to direction)
Schizophrenia - Associated Sxs: Often present 1. \_\_\_\_\_\_\_\_ 2. \_\_\_\_\_\_\_\_ 3. \_\_\_\_\_\_\_\_
- Before psychotic Sxs appear
- During remission
- Seen in 1st degree relatives
Schizophrenia - Associated Sxs: Cognitive Sxs: Overall mental task deficits in... 1.\_\_\_\_\_\_\_ 2.\_\_\_\_\_\_ 3. \_\_\_\_\_\_ 4.\_\_\_\_\_\_ 5.\_\_\_\_\_\_
- Attention
- Decreased processing speed (verbal tasks, visual stimuli)
- Decreased Verbal memory
- Decreased EF skills
- Decreased reasoning
Schizophrenia - Associated Sxs: Social Cognition Sxs: 1. \_\_\_\_\_\_ 2. \_\_\_\_\_\_ 3. \_\_\_\_\_\_
- Emotional recognition
- Social problem solving
- Theory of the mind (putting self in other’s shoes - recognizing that others have a mind as well)
Schizophrenia - Associated Sxs: Motor Sxs: 1.\_\_\_\_\_\_ 2.\_\_\_\_\_\_ 3.\_\_\_\_\_\_ 4.\_\_\_\_\_\_
- Early motor milestones (e.g., walking)
- Gesturing
- Sensory integration
- Motor planning and sequencing
Schizophrenia Onset:
Late _____/early _____ for males (family of origin might pull child back)
Mid ____ to early _____ for females (implications for later onset - might have two support systems - family of origin and family of marriage)
teens; 20s for males
mid 20s; early 30s for females
Schizophrenia Other sex differences: Females MORE likely to... 1. \_\_\_\_\_\_\_\_ 2. \_\_\_\_\_\_\_
- Be married
2. Have an affective component
Schizophrenia
Other sex differences:
Females are LESS likely to…
1. ______
- Have a Sx profile noteworthy for strong negative Sxs
Negative Sxs are associated with poorer outcome than positive Sxs
Schizophrenia
Prognosis:
A poorer prognosis is associated with…
1. Early _____
onset
Schizophrenia
Prognosis:
A poorer prognosis is associated with…
- Gradual _____
onset/poor premorbid functioning
Schizophrenia
Prognosis:
A poorer prognosis is associated with…
- ______ sex
the male
Schizophrenia
Prognosis:
A poorer prognosis is associated with…
- _____ Hx of Sz.
Family Hx
Schizophrenia
Prognosis:
A poorer prognosis is associated with…
- High levels of ______ _____ in family members with whom the client resides
- Increased _____ over-involvement
- Increased ______
expressed emotion;
increased emotional over-involvement;
increased hostility
Schizophrenia
Course:
Incidence of Sz. is ________ in different countries
the same
Schizophrenia
Course:
The course was _____ in developing (vs. developed) countries
better
Schizophrenia
Course Cultural Differences:
Cultures _____ in how they deal with Dxs
vary
Schizophrenia
Course Cultural Differences:
Closer links between ____ and _____ (may normalize behaviors)
Sxs; cultural/religious practices
Schizophrenia
Course Cultural Differences:
Stigma levels _____
vary
Schizophrenia
Course Cultural Differences:
More likely to be cared for by ______
family
Schizophrenia
Course Cultural Differences:
_______ likely to be married
More
Schizophrenia
Course Cultural Differences:
Extended ___________ may allow for more _______ re: home and life
family involvement; more role differentiation
Schizophrenia
Course Cultural Differences:
Developed nations may foster a _______ patient mentality
professional
Schizophrenia
Etiology: Genetics
Genetic factors account for up to ____ to _____ of variance in Sz.
60-80%
Schizophrenia
Etiology: Genetics
Adopted children had ______ rates of Sz if their bio moms had Sz
IF they grew up in adopted family that was rated as _______
higher; dysfunctional
Schizophrenia
Etiology: Neurodevelopmental Hypothesis
Diathesis + Stress = Sz
Diathesis is…
underlying vulnerability
Schizophrenia
Etiology: Neurodevelopmental Hypothesis: Diathesis + Stress
Genetic Diathesis
- If genetic, likely involves multiple genes
- Likely to develop into psychosis generally (vs. Sz specifically)
Schizophrenia
Etiology: Neurodevelopmental Hypothesis: Diathesis + Stress
Environmental Diathesis
Maternal complications (rubella, diabetes, smoking)
Schizophrenia
Etiology: Neurodevelopmental Hypothesis: Stress + Diathesis
1. Excessive _____ pruning during adolescence
2. Myelination
3. _______ use during adolescence increase risk of Sz.
4. Psycho_____ stress
- synaptic
- problems
- Cannabis
- Psychosocial
Schizophrenia Etiology: Brain Structural Issues: Associated but not uniquely so with.... 1. Enlarged \_\_\_\_\_ 2. Decreased \_\_\_\_\_\_
- ventricles
2. gray matter
Schizophrenia Etiology:
Dopamine Hypothesis:
Meds/drugs that increase dopamine lead to increase in _________
positive Sxs
Schizophrenia Etiology:
Dopamine Hypothesis:
Sz involves dysfunction in the DA system but….
not as simple as too much DA in the system
Schizophrenia Etiology: Dopamine Hypothesis: Other NTs likely to have a role: 1. \_\_\_\_\_\_\_ 2. \_\_\_\_\_\_\_
- Glutamate
2. GABA
Antipsychotic Tx administration methods:
1.
2.
3.
- Pill
- Liquid
- Depot (long term shot)
Affect DA and other neurotransmitters
A few days to work for agitation and hallucination
Several weeks to work for delusions
Antipsychotic Meds
Clozapine (Clozaril)
Most effective antipsychotic by far but serious side effects preclude widespread usage - regular blood drawing.
Can cause agranulocytosis - loss of WBC
Antipsychotic Side Effects:
Cardiac
QT prolongation
Antipsychotic Side Effects:
Alertness levels:
Sedation
Antipsychotic Side Effects:
Metabolic
Weight gain
Changes in metabolism
Increase risk of diabetes
Increase risk of high cholesterol
Antipsychotic Side Effects:
Motor (Extrapyramidal)
Rigidity
Muscle Spasms
Tremors, restlessness
Antipsychotic Side Effects:
Tardive Dyskinesia
- Sudden involuntary muscle movements, typically around the mouth, tongue, and face.
- Only sometimes reversible with meds discontinued.
Antipsychotic Side Effects:
Weight gain
Which meds are worst?
Worst:
Zotepine (Zoleptil)
Olanzapine (Zyprexa)
Antipsychotic Side Effects:
QTc Prolongation:
Which drugs are worst?
Worst:
Sertindole (Serdolect)
Amisulpride (Solian)
Antipsychotic Side Effects:
Sedation:
Which meds are worst?
Worst:
Zuclopethixol (Clopixol)
Clozapine (Clozaril)
Sz Tx:
Assertive Community Treatment: Med adherence is low for Sz, so ACT intervention developed.
Key Elements:
- Multidisciplinary team
- High patient contact
- Reduced caseload
- 24/7 availability
Sz Tx:
Assertive Community Treatment: Med adherence is low for Sz, so ACT intervention developed.
Efficacy
Compared to Tx as Usual (TAU) ACT has
- Increased med adherence
- Increased quality of life
- increased likelihood to be employed and living independently
- decreased time in hospital/re-hospitalization
- More cost effective
Sz Tx:
Family Psycho-education/Decrease expressed emotion
Key elements:
Typically lasts 6-9 months and involves…
- psychoeducation
- communication skills
- problem solving
- decreased high expressed emotion
- decreased hostility/criticism
- decreased emotional over-involvement
Sz Tx:
Family Psycho-education/Decrease expressed emotion
Efficacy:
Participants found to have…
- higher functioning
- higher med compliance
- decreased hospitalization
- decreased sense of burden among family members
Cochrane Review of Interventions with Sz:
CBT
showed some efficacy for positive Sxs but not for negative
However
- effects only lasted as long as continued CBT
- higher the quality of the study (methodologically), the lower the effect size
Cochrane Review of Interventions with Sz:
Social Skills training
- some decrease in negative Sxs and relapse
- unclear if reaches significance level
Cochrane Review of Interventions with Sz:
Supported employment
- Individualized employment - some positive results re: retaining employment
- low-quality data
