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Psychology & Neuroscience of Psychosis > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

What can explain why the voices heard by a patient with schizophrenia often know exactly what to say to hurt him/her?

A

Voices become a misinterpretation of patient’s inner feelings
- a worrying thought becomes a negative voice

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2
Q

What is the earliest and most famous ‘mad house’ in England?

A

Bethlem (Bedlam)

- founded in 1247

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3
Q

What happened in psychiatry with the industrialisation?

A

Psychiatric hospitals were built across Europe and USA

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4
Q

What were the key aspects of asylums during the institutionalisation in the 1800s?

A

Asylums
- should provide good accomodation

  • built in green areas, outside cities
  • provide healthier lifestyle to patients
  • allow patients to recover away from poor living conditions of Victorian cities
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5
Q

What was the reality of asylums during the institutionalisation in the 1800s?

A

Terrible conditions in the original ‘Mad houses’

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6
Q

What was the context of the building of asylums in the first half of the 19th century (1808-1845) in England?

A
  • Most major cities decided to build asylums
  • Movement to try and do the best for those with mental disease
  • Often, quite beautiful buildings
  • Initially good conditions and people were well looked after
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7
Q

What was the main difficulty in the asylums during the first half of the 19th century in England?

A

Lack of patient recovery

  • remote location of asylums -> hard for relatives to visit patients
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8
Q

What characterised the deterioration of asylum conditions in the 19th and 20th century?

A
  • Lack of patient discharge
  • Mental hospitals began to get overwhelmed with numbers
  • > conditions deteriorated
  • By 1900s, idea of moral therapy had declined
  • The mentally ill were segregated from rest of population
  • > patients were forgotten by society
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9
Q

What promoted a better understanding of the differences between patients in mental hospitals in the 1800s?

A

Mental hospitals allowed doctors to be exposed to different types of patients with a wide spectrum of disorders

-> alienists (now psychiatrists) realised there was different types of people with different types of diseases

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10
Q

What were common mental diseases identified by alienists in the 1800s?

A
  • General paralysis of the insane (illness secondary to chronic syphilis, which caused brain damage)
  • Mental handicap
  • Alzheimer’s disease
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11
Q

How were Emil Kraepelin and Alois Alzheimer connected?

A

Alois Alzheimer was in Kraepelin’s department in Germany

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12
Q

What was Dementia praecox?

A

Disease considered by Emil Kraepelin, currently known as schizophrenia

  • he compared it to Alzheimer’s disease
  • key difference was its earlier onset
  • it differentiated from ‘Manic depressive insanity/psychosis’, with a fluctuating course of frequent relapses, but better prognosis
  • worse outcome
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13
Q

Who coined the term schizophrenia in 1911?

A

Eugen Bleuler

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14
Q

What was Eugen Bleuler’s view on schizophrenia?

A
  • Existence of more than one type of schizophrenia
  • More psychological than organic: a neuropathological degenerating disorder
  • 4 A’s: autism, ambivalence, loose associations, blunting or incongruity of affect
  • more optimistic outcome than Kraepelin
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15
Q

What were the four ‘A’s of schizophrenia defined by Eugen Bleuler?

A
  1. Autism: difficulties in social communication
  2. Ambivalence: uncertainty
  3. Loose associations: unusual forms of thought
  4. Blunting or incongruity of affect: in the display of emotions
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16
Q

What the issue with Bleuler’s diagnostic criteria of schizophrenia?

A
  • It was hard to distinguish what the 4 ‘A’s were

- > in the US, there was an emerging over diagnosis of schizophrenia

17
Q

How is the Kraepelinian view of psychosis, modified by Eugen Bleuler, still used nowadays?

A
  • Dementia praecox -> Schizophrenia

- Manic depressive insanity/psychosis -> Bipolar disorder

18
Q

What were Schneider’s first rank symptoms as indicators of schizophrenia?

A
  1. Auditory hallucinations
    - thought echo
    - third-person hallucinations
    - running commentaries
  2. Thought insertion or withdrawal
  3. Thought broadcasting
  4. ‘Made’ acts, thoughts or feelings (via external force that takes over control of the person)
    - seen in acute episodes
  5. Delusional perception
    - delusional meaning given to a perceived thing
19
Q

What was Schneider’s view on Bleuler’s characterisation of schizophrenia?

A

Bleuler’s ideas were too complex for the average psychiatrist to detect reliably

20
Q

What are positive symptoms in schizophrenia?

A

Presence of abnormal phenomena

  • Delusions: fixed false idea, unshakeable, not shared amongst people from same culture
  • Hallucinations: perception when there is lack of stimulus
  • Formal thought disorder: disorganised thinking
21
Q

What are negative symptoms in schizophrenia?

A

Absence of normal behaviour

  • Flat or blunt affect: lack of emotional response
  • Cognitive difficulties
  • Poverty of speech
  • Loss of initiative: lack of motivation for everyday activities (e.g. eating)
  • Self-neglect: lack of care for one’s appearance
  • Social disinhibition: embarrassing or rude behaviour
22
Q

What are the rates variations of schizophrenia according to age and gender?

A
  • Tends to affect young people
  • Unlikely to occur in older people or children
  • Men are most likely to develop psychosis in early 20s
  • Women are most likely to develop psychosis later in life
23
Q

What does the oestrogen theory of later onset of psychosis in women propose?

A

Oestrogen is protective, hence it is unlikely for women to develop psychosis during their reproductive period

24
Q

What did Manfred Bleuler propose on the long-term course of schizophrenic psychoses (1973)?

A
  • “Large number of long-standing schizophrenic illnesses”
  • “On average, schizophrenia showed no further change for the worse after a duration of 5 years, but rather a tendency to improve”
  • > not necessarily a deteriorating disorder
  • > different from Alzheimer’s disease
25
Q

Who was Manfred Bleuler?

A
  • Son of Eugen Bleuler
  • he would stay with his dad an play with some of the patients
  • after graduating, he went on to medical school to become a doctor and psychiatrist
  • he worked and lived at Burgholzli psychiatric clinic in Switzerland
26
Q

What are the five possible outcomes of schizophrenia?

A
  1. One episode only in the lifetime
  2. One episode every 2 to 3 years (no symptoms in-between)
  3. One episode every 2 years (no symptoms in-between)
  4. Several episodes and symptoms continue (no worsening)
  5. Several episodes and symptoms continue, accumulate and get worse
    - accumulation of negative symptoms
27
Q

In a 10 years follow-up of people with schizophrenia, what was observed about the course and prognosis?

A
  • About 40% will have no psychotic symptoms at 10 years (half will be taking medication)
  • About 40% will have relapses (potential degradation of social/work relationships)
  • About 20% will go into a chronic form: treatment-resistant
28
Q

What is the traditional Kraepelinian dichotomy?

A

Psychosis
- ‘Dementia praecox’: true schizophrenia

  • ‘Manic depressive psychosis’: true bipolar disorder
29
Q

What is usually observed in real life on the traditional Kraepelinian dichotomy?

A

Often difficult to tell apart schizophrenia from bipolar disorder
- misdiagnosis

  • schizoaffective disorder in-between the schizophrenia and bipolar
30
Q

What is the issue with diagnosing people with schizophrenia?

A

It is not welcomed by patients
- they often find bipolar diagnosis more positive, with the existence of more available treatment for BD

  • stigma around schizophrenia due to generalised perception of those diagnosed being dangerous or violent
  • even though vast majority of people with schizophrenia are not dangerous or violent (concerns mostly those with substance misuse)
31
Q

Why was a dimensional view of psychosis suggested by psychiatrists?

A

In recent years, dissatisfaction with the diagnosis of schizophrenia

  • stigma
  • lack of explanation for its onset and outcome
32
Q

What does the multidimensional approach to the diagnosis of psychosis consist of?

A

5 factors

  • Negative symptoms (loss of motivation, cognitive difficulties, self-neglect)
  • Positive symptoms (delusions, hallucinations)
  • Manic
  • Depressive
  • Disorganisation (thought disorder)
33
Q

What did the SCAN interview study of Demjaha and colleagues (2009) show about psychotic patients?

A
  • 536 first-episode psychotic patients interview with SCAN
  • Usual five factors identified (negative, positive, manic, depressed, disorganisation), better when describing people and their responses to different treatments
  • Patient’s responses weren’t positive enough to justify abolishing previous diagnoses of schizophrenia and bipolar disorder
  • > Best approach: mix of categorical diagnosis with description of the factors
34
Q

What was the traditional view of schizophrenia?

A

Discrete categorical disease entity

- ‘sane’ vs ‘insane’

35
Q

What is the emerging view on schizophrenia and psychosis?

A

Continuum of psychosis
- in general population up to 15% might have psychotic symptoms

  • psychosis is similar to anxiety or depression, in that people experience it at some point in their lives
  • schizophrenia is severe psychosis
  • some people are not prone to paranoia
  • some are in the middle
  • some have many psychotic symptoms and need treatment
36
Q

What does the psychiatric literature suggest on the view of psychosis?

A

Psychosis as fluctuating matter, such as weight

  • in the dimensions, there’s a threshold (cut-off point) that makes the diagnosis of schizophrenia
  • factors that induce psychosis and schizophrenia also induce temporary paranoia or other psychotic symptoms in gen pop
  • > look at factors within our society that push people into developing psychosis and schizophrenia

Psychology & Neuroscience of Psychosis (16 decks)

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