Schizophrenia Flashcards
How does SZ impair a person’s life?
impairs perception or expression of reality and significant social or occupational dysfunction
What is the hallmark of SZ? What are some of its features?
- cognitive impairments
- pervasive, disabling, and treatment-resistant
What does SZ affect in a person’s life?
affects every aspect: thoughts, behaviors, social relationships, functional ability
What are the 4 types of positive symptoms?
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized behavior
What are delusions?
implausible/bizarre/baseless thoughts; fixed beliefs that are not changeable even with conflicting evidence
What are the 6 types of delusions?
- Persecutory
- Grandiose
- Delusions of reference
- Somatosensory
- Erotomanic
- Nihilistic
Persecutory Delusion
paranoia; believing one will be harmed or harassed by an individual, group, organization
Grandiose Delusion
thinking one is God, above all, untouchable
Delusions of Reference Delusion
believing everything is direct to one’s self
Erotomanic Delusion
believing others are in love with you when they aren’t; obsessive love
Somatic Delusion
dissociating with one’s body parts
Nihilistic Delusion
believing one is not dead or alive
What is a hallucination? How does it activate the brain?
-sensory events that lack environmental input – a thought causes brain activation (stimulus cannot be seen by others)
What are the involved senses in hallucinations?
audio (most common), visual, gustatory, olfactory, somatosensory, tactile
What are the two types of audio hallucinations? How do they vary?
-command or narrative
-volume & frequency
What is dysfunctional gating?
difficulty separating auditory sense and paying attention
What is disorganized speech?
word salad = speech is loosely associated or incoherent enough to impair communication
What are the two types of disorganized speech?
tangential; gets off topic, stays off topic
and
circumstantial; there a pattern in the speech enough to figure out what they’re saying
What is grossly disorganized behavior?
What is an example of it?
unpredictable agitation, silliness, social, bizarre behavior, disinhibition
Ex: catatonia
How are the 3 ways catatonia presented?
wild agitation (flailing limbs)
waxy flexibility
immobility
What are the 4 negative symptoms? How is each one presented?
- Affective flattening
- Alogia
- Anhendonia
- Avolition
What is affective flattening?
loss of emotional expression in the face, voice tone, eye contact, body language = constricted, flat, blunted
What is alogia? What must be considered?
reduction in speech fluency and productivity
reflected as slow or blocked thoughts = short and empty replies
*this could happen because of medication side effects or the disorder
What is anhendonia?
inability to experience pleasure
loss of pleasure in things one used to enjoy by anticipating that it will not be rewarding
What is avolition? How is it perceived?
1.experiencing a reduction, difficulty, or inability to start and continue goal directed activity
ex: stops brushing teeth, not engaging in any activity
- laziness
What is expressed emotion?
hostile response to the negative symptoms
How does expressed emotion range across cultures?
Least to highest: indian, mexican, british, anglo-american
What happens if there high or low expressed emotion?
High: person is less likely to take medication, more relapse/hospitalizations
Low: leads to an increase in social support and social relationships
What is needed for criteria A?
- must experience delusions, hallucinations, or disorganized speech, at least two, for one month and negative symptoms during the remainder of the time
What do you need for criteria B? Adults vs. Youth
while experiencing disturbances one must be fall below their normal level of functioning in 1 or more major areas of their life prior to the onset
ex: work, personal relationships, self-care
youth must overall fail their expected level of functioning of interpersonal, academic, or occupational functioning
What is needed for criteria C?
Must experience continuous disturbances for 6 months and minimum of 1 month of active-phase symptoms
What is needed for Criteria D?
one’s active-phase symptoms to not occur because of depressive or manic episodes, but if they happen at the same time the mood disorders can only be present for a minority of the time
What cannot happen in relation of disturbances and substance use?
symptoms cannot occur due to a substance or another medical condition
What can be present in SZ but not in psychosis?
What is specifically present in psychosis?
- negative symptoms: affect flattening, alogia, avolition, anhendonia
- delusions, hallucinations, and disorganized speech
What are some examples that can cause psychosis?
- head trauma
- drug use
- stroke
- tumors
- other psychiatric disorders
Up to what percentage of SZ patients perform poorly on cognitive tests than would be predicted by their parent’s education level?
How many SZ patients show cognitive impairment?
- 98%
- 85%
What are the 3 strongest cognitive deficits? What do they predict? What do they precede?
- homelessness
- chronic disability
- early mortality rates
These deficits predict the likelihood of success or failure.
They precede the onset of psychosis.
What is the relation between a patient’s psychosis insight and their mood?
The MORE insight they have the LOWER their mood becomes.
What plays a larger role in a patient’s inability to perform well? And why?
bad neurocognition
outcomes: fails to take medication, antipsychotics have minimal effect, & related to medical comorbidities
How does cognitive impairment affect social cognition?
less likely to be cautious/keep self safe
negative emotions such as fear are mostly impaired
What are the 7 cognitive dimensions affected by SZ?
Attention/vigilance
Reasoning/problem solving
Social learning
Working memory
Verbal fluency
Verbal learning/memory
Visual learning/memory
How many years is considered chronic SZ?
5 years or more
What did Emil Kraeplin do for SZ?
-distinguished SZ and named it dementia praecox = premature dementia = precocious madness
-identified the primary disturbance = COGNITION (hallmark)
-no recovery
-believed it was organically produced: poisoning of the brain (autointoxication), probably by sex hormones
What did Eugene Bleuler do for SZ?
coined SZ
Schizen - to split
Phren - soul,spririt,mind
defined it as “loosening of associations” = fragmented thinking
once diagnosed = no recovery for cognitive deficits
included the positive and negative symptom diagnosis
When is there an onset of psychosis in SZ patients? What is the average onset age for adult males and females?
- late teens - mid 30’s
- M - 23-25 yrs old
- F - 25-28 yrs old
What happens if there is an early onset of psychosis?
more severe symptoms, more chronic, less remission, more disability, worse quality of life
What is the international prevalence of SZ?
Which sex has the higher prevalence?
- approximately 1%
- slightly higher in males
What are the differences between male and female SZ patients?
Males:
1. severe form
2. neg symptoms
3. more chronic
Females:
1. less severe
2. depressive symptoms
3. favorable outcomes
Where are SZ patients?
6% homeless/shelters & jail/prison
5-6% in hospitals
10% in nursing homes
20% in supervised housing
25% living with family
28% live independently
Which cultural factors should be considered for assessment?
What cultural frameworks (customs) must be considered for assessment?
- witch craft
- ghosts/spirits
- hearing God’s voice
- level of eye contact
- body language
- hygiene
4 alogia/linguistic barriers
What is the range of suicide in SZ patients?
What is comorbid to suicide risk in SZ patients?
- 5-6% completed
20% attempted - substance use
Which disorders present high comorbidity to SZ?
- substance use disorders
- OCD
- panic disorder with social anxiety
What reduces life expectancy in SZ patients?
- metabolic disorder
- weight gain/obesity
- diabetes
- poor hygiene/diet/exercise
- medication side effects
What is the prodromal period?
How is it characterized?
What are the “soft signs”?
- 1-2 years before the onset of a psychotic break
- anxiety, depression, loss of function
- unusual beliefs (ideas of reference), illusions (NOT hallucinations), vague speech (mostly understandable), unusual behavior (mumbling in public)
What are 3 fetal hypoxia risks related to SZ?
- low oxygen to fetus
- risk to SZ development if it runs in the family
- emergency C-section, bleeding while pregnant, preeclampsia
What are some related maternal infection risks to SZ?
- influenza in the 2nd trimester
- other infections: upper respiratory, genital tract, measles, toxoplasmosis
- elevation in antibodies bc of infection
What are some environmental risk factors of SZ?
- fathers over 55
- malnutrition/famine = gene expression change
- higher incidences in urban areas
- seasonal/latitude = vitamin D sufficiency
- birth month = higher in winter months
What is the relation of cannabis use and psychosis?
- worsen illness
- increases relapse
- often generates more positive symptoms dependent on the dosage
What is the prevalence of trauma in adult SZ patients? Why?
- there is a higher rate of childhood trauma
- childhood trauma might puts them at risk of later development
What is the Dopamine hypothesis?
What drugs are at play?
- SZ patients have an excess of dopamine
- Drugs that increase DA: (agonists) cocaine and ketamine
- Drugs that decrease DA: (antagonists) L-Dopa, neuroleptics
What was the concluded prevalence in twins studies with SZ?
40-50% in identical twins (monozygotic
6-10% in fraternal twins (dizygotic)
What are two neurobiological abnormalities in the brain related to SZ?
- enlarges ventricles
- reduced tissue volume
- less active frontal lobes = Hypofrontality
*key dopamine pathway
