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Advanced Psychopathology > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

How does SZ impair a person’s life?

A

impairs perception or expression of reality and significant social or occupational dysfunction

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2
Q

What is the hallmark of SZ? What are some of its features?

A
  1. cognitive impairments
  2. pervasive, disabling, and treatment-resistant
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3
Q

What does SZ affect in a person’s life?

A

affects every aspect: thoughts, behaviors, social relationships, functional ability

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4
Q

What are the 4 types of positive symptoms?

A
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Disorganized behavior
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5
Q

What are delusions?

A

implausible/bizarre/baseless thoughts; fixed beliefs that are not changeable even with conflicting evidence

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6
Q

What are the 6 types of delusions?

A
  1. Persecutory
  2. Grandiose
  3. Delusions of reference
  4. Somatosensory
  5. Erotomanic
  6. Nihilistic
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7
Q

Persecutory Delusion

A

paranoia; believing one will be harmed or harassed by an individual, group, organization

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8
Q

Grandiose Delusion

A

thinking one is God, above all, untouchable

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9
Q

Delusions of Reference Delusion

A

believing everything is direct to one’s self

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10
Q

Erotomanic Delusion

A

believing others are in love with you when they aren’t; obsessive love

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11
Q

Somatic Delusion

A

dissociating with one’s body parts

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12
Q

Nihilistic Delusion

A

believing one is not dead or alive

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13
Q

What is a hallucination? How does it activate the brain?

A

-sensory events that lack environmental input – a thought causes brain activation (stimulus cannot be seen by others)

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14
Q

What are the involved senses in hallucinations?

A

audio (most common), visual, gustatory, olfactory, somatosensory, tactile

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15
Q

What are the two types of audio hallucinations? How do they vary?

A

-command or narrative
-volume & frequency

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16
Q

What is dysfunctional gating?

A

difficulty separating auditory sense and paying attention

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17
Q

What is disorganized speech?

A

word salad = speech is loosely associated or incoherent enough to impair communication

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18
Q

What are the two types of disorganized speech?

A

tangential; gets off topic, stays off topic
and
circumstantial; there a pattern in the speech enough to figure out what they’re saying

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19
Q

What is grossly disorganized behavior?
What is an example of it?

A

unpredictable agitation, silliness, social, bizarre behavior, disinhibition
Ex: catatonia

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20
Q

How are the 3 ways catatonia presented?

A

wild agitation (flailing limbs)
waxy flexibility
immobility

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21
Q

What are the 4 negative symptoms? How is each one presented?

A
  1. Affective flattening
  2. Alogia
  3. Anhendonia
  4. Avolition
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22
Q

What is affective flattening?

A

loss of emotional expression in the face, voice tone, eye contact, body language = constricted, flat, blunted

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23
Q

What is alogia? What must be considered?

A

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

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24
Q

What is anhendonia?

A

inability to experience pleasure

loss of pleasure in things one used to enjoy by anticipating that it will not be rewarding

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25
Q

What is avolition? How is it perceived?

A

1.experiencing a reduction, difficulty, or inability to start and continue goal directed activity
ex: stops brushing teeth, not engaging in any activity

  1. laziness
26
Q

What is expressed emotion?

A

hostile response to the negative symptoms

27
Q

How does expressed emotion range across cultures?

A

Least to highest: indian, mexican, british, anglo-american

28
Q

What happens if there high or low expressed emotion?

A

High: person is less likely to take medication, more relapse/hospitalizations
Low: leads to an increase in social support and social relationships

29
Q

What is needed for criteria A?

A
  1. must experience delusions, hallucinations, or disorganized speech, at least two, for one month and negative symptoms during the remainder of the time
30
Q

What do you need for criteria B? Adults vs. Youth

A

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

31
Q

What is needed for criteria C?

A

Must experience continuous disturbances for 6 months and minimum of 1 month of active-phase symptoms

32
Q

What is needed for Criteria D?

A

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

33
Q

What cannot happen in relation of disturbances and substance use?

A

symptoms cannot occur due to a substance or another medical condition

34
Q

What can be present in SZ but not in psychosis?
What is specifically present in psychosis?

A
  1. negative symptoms: affect flattening, alogia, avolition, anhendonia
  2. delusions, hallucinations, and disorganized speech
35
Q

What are some examples that can cause psychosis?

A
  1. head trauma
  2. drug use
  3. stroke
  4. tumors
  5. other psychiatric disorders
36
Q

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?

A
  1. 98%
  2. 85%
37
Q

What are the 3 strongest cognitive deficits? What do they predict? What do they precede?

A
  1. homelessness
  2. chronic disability
  3. early mortality rates

These deficits predict the likelihood of success or failure.

They precede the onset of psychosis.

38
Q

What is the relation between a patient’s psychosis insight and their mood?

A

The MORE insight they have the LOWER their mood becomes.

39
Q

What plays a larger role in a patient’s inability to perform well? And why?

A

bad neurocognition

outcomes: fails to take medication, antipsychotics have minimal effect, & related to medical comorbidities

40
Q

How does cognitive impairment affect social cognition?

A

less likely to be cautious/keep self safe
negative emotions such as fear are mostly impaired

41
Q

What are the 7 cognitive dimensions affected by SZ?

A

Attention/vigilance
Reasoning/problem solving
Social learning
Working memory
Verbal fluency
Verbal learning/memory
Visual learning/memory

42
Q

How many years is considered chronic SZ?

A

5 years or more

43
Q

What did Emil Kraeplin do for SZ?

A

-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

44
Q

What did Eugene Bleuler do for SZ?

A

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

45
Q

When is there an onset of psychosis in SZ patients? What is the average onset age for adult males and females?

A
  1. late teens - mid 30’s
  2. M - 23-25 yrs old
  3. F - 25-28 yrs old
46
Q

What happens if there is an early onset of psychosis?

A

more severe symptoms, more chronic, less remission, more disability, worse quality of life

47
Q

What is the international prevalence of SZ?
Which sex has the higher prevalence?

A
  1. approximately 1%
  2. slightly higher in males
48
Q

What are the differences between male and female SZ patients?

A

Males:
1. severe form
2. neg symptoms
3. more chronic

Females:
1. less severe
2. depressive symptoms
3. favorable outcomes

49
Q

Where are SZ patients?

A

6% homeless/shelters & jail/prison
5-6% in hospitals
10% in nursing homes
20% in supervised housing
25% living with family
28% live independently

50
Q

Which cultural factors should be considered for assessment?
What cultural frameworks (customs) must be considered for assessment?

A
  1. witch craft
  2. ghosts/spirits
  3. hearing God’s voice
  4. level of eye contact
  5. body language
  6. hygiene
    4 alogia/linguistic barriers
51
Q

What is the range of suicide in SZ patients?
What is comorbid to suicide risk in SZ patients?

A
  1. 5-6% completed
    20% attempted
  2. substance use
52
Q

Which disorders present high comorbidity to SZ?

A
  1. substance use disorders
  2. OCD
  3. panic disorder with social anxiety
53
Q

What reduces life expectancy in SZ patients?

A
  1. metabolic disorder
  2. weight gain/obesity
  3. diabetes
  4. poor hygiene/diet/exercise
  5. medication side effects
54
Q

What is the prodromal period?
How is it characterized?
What are the “soft signs”?

A
  1. 1-2 years before the onset of a psychotic break
  2. anxiety, depression, loss of function
  3. unusual beliefs (ideas of reference), illusions (NOT hallucinations), vague speech (mostly understandable), unusual behavior (mumbling in public)
55
Q

What are 3 fetal hypoxia risks related to SZ?

A
  1. low oxygen to fetus
  2. risk to SZ development if it runs in the family
  3. emergency C-section, bleeding while pregnant, preeclampsia
56
Q

What are some related maternal infection risks to SZ?

A
  1. influenza in the 2nd trimester
  2. other infections: upper respiratory, genital tract, measles, toxoplasmosis
  3. elevation in antibodies bc of infection
57
Q

What are some environmental risk factors of SZ?

A
  1. fathers over 55
  2. malnutrition/famine = gene expression change
  3. higher incidences in urban areas
  4. seasonal/latitude = vitamin D sufficiency
  5. birth month = higher in winter months
58
Q

What is the relation of cannabis use and psychosis?

A
  1. worsen illness
  2. increases relapse
  3. often generates more positive symptoms dependent on the dosage
59
Q

What is the prevalence of trauma in adult SZ patients? Why?

A
  1. there is a higher rate of childhood trauma
  2. childhood trauma might puts them at risk of later development
60
Q

What is the Dopamine hypothesis?
What drugs are at play?

A
  1. SZ patients have an excess of dopamine
  2. Drugs that increase DA: (agonists) cocaine and ketamine
  3. Drugs that decrease DA: (antagonists) L-Dopa, neuroleptics
61
Q

What was the concluded prevalence in twins studies with SZ?

A

40-50% in identical twins (monozygotic
6-10% in fraternal twins (dizygotic)

62
Q

What are two neurobiological abnormalities in the brain related to SZ?

A
  1. enlarges ventricles
  2. reduced tissue volume
  3. less active frontal lobes = Hypofrontality
    *key dopamine pathway

Advanced Psychopathology (10 decks)

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