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psyc236 > schizophrenia > Flashcards

schizophrenia Flashcards

1
Q

what is schizophrenia?

A

type of psychosis with disturbed thought, emotion, language and behaviour (thought as a brain disease and has a disconnection between the brain and the external world it perceives/interacts with)

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2
Q

what is psychosis?

A

broad term referring to a disconnection from reality (manifests as hallucinations and/or delusions)

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3
Q

what are the negative symptoms for schizophrenia?

A

-blunted affect (difficulty expressing emotions)
-anhedonia (reduced ability to experience pleasure)
-avolition (decrease ability to persist purposeful activities)
-apathy (lack of interest)
-social withdrawal
-poverty of speech

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4
Q

what are the positive symptoms for schizophrenia?

A

-disorganized speech
-delusions
-bizarre behaviour
-hallucinations

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5
Q

what is the diagnostic criteria A (how many)?

A

must have at least one of the three, two of five
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or abnormal motor behavior
-negative symptoms

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6
Q

what is diagnostic criteria B?

A

Social or Occupational Dysfunction:
-for a significant proportion of the time since onset, one of more major areas of functioning, such as work, interpersonal relations, or self-care are markedly below the level achieved prior to illness onset
-must be pervasive pattern
-dysfunctions usually appears in many domains
-not due to other disorders, substances, or medical condition

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7
Q

what is the duration?

A

-continuous signs of disturbance persist for at least 6 months
-at least one month of these six months must include criterion A symptoms

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8
Q

what is schizophreniform disorder?

A

symptoms present for more than a month but less than six months

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9
Q

what is brief psychotic disorder?

A

more than one symptom (delusions, hallucinations, disorganized speech, disorganized behaviour) for less than a month

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10
Q

what is schizoaffective disorder?

A

symptoms meet criteria for both schizophrenia and a major depressive or manic episode, positive symptoms are present for over 2 weeks outside of a depressive or manic episode, mood symptoms present for over half of illness duration

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11
Q

what is delusional disorder?

A

presence of at least one delusion for over a month, without meeting criteria for schizophrenia, functioning not impaired outside of specific impact of delusion

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12
Q

what is delusion? what are some types of delusions?

A

Delusions; erroneous beliefs that usually involve a misinterpretation of perceptions or experiences.

Types of Delusions;
-persecutory/paranoid
-guilt/sin
-grandiose
-religious
-somatic
-reference
-being controlled (feelings, movements, impulses)
-mind reading
-thought broadcasting (escape and experienced by others)
-thought insertion (thoughts not own and inserted)
-thought withdrawal (thought cessation and withdrawn)
-somatic passivity (bodily sensations imposed by ext agency)

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13
Q

what was the Buday et. al Study 2022?

A

-explored best-selling video games released between 2002 and 2021
-1/10 of the most popular games portray symptoms of mental illness
-75% of this content depict characters with a mental illness in a negative way
-the most common is Sz illness with paranoid delusions
-hallucinations were represented in 17 video games, they are represented as audiovisual and horror-like fo fear inducing
-only 3% of the video games portray an attempted intervention for these symptoms, majority negative toward psychiatry and represents medical field in a negative or ineffective manner

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14
Q

what was the Owen P Study 2012?

A

-analyzed 41 movies released between 1990 and 2010 that had depictions of schizophrenia
-most of the characters displayed positive symptoms of schizophrenia, with delusions being featured most frequently, followed by auditory and visual hallucinations
-majority of characters engaged in homicidal behavior
-about one-fourth of the characters committed suicide

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15
Q

what are the consequences of self-stigma?

A

-reduced confidence and self-esteem makes people doubt their abilities which may impact performance at work or school
-social isolation keeps people with psychosis from talking to friends and family members about their difficulties which can lead to isolation, shame and loneliness
-reduced motivation to take care of yourself
-not seeking treatment can lead to years of avoidable suffering and negative outcomes

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16
Q

what is self-stigma/internalized stigma?

A

-the process of structural stigma can lead to the experience of internalized stigma
-occurs when people internalize the myths about psychosis and begin to feel badly about themselves or believe these negative stereotypes

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17
Q

what occurs to individuals with schizophrenia and the stigma they receive?

A

-lead to emotional reactions (fear, blame, and pity) and the discrimination in the forms of avoidance, withdrawal, coercion, and segregation from society
-perpetuate feelings of rejection, shame, low self-esteem, lack of belongingness, and incompetence
-increased symptom severity, decreased treatment seeking behaviors, and treatment non-adherence

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18
Q

what is the stigma surrounding schizophrenia?

A

viewed negatively including negative attitudes, stereotypes, and beliefs of perceived dangerousness, responsibility for illness, controllability of symptoms and competence

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19
Q

what is stigma?

A
  1. labelling someone with a condition
  2. stereotyping people with that condition
  3. creating a division: “us vs them”
  4. discriminating against someone on the basis of their label
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20
Q

what is social skills training?

A

social interactions, coping with stress, household tasks, employment. Moderate effects on social and independent living skills, psychosocial functioning and negative symptoms

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21
Q

what is family therapy?

A

psychosocial intervention that conceptualizes the patient as a member of the family system; tailors treatment to the family, psychoeducation (clinical presentation, causes, treatments), problem solving and stress-related coping

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22
Q

why is early intervention important?

A

can shorten illness duration, reduce possible hospitalizations, reduce the need for medication, and promote recovery (with CBT techniques and inclusion of family therapy may reduce risk of relapse/hospitalization)

23
Q

why is cognitive behaviour therapy for psychosis important?

A

-many people experience psychotic-like symptoms without feeling distress
-recovery is possible
-delusions are understandable
-it is not the delusion/hallucination per se that is clinically relevant, but the distress/disability associated with it
-psychosis can happen to anyone if sufficiently stressed
-clients with psychosis are not different than clients with other mental health conditions
-most symptoms of psychosis are quite common in the ‘normal’ population
-there is no clear boundary between mental health and mental unwellness
-CBTp models look similar to anxiety models
-validating the patient

24
Q

what are the first generation antipsychotic medications? side effects?

A

(neuroleptics); D2 antagonist like chlorpromazine and haloperidol
Side effects; sedative and anticholinergic

25
Q

what are the second generation antipsychotic medications? side effects?

A

(atypical antipsychotics); D2/5HT2A antagonists like clozapine, quetiapine, olanzapine, and risperidone (dopamine-serotonin antagonists that are more effective in the face of treatment resistance)
Side effects; metabolic weight gain and tremors

26
Q

what are the third generation antipsychotic medications? side effects?

A

aripiprazole (abilify) partial D2 agonism
side effects; neuroendocrine

27
Q

what are the treatments for schizophrenia?

A

-antipsychotic medication
-cognitive remediation
-cognitive behavioral therapy for psychosis
-social skills training
-family therapy
-early intervention
-and others (occupational therapy, recreational therapy, harm reduction if substance use, sleep therapy, stigma reduction, etc)

28
Q

what are the cognitive effects of schizophrenia?

A

-dysfunction is present before the illness
-mild to moderate impairments are present in unaffected family members
-impairments are not a consequence of symptoms
-dysfunction persists as symptoms remit
-deficits are not an artifact of treatment
-some degree of impairment is universal

29
Q

what are the factors associated with functional recovery?

A

-positive/negative symptoms
-comorbid mental health symptoms (anxiety and depression)
-experience and opportunity
-cognition and social cognition
-stigma and many other factors

30
Q

what is the treatment success?

A

-symptomatic remission
-syndromal recovery
-sustained remission
-functional recovery

31
Q

what is remission?

A

mild/less on all psychosis items, moderate/less on all negative items, and sustained at least 2 years

32
Q

what is functional performance?

A

intact social functioning and intact everyday living skills (significant barrier; medication can help symptoms but this may still be affected)

33
Q

what is recovery?

A

convergence between remission and functional performance criteria

34
Q

what are some factors for a poor prognosis?

A

-male
-gradual onset
-early age of onset
-poorer premorbid functioning
-family history of Sz
-having families that express high negative emotions
-repeated stressful life events

35
Q

what is the prodromal phase?

A

-a period of escalating problems with adjustment and emergence of subclinical symptoms
-schizotypal symptoms, depression, academic/occupational failure are common
-acute onset; symptoms emerge over a few weeks (better prognosis)
-gradual onset; many months or years of behavioral change

36
Q

what is premorbid development?

A

-the primary brain insults and/or pathological processes occur long before clinical manifestation
-minor physical anomalies; often result of 2nd trimester insults (criteria time for neuronal migration)
-high palate
-low set ears
-variations in limb length and angle
-finger print patterns
-webbed digits

37
Q

what is the course of illness for schizophrenia?

A

Group 1: 22% only have a single episode of illness with no subsequent impairment
Group 2: 35% have repeated episodes of illness with no impairment between episodes
Group 3: 8% have repeated episodes of illness with some impairment between episodes
Group 4: 35% have repeated episodes of illness with gradually declining impairment between episodes
-environmental and social factors can influence the course

38
Q

what is chronic schizophrenia?

A

positive symptoms and impairment remain

39
Q

what is residual schizophrenia?

A

does not meet criteria, no positive symptoms, but has negative symptoms persisting

40
Q

what is recovered schizophrenia?

A

no symptoms present

41
Q

what are the dopamine and psychotic symptoms?

A

-everything becomes rewarding
-excess dopamine in striatal regions but reduced dopamine available in the prefrontal cortex leads to cognitive impairments

42
Q

what are the causes of schizophrenia that are influenced by neurotransmitters?

A

-drugs that increase dopamine (agonists) result in psychotic symptoms
-drugs that decrease dopamine (antagonists), reduce schizophrenia-like behavior (neuroleptics and L-dopa for parkinson’s)
-increased stimulation of D2 in striatum and decreased stimulation of D1 in prefrontal cortex

43
Q

what are the stressors?

A

-may activate underlying vulnerability and/or increase risk of relapse
-families show ineffective communication patterns and high expressed emotion is associated with relapse

44
Q

what are the anatomic and functional brain disturbances?

A

-enlarged ventricles and reduced tissue volume
-hypofrontality; less active frontal lobes (major dopamine pathway)
-associated with diffuse neurological dysregulation
-not unique to Sz

45
Q

what are the prenatal and obstetric factors?

A

risk factors of; fetal hypoxia, nutritional deficiency in the first trimester, and maternal stress (elevated glucocorticoid release associated with hippocampal abnormalities in offspring)
-maternal viral infection; risk is elevated in cohorts with flu epidemic (winter births are more common in Sz with viral infections most prevalent during critical neurodevelopment)

46
Q

what is the endophenotype approach?

A

Endophenotypes are intermediate phenotypes, their proximity to the genetic causes make them less complex than the syndrome

Criteria;
-It is associated with illness in the population
-Must be heritable
-State-independent (seen in individuals with and without the diagnosis)
-Within families, endophenotypes and illness co-segregate
-It is found in unaffected relatives more frequently than in the general population

47
Q

what did the genetic research find?

A

-risk of schizophrenia increases as a function of genetic relatedness
-one need not show symptoms of schizophrenia to pass on relevant genes
-schizophrenia has a strong genetic component, but genes alone are not enough

48
Q

what are limitations to the genetic approach?

A

-50% concordance in MZ twins who share 100% of genes
-87% of those with a parent with Sz do not develop Sz
-63% of those with Sz have no first- or second-degree relatives with Sz
-even the most widely replicated genetic polymorphism (COMT) only increases the risk for Sz by 1.5%
-candidate genes lack specificity to Sz; present in other disorders and healthy individuals
-the expression of genetic vulnerabilities to mental illness are largely determined by non-genetic factors

49
Q

what are the twin study results?

A

-risk of schizophrenia in monozygotic twins is 48%
-risk of schizophrenia drops to 17% for fraternal (dizygotic) twins

50
Q

what are the adoption study results?

A

risk of schizophrenia remains high in adopted children with a biological parent with schizophrenia

51
Q

what are the causes of schizophrenia?

A

diathesis; an underlying vulnerability that results in an increased risk
-damage to brain might occur prenatally and lie dormant for years
-psychosis tends to be expressed in late teens, early 20s

stress; a trigger or triggers that allow the vulnerability to emerge as psychosis
-possible that events are needed for its manifestation (stress)
-not synonymous with “anxiety”
-stressors might be; environmental or interaction of brain maturation with underlying risk

genetics; inherit a tendency for psychosis, not a specific form of schizophrenia
-other members are at increased risk of schizophrenia

52
Q

what is the disorganized speech?

A
  1. amount; poverty of speech (negative) and pressured speech
  2. connectedness; tangentiality, derailment, and circumstantiality
  3. less common forms; neologisms (new word or expression) and word approximations
53
Q

what are hallucinations?

A

-anomalous experiences (distortions of real perceptual experience like shape, color and size)
-illusions (a real object is misperceived as another like a moving curtain may be a burglar)
-pseudohallucination (less vivid perceptual experience, not a real object/image/sound, recognize that the percept is internally-generated)
-visual hallucinations occur in 15% of people with schizophrenia (tend to be unreal objects or parts rather than whole scenes)
-tactile hallucinations have an incidence of 5%
-somatic and gustatory are rare and often associated with delusions

psyc236 (3 decks)

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