schizophrenia Flashcards
what is schizophrenia?
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)
what is psychosis?
broad term referring to a disconnection from reality (manifests as hallucinations and/or delusions)
what are the negative symptoms for schizophrenia?
-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
what are the positive symptoms for schizophrenia?
-disorganized speech
-delusions
-bizarre behaviour
-hallucinations
what is the diagnostic criteria A (how many)?
must have at least one of the three, two of five
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or abnormal motor behavior
-negative symptoms
what is diagnostic criteria B?
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
what is the duration?
-continuous signs of disturbance persist for at least 6 months
-at least one month of these six months must include criterion A symptoms
what is schizophreniform disorder?
symptoms present for more than a month but less than six months
what is brief psychotic disorder?
more than one symptom (delusions, hallucinations, disorganized speech, disorganized behaviour) for less than a month
what is schizoaffective disorder?
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
what is delusional disorder?
presence of at least one delusion for over a month, without meeting criteria for schizophrenia, functioning not impaired outside of specific impact of delusion
what is delusion? what are some types of delusions?
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)
what was the Buday et. al Study 2022?
-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
what was the Owen P Study 2012?
-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
what are the consequences of self-stigma?
-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
what is self-stigma/internalized stigma?
-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
what occurs to individuals with schizophrenia and the stigma they receive?
-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
what is the stigma surrounding schizophrenia?
viewed negatively including negative attitudes, stereotypes, and beliefs of perceived dangerousness, responsibility for illness, controllability of symptoms and competence
what is stigma?
- labelling someone with a condition
- stereotyping people with that condition
- creating a division: “us vs them”
- discriminating against someone on the basis of their label
what is social skills training?
social interactions, coping with stress, household tasks, employment. Moderate effects on social and independent living skills, psychosocial functioning and negative symptoms
what is family therapy?
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
why is early intervention important?
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)
why is cognitive behaviour therapy for psychosis important?
-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
what are the first generation antipsychotic medications? side effects?
(neuroleptics); D2 antagonist like chlorpromazine and haloperidol
Side effects; sedative and anticholinergic
what are the second generation antipsychotic medications? side effects?
(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
what are the third generation antipsychotic medications? side effects?
aripiprazole (abilify) partial D2 agonism
side effects; neuroendocrine
what are the treatments for schizophrenia?
-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)
what are the cognitive effects of schizophrenia?
-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
what are the factors associated with functional recovery?
-positive/negative symptoms
-comorbid mental health symptoms (anxiety and depression)
-experience and opportunity
-cognition and social cognition
-stigma and many other factors
what is the treatment success?
-symptomatic remission
-syndromal recovery
-sustained remission
-functional recovery
what is remission?
mild/less on all psychosis items, moderate/less on all negative items, and sustained at least 2 years
what is functional performance?
intact social functioning and intact everyday living skills (significant barrier; medication can help symptoms but this may still be affected)
what is recovery?
convergence between remission and functional performance criteria
what are some factors for a poor prognosis?
-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
what is the prodromal phase?
-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
what is premorbid development?
-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
what is the course of illness for schizophrenia?
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
what is chronic schizophrenia?
positive symptoms and impairment remain
what is residual schizophrenia?
does not meet criteria, no positive symptoms, but has negative symptoms persisting
what is recovered schizophrenia?
no symptoms present
what are the dopamine and psychotic symptoms?
-everything becomes rewarding
-excess dopamine in striatal regions but reduced dopamine available in the prefrontal cortex leads to cognitive impairments
what are the causes of schizophrenia that are influenced by neurotransmitters?
-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
what are the stressors?
-may activate underlying vulnerability and/or increase risk of relapse
-families show ineffective communication patterns and high expressed emotion is associated with relapse
what are the anatomic and functional brain disturbances?
-enlarged ventricles and reduced tissue volume
-hypofrontality; less active frontal lobes (major dopamine pathway)
-associated with diffuse neurological dysregulation
-not unique to Sz
what are the prenatal and obstetric factors?
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)
what is the endophenotype approach?
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
what did the genetic research find?
-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
what are limitations to the genetic approach?
-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
what are the twin study results?
-risk of schizophrenia in monozygotic twins is 48%
-risk of schizophrenia drops to 17% for fraternal (dizygotic) twins
what are the adoption study results?
risk of schizophrenia remains high in adopted children with a biological parent with schizophrenia
what are the causes of schizophrenia?
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
what is the disorganized speech?
- amount; poverty of speech (negative) and pressured speech
- connectedness; tangentiality, derailment, and circumstantiality
- less common forms; neologisms (new word or expression) and word approximations
what are hallucinations?
-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
