Schizophrenia Flashcards
1
Q
public perception
A
- public believes that it is usually caused by biology and genetics
- lots of people believe that schizophrenics are dangerous and violent
2
Q
schizophrenia spectrum and psychotic disorders
A
- schizophrenia
- schizophreniform disorder
- brief psychotic disorder
- delusional disorder
- schizoaffective disorder
3
Q
psychosis/psychotic symptoms
A
impaired sense of reality
4
Q
schizophrenia
A
severe end of schizphrenia spectrum
1. anosognosia
- inability of those with the condition to recognize their own mental confusion
- challenge to assessment and treatment
2. psychosis is highly distressing
- because hallucinations seem real + logical
5
Q
positive symptoms
A
presence of unusual symptoms (50-70% experience positive symptoms)
- delusions
- hallucinations
6
Q
hallucination
A
perception of nonexistent or absent stimulus
1. auditory (most common)
2. visual
3. olfactory
4. tactile
5. gustatory
7
Q
delusion
A
false belief firmly held despite disconfirming evidence or logic
8
Q
types of delusions
A
- persecution
- grandeur
- reference
- control
- thought broadcasting
- thought withdrawal
9
Q
delusions of persecution
A
- others are plotting against them
- mistreating them
- trying to kill them
10
Q
delusions of grandeur
A
- special powers, talents or abilities
- is famous, important or powerful
11
Q
delusions of reference
A
- center of attention
- everything that happens revolves around them
- insignificant remarks, events or objects in environment have personal meaning
12
Q
delusions of control
A
other people, animals, objects are trying to control them
13
Q
delusions of thought broadcasting
A
others can hear their thoughts
14
Q
delusions of thought withdrawal
A
someone or something is removing thoughts from their mind
15
Q
negative symptoms
A
- absence of B present in most people (15-25% of individuals display primarily negative symptoms)
- types
1. flat affect
2. asociality
3. anhedonia
4. avolition
5. alogia
16
Q
negative symptoms: flat effect
A
- less emotional expressiveness
- voice intonation, facial expression, gestures
17
Q
negative symptoms: asociality
A
- loss of interest in social relationship, few friends
- poor social skills
18
Q
negative symptoms: anhedonia
A
inability to experience pleasure
19
Q
negative symptoms: avolition
A
- lack of energy or will, profound apathy
- e.g. lack of attention to personal hygiene
20
Q
negative symptoms: alogia
A
loss of meaningful speech, poverty of speech (amount, content)
21
Q
cognitive symptoms
A
- disordered think, communication, speech
- loose associations
- series of ideas presented with loosely apparent/unapparent/logical connections - overinclusiveness
- abnormal categorization - word salad
- random words/phrases linked together in unintelligible manner
common symptoms, generally present before psychotic episode
22
Q
psychomotor abnormalities: catatonia
A
marked disturbance in motor activity, either extreme excitement or immobility
23
Q
psychomotor abnormalities: withdrawn catatonia
A
- extremely unresponsive
- hold rigid pose for hours
- waxy flexibility
- another person can move the person’s limbs into strange positions that they can maintain for extended hours
24
Q
psychomotor abnormalities: excited catatonia
A
- agitation
- constant hyperactive motoractivity
- stereotypies (repeated movements)
25
DSM5 criteria for schizophrenia
- at least 2 of the following during a 1 month period (>1 must be 1, 2, or 3)
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic B
5. negative symptoms
- significant decline in functioning in 1+ major areas (work, interpersonal relations, self-care)
- continuous signs of the disturbance persist for at least 6 months
26
lifetime prevalence
about 1%
27
course: premorbid functioning
- prior to major symptom onset
- usually impaired
28
course: prodromal phase
onset and build up of symptoms
29
course: active phase
full blown symptoms
30
course: residual phase
symptoms no longer prominent
31
other prevalences of schizophrenia
- 50% comorbid with another disorder (usually SUD, depression or anxiety)
- high mortality rate (10% by suicide)
- account for about 30% of stays in psychiatric hospitals
- cognitive impairment and abolition = make employment difficult
- can be isolating
32
optimistic course: follow up study results
follow-up study
- 5 year: 50% in remission
- 20 year: 63% in remission (never had negative symptoms)
33
optimistic course: positive outcome factors
- female
- higher education, married, network of support
- higher premorbid leel of functioning
- integrated and comprehensive treatment
- less negative symptoms
34
myth busting
"People with schizophrenia are violent"
- majority of individuals are not aggressive (usually reaction, NOT spontaneous or random assault)
- risk of violence mediated by substance abuse comorbidity
- risk similar to patients with SUD without psychosis
- more frequently victimized
35
etiology: biological view
- excessive synaptic pruning
- genes and endophenotypes
- neurotransmitter dysregulation
- structural differences in brain
- prenatal or birth complications
36
genetic factors
1. family, twin and adoption methods suggest genetic predisposition (interaction of large number of genes)
2. C4 gene abnormalities
- excessive pruning leads to symptoms
3. endophenotypes
- irregularities in working memory, executive function, sustained attention, verbal memory
37
neurostructures
- enlarged ventricles (loss of brain cells)
- smaller cortex volume, especially prefrontal cortex
- may influence cognitive functioning
38
biochemical factors
- dopamine hypothesis
- use of cocaine, amphetamines, alcohol, cannabis increases risk of developing a psychotic disorder
- estrogen protective against psychotic symptoms
- conditions influencing prenatal or postnatal neurodevelopment have been associated with schizophrenia
39
biochemical factors: dopamine hypothesis
1. schizophrenia results from excess dopamine activity in certain areas of the brain
2. phenothiazines (antipsychotic med) will block receptor sites
3. L-dopa
- increase in dopamine levels, can produce schizophrenic-like symptoms
4. amphetamines
- produce similar symptoms to paranoia
40
biochemical factors: use of cocaine, amphetamines, alcohol, cannabis
cannabis use associated with structural changes in brain similar to those seen in schizophrenia
41
biochemical factors: estrogen protective against psychotic symptoms
- age of onset: 4-6 years earlier in men
- women more vulnerable to psychosis during lower estrogen phases
- estrogen impacts dopamine reactivity
42
biochemical factors: conditions influencing prenatal or postnatal neurodevelopment have been associated with schizophrenia
- pregnancy and birth complications
- prenatal infections
- head trauma
43
etiology: psychological
- childhood trauma
- drug abuse
- unusual thoughts
- lacking theory of mind
- early cognitive difficulties
44
cognitive deficits
1. deficits in theory of mind
- can contribute to communication and interpersonal problems
2. early cognitive difficulties
- e.g. developmental
3. misattributions/negative appraisals may lead to or maintain negative symptoms + delusions
45
etiology: social factors
- bullying
- exposure to abuse
- dysfunctional family interactions
- expressed emotions
46
exposure to abuse
- early adversities, maltreatment, chronic bullying, phyical abuse
- risk of psychotic symptoms increase when exposed to early stressors
- GxE (children at risk of psychosis may be more susceptible to early adverse experiences)
47
psychological stress interaction with biological vulnerability
increased life stress increases likelihood onset and relapse
48
expressed emotion
- negative communication pattern
- characterized by criticism among relatives of schizophrenics
- critical comments, statements of dislike/resentment, emotional overinvestment, overprotectiveness
- increased EE increases likelihood of relapse
49
etiology: sociocultural
- gender
- race and ethnicity
- immigration and migration
- low SES, poverty, social adversities
- culture
50
sociocultural factors: gender
sex differences
51
sociocultural factors: race and ethnicity
- hispanics and african americans = 2-3x increased rate
- unclear if clinician bias or actual differences in rates
- higher expose to stressors
- possible that previous discriminatory experiences lead to cultural mistrust and a healthy paranoia misinterpreted by clinicians
52
sociocultural factors: immigration and migration
increased stressors
53
sociocultural factors: low SES, poverty, social adversities
- more common in low SES
- sociogenic hypothesis: stressors associated with being in low social class may contribute to dev of schizophrenia
- social selection hypothesis: people with schizophrenia may drift into low SES living areas (generally more support for this)
54
sociocultural factors: how culture impacts the view of schizophrenia
- culture affects how people view or interpret symptoms
- differing views on etiology influence receptiveness to treatment approaches
55
recovery model
- focus on illness and deficit has shifted to one of recovery
- recovery does not require complete remission
- learn to productively engage in important life roles
56
EBT goal and possible treatments
goal: help individuals function in the community
treatments:
1. antipsychotic meds for acute psychotic symptoms
2. psychosocial treatments
3. CBTs
4. social skills training
5. cognitive enhancement therapy
6. family psychoeducational
7. assertive community treatment
8. integrated psychological treatment
57
EBT: holistic approach
antipsychotic meds + psychotherapy/psychosocial treatment
58
antipsychotics: neuroleptics
goal: reduce intensity of symptoms
1st generation (conventional antipsychotics)
- block dopamine receptors
2nd generation (atypical antipsychotics)
- act on both dopamine and serotonin receptors
- greater therapeutic benefits
- fewer side effects
- lower likelihood of morbidity and mortality
59
side effects of neuroleptics
1. contribute to high nonadherence
2. excessive sedation
3. extrapyramidal symptoms (dyskinesia and dystonic reactions)
60
tardive dyskenisia
involuntary and rhythmic movements of the tongue
61
CBT
- learn coping skills that allow clinets to manage positive/negative symptoms
- help increase motivation + engagement in social and vocational activities
- identification of negative beliefs and cognitive restructuring
- learn to let go of angry or fearful responses to psychotic symptoms, decatastrophize
62
specific CBTs: Social Cognition and Interaction Training (SCIT)
- learn communication and social skills
- address negative social cognitions
63
specific CBTs: Integrated Psychological Therapy (IPT)
- remediation of neurocognitive impairments and related social cognitive deficits
- building social, self-care and vocation skills
64
specific CBTs: Work-focused Cognitive Behavioural Therapy
- increased positive attitudes toward work
- bolster coping and problem solving skills
- improving social interaction skills
65
specific CBTs: Social Skills Training
- increase self-care B, meds adherence, conversational skills, job skills
- learn to break down task to make them less overwhelming
66
specific CBTs: Assertive Community Treatment (ACT)
- goal: help integrate individual into community
- provided with community services by multidisciplinary team
- team available 24/7
- research found ACT helps with stable housing, decrease in homelessness/hospitalizations and reduction of symptoms
67
family psychoeducation
1. educating family members about disorder
2. advice on monitoring effects of antipsychotic meds
3. teaching family members to cope with symptoms and its repercussions on family
4. develop skills in solving problems and managing stress
5. strengthen communication skills and reduce EE
68
cognitive remediation and enhancement
- improve cognitive deficits
- e.g. training attention, memory, problem-solving
- protection against grey matter loss in the brain
