Schizophrenia Flashcards

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1
Q

Schizophrenia

A
  • Distorted thinking, faulty perception and attention, lack of emotional expressiveness, disturbances in behavior etc.
  • Substance use, suicide, men more, culture differences (African Americans), beings in adolescence.
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2
Q

Positive symptoms: Delusions (6)

A

Belief contrary to reality:
- Thought insertion
- Thought broadcasting
- External force controlling their thinking/behavior
- Grandiose delusions: importance, power, knowledge, identity
- Ideas of reference
- Persecutory delusions: danger beliefs

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3
Q

Positive symptoms: Hallucinations

A
  • Sensory experiences in the absence of any stimulation from environment
  • Auditory more than visual
  • During: Broca’s area (frontal cortex: producing speech) and wernicke’s (temporal: understanding speech) are active. Therefore: miscommunication between the frontal lobe and temporal lobes.
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4
Q

Negative symptoms (5)

A
  • Endure beyond an acute episode.
  • Many negative symptoms = poor quality of life
    1. A-volition: lack of motivation.
    2. A-sociality: impairments in social relationships.
    3. Anhedonia: Loss of interest in please. Consummatory: experienced in the moment, anticipatory: pleasure from future events.
    4. Blunted effect: lack of outward expression of emotions
    5. Alogia: reduction in speech
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5
Q

Disorganized speech

A
  • Formal thought disorder: problems in organizing ideas and speaking coherently.
  • Loose associations or derailment: successful in communication but difficulty sticking to one topic
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6
Q

Disorganized behavior

A
  • No ability to organize behaviors to conform to community standards.
  • Catatonia: spectrum of unusual gestures or immobility or even waxy flexibility.
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7
Q

Prevalence

A
  • 1%
  • Men more likely
  • African Americans - bias
  • Comorbidity - substance abuse
  • Age: adolescents, not in children, later for women.
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8
Q

Etiology: Behavioral genetics

A
  1. Family studies: relatives = high risk, more negative symptoms, gene + environment/experiences
  2. Twin studies: high risk
  3. Adoption studies
  4. Familial high-risk studies
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9
Q

Etiology: molecular genetics research

A
  • Not transmitted by a single gene - multiple genes
    1. DRD2: encodes specific type of dopamine receptor (d2)
    2. COMT: associated with cognitive control processes that rely on prefrontal cortex. Chromosome 22.
    3. CNV deletions: 1% of genetic variance.
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10
Q

Etiology: dopamine theory

A
  • High dopamine levels = SP
  • Related with positive and disorganized symptoms.
  • Dopamine abnormalities in the prefrontal cortex accounts for negative symptoms - no strong evidence.
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11
Q

Etiology: other neurotransmitters

A
  • Blocking D2 and 5HT2 (serotonin and dopamine)
  • Little serotonin = too much dopamine = SP
  • Low levels of glutamate found in cerebrospinal fluid.
  • High levels of amino acid homocysteine which interacts with NMDA receptor.
  • PCP and ketamine induce positive and negative symptoms by interfering with NMDA receptors.
  • Decreases NMDA and low glutamate levels lead to SP and disorganized symptoms.
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12
Q

Etiology: brain structures and functions

A
  1. Enlarged ventricles
    - Loss of brain cells.
    - Correlated with impaired performance on neuro-psychological tests, poor functioning and poor response to medication.
  2. Prefrontal cortex
    - Plays a role for speech, decision making, emotion, goal-direction etc.
    - MRI show reduction in gray matter and volume.
    - Lower glucose metabolism
    - Less activation related to severe negative symptoms
    - Dendritic spines are lost (not neurons) = disrupted connections between neurons = speech and behavioral disorganization symptoms. Link with CNV genes.
  3. Temporal cortex
    - Temporal gyrus, hippocampus, insula, fusiform gyrus, amygdala and cingulate cortex.
    - Reducting in cortical gray matter and volume
    - HPA axis affected.
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13
Q

Connectivity in the brain

A
  • Less connectivity in brain white matter in the frontal/temporal cortices.
  • Less connectivity in the brain networks, frontro-parietal and default mode networks = poor performance on cognitive tests.
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14
Q

Etiology: environmental factors

A
  1. Damage during gestation or birth: reduced oxygen - loss of cortical gray matter.
  2. Maternal infections during pregnancy: toxoplasma gondii
  3. Cannabis: worsens symptoms + increase onset.
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15
Q

Etiology: sociocultural factors

A
  • High poverty = SP
  • Living in urbanc areas = SP
  • Migration = SP (3x for first generation, 4x for second generation)
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16
Q

Etiology: Family related factors

A
  • High EE (critical comments + hostility + emotional over-involvement) influences relapse.
  • Anglo-Americans higher EE than Mexican Americans
  • High EE increases stress = activation HPA axis which increases dopamine levels.
17
Q

Etiology: retrospective studies

A
  • Low IQ, more delinquent and withdrawn
  • Boys rated disagreeable, girls rated as passive
  • Young adults showed poor motor skills and expression of negative emotions
  • Adults scored lower on IQ and other cognitive tests
18
Q

Etiology: prospective studies

A
  • Low IQ before age 7 and consistent = Schizophrenia
  • Social and academic difficulties predicted conversion to the disorder.
19
Q

Treatment for schizophrenia: medication (first generation)

A
  • Reduce positive and disorganized symptoms, little effect on negative symptoms.
  • 30% do not respond, 50% quit after 1y, 75% after 2y
  • Maintenance dose: just enough to see therapeutic effect
    Side effects:
  • Sedation, dizziness, parkinson’s symptoms, tremors, dystonia, akasthesia.
20
Q

Treatment for schizophrenia: medication (2nd generation)

A
  • Work the same, but added advantage for positive symptoms.
  • Equally effective but more effective for negative symptoms
  • 75% stopped after 18m
    Side effects:
  • Parkinson’s symptoms, weight gain, diabetes etc.
21
Q

Treatment for schizophrenia: psychosocial interventions + medications

A
  • Skill training, cognitive behavior therapy, family based.
  • Combining = low rates of relapse and discontinuations, improvements in functioning
22
Q

Treatment for schizophrenia: social skills training

A
  • How to successfully manage a wide variety of interpersonal situations.
  • Role playing, group exercises in therapy group and actual social situations.
  • Reduces relapses, better social functioning and high quality of life.
23
Q

Treatment for schizophrenia: family therapy

A
  • Education
  • Information about antipsychotic meds
  • Blame avoidance and reduction
  • Communication and problem-solving skills within family
  • Social network expansion
  • Hope
  • Effective at reducing relapse if lasts for 9 months.
24
Q

Treatment for schizophrenia: CBT

A
  • Testing out delusional beliefs through discussions
  • Reduces negative symptoms
  • Combination of cbt + social skills = effective.
  • NAVIGATE: other combination (medication + family psycho-education + individual therapy + employment and education) = effective for those who started early.
25
Q

Treatment for schizophrenia: cognitive remediation therapy

A
  • Improves the fundamental aspects of cognition
  • Hours of computer-based training in attention, memory, and problem solving.
26
Q

Treatment for schizophrenia: psycho-education

A
  • Knowledge about their illness, symptoms, course of symptoms, biological + psychological triggers, treatment etc.
27
Q

Treatment for schizophrenia: residential treatment

A
  • Alternative for those not well enough to live on their own/with families.
  • Part time job/live regular lives before gradually returning to ordinary community life.