Schizophrenia Flashcards
Psychosis
broad term referring to a
disconnection from reality
- Typically manifests as hallucinations and/or delusions
Schizophrenia
a type of psychosis with
disturbed thought, emotion, language, and behaviour
– It is a brain disease (more likely, brain diseases)
– A disconnection between the brain and the external world it perceives and interacts with
Diagnostic Criteria for Schizophrenia
Criterion A. (two or more of the following five + at least one of the first three)
(1)Delusions
(2)Hallucinations
(3)Disorganized Speech
(4)Grossly disorganized or abnormal motor
behavior
(5)Negative symptoms: Alogia, Asociality, Apathy, Anhedonia, Affective Flattening
Criterion B. Social or Occupational Dysfunction
- For a significant proportion of the time since onset,
one or more major areas of functioning, such as
work, interpersonal relations, or self-care are
markedly below the level achieved prior to illness
onset (or, if onset during childhood/adolescent,
failure to achieve expected level of functioning) - Must be a pervasive pattern
- Dysfunction usually appears in many domains
Criterion C. Duration
- Continuous signs of
disturbance persist for at least
6 months. - At least 1 month of the 6
month period (or less time if
successfully treated), must
include Criterion A symptoms - The remaining time may
include periods of prodromal or residual symptoms, which may include only negative
symptoms or attenuated
positive symptoms
Schizoaffective Disorder
Co-occurring mood disorder, either bipolar or depressive
type; two week period of just positive symptoms that
precede or follow the mood episode
Schizophreniform Disorder
Criteria the same as schizophrenia but lasts 1 to 6
months; no requirement for decline in functioning
Delusional Disorder
Delusions for one month; no other psychotic symptoms;
functioning not impaired; behaviour not bizarre or odd
Brief Psychotic Disorder
Positive symptoms that last for one day to one month
Substance/medication-
induced Disorder
Symptoms temporally related to use or withdrawal from
a substance
Psychotic Disorder due
to another medical
condition
Positive symptoms caused by a medical condition, e.g.,
epilepsy
Delusions
Erroneous beliefs that usually involve a misinterpretation of perceptions or experiences
- Persecutory/Paranoid
- Guilt/Sin
- Grandiose
- Religious
- Somatic
- Reference
- Being Controlled: Feelings, movements, impulses
- Mind Reading
- Thought Broadcasting: escape and experienced by others
10.Thought Insertion: thoughts not own and inserted
11.Thought Withdrawal: thought cessation and withdrawn
12.Somatic passivity: bodily sensations imposed by external
agency
I lock my door at night to people are out to get me
3 Mechanisms of Relevance
Reward system is hypersensitive
* Paradoxically, this makes behaviour look like it is not goal-directed
* Affects ability to distinguish between the salience of phenomena
Jumping to conclusions
* Making a decision or forming a belief
with very little information
* Contributes to delusion formation
because beliefs are often formed with
very little evidence
Confirmatory biases:
* Preferentially seek evidence to confirm belief system and reject contradictions
AUDITORY HALLUCINATIONS
Auditory is most common (>50% of Sz)
* Not simply an illusion or distortion of sounds in
environment
* Voices usually intensify if
* there is less noise in environment
* ambiguous environment
* stress
* The misattribution of one’s own thoughts
* Not a faulty perceptual process
* In other words, it is not the voices I hear, it is the
thought I do not recognize as my own
i hear my name when no one really said it to the voices in my head talk to me
Visual Hallucinations
15% of Schizophrenia
Patients
– Tend to be unreal objects or parts rather than whole
* A big octopus like monster
* A tail coming from my backside
Tactile Hallucinations
incidence of ~5%
– Tend to produce fear and action
Somatic and gustatory hallucinations
rare and often associated
with delusions
– My pancreas has been equipped with a flux capacitor,
which allows me to travel back to my birth
Communication Abnormalities
Amount:
A. Poverty of speech (often subsumed under Negative Symptoms – Alogia)
B. Pressured speech
Connectedness:
Disorganized speech, aka, formal/positive thought
disorder; often amalgamated with Positive Symptoms)
* Tangentiality - tendency to speak about topics unrelated to the main topic of discussion
* Derailment - lack of connections in ideas
* Circumstantiality - non-direct thinking
Avolition/ Apathy
Lack of motivation and interest in daily activites
Anhedonia
Diminished capacity to anticipate and experience pleasurable emotions
Asociality
Lack of interest in social interactions
Alogia
Poverty of speech
Affective Flattening
Lack of emotional expressivity and diminished facial expression
The Course of Illness
Premorbid - Prodromal - Active - (Chronic or Residual or Recovery)
PREMORBID DEVELOPMENT
Concept of Neurodevelopmental Disease
* The primary brain insult(s) and/or pathological processes
occur long before clinical manifestation
* Minor physical anomalies: often the result of 2nd trimester
insults - critical time for neuronal migration
* High palate
* Low-set ears
* Variations in limb length and angle
* Finger-print patterns
* Webbed digits
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
(typically better Prognosis)
* Gradual Onset: Many months or years of behavioural
change
Remission
*Mild or less on all psychosis items
* Moderate or less on all negative items
* Sustained at least 2 years
Functional Performance:
* Intact social functioning
* Intact everyday living skills
Recovery
- Less precisely defined
- Convergence of remission and improvement of functional performance: functional independence, maintaining satisfying relationships, being productive, having a sense of
empowerment, overcoming feelings of stigma
Etiology of Schizophrenia
Diathesis-Stress Model
- Diathesis: An underlying vulnerability
- 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 allows the vulnerability to
emerge as psychosis - Possible that events are needed for its manifestation (stress)
- Environmental/psychosocial
- Interaction of brain maturation with underlying risk
- Drug use: evidence for first psychotic episode corresponding with
cannabis use - Concern: not every case of Sz shows onset with a stresso
Sz + Genetics
Inherit a tendency for psychosis biologically, not a specific form of schizophrenia
monozygotic twins is 48%
drops to 17% for dizygotic
Neurobiology and Neurochemistry: The Dopamine Hypothesis
Drugs that increase dopamine (agonists), result in psychotic
symptoms
* Drugs that decrease dopamine (antagonists), reduce
schizophrenia-like behaviour
* Examples include neuroleptics and L-Dopa for Parkinson’s disease
Treatment for Sz
Antipsychotic Medications
Chlorpromazine
* 1st antipsychotic medications
* Mood disorders, mania, agitation
* Motor abnormality side effects e.g., Parkinston’s like symptoms, tardive dyskenesia
Clozapine
* 2nd generation antipsychotic
* Symptom control with fewer side effects
* Control positive symptoms
* Little effect on negative symptoms, no effect on cognitive symptoms
Family Treatment
*Conceptualizes the patient
as a member of a family
system
* Aims for active involvement
of each family member
* Supports deinstitutionalization
CBT
Focusing on four areas
1.Emotional disturbance
2.Psychotic symptoms
3.Social functioning
4.Risk of relapse
Skills Training
* A learning-based intervention
model for the treatment of
functional disabilities associated
with schizophrenia
* Promotes independence
* Reduces stressors
Cognitive Remediation
* Focused on treating
neurocognitive impairments in
domains such:
* Attention
* Memory
* Problem solving
