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Psychological disorder > schizophrenia > Flashcards

schizophrenia Flashcards

1
Q

Whats psychosis?

A

Grossly impaired reality testing

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2
Q

What is schizophrenia

A

Its characterised by primary psychosis

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3
Q

Where does secondary psychosis occur

A

Bipolar disorder
Depression
Substance use
Neurological conditions

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4
Q

Whats the DSM-5 criteria for schizophrenia

A

A. Two or more, but must have one of 1/2/3

  1. Delusions
    2, Hallucinations
  2. Disorganised speech
  3. Disorganised/catatonic behaviour
  4. Negative symptoms(diminished emotional expression/motivation

B. Present for 6 or more months

C. Distress/ impaired functioning

D. Not better explained by another disorder, medication etc.

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5
Q

What are the positive symptoms of psychosis

A

Hallucinations
Delusions

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6
Q

What are hallucinations

A

A sensory perception in the absence of a corresponding external or somatic stimulus, with or without insight

where you hear, see, smell, taste or feel things that appear to be real but only exist in your mind

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7
Q

What are the types of hallucinations

A

Visual

Tactile

Auditory

Olfactory - smell

Gustatory- taste

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8
Q

Whats the most common type of hallucination

Give examples

A

Auditory hallucination

Examples:
Hearing your thoughts spoken out loud

Voice commentating on what you’re doing

A voice/ multiple voices speaking to you

Non verbal sounds

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9
Q

What are delusions?

A

A false belied based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.

Delusions are beliefs that are strongly held despite clear evidence or proof to the contrary. They often involve beliefs about oneself, others, or the world that are not based on reality.

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10
Q

What are some examples of delusions

A

Delusions of reference

Persecutory delusions

Grandiose delusions

Erotomanic delusions

Somatic delusions

Thought insertion

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11
Q

What are delusions of reference

A

They see something and then believe that its a message to them

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12
Q

What are persecutory delusions

A

Belief that someone is spying on you or attempting to harm them or someone close to them

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13
Q

What are grandiose delusions?

A

Inaccurate belief that someone has special powers, mission, wealth or identity.

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14
Q

What are erotomanic delusions?

A

Believes that someone is in love with them

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15
Q

What are somatic delusions

A

False belief that they have a physical defect or abnormality

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16
Q

What is thought insertion?

A

believes that they’re thinking someone else’s thoughts

example: though:I LOVE DOGS
but thats what x is thinking not me

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17
Q

Similarity between hallucinations and delusions

A

They are often thematically linked

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18
Q

What are the disorganised symptoms of psychosis/schizophrenia

A

Disorganised speech

Disorganised behaviour

Catatonic behaviour

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19
Q

Whats disorganised speech

A

Disorganised thoughts lead to disorganised speech

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20
Q

What are examples of disorganised speech

A

Loose associations

Neologisms- newly coined words

Metonyms- using inappropriate but slowly related words

Word salad

Flight of ideas

Echolalia- meaningless repetition of someones words

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21
Q

Whats disorganised behaviour

A

Behaviour which is not typical of the persons culture/ inappropriate to the context in which it takes place

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22
Q

What are signs of disorganised behaviour?

A

Decline in daily functioning/hygiene

Inappropriate or unusual emotional responses- extreme agitation

Dressing in an odd manner

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23
Q

What is catatonia?

A

Stuporous or excited

Muscular rigidity

Stupor

Repeated gesturing

Flailing

Unusual postures

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24
Q

What are the negative symptoms of psychosis/schizophrenia?

A

Avolition/apathy

Asociality

Anhedonia

Blunted affect

Alogia

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25
Q

Whats abolition/apathy

A

Lack of motivation

Lack of interest in things

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26
Q

Whats asociality

A

Social withdrawal

Spends time alone

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27
Q

Whats anhedonia

A

Inability to find pleasure in things

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28
Q

Whats blunted affect

A

Lack of outward expression of emotion

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29
Q

Whats alogia?

A

Poverty of speech

Doesn’t talk

30
Q

Whats the prevalence of schizophrenia

A

Lifetime prevalence of about 0.7%

More prevalent among men

Peak age of onset is 25, later for women

31
Q

What are the phases of schizophrenia?

A

Pre morbid phase- ages 0-15

Prodrominal phase: ages 15-20
Odd behaviours and subtle negative symptoms
Onset 3 years from promodromal symptoms

Acute phase ages 20-40
Positive symptoms
Negative symptoms
remissions
relapses

Final phase-40+
Poor social functioning
negative symptoms
cognitive symptoms

ON AVERAGE AFTER 1 YEAR OF SYMPTOMS AND AFTER THE FIRST PSYCHOTIC EPISODE, THEN MEDICAL ATTENTION

32
Q

What did Emile Kraepelin do?

A

Defined the first approximation of schizophrenia

Largely remembered for his work on psychosis

distinguished between 2 forms:

Dementia praecox
Manic Depression

33
Q

Whats dementia praecox

A

Progressive degenerative disease that results in an irreversible loss of cognitive function.

The hallucinations arise from the cognitive decline.

34
Q

What is manic depression?

A

Alteration between depression and manic psychosis

There’s no irreversible loss of cognitive function

35
Q

What did Paul Eugen Bleuler do?

A

Coined the word schizophrenia

Schizen- to split

Phren- the mind

Characterised schizophrenia as a breaking of associative threads

Which lead ppl to believe that this meant multiple personalities

36
Q

Whats the role of dopamine and psychosis

A

Dopamine hyperactivity is associated with psychosis

37
Q

How can you prove that dopamine has a role in psychosis?

A

Because antipsychotic meds reduced domaine levels

and Parkinson’s medications that increased dopamine have psychotic side effects

amphetamines which increase dopamine amplify schizophrenia symptoms in patients

38
Q

What are the issues with dopamine theories and schizophrenia

A

When u take anti-psychotic medication, dopamine receptors are rapidly blocked but the treatments don’t work right away

These theories don’t account for the wide array of symptoms experienced by schizophrenia patients or their heterogeneity

Other neurotransmitters are also involved in the complex aetiology

39
Q

What do medications work on for schizophrenia

A

the positive symptoms and disorganisation

40
Q

Do drugs work on the negative symptoms of schizophrenia?

A

Negative symptoms are linked to hypo-activity of dopamine neurons in the prefrontal cortex

Conventional/first generation antipsychotics only decrease striata dopamine

Atypical/ second generation antipsychotics work better on negative symptoms

NB: All the treatments impact on the dopamine system of the brain and impact it in various ways

41
Q

Whats the hypothesis on dopamine and negative symptoms of schizophrenia

A

imbalance of dopamine

42
Q

What are the brain differences in people with schizophrenia

A
  1. Increased ventricle size- almost 18% larger
  2. cortical thinning in schizophrenia- largely in the prefrontal cortex
  3. Reduced grey matter Fewer dendrite spines which cause a disconnection between neurons
  4. Synaptic pruning

These are progressive changes

43
Q

What is the prefrontal cortex involved with?

A

Decision-making

Working memory

Reasoning, Judgement

Goal-directed behaviour

Top-down control over impulses

Impaired performance on cognitive tests that probe these functions in schizophrenia

44
Q

What is synaptic pruning?
Whats its relation to schizophrenia

A

Pruning is an important
developmental process
that the brain undergoes during adolescence - getting rid of unused connections

Overzealous pruning might occur in schizophrenia

45
Q

Whats the neurocognitive theory of schizophrenia?

A

Predictive Coding theory

46
Q

What is predicting coding theory

A

Prediction error- way in which animals use new info to update beliefs

PE represents a mismatch between what we expect and what actually happens

The bigger the mismatch, the more we should update.

47
Q

Do schizophrenia patients have abnormalities in belief updating?

A

Dopamine is crucial for prediction error

Have overweight evidence in favour of beliefs and underweight evidence for the contrary

But they all may attach more significance/salience to random stimuli - may explain why hallucinations exist

48
Q

What is sensorimotor gating?
What about for schizophrenia patients?

A

Pre-pulse inhibition
if you give someone a warning, they’re less likely to be startled by the pulse

Schizophrenia patients don’t reduce their startle when given a pre pulse

Antipsychotics correct this

49
Q

Genetics and heritability in relation to schizophrenia

A

There’s not a single gene responsible for schizophrenia

50
Q

Whats the problem with a lot of the studies published about schizophrenia

A

They were candidate gene studies so only looked at specific genes

Small samples with inconsistent findings and publication bias lead to a bunch of false positives

Studies have disproven candidate genes

51
Q

Generic aetiology of schizophrenia

A

Highly heritable-80%

Polygenic trait- various genes with each a small contribution

52
Q

What are the environmental risk factors of schizophrenia?

A

Birth complications, ie. a lack of oxygen

Prenatal exposure to infection, ie. flu

Adolescent drug use, ie. marijuana use

Early cognitive deficits, ie. low iq

Low socio economic status

Early trauma/abuse

53
Q

Whats the sociogenic hypothesis for schizophrenia

A

Stress/low education causes schizophrenia

54
Q

What is the social selection hypothesis for schizophrenia?

A

Schizophrenia leads to people earning less

55
Q

What is the treatment for schizophrenia and that are the types?

A

Neuroleptics/antispychotics

first generation/conventional

Second generation/atypical

56
Q

What do typical/conventional psychotics do?

Give an example of a typical psychotic

A

They act on dopamine/d2 receptors

Better for positive and disorganised symptoms

Example: Haloperidol

57
Q

What do atypical psychotics do?

Give an example of a typical psychotic

A

Focus on serotonin rather than dopamine

work better for negative symptoms but this may be exaggerated through biased studies

Example: Olanzapine

58
Q

What are the side effects of first gen/ conventional/typical antipsychotics?

A

Blurred vision

Extrapyramidal side effects- motor issues like tremor

Sexual dysfunction

59
Q

What are the side effects of second gen/ atypical antipsychotics?

A

Weight gain

Sedation

60
Q

What should pharmacotherapy be coupled with when it comes to schizophrenia and why?

A

Psychotherapy because recovery doesn’t just mean the reduction of symptoms but also improving cognitive ability

61
Q

What are the types of psychotherapy for schizophrenia and what do they do?

A

Social skills training- improves functionality

CBT- manage negative symptoms and stress

Family therapy and psychoeducation- morose the level of support and understanding from the patients family

62
Q

Comment on schizophrenia and crime

A

They’re more likely to commit crimes than general population

they’re more likely to be victims of crimes

they’re more likely to be the victim than commit one

63
Q

Whats Not Guilty by Reason of Insanity?

A

Defendant shouldn’t be held liable for an illegal act if its attributed to a mental disorder such that;

They didnt know the nature/quality of the act- thinking that a fire would only harm bad things

They didnt know that what they were doing was wrong, ie. understanding that stealing is illegal

They were unable to refrain from committing the act(much harder to show)

64
Q

What is not a defence that falls under NGRI

A

Intoxication

65
Q

What was the case of John Hickney JR

A

Attempted to assassinate President Reagan to impress an actress

Found NGRI and institutionalised for 35 years

Public outraged but he was institutionalised for longer than his sentence could’ve been.

66
Q

NGRI in Ireland

A

Between 2014/2018 19/20 attempted murder cases accepted insanity plea

67
Q

What are schizophrenia and other psychotic disorders

A

Schizotypal (Personality) Disorder

Schizophrenia

Schizoaffective Disorder

68
Q

Whats schizotypal personality disorder

A

Has eccentric behaviours like talking to themselves

Socially isolated

Is highly suspicious of others

Strange beliefs/theories but not full blown delusions

Diorganised speech

69
Q

Light schizophrenia

A

Similar but milder cognitive defects

Similar but milder brain changes, ie. enlarged ventricles

Genetically linked to schizophrenia

Antipsychotics

70
Q

Whats schizoaffective disorder?

A

Where there’s a major mood episodes- major depressive or manic

with schizophrenia symptoms

71
Q

How is schizoaffective disorder treated?

A

Treated in the same way but add antidepressants for depression and lithium for bipolar

72
Q

Is schizophrenia just an artificial category?

A

Mild psychotic experiences
occur in people without
schizophrenia

Negative symptoms are
common in the general
population

Psychological disorder (20 decks)

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