schizophrenia Flashcards
Whats psychosis?
Grossly impaired reality testing
What is schizophrenia
Its characterised by primary psychosis
Where does secondary psychosis occur
Bipolar disorder
Depression
Substance use
Neurological conditions
Whats the DSM-5 criteria for schizophrenia
A. Two or more, but must have one of 1/2/3
- Delusions
2, Hallucinations - Disorganised speech
- Disorganised/catatonic behaviour
- 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.
What are the positive symptoms of psychosis
Hallucinations
Delusions
What are hallucinations
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
What are the types of hallucinations
Visual
Tactile
Auditory
Olfactory - smell
Gustatory- taste
Whats the most common type of hallucination
Give examples
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
What are delusions?
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.
What are some examples of delusions
Delusions of reference
Persecutory delusions
Grandiose delusions
Erotomanic delusions
Somatic delusions
Thought insertion
What are delusions of reference
They see something and then believe that its a message to them
What are persecutory delusions
Belief that someone is spying on you or attempting to harm them or someone close to them
What are grandiose delusions?
Inaccurate belief that someone has special powers, mission, wealth or identity.
What are erotomanic delusions?
Believes that someone is in love with them
What are somatic delusions
False belief that they have a physical defect or abnormality
What is thought insertion?
believes that they’re thinking someone else’s thoughts
example: though:I LOVE DOGS
but thats what x is thinking not me
Similarity between hallucinations and delusions
They are often thematically linked
What are the disorganised symptoms of psychosis/schizophrenia
Disorganised speech
Disorganised behaviour
Catatonic behaviour
Whats disorganised speech
Disorganised thoughts lead to disorganised speech
What are examples of disorganised speech
Loose associations
Neologisms- newly coined words
Metonyms- using inappropriate but slowly related words
Word salad
Flight of ideas
Echolalia- meaningless repetition of someones words
Whats disorganised behaviour
Behaviour which is not typical of the persons culture/ inappropriate to the context in which it takes place
What are signs of disorganised behaviour?
Decline in daily functioning/hygiene
Inappropriate or unusual emotional responses- extreme agitation
Dressing in an odd manner
What is catatonia?
Stuporous or excited
Muscular rigidity
Stupor
Repeated gesturing
Flailing
Unusual postures
What are the negative symptoms of psychosis/schizophrenia?
Avolition/apathy
Asociality
Anhedonia
Blunted affect
Alogia
Whats abolition/apathy
Lack of motivation
Lack of interest in things
Whats asociality
Social withdrawal
Spends time alone
Whats anhedonia
Inability to find pleasure in things
Whats blunted affect
Lack of outward expression of emotion
Whats alogia?
Poverty of speech
Doesn’t talk
Whats the prevalence of schizophrenia
Lifetime prevalence of about 0.7%
More prevalent among men
Peak age of onset is 25, later for women
What are the phases of schizophrenia?
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
What did Emile Kraepelin do?
Defined the first approximation of schizophrenia
Largely remembered for his work on psychosis
distinguished between 2 forms:
Dementia praecox
Manic Depression
Whats dementia praecox
Progressive degenerative disease that results in an irreversible loss of cognitive function.
The hallucinations arise from the cognitive decline.
What is manic depression?
Alteration between depression and manic psychosis
There’s no irreversible loss of cognitive function
What did Paul Eugen Bleuler do?
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
Whats the role of dopamine and psychosis
Dopamine hyperactivity is associated with psychosis
How can you prove that dopamine has a role in psychosis?
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
What are the issues with dopamine theories and schizophrenia
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
What do medications work on for schizophrenia
the positive symptoms and disorganisation
Do drugs work on the negative symptoms of schizophrenia?
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
Whats the hypothesis on dopamine and negative symptoms of schizophrenia
imbalance of dopamine
What are the brain differences in people with schizophrenia
- Increased ventricle size- almost 18% larger
- cortical thinning in schizophrenia- largely in the prefrontal cortex
- Reduced grey matter Fewer dendrite spines which cause a disconnection between neurons
- Synaptic pruning
These are progressive changes
What is the prefrontal cortex involved with?
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
What is synaptic pruning?
Whats its relation to schizophrenia
Pruning is an important
developmental process
that the brain undergoes during adolescence - getting rid of unused connections
Overzealous pruning might occur in schizophrenia
Whats the neurocognitive theory of schizophrenia?
Predictive Coding theory
What is predicting coding theory
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.
Do schizophrenia patients have abnormalities in belief updating?
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
What is sensorimotor gating?
What about for schizophrenia patients?
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
Genetics and heritability in relation to schizophrenia
There’s not a single gene responsible for schizophrenia
Whats the problem with a lot of the studies published about schizophrenia
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
Generic aetiology of schizophrenia
Highly heritable-80%
Polygenic trait- various genes with each a small contribution
What are the environmental risk factors of schizophrenia?
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
Whats the sociogenic hypothesis for schizophrenia
Stress/low education causes schizophrenia
What is the social selection hypothesis for schizophrenia?
Schizophrenia leads to people earning less
What is the treatment for schizophrenia and that are the types?
Neuroleptics/antispychotics
first generation/conventional
Second generation/atypical
What do typical/conventional psychotics do?
Give an example of a typical psychotic
They act on dopamine/d2 receptors
Better for positive and disorganised symptoms
Example: Haloperidol
What do atypical psychotics do?
Give an example of a typical psychotic
Focus on serotonin rather than dopamine
work better for negative symptoms but this may be exaggerated through biased studies
Example: Olanzapine
What are the side effects of first gen/ conventional/typical antipsychotics?
Blurred vision
Extrapyramidal side effects- motor issues like tremor
Sexual dysfunction
What are the side effects of second gen/ atypical antipsychotics?
Weight gain
Sedation
What should pharmacotherapy be coupled with when it comes to schizophrenia and why?
Psychotherapy because recovery doesn’t just mean the reduction of symptoms but also improving cognitive ability
What are the types of psychotherapy for schizophrenia and what do they do?
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
Comment on schizophrenia and crime
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
Whats Not Guilty by Reason of Insanity?
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)
What is not a defence that falls under NGRI
Intoxication
What was the case of John Hickney JR
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.
NGRI in Ireland
Between 2014/2018 19/20 attempted murder cases accepted insanity plea
What are schizophrenia and other psychotic disorders
Schizotypal (Personality) Disorder
Schizophrenia
Schizoaffective Disorder
Whats schizotypal personality disorder
Has eccentric behaviours like talking to themselves
Socially isolated
Is highly suspicious of others
Strange beliefs/theories but not full blown delusions
Diorganised speech
Light schizophrenia
Similar but milder cognitive defects
Similar but milder brain changes, ie. enlarged ventricles
Genetically linked to schizophrenia
Antipsychotics
Whats schizoaffective disorder?
Where there’s a major mood episodes- major depressive or manic
with schizophrenia symptoms
How is schizoaffective disorder treated?
Treated in the same way but add antidepressants for depression and lithium for bipolar
Is schizophrenia just an artificial category?
Mild psychotic experiences
occur in people without
schizophrenia
Negative symptoms are
common in the general
population
