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PS280 > schizophrenia > Flashcards

schizophrenia Flashcards

1
Q

schizophrenia

A

psychotic disorder characterized by many disturbances in thought, emot, behav

  • disordered thinking, faulty perception and attention
  • flat/inappropriate affect
  • bizarre motor activity

onset: late adolesence or early adulthood
- earlier in men than women

10% suciide, 50% comorbidity

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2
Q

prevalence of schizo

A

worldwide variations

africcan highest auditory hallucinations
asian pops lowest rate
higher psychotic immigrants fro caribbean and bermuda

incidence men > women

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3
Q

mortality and comorbidity

A

20-25yr life expectancy decrease
- assoc w drug use, low family involvement, longer time to initial symptom remission

comorbidity
- 37% subs abuse
- 40% depression
- high anx, esp social anx

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4
Q

course of schizo

A

early treatment is vital to inc success and reduce LT disability

sometimes occurs in childhood

ppl typically have ACUTE EPISODES w intense symptoms
- in b/w episodes: still debilitating, less severe

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5
Q

hospitalization

A

occasional hospitalization, mainly CTO
- inc hospitalization men 20-24, women 40-49

30% of psych hosp patients have schizo

in canada, 20% young men in gen hospitals

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6
Q

remission

A

rates vary w studies

more than 1/3 remission
- assoc w mild initial symptoms
- better premorbid functioning
- early treatment
- shorter duration of untreated psychosis

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7
Q

why is diagnosing schizo unique

A

greater variability of symptoms

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8
Q

positive symptoms

A

TOO much of a behav not present in reg ppl

disorganized speech/thought disorder: difficulty organizing ideas and speaking coherently

loose associations: don’t stick to one topic

derailment

delusions: beliefs contrary to reality
- recepient of bodily sensations or thoughts imposed by external force
- believe others hear thoughts
- thoughts stolen by agency
- more than 1/2 of patients have delusions, also mania and delusions depression

hallucinations: distorted reality
- 74% report auditory i.e. own thoughts by other voice, arguing, comments on behav

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9
Q

negative symptoms

A

absence of behav ppl should have

includes:
- attentional deficits that reduce WM and impact entire life

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10
Q

alogia

A

lack speech, or inc speech w/o meaning

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11
Q

anhedonia

A

lack interest in ppl, sex, activities

acknowledge symptoms

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12
Q

asociality

A

few friends, poor soc skills, little interest in ppl

also reported in childhood

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13
Q

avolition

A

lack energy, cannot keep routine

dec hygiene, etc.

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14
Q

flat affect

A

lack of emotional expressiveness

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15
Q

negative symptoms not from schizo

A

some from alternative factor i.e. antipsychotic meds

flat affect in most schizo patients

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16
Q

catatonic immobility

A

unusual postures maintained over long time
- called waxy flexibility (resistance to moving)
- limbs strange, rigid, move and stay in one spot

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17
Q

inappropriate affect

A

i.e. laugh when someone dies, enraged at simple question

rapid emot shift w/o explanation

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18
Q

other symptoms of schizo

A

similar to mania
- inc in activity, excited, flailing arms

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19
Q

impact of symptoms on life

A

leads to solitude bcs lack social skills

unemployment and homelessness due to avolition and cog impairments

distress from hallucinations and delusions

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20
Q

kraepelin

A

thought 2 types of endogenous pyshcoses
- manic-depressive illness
- dementia-praecox: older term of schizo

believed dementia-praecox from early onset and deterioration of ment functioning

suggested 3 classes of schizo

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21
Q

blueler

A

first to use schizophrenia

22
Q

DSM-IV-TR schizo classes

A

disorganized/hebephrenic:
- disorganized speech, invent new works
- flat affect, shift emotions
- no goals

catatonic:
- alt b/w catatonic immobility and excitement
- one symptom dominates
- more sudden catatonic onset

paranoid:
- hallucinations and delusions of persecution
- grandiose, jealous
- incorporate unimportant events into delusions
- can be violent, still emotionally respond
- alert and verbal, can be employed

kraepelin’s hebephrenic schizo –> disorganized

23
Q

Delusional disorder

A

Delusions of persecution WITHOUT hallucinations or thought disorder

Not scizo

24
Q

DSM-5 classifications

A

Got rid of subtypes and refused alternatives
- subtypes not used diagnosticaally, low reliability and vali
- now use dimensional rating of symptoms

25
Q

Genetics and schizo

A

Negative symptoms have STRONG genetic component

Relatives at risk
- 90% ppl w schizo don’t have parents e it
-60-80% don’t have siblings w it

Identical twins greater than frat, but not 100%
- concordance Inc w severity
- common environment could be cause…intrauterine likely to have same blood supply

Copy number varianrs: ID twins can have diff numbers of genes bcs of mutation

Adoption studies: kids hrowimg up away from schizo mother still at inc risk

26
Q

Cross disorder group

A

Stem from genetic variations and neural complexity
- schizo have up to 40 protein altered genes and fewer synapses

  • schizo
  • autism
  • MDD
  • bipolar
  • ADHD
27
Q

Dopamine hypothesis

A

Inc sensitivity dopamine receptors causes schizo
- evidence: effective drugs Dec dopamine
- give side effects like Parkinsons, which is caused BY dopamine excess

28
Q

amphetamine psychosis

A

resembles paranoid schizo and can inc schizo symps

amphetamines release NE and DOPAMINE, thought to cause symps

29
Q

HVA

A

dopamine metabolite

is NOT excessive in schizo patients

proposal: excess/oversensitive dopamine RECEPTORS is factor of schizo

30
Q

brains of schizo patients

A

enlarged ventricles, struct issues of hippocampus

dec vol basal ganglia and limbic system

DEC GRAY MATTER in temp/frontal lobe
- prefrontal cortex (decisions, speech) has dec gray matter and lower metabolic rates

31
Q

developmental factors

A

complications during birth for schizo mothers
- dec o2 to brain

viruses impact fetal development

low birthweight and childhood CNS infection

32
Q

sociogenic hypothesis

A

stressors assoc w low SES environ contribs to schizo
- bio factors assoc w low SES i.e. lack nutrition

33
Q

social selection theory

A

while developing psychosis, ppl w schizo drift into areas of poverty
- growing cog issues may impair work

34
Q

schizophregenic mother

A

early theories: cold and dominant conflict-inducing parent causes schizo

35
Q

EE

A

expressed emotion

high EE: critical, demanding, emotional over-involvement and lack warmth

36
Q

relapse and EE

A

10% low EE family relapse
58% high EE family relapse

cause NEGATIVE SYMPS bcs critical comments dec belief to control symps

schizo may be caused by high EE, or cause high EE

37
Q

pre-onset schizo features

A

boys: disagreeable
girls: passive

both: lower IQ, poor motor skills, negative affect, withdrawn

38
Q

high risk kids

A

mother has chronic schizo

have attentional dysfunctin, low IQ, poor concentration and verbal activity

MRI: dec gray matter (PREDATES onset)

39
Q

schizo therapies

A

schizo patients lack insight abt condition
- likely to deny treatment and drugs
- esp paranoid schizo

antipsychotic meds control acute symps
- also strats for maintaining adherence

treat comorbid disorders

inc soc skills

40
Q

early schizo treatments

A

insulin coma therapy: large dose to induce coma, ineffective and bad

ECT shock

41
Q

rTMS

A

repetitive transcranial magnetic stimulative

non-invasive, alleviates auditory hallucinations

42
Q

1st gen antipsychotics

A

30-50% don’t respond
- can treat NEGATIVE symps, not rlly positive ones

side effects: sexual dys, dizzy, blurry eyes

extrapyramidial side effects: nerve dysfunction resembling parkinson’s

half ppl quit after 1 yr

43
Q

extrapyramidial side effects

A

due to drug action that antagonizes doapmine
- dyfunction of nerve tracts from brain to SC
- causes shuffle gait, drooling

44
Q

akathesia

A

disturbing inner restlessness, inc suicide

45
Q

dyskinesia

A

abnormal motion of vol/invol muscles

chewing and other lip, leg, finger mvmnts

46
Q

tardive dyskenisa

A

mouth muscs involuntary suck, lip smack, chin wag

when severe, entire body moves invol

10-20% will dev it
- no treatment

47
Q

neuroleptic malignant syndrome

A

occurs 1% sometimes fatal

musc rigidity followed by fever
- inc BP, racing hear, coma

48
Q

2nd gen antipsychotics

A

clozapine: therapeutic gains in MANY ppl who don’t respond to trad antipsychotics
- greater gains

olanzapine and risperidone: fewer motor side effects
- risperidone assoc w lower length of 1st hospitalization

49
Q

psych treatment

A

social skills training: skills, processing, behav in social settings

family therapy: to reduce EE
- educate bio vulnerability for schizo
- teach cog issues and symps
- signs of relapse
- inc communication and problem solving
- w meds, will dec relapse for 1-2yrs

CBT: motivation and engage in social activities
- address delusions/hallucinations
- moderate inc of cog perf

assertive community treatment: teams give community services
- treat subs abuse
- employment help

treat issues w attention, memory, social adaptation

50
Q

homeless MI

A

assoc w male gender, younger age when first homeless
- alc use and daily drug use
- prolongued homelessness can lead to 2+ disorders

schizo want to work
- employment can dec MI symptoms

shortage of subsidized housing for psych clients

51
Q

MH pros vs general practitioners

A

MH pros: endorse destigmatizing attitudes

gen practitioners: endorse stigma and beliefs of dangers

PS280 (10 decks)

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