schizophrenia Flashcards
schizophrenia
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
prevalence of schizo
worldwide variations
africcan highest auditory hallucinations
asian pops lowest rate
higher psychotic immigrants fro caribbean and bermuda
incidence men > women
mortality and comorbidity
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
course of schizo
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
hospitalization
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
remission
rates vary w studies
more than 1/3 remission
- assoc w mild initial symptoms
- better premorbid functioning
- early treatment
- shorter duration of untreated psychosis
why is diagnosing schizo unique
greater variability of symptoms
positive symptoms
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
negative symptoms
absence of behav ppl should have
includes:
- attentional deficits that reduce WM and impact entire life
alogia
lack speech, or inc speech w/o meaning
anhedonia
lack interest in ppl, sex, activities
acknowledge symptoms
asociality
few friends, poor soc skills, little interest in ppl
also reported in childhood
avolition
lack energy, cannot keep routine
dec hygiene, etc.
flat affect
lack of emotional expressiveness
negative symptoms not from schizo
some from alternative factor i.e. antipsychotic meds
flat affect in most schizo patients
catatonic immobility
unusual postures maintained over long time
- called waxy flexibility (resistance to moving)
- limbs strange, rigid, move and stay in one spot
inappropriate affect
i.e. laugh when someone dies, enraged at simple question
rapid emot shift w/o explanation
other symptoms of schizo
similar to mania
- inc in activity, excited, flailing arms
impact of symptoms on life
leads to solitude bcs lack social skills
unemployment and homelessness due to avolition and cog impairments
distress from hallucinations and delusions
kraepelin
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
blueler
first to use schizophrenia
DSM-IV-TR schizo classes
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
Delusional disorder
Delusions of persecution WITHOUT hallucinations or thought disorder
Not scizo
DSM-5 classifications
Got rid of subtypes and refused alternatives
- subtypes not used diagnosticaally, low reliability and vali
- now use dimensional rating of symptoms
Genetics and schizo
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
Cross disorder group
Stem from genetic variations and neural complexity
- schizo have up to 40 protein altered genes and fewer synapses
- schizo
- autism
- MDD
- bipolar
- ADHD
Dopamine hypothesis
Inc sensitivity dopamine receptors causes schizo
- evidence: effective drugs Dec dopamine
- give side effects like Parkinsons, which is caused BY dopamine excess
amphetamine psychosis
resembles paranoid schizo and can inc schizo symps
amphetamines release NE and DOPAMINE, thought to cause symps
HVA
dopamine metabolite
is NOT excessive in schizo patients
proposal: excess/oversensitive dopamine RECEPTORS is factor of schizo
brains of schizo patients
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
developmental factors
complications during birth for schizo mothers
- dec o2 to brain
viruses impact fetal development
low birthweight and childhood CNS infection
sociogenic hypothesis
stressors assoc w low SES environ contribs to schizo
- bio factors assoc w low SES i.e. lack nutrition
social selection theory
while developing psychosis, ppl w schizo drift into areas of poverty
- growing cog issues may impair work
schizophregenic mother
early theories: cold and dominant conflict-inducing parent causes schizo
EE
expressed emotion
high EE: critical, demanding, emotional over-involvement and lack warmth
relapse and EE
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
pre-onset schizo features
boys: disagreeable
girls: passive
both: lower IQ, poor motor skills, negative affect, withdrawn
high risk kids
mother has chronic schizo
have attentional dysfunctin, low IQ, poor concentration and verbal activity
MRI: dec gray matter (PREDATES onset)
schizo therapies
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
early schizo treatments
insulin coma therapy: large dose to induce coma, ineffective and bad
ECT shock
rTMS
repetitive transcranial magnetic stimulative
non-invasive, alleviates auditory hallucinations
1st gen antipsychotics
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
extrapyramidial side effects
due to drug action that antagonizes doapmine
- dyfunction of nerve tracts from brain to SC
- causes shuffle gait, drooling
akathesia
disturbing inner restlessness, inc suicide
dyskinesia
abnormal motion of vol/invol muscles
chewing and other lip, leg, finger mvmnts
tardive dyskenisa
mouth muscs involuntary suck, lip smack, chin wag
when severe, entire body moves invol
10-20% will dev it
- no treatment
neuroleptic malignant syndrome
occurs 1% sometimes fatal
musc rigidity followed by fever
- inc BP, racing hear, coma
2nd gen antipsychotics
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
psych treatment
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
homeless MI
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
MH pros vs general practitioners
MH pros: endorse destigmatizing attitudes
gen practitioners: endorse stigma and beliefs of dangers
