Schizophrenia Flashcards
what is psychosis
grossly impaired reality testing
which disorder is characterised by primary psychosis
schizophrenia
which disorders occur with secondary psychosis
bipolar disorder
substance use
neurological conditions
depression
DSM criteria for schizophrenia
delusions
hallucinations
disorganised speech
disorganised or catatonic behaviour
negative symtptoms
how many criteria must one have for SCZ diagnosis
2 or more
but must feature
- delusions
- hallucinations
- disorganised speech
how long must SCZ be ongoing for diagnosis
greater than 6 months
what are negative symptoms of SCZ
diminished emotional expression or motivation
what are the positive symptoms
hallucinations and delusions
what is a hallucination
sensory perception in absence of corresponding external or somatic symptoms
do hallucinations have insight
they can or they can not
examples of hallucinations
visual
auditory
olfactory
tactile
gustatory
which are the most common SCZ hallucinations and examples
auditory
- hearing thoughts spoken out loud
- multiple voices speaking to you
- non verbal sounds
what are delusions
false believe based on incorrect inference about external reality that is firmly held despite what constitutes as incontrovertible and obvious proof/evidence to the contrary
do delusion have insight
no
what are delusions of reference
believe that someone on radio/tv is talking to scz directly, who has special awareness of them
what are persecutory delusions
that someone is out to get you, harm you
what are grandiose delusions
that you have special powers, play an important, huge role in saving planet etc
what are erotomanic delusions
where people are entangled in romantic relationships with someone they’ve never met
what are somatic delusions
fixed and firm beliefs about bodily symptoms, metal in blood etc
what are thought insertion delusions
idea that someone has put thoughts in your head
what is loose association
incoherence in linking ideas
what are neologisms
words that do not exist
what are metonyms
words which are related but not correct
what is flight of ideas
comes out incomprehensibly, too fast
what is echolalia
meaningless repetition of someones words
what is disorganised behvaiour
behaviour which is not typical of a persons culture or inappropriate to context it takes place in
outcomes of disorganised behvaiour
decline in daily functioning, hygiene
inappropriate or unusual emotional responses
dressing in odd manner
catatonia
what is catatonia
muscular rigidity
stupor
repeated gesturing
flailing
unusal postures
what is avolition/apathy
lack of motivation or interest in things
what is asociality
social withdrawal, tend to spend time alone
what is anhedonia
inability to find pleasure in things
what is alogia
poverty of speech
does not talk
what is a blunted affect
lack of outward expression of emotion
lifetime prevalence of SCZ
0.7%
SCZ and sex differences
men - 1.4
women - 1
what is peak age of onset of SCZ
~25
(slightly later in women)
theories on why SCZ appears later in women
having children may explain gap in development
secondary bump in psychological symptoms happens in menopause
how long do symptoms last after first psychotic episode before medical attention
avg 1 year
what occurs in the prodromal phase
odd behaviours
subtle negative symptoms
what occurs in the acute phase
positive symptoms
negative symptoms
remissions
relapses
what occurs in the final phase
poor social functioning
negative symptoms
cognitive symptoms
who was emile kraepelin
one of the founders of scientific psychiatry
distinguished 2 forms of psychosis
what were Kraepelin’s forms of psychosis
dementia praecox
manic depression
what is dementia praecox
progressive neurodegenerative disease
what does dementia praecox result in
irreversible loss of cognitive function
- hallucinations arise
what is manic depression
alternation between depression and manic psychosis
who proposed the term schizophrenia
paul eugen bleuler
what did paul eugen bleuler want to emphasise
the loss of normal relational linages between thoughts, misattributions to wrong sources, disconnection in brain, mental confusion
what did paul eugen bleuler characterise SCZ as
a breaking of associative threads
which neurotransmitter’s hyperactivity is associated with psychosis
dopamine
how do antipsychotic medications help SCZ
reduce dopamine
how do amphetamines work in patients with SCZ
amplify SCZ symptoms
what are the issues with the model of dopamine dysregulation in explaining SCZ
does not account for the array or heterogeneity of SCZ symptoms
what neuro activity are negative symptoms associated with
hypo-activity of dopamine neurons in prefrontal cortex
what are changes in SCZ brains over time
enlargement of ventricles
thinning of cortex mostly in PFC
what functions does the PFC control
decision making
working memory
reasoning
judgement
goal directed behaviour
top down control over impulses
what happens when grey matter is reduced
fewer neurons
SCZ and synaptic pruning
overzealous pruning due to issues in evalauting information based on evidence
what is predictive coding theory
how the brain functions in a bayesian way
how people establish beliefs about world and updates beliefs when new information is acquired
what is prediction error
represents a mismatch between what we expect and what happens
which neurotransmitter is foundational for prediction error
dopamine
SCZ and predictive coding
SCZ patients overweight evidence in favour of beliefs, and underweight evidence contrary
pre-pulse inhibition and SCZ
do no reduce startle when given a warning
how heritable is SCZ
80%
environmental risk factors for SCZ
birth complications
prenatal exposure to infection
adolescent drug use
early cognitive deficits
low SES
early trauma and abuse
what is the social selection hypothesis
SCZ leads people to earn less and other socioeconomic indicators
medications for SCZ - names
neuroleptics (antipsychotics)
which receptors do conventional antipsychotics act on
dopamine 2 receptors
conventional antipsychotics and efficacy
effective for positive symptoms and disorganisation
more severe side effects
side effects of conventional antipsychotics
blurred vision
tremors, lip smacking
sexual dysfunction
2nd gen antipsychotics
weight gain
sedation
2nd gen antipsychotics efficacy
better on negative symptoms
how does social skills training help SCZ
improves functionality
how does CBT help SCZ
manages negative symptoms and stress
how does family therapy and psycheducation help SCZ
improves level of support and understanding
but not a cure
rates of crime and SCZ
2x bigger in SCZ than general population
SCZ 14x more likely to be victim
typical applicant of not guilty by reason of insanity defence
SCZ patients
what are the conditions of NGRI defence
should not be held responsible is attribute to disorder which
- did not know nature / quality of act
- did not know they were doing something wrong
- unable to refrain from committing act
SCZ and NGRI
did not know nature or quality of act
ID and NGRI
did not know nature or quality
did not know they were doing something wrong
john hickey jr
tried to assassinate ronald reagin in 1981
- because in love with jodie foster, wanted to impress her
- found NGRI, institutionalised for 35 years
