Schizophrenia Flashcards
What is the history of the investigation of schizophrenia?
Emil Kraepelin (1898) described the disorder as dementia praecox, a form of dementia with an inevitable, progressive intellectual deterioration, but not all cases declined.
Eugen Bleuler (1908) created term schizophrenia. Cog decline is not part of the disorder, means ‘split’ ‘mind’ -> split emotions/cognitions, withdrawal from reality, fragmentation of cognitive processes
How common is schizophrenia?
the lifetime prevalence approximately 1% (0.7-2%) equally affects males and females.
starts earlier in males (teens, early 20s)
later in females (20s-30s)
rarely in late childhood
What is the occurrence of self-harm and suicide in schizophrenia?
25-50% show suicidal and non-suicidal self-harm
12 times more likely to commit suicide than individuals without schizophrenia
what are the 2 major symptom clusters of schizophrenia? (Crow, 1980)
Positive symptoms (positive and disorganised)
Negative symptoms
what are the characteristics of positive symptoms of schizophrenia?
excesses or distortions
sudden onset/acute episodes
good response to medication
what are the 6 positive symptoms of schizophrenia?
- disorganized speech
- incoherence
- loose associations (derailment)
- DELUSIONS
- HALLUCINATIONS
- bizarre behaviour
what is meant by disorganized speech in schizophrenia? 3
positive symptom
- problems to organize thoughts, to speak them, to make others understand
- many patients’ speech is not disorganized, sometimes just bizarre.
- diagnostic symptom but not the principle one any more
what are three characteristics of disorganized speech in schizophrenia?
neologisms = invention of new words with no meaning
perseveration = repeating their own words
clang, rhyme = rhyming words
what is incoherence in schizophrenia?
positive symptom
- hard to follow their speech
- references to their central ideas but is not connected to the other part of their speech (jumbled up)
what is loose associations in schizophrenia?
positive symptom
- difficulty sticking to one topic
- trains of association - very difficult to follow
what are delusions in schizophrenia?
positive symptom
- beliefs held contrary to reality
- very common symptom in schizophrenia (65%)
- occurs also in mania, delusional depression but delusions in schizophrenia are the most bizarre
can you give examples of delusions in schizophrenia?
delusion of reference = personal meaning in unrelated things
delusion of grandeur = inventors, Christs, saints
own thoughts have been replaced, stolen, broadcasted
identity confusions
what is abnormal perception and hallucinations in schizophrenia?
positive symptom
- heightened perception
- de-realization (the world is not real)
- feelings are detached from the body and the self
- hallucinations: sensory experiences in the absence of any environmental stimulations
- hallucinations mainly auditory (74%) and can be frightening.
what are characteristics of negative symptoms in schizophrenia?
- behavioural deficits
- chronic course
- too many negative symptoms predictors of poor prognosis (prediction on how the med cond will develop)
- respond poorly to medications
- genetic background
(negative symptoms can be side effects of medications)
what are thew two domains of negative symptoms in schizophrenia?
motivation and pleasure = motivation, emotional experience, sociality
expression domain = outward expression of emotion, vocalization
what are the 5 negative symptoms of schizophrenia?
- Apathy/avolition
- Alogia
- Anhedonia
- Blunted/Flat affect
- Asociality
what is avolition/apathy in schizophrenia?
negative symptom
- lack of energy
- absence of interest in routines, hobbies, work, school, everyday activities
what is alogia in schizophrenia?
negative symptom
- poverty of speech
- or speech without much content
what is anhedonia in schizophrenia?
negative symptom
- inability to experience pleasure
- consummatory versus anticipatory pleasure > latter more impaired
- do not enjoy recreation, others’ company
- usual pleasure activities not enjoyable
what is catatonia in schizophrenia?
a psychomotor symptom, motor abnormality.
- repeated gestures, peculiar movements, some might be purposeful but bizarre (ritualistic)
- sometimes unusual activity with lots of energy in movements (similar in mania)
what is inappropriate affect in schizophrenia?
sometimes listed as disorganized/positive symptom
- rapid shift from one emotional state to other
- inappropriate affect - laughing at sad stories, angry at simple things.
- not frequent, but if present, important symptom.
high correlation with substance abuse and suicide.
what is the DSM-5 diagnosis criteria of symptoms for schizophrenia?
at least two of these symptoms for at least one month:
delusion
hallucinations
disorganized speech
disorganized behaviour
negative symptoms
what 3 criteria (not symptom based) does the DSM-5 diagnosis for schizophrenia state?
- functioning in work, relationships, or self-care has declined since onset
- signs of disorder for at least 6 months prior to acute stage (prodromal stage)
- during a prodromal or residual phase, negative symptoms or two more of symptoms listed above in less severe form
what are the three phases of schizophrenia?
- premorbid phase: symptoms are not obvious, but withdrawn, speak in odd ways
- active phase
- residual phase: return to premorbid levels, people with good premorbid functioning have the best chance to recover faster
can you name 4 differential diagnoses from schizophrenia?
schizoaffective disorder = symptoms from both mood disorders and schizophrenia. either a dep or manic episode + schz symptoms
brief psychotic disorder = less than 1 month
delusional disorder = does not meet criteria of schizophrenia, and not as bizarre
shared psychotic disorder = persons delusions are lead by another indv illness, disorder ceases as other person is removed
Gottesman et al. (2010) did a family study with 2 million people on genetic factors on schizophrenia. what did they find?
- risk is highest if both parents had schz
- next: one parent schz, one parent bipolar
- next: one parent schz
multiple common genes associated with schizophrenia and which other disorder?
bipolar
what neurotransmitters are associated with schizophrenia?
dopamine and glutamate
What is the dopamine theory in schizophrenia?
there is excess dopamine activity in certain brain regions (mesolimbic pathway) that is linked to positive symptoms like hallucinations and delusions.
Conversely, reduced dopamine activity in the prefrontal cortex may be associated with negative symptoms such as cognitive impairments and social withdrawal
how does the dopamine theory work in the brain?
People with schz don’t have more dopamine in their brain but more D2 receptors or oversensitive receptors.
Antipsychotic drugs are effective as they block postsynaptic dopamine (D2) receptors.
why can the dopamine theory as treatment be controversial?
it takes several weeks until the antipsychotics start to be effective, even though the blockade of dopamine starts immediately.
Why? > receptor activity must be brought below normal for therapeutic effect
can you explain the role of serotonin with anti-psychotic medications?
AP meds block the serotonin receptor 5HT2, it regulates dopamine transmission in the mesolimbic pathway.
Serotonin is the ‘feel-good’ chemical, possibly why negative symptoms of schizophrenia are heightened on AP meds.
What is GABA and it’s role in schizophrenia?
GABA is the primary inhibitory neurotransmitter, and is associated with calmness, relaxation and regulating mood, GABA transmission is disrupted in the prefrontal cortex of people with schz
Wat is glutamate and its role in schizophrenia?
Glutamate is an excitatory neurotransmitter that stimulates nerve cells for brain function. Associated with energy levels, cog function.
low levels of glutamate found in cerebrospinal fluid of people with schz
could you tell me about brain ventricles of people with schizophrenia?
large fluid-filled spaces implies cortical/subcortical cell loss.
size appears to increase over course of illness
however, not specific to schz, also seen in other dis.
Give 4 structural abnormalities of the prefrontal cortex in schizophrenia
- MRI studies show reduction in gray matter, fewer dendritic spines, meaning reduced communication between neurons
- poor performance on neuropsychological tests of prefrontal function (Wisconsin card sorting test, word fluency, cognitive ability)
- speech related symptoms/speech production
- reduced metabolic activity revealed by PET and fMRI
give 4 points on temporal lobe dysfunction in schizophrenia
- volume reduction in the left posterior temporal gyrus (Wernicke area: language processing)
- volume reduction in the superior temporal gyrus (primary auditory cortex - auditory hallucinations)
- reduce volume of hippocampus (related to memory problems)
- abnormal activity of the amygdala (emotional problems, inappropriate behaviour)
can you please give me two points about ‘people with the lowest social class have the highest prevalence for schizophrenia?’
- Sociogenic hypothesis = stress comes from the social status
- Social selection-theory = people with schz will drift to poverty sooner or later
can you name 4 psychological sociocultural factors affecting schz?
- Poverty: higher rates among urban poor
- trauma: child trauma or maltreatment a risk factor for nearly all psych disorders, including schz
- urbanicity: higher rates among people living (born and raised) in urban areas (nearly 3x than rural)
- migration: first and second generation migrants
how can psychological stress be related to schz?
stress -> HPA axis -> cortisol -> dopamine -> increased symptoms of schz in vulnerable individuals
can you tell me about influenza infection in pregnancy in schz?
- season changes in birth of schz people, winter-spring excess of births, infection in the 2nd trimester, virus disrupts developing the brain
- fingerprint abnormalities, may indirectly indicate infection
- mothers of ppl with schz are more likely to be exposed to influenza virus
what school of psych does double bind theory come from?
psychoanalytic: regression of the ego to previous stages due to non-nurturing environment, narcissism, self-centred symptoms, symptoms are effort to regain ego-control
what is the double bind theory?
when receiving contradicting messages from close relationships may develop disordered thinking as a mechanism.
can you give three examples of 1st generation neuroleptic medications and what they do?
phenothiazine, chlorpromazine, thorazine - block dopamine uptake.
around 70% patients respond to treatment
many stop treatment due to severe side effects (rigid movement/ muscle)
not very effective on negative symptoms
what is CBSST?
cognitive behavioural social skills training -> combines cbt and social skills training, focuses on reducing symptoms and improving functioning.
can you give me three examples of second generation antipsychotics and what they do?
clozapine, olanzapine, risperidone
dopaminergic and serotonergic effects
- equally as effective as 1st gen drugs when reducing pos symptoms and disorganisation
- modestly more effective at reducing negative symptoms and improving cog function
- side effects: weight gain
what is social skills training?
teaching skills for managing interpersonal situations, involves role playing, and is associated with fewer relapses, better social functioning and a higher quality of life.
what is psychoeducation?
educating people about their families about their illness, effective in reducing relapse and rehospitalization and increases medication compliance.
what is CBT-p?
cognitive behavioural therapy - psychosis, to recognise and challenge delusional beliefs. Reduces negative symptoms, currently the most effective treatment.
what is NAVIGATE treatment program?
an intervention
shown promise for young people in schz early course
combines meds, family psychoeducation, indv therapy, and assistance with employment and education
can you name 6 psychological treatments for schz?
social skills training
psychoeducation
CBT-p
CBSST
interventions (navigate)
residential treatment
