Schizophrenia Flashcards
Psychosis is
a condition characterised by disturbances in perception and thought and loss of contact with reality
Delusion is
belief or belief system that is clearly not based in reality e.g. Ideas of reference, delusions of grandeur
Hallucination is
sensory perception that is not based in reality. May be visual, auditory, or tactile.
Loose associations are
inconsequential statements - jumping from one point to another.
Tangentiality is
points being very loosely related so that they eventually go right off topic
Neologisms are
made up words that have meaning only to user.
Blocking is
when words and ideas “disappear” from mind - sentences end in silence.
Word salad/flight of ideas
words and ideas mixed up and confused so that they are very hard to follow.
preservation
continual repetition of words or ideas.
Clang associations
repeated use of words due to their rhyming nature.
Catatonic stupor
complete lack of responsiveness to outside world, usually involving motionlessness.
Waxy flexibility
holding of postures that have been placed by someone else for long periods of time.
prodromal phase
prodromal for preceding. 1st of 3 phases in S. clear deterioration in previous functioning. Mainly negative symptoms. something going on, but not sure what. Social difficulties, many poor diagnosis usually, difficulty with relationships, characterised by negative affect
Active psychotic phase:
2nd of 3 phases. onset of positive psychotic symptoms. Characterized by hallucinations, paranoid delusions, and extremely disorganized speech and behaviours.
Residual phase:
Residual for residue left over. 3rd of 3 phases. return to mainly negative symptoms. Variable in different people. absence of positive symptoms, still something going on but not active. Phase resembles prodromal phase in that there are negative symptoms like social withdrawal, uncharacteristically low energy levels and low mood.
Prevalence of S in pop?
0.5% to about 1%
Age of Onset:
Most common – late adolescence to early adulthood. But long tail. Average 25 (males), 29 (females)
Sex differences generally in S
Little diff. overall.
– Males earlier onset
– males more negative symptoms, while women have more positive, psychotic symptoms
-cobormidity for males: Aggression disorders, substance use disorders, Anti-social Behaviours in males, but women S is comorbid with mood disorders/affective symptoms.
Heritability?
STRONGLY GENETIC BISH. If you have schizophrenia, there’s ten times more likely your kids will have it. (10% risk in 1st degree relative)
How much variance do genes contribute to symptoms of S?
80% of the variance in symptoms of S are mediated by genes. Still room for environmental factors to influence things.
What have adoption studies found?
- Adoption studies: find that a biological parent confers a great deal of risk to offspring (even when offspring are raised away from S parent). Many twin studies – concordance ~ 50% MZ; 10% DZ.
- Adoption studies: If adopted by someone with S, doesn’t give you S, you have to have the genes.
What are three things that are Inherited?
So-called “endophenotypes”
– Schizotypy (things typical to them e.g. loosening of associations, more magical types of thinking, more flowery language).
– Attentional difficulties e.g. inability to filter out irrelevant information
– Smooth pursuit eye movement: S’s eyes dart around all over the place when trying to follow a wave form on computer. Also their relatives without S seem to trouble with this, suggesting there may be that suggests some underlying genetic process responsible for S.
What is Dementia Praecox?
archaic term for schizophrenia.
Term went from Dementia Praecox to ……… ?? And what does this mean?
Schizophrenia obviously. lol.
– “Split Mind” Schizo = split, phrenia = mind/brain
Disruption of the normal associative processes. The way in which they think is very split, haphazard and disjointed thoughts
Symptom 1) Disturbances of thought content
4 subsets to this
Delusions and unusual ideas
Delusions can include:
– Thought broadcasting e.g. others can hear what I’m thinking
– Thought insertion e.g. ppl are inserting thoughts into my head
– Persecutory delusions e.g. people or organisaton out to get me or harm me
– Delusions of reference e.g. im a special person, centre of attention
Symptom 2) Disturbances in FORM of thought
Failures to conform to basic rules of communication. Problems with associations, words, etc.
Formal thought disorder includes:
– Loosening of associations e.g. flow of logic is not consistent, ideas jump, incoherent in speech, make up new words
– Incoherence of speech
– Poverty of content
– Overly concrete: e.g. often use words in very concrete, literal sort of way. Hard to follow what their argument is.
Symptom 3) Disturbances in perception
o Illusions (something in reality is distorted) o Hallucinations (perceptions that are out of touch in reality) often auditory (hearing voices) or visual (see things), tactile hallucinations (feeling things that are not there→much more common in substance abuse). Includes hallucinations, illusions, attentional difficulty, and hypersensitivity
Symptom 4) Disturbances in affect
o Not experiencing a lot of emotion at all, flat, full.
o Or extreme affects e.g. laughing or crying for unexpected reasons (often the result of a hallucination so is righteous to them, but no one else knows that).
o Often result of medication though, don’t know if its medication or not
Symptom 5) Psychomotor disturbances
o Commonly result of medication
o Motor difficulties e.g. ticks and grimaces, odd ways of standing, waxy flexibility (hold a posture for a long period of time)
Symptom 6) Disturbances in interpersonal functioning
o S person will withdraw from others
o Poor social skills
o Emotional relationships are limited and don’t tend to be extensive outside of families.
Other symptoms
o Confusion about own identity
o Unkept, disturbances to self-care. Might not eat well
Paranoid type
extreme preoccupation with elaborate delusional system. Often involves both hallucinations and delusions related to persecution. Most commonly delusions of reference, grandiosity or jealousy.
Disorganised type
extreme disturbances in form of thought. Generally very incoherent, incongruous affect, lack of systematic delusions.
hebephrenic (referring to extreme childishness) was caused this because these people regress like little babies. Very extreme form of S. Almost completely incoherent. “word salad” their words are like salad, thrown around everywhere, thoughts will bounce around all of the place. No systematic set of delusions either.
Catatonic type
psychomotor disturbance, especially catatonic posturing and mutism
characterised by extreme psychomotor disturbances e.g. mutism (lack of talking), catatonia (extreme rigidity for weeks even→engaging in some very extreme hallucination, but no way of knowing what about because they don’t respond to external world), waxy flexibility.
Undifferentiated type
meet criteria for schizophrenia, but do not fit other categories
Residual type
have met criteria for S in the past, but don’t meet the full criteria anymore and call them residual. Might show some minor symptoms. previous schizophrenic episode. most commonly blunted affect, social withdrawal, etc.
Positive symptoms
core features of an active psychotic episode. They are called ‘positive’ because they are excessive/extreme. • Hallucinations • Delusions • Thought disorder • Bizarre behaviour
Negative symptoms
‘negative’ in the sense you have too little of them, an absence of something. The period between the big psychotic positive episodes. Characterised by: • Flat mood • Poverty of speech • Lack of positive feelings • Poor attentional focus
Negative symptoms are associated with stronger OR poorer pre morbid adjustment? Explain.
Negative systems associated with poorer pre morbid adjustment.
People with greater difficulty before first psychotic episode show more negative symptoms leading up to episode.
Which symptoms respond better to treatment (pos or neg?)
+ symptoms respond better to treatment.
- symptoms are more common in females OR males?
Males
The role of dopamine (biochemical 1 of 2) in brain for S?
Excessive activity or activation of dopamine for S, particularly in positive symptoms
What happens to level of glutamate in brains of those with S? (biochemical 2 of 2)
- Increased DA activity may block glutamate
* Reduced activity of glutamate
What 3 pieces of evidence supports the fact that there is excessive dopamine in brains of S?
(2 are about role of drugs, 1 is about DA receptors)
- Drugs that reduce DA activity reduce positive symptoms
- Drugs that increase DA activity increase positive symptoms
- Increased DA receptors in brain – especially D2
What are 4 questions we can ask about le importance of excessive dopamine
(hard one- u got this)
1) DA doesnt seem to have an effect on neg symptoms.
2) Delay of response to neuroleptics
3) No difference in HVA levels (When dop is broken down its excreted as HVA. If you have excessive dop activity you should have higher HVA in spines of ppl with S, studies don’t show this. A bit odd)
4) Effectiveness of new generation anti- psychotics – role of serotonin, glutamate
Is their evidence of brain abnormalities in those with S?
Yes! consistent evidence. Used to think of S as a brain disease/type of dementia.
Parts of brain with abnormalities?
Quite broad – especially frontal & temporal lobes, and subcortical areas e.g., thalamus, amygdala, hippocampus.
Basically all of it lol
Evidence for the brain disease model of S?
- Brain weight is reduced.
- ventricles (open spaces) in brain are bigger.
- Atrophy at cortical and subcortical level.
- When measure metabolic activity it is usually less than normal ppl.
note. atrophy= tissue degeneration
WILD CARD: Some abnormalities appear before onset but degeneration continues over time. Hard to know how much is due to brain abnormalities or medicine.
Yay :)
What is the Diathesis stress theory?
Diathesis stress theory: some vulnerability, then something in environment triggers that. But having the vulnerability doesn’t necessity mean you will have S yourself. Needs an environmental stress.
What is the Viral Infection Theory?
What theory is tied to this?
Viral Infection Theory: That S may be a physical virus someone has catched, if they have the genetic vulnerability. Pre-natal or early post-natal viral infection that affects brain development. Vulnerable stage. May affect brain development and get brain disorder of S. S seems to be more common after flu epidemics.
Tied: The seasonal effect: people with S are more likely to be born e.g. a few months following winter/ or spring →then tied this in to flu effect lol.
Does the age of the dad have an affect?
Yes. Paternal age.
• People with S are more likely to be born to older fathers. 45+ yrs old (increases chance by 2 or 3 times, but also other disorders like autism etc). Germ cells are precursors to the sperm. They have greater chance of mutating.
Does substance use affect onset of S?
Yes someone who is vulnerable may trigger S through substance abuse.
- Tobacco use more common in schizophrenia
- Cannabis use more common in schizophrenia
- Evidence that use of cannabis can trigger psychotic episode – only in those with predisposition
What four social environment factors are associated with higher incidence of S?
- Urban living (e.g. cities)
- Immigration e.g. loss of social support with stress of immigration.
- Negative life events –>onset of psychotic episodes
- High expressed emotions EE in relatives –> causes relapse.
What is high expressed emotions (EE) ?
relatives expressing high criticism or who are more intrusive or critical. S who go back to a family with more expressed emotion is more likely to relapse.
