Schizophrenia Flashcards
Psychosis refers to loss of contact with external reality characterised by…
impaired perceptions and thought processes
In 1911, Bleue introduced the idea of the ‘Split mind’ which consists of which 3 elements?
- Fragmentation of thoughts
- Splitting of thoughts from emotions
- Withdrawal from reality
What is schizophreniform disorder?
A provisional diagnosis; someone with psychotic symptoms >1 month <6months
To be diagnosed with schizophrenia, Criterion A states you need to have 2 of the following features:
At least one must be 1, 2 or 3
- Delusions
- Hallucinations
- Disorganised speech (formal thought disorder)
- Grossly disorganised or catatonic behaviour
- Negative symptoms
Continuous signs of disturbance need to be present for
6 months, may see a gradual deterioration in functioning
What are the positive symptoms (presence of problematic behaviours)?
- Hallucinations
- Delusions
- Formal thought disorder
- Behavioural/motor disturbances
- lack of insight (unawareness that what they’re experiencing is not reality)
What are the negative symptoms (absence of healthy behaviours)?
Affective flattening
- social withdrawal
- anhedonia
- emotional blunting (not responding emotionally)
- confusion
Avolition
- Amotivation
- Apathy
- Self-neglect (eg lack of hygiene)
Alogia
- Poverty of speech
- Poverty of content
Presence of negative symptoms predicts…
poorer response to treatment
____ of schizophrenic patients report experiencing hallucinations, which come in many forms:
75%
- auditory
- visual
- olfactory (smell)
- gustatory (taste)
- tactile (feeling something crawling on their skin)
Delusions are beliefs that are not …
culturally accepted
Delusions are categorised on content and bizarreness:
eg
- paranoid/persecutory delusions
- referential delusions
- grandiose delusions
- nihilistic delusions
- erotomanic delusions
What are referential delusions?
Neutral event (TV news) interpreted to hold personal meaning
What is formal thought disorder?
Disorganised thinking - disturbances in flow and/or form of speech (not content as in delusions)
What are some positive manifestations of formal thought disorder?
- circumlocution or circumstanciality (very indirect, long-winded descriptions)
- derailment (slipping from one topic to another)
- tangentiality (irrelevant responses to questions)
- echolalia (seen in acute phase, person involuntarily has parrot like repetition)
- word salad (incomprehensible stream of words)
- clang association (phrases linked through sound rather than meaning eg pass me the spoon, moon, i’m cocoon)
What is catatonic behaviour?
A marked decrease in reactivity to the environment
- in terms of posture or behaviour
eg
Stupor - no psychomotor activity; not actively relating to the environment
Catalepsy - rigid posture/position of limbs despite gravity
Waxy flexibility
Echopraxia - imitating another’s movements
Grimacing
Negativism
Mutism
What is the male:female ratio?
3:2
Early onset is associated with…
poorer outcomes
____ of sufferers unable to work,
50%, 25%
____ attempt suicide
30%
What are the 4 main phases in the clinical course of schizophrenia?
Premorbid phase - subtle cognitive, motor or social deficits
Prodromal phase - change in behaviour, functional decline, lasts ~2 years
Psychotic phase - lasts around 1 year, florid psychotic symptoms
Recovery phase
one parent, child =
two parents, child =
10%
40%
What is the dopamine hypothesis?
Overproduction and oversensitivity of dopamine receptors
Abnormally large responses to low amphetamine doses suggests…
over-sensitivity rather than excessive dopamine level
How do patients respond to anti-dopaminergic medication?
effective in 60%, especially for treating positive symptoms
There may be two separate syndromes:
- caused by dopamine activity and associated with positive symptoms
- caused by brain degeneration and associated with negative symptoms
What is the most consistent neuroanatomical finding?
Schizophrenics have much larger ventricles (twice the size of normals), which indicates a loss of brain tissue
Schizophrenics lose brain tissue in the ________. This is linked to ________
Prefrontal cortex, negative symptoms (damage to executive functioning system)
Structural brain abnormalities (eg in hippocampus) appear to _____ onset of psychosis and to ________ with progressive illness
predate, worsen
Indicates schizophrenia as a degenerative brain disorder
Early neurodevelopmental damage eg _____ may play a key role
viruses
Greater likelihood of _______ birth as it is associated with _________
winter or spring
Vitamin D deficiency
Pregnant mothers’ exposure to ______ has also been associated with schizophrenia
viral illnesses eg measles
_______ increase for urban births
________ increase among lower socioeconomic classes
Twofold
eightfold
obstetric complications such as _________, _________ are implicated
poor nutrition
viral infections
Once the patient is stabilised and on medication, you can start to address the _______ symptoms. Ie….
negative
help people notice when stressors arrive and how to cope
What is the difference between primary and secondary delusions?
Primary delusions = formed without a prior psychopathological event or process having led to the false conclusion ie belief appeared out of the blue
Secondary delusions = theoretically secondary to abnormal changes in mood, memory or perception (esp hallucinations)
eg auditory hallucinations might form the source of evidence for the patient’s persecutory delusion
_________ is less responsive to treatment for schizophrenia, which suggests that it may have an underlying neurobiological basis separate from other psychotic symptoms
Catatonia
Approx. ___ of patients with psychosis report current use of cannabis, which has been shown to be a predictor of increased risk of relapse of psychosis
23%
A NZ study of note has supported the theory that the use of ________ may trigger psychosis in young people with a specific genetic profile. As well as increasing the risk of developing psychosis in genetically vulnerable individuals, the use of ______ is associated with earlier onset of psychosis.
cannabis
Increased prevalence rate of psychotic conditions among ______ and in _______ countries compared to ________ countries.
migrants, developed, developing
The duration of untreated psychosis (DUP) is related to…
the time taken to respond to treatment once it commences
Relapse of psychosis is associated with..
- discontinuation of antipsychotic medication
- cannabis and amphetamine use
- poorer premorbid adjustment
- conflictual interpersonal relationships (high EE)
Amphetamines, which release ______, can produce symptoms of schizophrenia
dopamine
At the core of Morrison (2001)’s cognitive model of psychosis is the idea that psychosis entails…
culturally unacceptable interpretations of ‘intrusions into awareness’, which are defined as thoughts, images or impulses that intrude upon the individual’s consciousness and are uncontrollable
