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PSYC 100 - clinical > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

what is psychosis

A

cluster of disorderds, delusions, hallucinations and/or loss of contact with reality
schizophrenia is a type of psychosis

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2
Q

annual cost of schizophrenia

A

$65 billion anually

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3
Q

historical background of schizophrenia

A

haslam - a form of insanity, pinel working at same time
Kraeplin - dementia praeox (premature loss of mind). focused on onset and outcomes. combined symptoms which had been considered separate - spotte shared similar underlying features
Bleuler - introduced term schizophrenia meaning splitting the mind

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4
Q

facts about schizophrenia

  • course
  • gender
A

generally chronic
16-25 yo onset = young phenomena
moderate-to-severe lifelong impairment
life expectancy is slighty less than average - suicide, poverty, homelessness etc
equal gender distribution but women =better long term prognosis and different onset (men diagnosed earlier and women later)

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5
Q

rule of thirds in schizophrenia

A 
1/3 = psychotic then back to functioning
1/3 = stay psychotic but just about independent
1/3 = downwards spiral
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6
Q

recent findings about schizophrenia

A

not a single disorder
8 genetically based variations
symptoms include clusters linked to different variations

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7
Q

DSM5 schizophrenia

A 
2 or more
-delusions
-hallucinations
-disorganised speech
-disorganised or catatonic behaviour
-negative symptoms (eg flat affect)
impaired functioning
6 months (1 month of active symptoms)
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8
Q

dimensional assessment of schizophrenia

A 
used to have subtypes but elimiated for DSM5
focus on symptom pattern and severity
dimensions
-hallucinations
-delusions
-disorganized speech
-psychomotor behaviour (catatonia)
-negative syptoms
-cognition
-depression
-mania
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9
Q

positive symptoms of schizophrenia

A

active manifestations of abnormal behaviour or distortions of normal behaviour
delusions (90%)
hallucinations

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10
Q

types of delusions

A 
somatic
grandeur
persecution
manifestation
delusion - strong belief that are misinterpreted as reality
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11
Q

what are hallucinations

A

sensory events without environmental input
auditory are the most common (can be any sensory modality)
normal volume, known, external, negative

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12
Q

brain studies of auditory hallucinations

A

broca’s area is active - speech production not wernicke’s (hearing bit)
= its their own inner voice

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13
Q

negative symptoms of schizophrenia

A

absence or insufficiency of normal behaviour
avolition (apathy) - inability to initiate and persist in activities
alogia - a relative absence of speech
anhedonia - inability to experience pleasure or engage in pleasureable activities
flat affect - show little expressed emotion, but may still feel emotion

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14
Q

define associative splitting

A

a separation among basic functions of human personality seen by some as the characteristic feature of schizophrenia
does not mean multiple personalities

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15
Q

capgras and cobards

A

Capgras - friend / family member has been replaced by a double
cobards - person believes they are dead, delusions

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16
Q

disorganised symptoms of schizophrenia

A

severe and excessive disruptions in
speech
affect - inappropriate eg crying at a funeral
behaviour

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17
Q

speech disordered in schiophrenia

A

cognitive slippage - ilogical and incoherent
tangentiality - going off on a tangent
loose associations or derailment

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18
Q

behaviour disordered in schizophrenia

A

disruption in goal directed behaviour
devline in routine daily functioning
catatonia - spectrum from wild agitation, waxy flexibility to complete immobility

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19
Q

can you spot schizophrenia signs in at risk children

A

studied at risk kids eating luncha nd interacting
then followed up 2 years later
those who later went on to develop schizophrenia typically displayed a less poisitve and more negative affect = so emotional affec could be a way to spot schizophrenia potentail in at risk children

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20
Q

how did we use to classify schizophrenia

A

paranoid
disorganized - silly, immature emotionality
catatonic - alternate mobility, excited agitation
dropped for DSM5
but in practice clinics often their own way of categorizing based on symptoms to aid recovery eg positive symptoms = good prognosis, largely negative or disorganised = poor prognosis

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21
Q

problems with diagnosis of schizophrenia

A

heterogeneity of symtoms
-symptoms change as dis develops
-schizophrenics can slip back into reality
treatment response varies
unitary disorder?
is it distinct from normal experince? yes
one of the most studied disorders but still not well understood

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22
Q

delusional disorder

A

delusions without other major schizophrenia symptoms
may show other negative symptoms
types of delusions = erotomanic (soulmate belief), grandiose (JC picked me), jealous (spout is cheating), persecutory (gov is after me), somatic
so a persistent belief that is contrary to reality. delusions are long standing and persisting
rare
late onset
more females than males
do function
aspects of hereditable personality traits

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23
Q

brief psychotic disorder

A

one or more positive symptoms of schizophrenia
usually precipitated by extreme stress or trauma
lasts less than a month

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24
Q

schizotypal personality disorder

A

odd beliefs and behaviour but reality testing generally intact
may reflect a less severe form of schizophrenia

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25
Q

schizophreniform disorder

A

schizophrenic symtpms for less than 6 months
associated with good premorbid functioning
2/3 go on to develop schizophrenia

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26
Q

schizoaffective disorder

A

schizophrenia with mood disorder symptoms during the psychosis
so need 2 weeks without mood symptoms major mood episode

27
Q

shared psychotic disorder

A

a psych disturbance in which inidividuals develop a situation similar to that of a person whom they share a close relationship
in DSM5 included under delusional disorder

28
Q

atteniated psychosis syndrome

A

a diagnosis under study that would be given to a person who is beginning to experience one or more of the symptoms of schizophrenia, such as hallucinations or delusions but is aware these are unusual experiences
high risk of developing schizophrenia - may be an prodomal stage

29
Q

early schizophrenia signs

A

more severe symptoms first occur in late adolescence / early adulthood but may even be signs in early childhood
physical abnormalities
poor motor coordination
mild cognitive and social problems
but cannot be sure a child will develop schizophrenia

30
Q

prodomal stage

A

perios of 1-2 years before serious symptoms of schizophrenia occur but when less severe but unusual behaviours start to appear

31
Q

schizotypal personality disorder

A

a personality disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with and reduced capacity for close relationships as well as cognitive or perceptual distortions

32
Q

culture and schizophrenia

A

some argue it isnt real and just a derogatory label for people who behave outside of cultural norms
but emotional pain = it is real
course and treatment outcomes vary from culture to culture (worse outcomes in Asis)
in london blacks = more likley to be detained against their will etc

33
Q

natural course of schizophrenia

A

premorbid
prodromal
onset / deterioration
chronic / residual

34
Q

genetic influences from family studies

A

inherit a tendency for schizophrenia - any type not a specific type
schizophrenia increases risk in other family members. also more severe = more risk

35
Q

genetic influences from twin studies

A

risk in MZ twins rhighest

so definitley genes but also big environment

36
Q

genetic influences from adoption studies

A

risk remain high in adopted children with a biological parent suffereing from schizophrenia
but highly supportive / good adoption fmaily = protective

37
Q

summary of genetic research

A

risk increases as a function of genetic relatedness
multiple genes involved
one need not show symptoms of schizophrenia to pass on relevant genes
schizophrenia has a strong genetic component, but genes alone are not enough
paternal age = more cell divisions in sperm

38
Q

Genain quads

A

4 women, all schizophrenic. same genetics and same dysfunctional family
but different onset, symptoms, course and outcomes

39
Q

de novo mutations

A

gene mutations that occur as a result of a mutation in a germ cell

40
Q

how can identical siblings have different environmens

A

different prenatal and faimly experiences = unshared environemtns
eg diff treatment by fam
different nutrients in womb as have to compete for them
differeing traumatic birth experiences

41
Q

implicated genes / chromosomes

A 
15 / 23 have been implicated
neuroreglin 1 = NMDA, GABA, Ach receptors
synaptic plasticity
DA metabol
G72 - regulates glutamatergic activity
mylenation, glial function
42
Q

smooth pursuit eye movement

A

tracking a moving object visually with head kept still

tracking is impaired in persons with schizophrenia including their relatives

43
Q

offspring of twins study

A

identical twin pairs plus frat twin pairs
wanted to determine relative likelihood childs risk
data showed you can have genes that predisopose you to schizophrenia, not show dis yourself, but still pass dis onto your children

44
Q

what genetic methods can we use

A

genetic linkage studies - known genes as marker points
endophenotyping - find basic processes that contribute to the behaviours or symptoms of the dis and find the gene / genes that cause these difficulties (eg smooth eye pursuit movements)

45
Q

dopamin hypothesis

A

overactivity of dopamine DA neurons in the brain causes schizophrenia

46
Q

support for dopamine hypothesis

A

drugs (eg neuroleptics) that block dopamine receptors reduce positive symptoms, acting on D1 and D2
amphetamines which increase dopamine = create positive symptoms
high number of D2 receptors in schizophrenic brains
so dopamine agonist = schizophrenic activity up, dopamine antagonist = schizophrenic activity down

47
Q

problems with dopamine hypothesis

A

dopamine antagonists don’t treat negative symptoms
new drugs = poor dopamine antagonists but work really well
time lapse - immediately in brain but no improvement for 2 weeks
parkinsons
neuroleptics increase D2 receptors
PET scans = inconclusive

48
Q

revised dopamine hypothesis

A

overactivity of dopamine neruson in the mesolimbic pathway may cause the symtptoms
-anitpsychotics which block dopamine receptors lessen positive symptoms
but
underactivity of dopamine neurons in the mesocortical pathway in the prefrontla cortex may cause negative symtoms
-anitpsychotics have little or no effect on the negative symptoms
and glutamate hypofunctioning - especially hallucinations

49
Q

structural and funcitonal abnormalities in the brain

A

enalrged ventricels and reduced tissue volume = there has been atrophy
inverse relationshup between ventricle size and response to medication
abnormal neural migration (fetus brain)
gray metter loss in adolesence
hypofrontality - less active frontal lobes (major dopamin pathway)

50
Q

what is the hypofrontality hypothesis

A

discordant twins = low blood flow only in afected twin
cognitive flexibility
-schizophrenics cant shift sttention to other criterion
-functional imaging = frontal lobe activity lower at rest esp in right hemisphere, does not increase during task
-drug treatment increased activation of frontal lobes

51
Q

influenza and schizophrenia

A

individuals with schizophrenia and exposed to influenze prenatally = more likely to have enlarged ventricles

52
Q

marijuana use and schizophrenia

A

chronic and early use of marijuana is a potential influence
high doses = increased lieklihood of developing schizophrenia
but also schizophrenics are more likely ot have a cannabis use disorder
but correlations = unclear why and how

53
Q

stress and schizophrenia

A

may activate underlying vulnerabilty and/or increase risk of relapse
large city = increased risk
engage in combat in war = display temporary symptoms of schizophrenia
high number of stressful events reported in 3 weeks prior to showing disorder shown in many research centres but is retrospective

54
Q

california earthquake study

A

assessed schizophrenics, bipolar and healthy controls
both patient groups = more stress related symtoms than controls
schizophrenics = lower leveles of self esteem and more liekly to engage in avoidance coping

55
Q

schizophrenergic mother

A

obselete and unsupported theory

mum was cold, dominating and rejecting = caused schizophrenia in heroffspring

56
Q

double blind communication

A

obselet, unsupported theory

practice of transmitting conlicting messages that was thought to cause schizophrenia = again all parents fault …

57
Q

expressed emotion

A

hostility, criticism and over-involvement demonstrated by some families towards a fmaily member with a psych dis. can contribute to relapse
so high EE = see symptoms as controllable
cultural variations = variations in high EE

58
Q

role of pscyh factors in schizophrenia

A

likely to exert only a minimal effect in producing schizophrenia

59
Q

how did we used to treat schizophrenia

A

huge insulin doses = to induce comas
risk of serious illness and death
psychosurgery and ECT (we still use ECT in last ditch cases)

60
Q

antipsychotic (neuropleptic meds)

A

dopamine atagonists are often the first line of treatment
most reduce or elimnate positive symptoms
acute and permament extrapyramidal and parkinson’s like symptoms are common
poor compliance is common
atypical (risperdal, olazapine) have better side effect profiles than Thorazine

61
Q

what do we mean by extrapyramidal symptoms

A

work on neurotransmitter symptoms
akinesia - expressionless face, slow motor activity, monotomous speech
tardive dyskinesia - involuntary movements of tongue, face, jaw. tends to be from long term high does useage
dont tend to be reversible

62
Q

one way tried to get round poor med compliance

A

inject every few weeks

still would just not rock up for next injection

63
Q

psychosocial approaches for schizophrenia

A

behavioural (ie toekn economies) on impatient units
community care
social and living skills
behavioural family therapy
vocational rehabilitation
are usually a necessary part of treatment
self-help groups seem to do well (maybe just the kind of people who attend though)
ACT - wide ranging multidiscplinary training
sadly country differences ie lock up in some cultures

64
Q

prevention of schizophrenia

A

identify and treat high risk children
instability of family rearing environment = can trigger onset
so poor parenting = strain on already vulnerability
attenuated psychosis syndrome might help

PSYC 100 - clinical (13 decks)

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