Schizophrenia Flashcards
1
Q
SCHIZOPHRENIA
A
- Loss of contact w/reality
- Abnormalities in senses, perception, thinking, action, sense of self & others
- Onset: late adolescence, early adulthood
2
Q
Schizophrenia Hallmark Symptoms:
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REQUIRED: delusions, hallucinations & disorganized speech + 2 more symptoms for 6MTHS (disturbance/impairment)
- Delusions
- Hallucinations
- Disorganized Speech & Thought
- Disorganized speech & catatonic behavior
- Negative Symptoms
3
Q
Delusions:
A
Erroneous belief
Firm in wrong belief despite contradictory evidence
Occurs in 90%
4
Q
Types of Delusions
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Persecutory Delusions of Reference: Grandiose Delusions Erotomanic Delusions Thoughts, Control, Withdrawal & Broadcasting (think
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Q
Persecutory
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feeling of being followed or under surveillance
Being made fun of by others
6
Q
Delusions of Reference:
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Feeling that bulletins have a direct reference to them
Music → about them
Car license plates → bout them
7
Q
Grandiose Delusions
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Belief they have exceptional power, talent or fame
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Q
Erotomanic Delusions
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Romantically or sexually involved w/a celebrity
9
Q
Thoughts, Control, Withdrawal & Broadcasting (think others can hear/read thoughts)
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Aliens inserting thoughts into mind/removing, controlling, or broadcasting thoughts against their will
Could be microwave or other inanimate objects
10
Q
Hallucinations
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Usually worse when alone, can hear voices, auditory is most common Sensory experience (touch, auditory, smell, tactile) Seems real, but no external stimulus
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Q
Types of Hallucinations
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Auditory Hallucinations Visual Hallucinations Tactile Hallucinations Olfactory Hallucinations Gustatory Hallucinations
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Q
Auditory Hallucinations
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- hearing of voices usually talking about the person. Running commentary, Includes “command hallucinations”
13
Q
Visual Hallucinations
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- can be clear or vague/distorted; can be frightening
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Q
Tactile Hallucinations
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snakes, bugs, people or hands touching them, something inside or outside the body
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Q
Olfactory Hallucinations
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unpleasant odors (decaying body, blood, corpse) person often thing it’s coming for them.
16
Q
Gustatory hallucinations
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strange, usually unpleasant taste (like blood)
17
Q
Which of the following is true about the connection between psychopathy and antisocial personality disorder?
A
a. Psychopathy is a personality trait that rarely causes problems.
b. Psychopathy is a less severe form of antisocial personality disorder.
c. Not all people who have antisocial personality disorder have psychopathy
d. All people who exhibit violent behavior are psychopaths.
18
Q
Disorganized Speech
A
Loose Speech: syntax is okay, but words or word order don’t make sense
Incoherence
Use of neologisms (made up words that sound real)
19
Q
Disorganized & Catatonic Behavior
A
Impairment, goal-oriented activity (complete tasks in a pattern
Work, hygiene
- Display unusual or silly behavior
- bizzare grimacing or mimic behavior (movements and auditory)
- Unpredictable agitations/repetitive behaviors (sexual behaviors in public)
- pacing, walking in circles, outbursts
- catatonia (no movement at all) doesn’t move, speak or move for long periods of time–just stares
20
Q
Negative Symptoms
A
- Absence of normal behavior
- Flat affect, alogia (grunts, one word answers), asocial, avolition (lack of motivation, not able to complete task)
- Anhedonia: loss of interest in doing things that bring them pleasure
21
Q
Epidemiology
A
- More common in males & males have more severe form
Onset typically late adolescence, or early adulthood 18-30yrs
Spark in late 40’s women (menopause)
22
Q
Commonly associated features
A
Neuropsychological Testing
- Poor “executive functioning” (ability to understand & make decisions )
- Trouble focusing or paying attention
- Problems w/working memory (ability to use info immediately after learning it)
23
Q
Other psychotic disorders:
A
- Schizoaffective disorder
- Schizophreniform
- Delusional Disorder
- Brief psychotic disorder
24
Q
Schizoaffective disorder
A
- Both psychotic and mood symptoms and severe mood symptoms (depression or mania)
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Schizophreniform
- Like schizophrenia but for less than six months
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Delusional Disorder
- Delusional but behaves quite normally
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Brief Psychotic Behavior
- At least 1 day, but does not last a month--return to premorbid functioning
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Schizophrenia Causes
Genetic Factors: twin & adoption studies x Environmental factors (COMT gene)
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Genetic Factors
Twin studies: concordance rates
Monozygotic twins 48-50%
Dizygotic twins: 10-17%
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Heritability Index
Adoption studies
- 16% of kids w/schizophrenia parent → foster care developed schizophrenia)
- 0% of kids w/no schizophrenia parent → foster care developed schizophrenia
- Retrospective study of adopted adult schizophrenia patients revealed biological relatives 13% v. 1%
- HOME life important for development of schizophrenia
- Only youth at risk + adverse adoptive environment developed disorder
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COMT Gene
- Gene involved in dopamine metabolism-located on chromosome 22
- Gene x environment interaction cannabis and adolescence → more likely to become psychotic if they used cannabis during adolescence
Polygenic
Some genes similar to those found in bipolar disorder
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Genes → Brain vulnerability
- Neurotransmitter system abnormalities
| - Structural anatomical differences
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Commonly associated features w/schizophrenia
Neuropsychological testing
- poor "executive functioning" (ability to understand info and make decisions)
- trouble focusing or paying attention
- problems w/"working memory" (ability to use info immediately after learning it)
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Brief Psychotic Disorder
At least one day but does not last one month before returning to premorbid functioning
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10 other candidate genes for Schizophrenia
related to dopamine, glutamate &
| - inflammation genes are over represented in schizophrenia
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Adolescent Cannabis use
- more likely to develop schizophrenia later
| - critical time during brain development (teen years)
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Polygenic
- many contributory genes
- many mutations
- similar to bipolar (some overlap & characteristics)
38
Which of the following best describes the relationship between schizophrenia and DID?
A) Both involve a split in the individuals personality, with alternate personalities emerging
B) Reality testing is intact in schizophrenia but not in DID
C) Both Schizophrenia and DID are largely influenced by genetics
D) Schizophrenia is characterized by psychotic symptoms whereas DID is not **correct answer is D
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Prenatal Exposures increase Brain Vulnerability
- prenatal infection
- Rhesus incompatibility (blood typing)
- prenatal birth complications
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Schizo --> prenatal infection
- Elevated schizophrenia in children born to moms with flu in 4-7month of gestation
* *during the first/second trimester like getting the flu can increase the risk of developing schizophrenia
- causes change in the fetal brain development, making them more susceptible to increased ris
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Rehsus
different blood type between mom & fetus
- can be corrected, but if it is not corrected can lead to oxygen deprivation
- May lead to oxygen deprivation—which can lead to dopamine supersensitivity
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Prenatal birth complications
oxygen supply
- low birth weight
- related to dopamine sensitivity
- damage to hippocampus
- Breech delivery, prolonged labor, etc. affect oxygen supply • Cells in hippocampus are susceptible to damage from hypoxia; oxygen deprivation can lead to dopamine supersensitvity
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• Dopamine hypothesis
- –Drugs that increase dopamine (amphetamines; LDOPA for Parkinsonsdisease)
• Result in schizophrenic like behavior (hallucinations, paranoia)
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Drugs that reduce dopamine (antipsychotics)
• Decrease schizophrenic like behavior
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Excess production of dopamine in Schizophrenia
- too much in their environment pull their attention
- irrelevant stimuli
- (random sensory events acquire salience)
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Overactive dopamine system can result in suppression of glutamate
– Glutamate, low levels of this neurotransmitter can causes schizophrenia like symptoms and degeneration of neurons in key brain areas
- GLUTAMATE is important for memory and learning
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Not simple, complicated
over receptors, neurotransmitters affecting each other (dopamine, glutamate)
- not enough inhibitors
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Anatomical Differences
- more brain fluid in ventricles, less brain volume
- decreased brain volume
- not seen in EVERY case, it's not unique but representative in patients of schizophrenia
- twin: adoptive large, adoptive + positive environment, maybe larger, but not as large
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Anatomical Differences
* Decreased brain volume (3% reduction)
* Decrease in gray matter worsens over time
* Reduced volumes in frontal lobe-decision making and planning
* Reduced volume-Abnormalities in temporal lobe areas such as hippocampus and amygdala—involved in emotion and memory, and processing auditory info
* Reduced volume of the thalamus-relay center for most sensory input
* White matter disruptions which affect how well the nerve fibers of the brain communicate—correlated with cognitive impairments
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Psychological and Social Factors
- Role of Stress: (traumatic event, migration etc.) • May activate underlying vulnerability • Stress = cortisol à cortisol positively associated with dopamine release
- Family Interactions: Families show ineffective communication patterns (vague, confusing and unclear) • High expressed emotion (criticism, hostility and emotional overinvolvement)
**immigrants more likely to develop schizophrenia (not bidirectional, schizophrenic people are not migrating)
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Role of Stress
Stress = cortisol --> positively associated w/dopamine release
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Family interactions
- high expressed emotion (criticism, hostility and emotional overinvolvement)
- family stress has a role in schizophrenia & in relapse
* *this is also a high indicator for patients that are most likely to relapse
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What other nongenetic factors increase risk for schizophrenia?
A) Head injury
B) Urban upbringing
C) Migrant Status
D) All of the above **correct answer
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A Diathesis-Stress Model of Schizophrenia
Genetic + prenatal factors/events --> brain vulnerability --> stress during developmental maturation process --> PSYCHOSIS
**Symptoms not expressed until brain maturation reveals them
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Early indications of vulnerability; Prodromal Factors
•Home movies of individuals who went on to develop schizophrenia vs. controls (Walker et al., 1993)
* More motor abnormalities including unusual hand movements
* Less positive facial emotion and more negative facial emotion
- other studies have found
- - • Delayed speech and delayed motor development at age 2 among individuals who went on to develop schizophrenia
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Treatment: Pharmacotherapy
Antipsychotic treat positive symptoms (delusions, hallucinations, etc.) and block dopamine receptors
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First-Generation Antipsychotics
Haldol, Thorazine
•Side Effects
•Muscle spasms, shaking, , body rigidity, tardive dyskinesia. Drowsiness, dry mouth, weight gain
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Second-Generation Antipsychotics
* Clozaril, seroquel, olanzapine, risperidone
* Side effects
* drowsiness, weight gain, tired, depressed, drop in white blood cell count
* increased risk of stroke, sudden cardiac death, blood clots, and diabetes
**more side effects that lead to metabolic symptoms that increase risk of strokes, heart problems (different set of side effects)
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Psychosocial Approaches
Behavioral Family Therapy (to reduce expressed emotion, to help them be more understanding of symptoms and establish routines that work for them)
Social and Living skills Training (how they communicate w/others, eye contact, proximity, life skills like planning, routine, basic hygiene, grocery shopping (basic life skills))
Cognitive remediation ( computer tasks that focus on sequencing to solve problems, help them develop these skills to apply to their daily life skills)
Cognitive behavioral therapy ( mixed data, some say it can be effective other data suggests it does not help)
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Cognitive Behavioral Therapy for Psychosis
**ways that CBT might be useful for ppl w/less severe schizophrenia
Positive Symptom: Hallucination
Technique: normalizing, enhancing coping skills
Positive Symptom: Delusion
Technique: Inference chaining & peripheral questioning
Negative symptoms
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Women have less schizophrenia
Estrogen was effective in reducing psychotic symptoms
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Outcomes
* Poor prognosis prior to the 1950s
* antipsychotic drugs introduced
* 15-25 years outcomes
* With treatment (typically meds), good prognosis for 40%; about 20% of these show minimal impairment
* Medication and social skill training and or family stress management fare best; 60% response rate after 2 years • Long-term institutionalization rate-12%
* Most common is chronic pattern of relapse and recovery
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Early intervention w/schizophrenia
- itnerven at the stress level (manage stress level) to not lead to bigger events which can trigger psychotic episode
- can help them manage stress so that it doesn't lead to a more unfavorable psychotic episode
