schizophrenia Flashcards
what is schizophrenia?
a disorder characterized by the profound disruption of basic pyschological processes, a distorted perception of reality, altered or blunted emotion, and diturbances in though, motivation, and behavior
occurs in about 1% of the population
delusion: a patently false belief system, often bizarre and grandiose, that is maintained in spite of its irrationality
hallucination: a false perceptual experience that has a compelling sense of being real despite the absence of external stimulation
disorganized speech: a severe disruption of verbal communication in which ideas shift rapidly and incoherently from one to another unrelated topic
grossly disorganized behavior: behavior that is inappropriate for the situation or ineffective in attaining goals, often with specific motor disturbances (catatonic behavior = a marked decrease in all movement or increase in muscular rigidity and overactivity)
negative symptoms: emotional and social withdrawal, apathy, poverty of speech, and other indications of the absence or insufficiency of normal behavior, motivation, and emotion
subtype include: paranoid, catatonic, disorganized, undifferentiated, and residual
videoclip
man continuously plays with hair
high functioning intellectually but has little insight
formal though disorder - goes from talking about picture to sperm and egg to brain…
some of the things he says do not make sense - “the picture has a headache”
not realizing that he has distorted thinking - says that he is there because he wants to stop smoking
what positive symptoms are “excess” in those with schizophrenia?
delusions = distorted thoughts (persecuation, reference, gradeur, identity, guilt, control)
hallucinations: sensory experience (usually auditory)
loosening of associations: ex. man in video talking about picture, then sperm and egg, then brain, etc
disorganized and inappropriate behavior: depends on how acute the disorder is
what are the different types of delusions?
persecution: belief that others are persecuting, spying on, or trying to harm them - paranoid delusion, most harmful/ threatening (want defense and have a high level of anxiety)
reference: belief that objects, events, or other people have particular significance to them (ex. newcast provides coded instructions - really are not realted to them)
grandeur: belief that they have great power, knowledge, or talent
identity: belief that they are someone else, such as jesus or the president
guilt: belief that they have committed a terrible sin (they really haven’t done anything)
control: belief that their thoughts and behaviors are being controlled by external forces (someone is inserting/taking/removing thoughts - behaviors being controlled)
have to defy credibility - cannot be possible
what are the negative symptoms involved in skitzophrenia?
they are deficits in functioning and indicate a worse prognosis
- isolation
- withdrawal
- apathy
- blunted emotional expression - nonresponsive emotionally, feel increasingly isolated, lack of motivation (disengaged)
neg symptoms are less influenced by meds than postivie symptoms
- not everyone has negative symptoms
- eliminate/ reduce intensity of delusions
- don’t process emotion right - apathetic
what are the 2 forms disordered thought comes in?
formal thought disorder
- seen in “derailed” or “incoherant” speech, evident in some subtypes of schizophrenia
- world salad - jumbling words
- way words connct doesn’t make sense - however it makes sense to them
disorder of thought content (delusions)
- delusions may not be incoherant!
- note that formal though disorder usually involes disorder of thought content, but disorder of thought content does not entail formal thought disorder
- think thoughts are organized
disorders mood in skitzophrenia
if mood disturbance is present in schiz, it usually presents as “flat” or “inappropriate” affect
ex. laughing inappropriately or being disengaged
if there is significant depresison or mania in the clinical picutre, the diagnosis probably shifts away from one of schizophrenia and toward one of:
- schizoaffective disorder (emotional aspects)
- pyschotic mood disorder (major depressive)
- remember mood congruent concept*
can see mood instability/ pyschotic aspects
what are the different subtypes of schizophrenia?
paranoid
catatonic
disorganized
undifferentiated
residual
what is the paranoid type?
preoccupation with one or more delusions (usulaly persecutory or grandiose) or frequent auditory hallucinations
very paranoid - will be persecuted/harmed - feel threathened
none of the following is :prominent:
- disorganized speech
- disorganized behavior
- flat or inapporpriate affect
sometimes hard to tell if just delusional… takes time to listen
book description: symptoms dominated by absurd,illogical, and changable delusions, fequently accompanied by vivid hallucinations, with a resulting impairment of critical judgment and erratic, unpredicatable, and occasionally dangerous behaviors. in chronic cases, there is usually less disorganization of behavior than in other types of schiz and less extreme withdrawal from social interaction
what is the disorganized type?
ALL of the following are prominent:
- disorganized speech
- disorganized behavior
- flat or inappropriate affect
obviously disordered and disorganized
ex. conveying letter that is very disorganized (they have no idea that it is)
book description: usually occurs at an ealier age than most other types of schiz and represents a more severe disintegration of the personality. emotional distortion and blunting typically are manifested in inappropriate laughter and silliness, peculiar mannerisms, and bizarre, often obscene behavior
what is the catatonic type?
clinical picture is dominated by catatonic motor behaviors such as…
“scared stiff” theory - freeze in weird positions, frozen motor behavior
book description: often characterized by alternating periods of extreme withdrawal and extreme excitement although in some cases one or the other reaction predominates. in the withdrawal reaction there is a sudden loss of all animation and a tendency to remain motionless for hours or even days in a single position. the person may undergo an abrupt change, with excitement coming on suddenly, the person may talk or shout incoherently, pace rapidly, and engage in uninhabited, impulsive, and frenzied behavior. in this state, an individual may be dangerous
what is the undifferentiated type?
criteria not met for paranoid, disorganized, or catatonic types
may be delusional but not paranoid, may be organized delusion, may hallucinate but not paranoid type hallucinations (delusions but not being harmed)
ex. a man was convinced that she was a man dressed as a woman and that she was interviewing him - very upset because he thought nothing was wrong when she diagnosed him (tried to explain his thoughts)
book description: a pattern of symptoms in which there is a rapidly changing mixture of all or most of the primary indicators of schiz, commonly observed are indications or perplexity, confusion, emotional turmoil, delusions, excitement, dreamlike withdrawal, depression, and fear. most often this picture is seen in patients who are in the process of breaking down and developing schiz. it is also seen, however, when major adjustment demands impinge on a person with an already-established schiz psychosis. in such cases, it greuently foreshadows an impending change to another primary schiz subtype
what 3 videos were shown in relation to schiz?
ms. wilcox
ms. leonard
david
same diagnosis but very different
- don’t refer to someone as skitz
- don’t label!
david video clip
glasses broken
FBI told him they weren’t interested in him - he thought they were
doesn’t think this due to illness - organized but delusional, goes off on tangents - his thoughts follow directly from his irrational but coherent premises
no dental service for mental illness (afraid of them implanting something) - people with mental illnesses are reluctant to use health services
no flat affect, inappropriate affect, and incoherant thinking
his premises are wrong-headed and delusional however
diagnosis: skitz and paranoid type
ms. leonard videoclip
doesn’t move or talk at first
hears voices - threatening and getting louder (taking over body) - although she takes meds she thinks they are getting louder
she thinks she is pregnant but hse has her period
confused and distressed and afraid (braces self)
she is hallucinating - responds to internal stimuli - can tell this is real by her pauses
diagnosis? skitz, paranoid type
mrs, wilcox videoclip
stabbed herslef becauseshe though family and freinds were being harrassed
mom died without being sick - she wanted to take her to the hospital but she didn’t and then she died
her sister’s house was destroyed by a tornado
she was not on her meds
afraid that her phone was bugged
diagnosis? skitz, paranoid type
observations? not obviously hallunating like ms. leonard and not chaotic and disorganized like david
what causes schizophrenia?
primarily a brain disorder
can happen to well functioning people
genetic studies show heritability and polygenic causation
anatomical stuies show diverse structural abnormalities
dopamine and glial cells may be involved in causation
what is the role of genetic predispostion?
lack of 100% concordance in MZ twins demonstrates that despite clear evidence of genetic vulnerability, non-genetic environmental factors have causal force
less biological factors than bipolar disorder
100% MZ twin
50% in offspring in parents
50% sibling
what environmental factors influence schizophrenia?
stress is implicated in etiology
environmental spread of a “schizovirus” has been hypothesized
- born in late winter/early spring (mother has flu or illness during the 2nd trimester) - time period that greatly affects brain development
- urban places more likely - more stressful environmant, more exposure to viruses
higher concordance in latesplitting MZ twins (^0% compared to earlysplitting MZ twins (10-30%) supports the viral theroy
- early - 1st 4 days, separate placentas, exactly identical
- late - occure later, share placenta, 2x rate, mirrored (ex. handedness)
*diathesis stress- both due to predisposition and triggers
in those at risk for schiz, enviornmental stress contributes to its development
- study of adopted kids in pyschologically healthy families vs. adopted children with families that were disturbed
- in healthy families, none became pyschotic
- in distubed families, 11 percent of the kids became pyschotic and 41 percent had severe pyschologcial disorders
etiology: dopamine dysfunction?
mechanism of action of typical antipyschotic meds is as dopamine antagonists
this data is a part of the support for theory that schiz etiology is importantly linked to dopamine excess or dopamine receptor dysfunctions
dont know causes exactly - stress, environmental, genetic?
how do dopamine antagonists work?
block symptoms of schiz. occupies the dopamine site on the receptor, preventing recptor activation by dopamine
blocks receptors - leaves dopamine in the synapse and breaks it down and then reuptakes it
what does MRI data on MZ twin discordance prove?
schiz in identical twins - when twins differ
twin with schiz typically has enlarged, fluid filled cranial cavities (larger brain ventricals)
the difference between the twins implies some nongenetic factor, such as a virus
etiology: hippocampus?
structurally disorganized pyramidal neurons in hippocampus
why on the hippocampus?
- schiz may be caused by a virus that attacks the hippocampus, a part of the brain that processes sensory perceptions (reality testing issue)
- damage to hippocampus would account for schiz patients vulnerability to sensory overload - have to manage a high level of sensation
what other problem with the brain affects a person with skitz?
brain tissue loss in adolescent schiz
increases over years - ongoing brain damage
cortical regions of the brain - causes thoughts in the brain to scrambel and causes the brain to stop cooperating
