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EXAM 3 - Psych 405 > Schizophrenia and other psychoses > Flashcards

Schizophrenia and other psychoses Flashcards

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1
Q

What mood disturbances are characteristic of schizophrenia?

A

(1) Thought: disordered thinking
- Ideas not logically related
- Faulty perception and attention
(2) Emotion: lack of emotional expressiveness
- Inappropriate or flat emotions
(3) Behavior: disturbances in movement or behavior
- Disheveled appearance

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2
Q

How does schizophrenia affect people’s interpersonal life and independence?

A

It can disrupt interpersonal relationships and diminish capacity to live independently

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3
Q

Are there increased rates of suicide and death in people who have schizophrenia? And what are those rates?

A

Yes, there are increased rates. 1-15% of people have tried to commit suicide at least once

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4
Q

Define schizophrenia

A

Neurodevelopmental disorder that is associated with neurocognitive impairment

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5
Q

What delusion contributes to increased rates of suicide in schizophrenia?

A

Voices make them question why they would even want to live with the disorder

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6
Q

What makes schizophrenia different than mood disorders?

A

It is primarily cognitive

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7
Q

Define positive symptoms of schizophrenia and give 4 examples

A

Disturbances in which normal functions are distorted or exaggerated (excessive perceptions)

  • Hallucinations
  • Thought disorder (content)
  • Bizarre behavior
  • Thought disorder (form)
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8
Q

Define negative symptoms of schizophrenia and give 5 examples

A

Disturbances in which normal functions are diminished or absent (lack of pleasure)

  • Anhedonia
  • Alogia
  • Affect
  • Avolition
  • Attentional impairment
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9
Q

What are examples of disorganized symptoms?

A
  • Disorganized behavior

- Disorganized speech

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10
Q

Define delusions

A
  • Firmly held beliefs
  • Contrary to reality
  • Resistant to disconfirming
    evidence
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11
Q

Define hallucinations

A
  • Sensory experiences in the absence of sensory stimulation
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12
Q

Outline types of delusions

A
  • Persecutory delusions (The CIA planted a listening device in my head, 65% have these)
  • Thought insertion
  • Thought broadcasting
  • Outside control
  • Grandiose delusions
  • Ideas of reference
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13
Q

Outline different types of hallucinations

A
  • Auditory: 74% have this symptom
  • Visual (negative and scary)
  • Hearing voices
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14
Q

What area of the brain is activated during hallucinations?

A

Broca’s area

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15
Q

What is thought insertion?

A

Some device has inserted thoughts inside your head without consent

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16
Q

What are delusions?

A

False beliefs

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17
Q

What are grandiose delusions?

A

Feelings of ultimate superiority: believing you are Jesus

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18
Q

What are ideas of reference?

A

Watching TV and you think the newscaster is speaking directly to you

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19
Q

Describe what disorganized speech (formal thought disorder) looks like in disorganized symptoms of schizophrenia

A
  • Incoherence

- Loose associations (derailment): rambles, difficulty sticking to one topic

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20
Q

Describe what disorganized behavior looks like in disorganized symptoms of schizophrenia

A
  • Odd or particular behavior: silliness, agitation, unusual dress (wearing several heavy coats in hot weather)
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21
Q

Define avolition

A
  • Lack of interest; apathy
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22
Q

Define asociality

A

Inability to experience pleasure in social situations

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23
Q

Define blunted affect

A

Exhibits little to no affect in face or voice

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24
Q

Define alogia

A

Reduction in speech

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25
Q

What are 3 movement symptoms of schizophrenia?

A

1) Catatonia
2) Catatonic immobility
3) Waxy flexibility

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26
Q

Define catatonia

A
  • Motor abnormalities
  • Repetitive, complex gestures (usually of the fingers or hands)
  • Excitable, wild flailing of limbs
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27
Q

Define catatonic immobility

A
  • Maintain unusual posture for long periods of time e.g. stand on one leg
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28
Q

Define waxy flexibility

A

Limbs can be manipulated and posed by another person

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29
Q

Where are the rates of schizophrenia better?

A

Rural areas

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30
Q

What is the lifetime prevalence of schizophrenia?

A

1%

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31
Q

Is schizophrenia more common in men or women?

A

Men

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32
Q

When is schizophrenia typically diagnosed?

A

Late adolescence or early adulthood (18-35)

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33
Q

Do men or women have early onset of schizophrenia?

A

Men

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34
Q

Why are delusions developed?

A

To explain hallucinations

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35
Q

What do hallucinations occur concurrently with?

A

Delusions

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36
Q

What does social functioning look like in men with schizophrenia?

A

Poor social functioning; more schizotypal traits

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37
Q

What does social functioning look like in women with schizophrenia?

A

Good social functioning; fewer schizotypal traits

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38
Q

Do men have more negative or positive traits and what do those look like?

A

Negative symptoms; more withdrawn and passive

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39
Q

Do women have more negative or positive traits and what do those look like?

A

More positive symptoms: hallucinations and paranoia; more emotional and impulsive

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40
Q

What does the course of schizophrenia look like in men?

A

More chronic, poorer response to treatment

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41
Q

What does the course of schizophrenia look like in women?

A

Less often chronic; better response to treatment

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42
Q

Define schizophreniform disorder?

A
  • Same symptoms as schizophrenia

- Symptom duration greater than 1 month but less than 6 months

43
Q

Define brief psychotic disorder

A
  • Symptom duration of 1 day to 1 month

- Often triggered by extreme stress, such as bereavement

44
Q

Define schizoaffective disorder

A
  • Symptoms of both schizophrenia and mood disorder

- DSM5 likely to require appearance of major depressive or manic episode

45
Q

What happens to people with these other psychotic disorders?

A

2/3rds develop schizophrenia or schizoaffective disorder

46
Q

What is schizotypal personality disorder?

A

People are described as odd or eccentric and have very few close relationships
- They do not understand how relationships form or the impact of their behavior on others

47
Q

** Test hints **

A
  • We will have vignettes and she will ask us to diagnose them with the options above (psychotic disorders)
  • You should be able to tell the difference between disorders from symptom duration
  • If she mentions mood symptoms think about schizoaffective disorder
48
Q

What is delusional disorder?

A
  • Person is delusional about persecution, being followed, jealousy, erotomania (loved by a famous person), somatic delusions
  • They do not have other symptoms of schizophrenia
  • They do not have hallucinations
49
Q

How are genetic and environmental factors playing a role in the etiology of schizophrenia?

A
  • 86% of the variance of schizophrenia is due to genetic factors
  • Family studies
  • Adoption studies
50
Q

Do MZ or DZ twins have a higher rate concordance rate for schizophrenia? What are those rates?

A

MZ - 100% genetic overlap and DZ - 50% genetic overlap

51
Q

What increases the risk of schizophrenia?

A

Degree of genetic relatedness through relatives even if the relatives have not shared specific environment with the patient

52
Q

Is schizophrenia caused by single gene?

A

Not likely that the disorder is caused by a single gene

53
Q

What type of symptoms have a stronger genetic component?

A

Negative symptoms

54
Q

According to twin studies what is the risk for MZ compared to DZ?

A

44% risk for MZ twins and 12% risk for DZ twins

55
Q

What do adoption studies tell us about schizophrenia?

A

Increased likelihood of developing psychotic disorders

56
Q

What is transmitted from genotype to phenotype?

A

It is not the certainty of getting schizophrenia but rather what biological relatives inherit from their schizophrenia relatives is the predisposition or heightened liability (called the diathesis to develop schizophrenia

57
Q

Are genetic factors sufficient for the development of schizophrenia?

A

Interaction between genes plus non genetic environmental factors

58
Q

Describe the Diathesis-Stress Model of Schizophrenia?

A
  • Thick line: schizophrenia
  • Thin line: schizotypal personality disorder
  • Schizotypal –> closer to developing schizotypal but do not experience actual psychosis but experience psychotic like symptoms and the genetic and environmental diathesis are so similar that reaching the threshold for schizotypal is easier and could develop into schizophrenia
59
Q

What is a gene environment interaction?

A

There is a genetically influenced sensitivity to the environment, whereby some individuals are more vulnerable to a given environmental stress factor than others, based on their genotype

60
Q

What is an example of a gene-environment interaction?

A

Differential effect of cannabis on risk of schizophrenia based on COMT Val/Met allele

61
Q

What is the COMT gene related to?

A

Metabolism of dopamine and disturbance of schizophrenia

62
Q

What does the “Association Between Cannabis and Risk for Schizophrenia” Graph show?

A
  • Study looked at effects of people who used cannabis between 13 and 18 and saw what genotype they had (Met/Met), (Val/Met), and (Val/Val)
  • Adolescents using cannabis had higher reports of experiencing psychotic symptoms especially with people who had the Val/Val allele who were more susceptible
63
Q

What are somatic hallucinations?

A
  • Hearing voices telling individuals what to do
  • Carrying on conversations with the voices no one can hear
  • Bothered by strange smells
  • Bothered by strange tastes of food you haven’t eaten
64
Q

What are other examples of hallucinations in schizophrenia?

A
  • Believed some one is testing you
  • Believed someone is spying or following you
  • Believed someone was reading your mind or hearing your thoughts
  • Belief someone you met is in love with you (erotomania)
  • Believed strange forces were working on you
65
Q

What causes schizophrenia?

A

Although genetic factors play a major role

66
Q

What brain structures are affected in people who have schizophrenia?

A

Hippocampus, amygdala, hypothalamus, nucleus, cingulate gyrus, prefrontal cortex

67
Q

What is the dopamine theory?

A

Schizophrenia is due to excess levels of dopamine

68
Q

How do drugs to treat schizophrenia work?

A

They alleviate symptoms reducing dopamine activity

69
Q

What effect do amphetamines have?

A

Increase dopamine levels which can induce psychosis

70
Q

What is the dopamine theory revised?

A

There is an excess numbers of dopamine receptors or oversensitive dopamine receptors

71
Q

Where are the dopamine receptors localized?

A

Mesolimbic pathway

72
Q

What are mesolimbic dopamine abnormalities related to?

A

Positive symptoms

73
Q

What is underactive dopamine activity in the mesocortical pathway mainly related to?

A

Negative symptoms

74
Q

What are the environmental factors of the brain structure and function especially during birth? Explain this.

A

Damage during gestation or birth

  • Obstetrical complication rates high in patients with schizophrenia
  • There is a reduced supply of oxygen during delivery which may result in a loss of cortical matter
75
Q

What are to case study examples of viral damage to the fetal brain?

A
  • Presence of parasite, toxoplasma gondii, associated with 2.5x greater risk of developing schizophrenia
  • Schizophrenia rates higher when the mother had flu in second semester trimester of pregnancy
76
Q

Why doesn’t the dopamine theory completely explain schizophrenia?

A
  • Anti psychotics block dopamine rapidly but symptom relief takes several weeks
  • To be effective, antipsychotics must reduce dopamine activity to below normal levels
77
Q

What are other neurotransmitters other than dopamine involved?

A
  • Serotonin
  • GABA
  • Glutamate
78
Q

What medication shows promise?

A

Ones that targets glutamate

79
Q

What cortex matures in adolescence and early adulthood?

A

Prefrontal cortex

80
Q

When does dopamine peak?

A

Adolescence

81
Q

How is cortisol connected to dopamine activity?

A

Stress activates HPA system which triggers cortisol secretion –> cortisol increases dopamine activity

82
Q

How are synaptic connections made?

A

Excessive pruning

83
Q

What is cannabis use during adolescence associated with? What does this explain?

A

Increased risk of developing schizophrenia which can explain why symptoms appear in late adolescence but brain damage occurs in early in life

84
Q

What behaviors disrupted by schizophrenia are governed by the prefrontal cortex?

A

Speech, decision making

85
Q

What tests do people with schizophrenia show impairment on?

A

Neuropsychological tests of prefrontal cortex

86
Q

What did these tests show?

A

Failure to show frontal activation related to negative symptoms

87
Q

What happens due to loss of dendritic spines?

A

Disrupted communication among neurons

88
Q

What are 5 first generation antipsychotic medications?

A

Thorazine, Hadol, and Navane, Prolixin, Stelazine

89
Q

What effects do anti psychotic have?

A
  • Reduce agitation, violent behavior
  • Block dopamine receptors
  • Little effect on negative symptoms
90
Q

What are the side effects of extrapyramidal?

A

Tardive dyksinesia (involuntary movements)

91
Q

What do people with schizophrenia have to do to prevent relapse?

A

Maintain dosage

92
Q

What is an example of second-generation antipsychotics and its effects?

A
  • Clozaril (impacts serotonin and dopamine receptors)
  • Fewer motor side effects
  • Less treatment noncompliance
  • Reduces relapse
  • Target negative symptoms
93
Q

What are side effects of clozaril?

A
  • Can impair immune symptom functioning (agranulocytosis - loss in white blood cells)
  • Seizures, dizziness, fatigue, drooling, weight gain, diabetes
94
Q

What new medications help improve cognitive functioning?

A
  • Zyprexa

- Risperdal

95
Q

What are 6 second generation drugs?

A

Clozaril, abilify, zyprexa, risperdal, geodon, and seroquel

96
Q

Is weight gain common among people with schizophrenia?

A

yes

97
Q

What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) show about second generation drugs?

A
  • They are not more effective than first gen drugs
  • They did not produce fewer unpleasant side effects
  • Nearly three quarters stopped taking the medications before the study ended
98
Q

Why are people of color sometimes not prescribed second gen drugs?

A

They are at higher risk of diabetes, weight gain etc. and taking the drugs will exacerbate these conditions

99
Q

What is the Outcomes Research Team (PORT) treatment recommendation?

A

Medication plus psychosocial intervention

100
Q

What is social skills training? and skills they work on? through what type of practice?

A
  • Teach skills for managing interpersonal situations
  • Job application
  • Reading bus schedules
  • Role playing through in group and in vivo
101
Q

What parts of schizophrenia do families have a hard time understanding?

A

Negative symptoms

102
Q

What is the point of family therapy?

A
  • Educate family about causes, symptoms, and signs of relapse
  • Stress importance of medication
  • Help family to avoid blaming patient
  • Improve family communication and problem-solving
  • Encourage expanded support networks
  • Instill hope
103
Q

What percent of people actually recover from schizophrenia recover, commit suicide, and hospitalized?

A
  • 10%
  • 25%
  • 15%

EXAM 3 - Psych 405 (4 decks)

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