Schizophrenia and other psychoses Flashcards
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
2
Q
How does schizophrenia affect people’s interpersonal life and independence?
A
It can disrupt interpersonal relationships and diminish capacity to live independently
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
4
Q
Define schizophrenia
A
Neurodevelopmental disorder that is associated with neurocognitive impairment
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
6
Q
What makes schizophrenia different than mood disorders?
A
It is primarily cognitive
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)
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
9
Q
What are examples of disorganized symptoms?
A
- Disorganized behavior
- Disorganized speech
10
Q
Define delusions
A
- Firmly held beliefs
- Contrary to reality
- Resistant to disconfirming
evidence
11
Q
Define hallucinations
A
- Sensory experiences in the absence of sensory stimulation
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
13
Q
Outline different types of hallucinations
A
- Auditory: 74% have this symptom
- Visual (negative and scary)
- Hearing voices
14
Q
What area of the brain is activated during hallucinations?
A
Broca’s area
15
Q
What is thought insertion?
A
Some device has inserted thoughts inside your head without consent
16
Q
What are delusions?
A
False beliefs
17
Q
What are grandiose delusions?
A
Feelings of ultimate superiority: believing you are Jesus
18
Q
What are ideas of reference?
A
Watching TV and you think the newscaster is speaking directly to you
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
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)
21
Q
Define avolition
A
- Lack of interest; apathy
22
Q
Define asociality
A
Inability to experience pleasure in social situations
23
Q
Define blunted affect
A
Exhibits little to no affect in face or voice
24
Q
Define alogia
A
Reduction in speech
25
What are 3 movement symptoms of schizophrenia?
1) Catatonia
2) Catatonic immobility
3) Waxy flexibility
26
Define catatonia
- Motor abnormalities
- Repetitive, complex gestures (usually of the fingers or hands)
- Excitable, wild flailing of limbs
27
Define catatonic immobility
- Maintain unusual posture for long periods of time e.g. stand on one leg
28
Define waxy flexibility
Limbs can be manipulated and posed by another person
29
Where are the rates of schizophrenia better?
Rural areas
30
What is the lifetime prevalence of schizophrenia?
1%
31
Is schizophrenia more common in men or women?
Men
32
When is schizophrenia typically diagnosed?
Late adolescence or early adulthood (18-35)
33
Do men or women have early onset of schizophrenia?
Men
34
Why are delusions developed?
To explain hallucinations
35
What do hallucinations occur concurrently with?
Delusions
36
What does social functioning look like in men with schizophrenia?
Poor social functioning; more schizotypal traits
37
What does social functioning look like in women with schizophrenia?
Good social functioning; fewer schizotypal traits
38
Do men have more negative or positive traits and what do those look like?
Negative symptoms; more withdrawn and passive
39
Do women have more negative or positive traits and what do those look like?
More positive symptoms: hallucinations and paranoia; more emotional and impulsive
40
What does the course of schizophrenia look like in men?
More chronic, poorer response to treatment
41
What does the course of schizophrenia look like in women?
Less often chronic; better response to treatment
42
Define schizophreniform disorder?
- Same symptoms as schizophrenia
| - Symptom duration greater than 1 month but less than 6 months
43
Define brief psychotic disorder
- Symptom duration of 1 day to 1 month
| - Often triggered by extreme stress, such as bereavement
44
Define schizoaffective disorder
- Symptoms of both schizophrenia and mood disorder
| - DSM5 likely to require appearance of major depressive or manic episode
45
What happens to people with these other psychotic disorders?
2/3rds develop schizophrenia or schizoaffective disorder
46
What is schizotypal personality disorder?
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
*** Test hints ***
- 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
What is delusional disorder?
- 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
How are genetic and environmental factors playing a role in the etiology of schizophrenia?
- 86% of the variance of schizophrenia is due to genetic factors
- Family studies
- Adoption studies
50
Do MZ or DZ twins have a higher rate concordance rate for schizophrenia? What are those rates?
MZ - 100% genetic overlap and DZ - 50% genetic overlap
51
What increases the risk of schizophrenia?
Degree of genetic relatedness through relatives even if the relatives have not shared specific environment with the patient
52
Is schizophrenia caused by single gene?
Not likely that the disorder is caused by a single gene
53
What type of symptoms have a stronger genetic component?
Negative symptoms
54
According to twin studies what is the risk for MZ compared to DZ?
44% risk for MZ twins and 12% risk for DZ twins
55
What do adoption studies tell us about schizophrenia?
Increased likelihood of developing psychotic disorders
56
What is transmitted from genotype to phenotype?
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
Are genetic factors sufficient for the development of schizophrenia?
Interaction between genes plus non genetic environmental factors
58
Describe the Diathesis-Stress Model of Schizophrenia?
- 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
What is a gene environment interaction?
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
What is an example of a gene-environment interaction?
Differential effect of cannabis on risk of schizophrenia based on COMT Val/Met allele
61
What is the COMT gene related to?
Metabolism of dopamine and disturbance of schizophrenia
62
What does the "Association Between Cannabis and Risk for Schizophrenia" Graph show?
- 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
What are somatic hallucinations?
- 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
What are other examples of hallucinations in schizophrenia?
- 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
What causes schizophrenia?
Although genetic factors play a major role
66
What brain structures are affected in people who have schizophrenia?
Hippocampus, amygdala, hypothalamus, nucleus, cingulate gyrus, prefrontal cortex
67
What is the dopamine theory?
Schizophrenia is due to excess levels of dopamine
68
How do drugs to treat schizophrenia work?
They alleviate symptoms reducing dopamine activity
69
What effect do amphetamines have?
Increase dopamine levels which can induce psychosis
70
What is the dopamine theory revised?
There is an excess numbers of dopamine receptors or oversensitive dopamine receptors
71
Where are the dopamine receptors localized?
Mesolimbic pathway
72
What are mesolimbic dopamine abnormalities related to?
Positive symptoms
73
What is underactive dopamine activity in the mesocortical pathway mainly related to?
Negative symptoms
74
What are the environmental factors of the brain structure and function especially during birth? Explain this.
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
What are to case study examples of viral damage to the fetal brain?
- 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
Why doesn't the dopamine theory completely explain schizophrenia?
- Anti psychotics block dopamine rapidly but symptom relief takes several weeks
- To be effective, antipsychotics must reduce dopamine activity to below normal levels
77
What are other neurotransmitters other than dopamine involved?
- Serotonin
- GABA
- Glutamate
78
What medication shows promise?
Ones that targets glutamate
79
What cortex matures in adolescence and early adulthood?
Prefrontal cortex
80
When does dopamine peak?
Adolescence
81
How is cortisol connected to dopamine activity?
Stress activates HPA system which triggers cortisol secretion --> cortisol increases dopamine activity
82
How are synaptic connections made?
Excessive pruning
83
What is cannabis use during adolescence associated with? What does this explain?
Increased risk of developing schizophrenia which can explain why symptoms appear in late adolescence but brain damage occurs in early in life
84
What behaviors disrupted by schizophrenia are governed by the prefrontal cortex?
Speech, decision making
85
What tests do people with schizophrenia show impairment on?
Neuropsychological tests of prefrontal cortex
86
What did these tests show?
Failure to show frontal activation related to negative symptoms
87
What happens due to loss of dendritic spines?
Disrupted communication among neurons
88
What are 5 first generation antipsychotic medications?
Thorazine, Hadol, and Navane, Prolixin, Stelazine
89
What effects do anti psychotic have?
- Reduce agitation, violent behavior
- Block dopamine receptors
- Little effect on negative symptoms
90
What are the side effects of extrapyramidal?
Tardive dyksinesia (involuntary movements)
91
What do people with schizophrenia have to do to prevent relapse?
Maintain dosage
92
What is an example of second-generation antipsychotics and its effects?
- Clozaril (impacts serotonin and dopamine receptors)
- Fewer motor side effects
- Less treatment noncompliance
- Reduces relapse
- Target negative symptoms
93
What are side effects of clozaril?
- Can impair immune symptom functioning (agranulocytosis - loss in white blood cells)
- Seizures, dizziness, fatigue, drooling, weight gain, diabetes
94
What new medications help improve cognitive functioning?
- Zyprexa
| - Risperdal
95
What are 6 second generation drugs?
Clozaril, abilify, zyprexa, risperdal, geodon, and seroquel
96
Is weight gain common among people with schizophrenia?
yes
97
What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) show about second generation drugs?
- 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
Why are people of color sometimes not prescribed second gen drugs?
They are at higher risk of diabetes, weight gain etc. and taking the drugs will exacerbate these conditions
99
What is the Outcomes Research Team (PORT) treatment recommendation?
Medication plus psychosocial intervention
100
What is social skills training? and skills they work on? through what type of practice?
- Teach skills for managing interpersonal situations
- Job application
- Reading bus schedules
- Role playing through in group and in vivo
101
What parts of schizophrenia do families have a hard time understanding?
Negative symptoms
102
What is the point of family therapy?
- 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
What percent of people actually recover from schizophrenia recover, commit suicide, and hospitalized?
- 10%
- 25%
- 15%
