Schizophrenia And Other Psychotic Disorders

Question 1

What is schizophrenia spectrum disorder? P 484

Answer 1

It constitutes the group of diagnoses covered in the chapter.
Under this umbrella of schizophrenia spectrum disorders includes;
Schizophreniform, schizoaffective, delusional, brief psychotic disorder, schizotypal personality disorder.

Question 2

Mental health workers typically distinguish between 3 dimensions of symptoms of schizophrenia p 484,
What are these 3 dimensions?

Answer 2

Positive symptoms - generally refer to symptoms around distorted reality.
Negative symptoms - involve deficits in normal behaviour in such areas as speech, blunted affect, and motivation.
Disorganised symptoms- rambling speech, erratic behaviour and inappropriate affect (eg smiling when upset)

Question 3

A diagnosis of schizophrenia requires? P 484

Answer 3

Two or more positive, negative snd or disorganised symptoms to be present for at least one month, with at least one of these symptoms included delusions, hallucinations or disorganised speech.
Severity is based on dimensional assessment.

Question 4

What is the prevalence of positive symptoms of schizophrenia? P 484

Answer 4

Between 60% and 80% experience hallucinations
Approximately 70% experience delusions

Question 5

A belief that is seen by most members of a society as a misrepresentation of reality is called? P 484

Answer 5

Disorder of thought content or a delusion

Question 6

What is a delusion of grandeur? P 484

Answer 6

A mistaken belief that the person is famous or powerful

Question 7

A common delusion of schizophrenia is that others are out to get them, referred to as? P 484

Answer 7

Delusions of persecution- which can be the most disturbing.

Question 8

The numerous theories attempting to explain why someone would come to believe such obviously improbable things (eg that you are a human robot repeating the same thing endlessly) can be summarised into two themes being? P485

Answer 8

A motivational view of delusions - looks at these beliefs as attempts to deal with and relieve anxiety and stress. A person develops stories around some issue. Preoccupation with the delusion distracts the person from the upsetting aspects of the world, such as hallucinations.

Deficit view of delusions - sees these beliefs as resulting from brain dysfunction that creates these disordered cognitions or perceptions.

Question 9

Negative symptoms characteristic of schizophrenia include? P 487

Answer 9

Avolition (apathy): inability to initiate and persist in activities
Alogia: relative absence of speech
Anhedonia: presumed lack of pleasure
Asociality: a lack of interest in social interactions
Affective flattening: a lack of emotional expression (although they may be feeling appropriately on the inside)
A study indicated that high risk children who showed less positive but more negative affect typically developed schizophrenia later, thus expression of emotion may be a potential predictor/ identifier.

Question 10

Development p 494
Discuss

Answer 10

The more severe symptoms of schizophrenia first occur in late adolescence or early adulthood although signs may be present in early childhood. Children who go on to develop schizophrenia show early clinical features such as mild physical abnormalities, poor motor coordination and mild cognitive and social problems. Unfortunately these are not specific enough to schizophrenia.
Up to 85% of people go through a prodromal stage a one to two year period before the serious symptoms occur but when less severe yet unusual behaviours start to emerge. These behaviours are the ones seen in schizotypal personality disorder; ideas of reference, magical thinking and illusions (such as feeling the presence of another person when they are alone) …

Question 11

Natural History of schizophrenia stages p 495

Answer 11

Question 12

Schizophrenia and cultural contributions / causes p 495
Discuss

Answer 12

Schizophrenia is universal, experienced in all walks of life.
The course and outcome of schizophrenia vary from culture to culture. The stressors associated with significant political, social and economic problems that are prevalent in many areas of Africa, Latin America and Asia contribute to poorer outcomes. The lack of adequate mental health infrastructure in low and middle income countries is also a problem for providing consistent care…
In the United States, proportionally more African Americans receive the diagnosis than European Americans. … They may be victims of bias and stereotyping…
An additional factor contributing to the imbalance may be the level of stress associated with factors like stigma, isolation and discrimination.

Question 13

Schizophrenia and genetic influences p495
Discuss -Findings from family studies

Answer 13

Despite the possibility that schizophrenia may be several different disorders, we can safely say genes are responsible for making some individuals vulnerable to schizophrenia.
Family studies show p 496 families that have a member with schizophrenia are at risk not just for schizophrenia alone or for all other disorders; instead, there appears to be some familial risk for a spectrum of psychotic disorders related to schizophrenia .
Twin and adoption studies show ; approximately 48% chance of having schizophrenia of it has affected your identical twin, 17% with a fraternal twin, and having any relative with schizophrenia makes you more likely than someone without such a relative (about 1% if you have no relative).

Question 14

Schizophrenia and genetic influences p497
Discuss -Findings from adoption studies

Answer 14

Sample of around 20,000 women with schizophrenia, researchers found 190 children who had been given up for adoption.
Data supports the idea that schizophrenia represents a spectrum of related disorders all of which overlap genetically.
Adopted child with biological mother with schizophrenia = around 5% chance of developing schizophrenia.
Adopted child with biological mother with schizophrenia or one of the related psychotic disorders, risk rose to about 22% for child developing one of these disorders.
At the same time this study showed the gene environment interaction at play with a good home environment reducing the risk of schizophrenia.

Question 15

What is endophenotyping?
Schizophrenia genetic research p 499

Answer 15

Researchers try to find basic processes that contribute to the behaviours or symptoms of the disorder and then find the gene or genes that cause these difficulties.

Question 16

Schizophrenia and neurobiological influences p500
Discuss Dopamine related drugs and the assumptions made from observations.

Answer 16

Antipsychotic drugs (neuroleptics) often effective in schizophrenia treatment- they are antagonists, partially blocking the brain’s use of dopamine

These neuroleptic drugs can produce negative side effects similar to those in Parkinson’s disease, caused by insufficient dopamine.

L-Dopa, a dopamine agonist used to treat Parkinson’s disease, produces schizophrenia like symptoms in some people.

Amphetamines which also activate dopamine can make psychotic symptoms worse in some people with schizophrenia.

Taking these observations together, researchers theorised that schizophrenia in some was attributed to excessive dopamine activity

Question 17

Schizophrenia and neurobiological influences p500
Discuss Dopamine related drugs and the assumptions made from observations - the evidence that contradicts dopamine theory.

Answer 17

A significant number of people with schizophrenia are not helped by the use of dopamine antagonists

Although the neuroleptics block the reception of dopamine quite quickly, the relevant symptoms subside only after several days or weeks.

These drugs are only partly helpful in reducing the negative symptoms.

Question 18

Treatment of schizophrenia p504
In western societies, treatment typically begins with?

Answer 18

One of the neuroleptic drugs invaluable in reducing symptoms. They are typically used with a variety of psychosocial treatments to reduce relapse, compensate for skills deficits and improve cooperation for taking medication.

Question 19

Treatment of schizophrenia
Biological interventions p 505

Answer 19

Basically talks about the history and non beneficial treatments although electroconvulsive therapy ECT is used today with a limited number of people in combination with antipsychotic medication

Question 20

Treatment of schizophrenia
Antipsychotic medication p 505

Answer 20

Adds to earlier discussion about dopamine findings to add that these dopamine antagonists can affect other systems such as the serotonergic and glutamate systems.

Adds to earlier discussion on neuroleptics to say that when these are effective, they help clearer thinking and reduce hallucinations and delusions and work to a lesser extent the negative and disorganised symptoms such as social deficits.

Question 21

Treatment of schizophrenia
Noncompliance with medication why
p 506

Answer 21

In one large study 74% had stopped taking their medication 18 months after initial use.
Why:
Negative doctor patient relationship
Cost of medicine
Stigma
Poor social support
Negative side effects a major reason which include
Antipsychotics: grogginess, blurred vision, dryness of mouth
Because these drugs affect neurotransmitter systems, more serious side effects called extrapyramidal symptoms can also result such as motor difficulties similar to Parkinson’s disease.
For example
Akinesia - one of the most common and includes expressionless face, slow motor activity and monotonous speech
Tardive dyskinesia involves involuntary movements of the tongue, face, mouth or jaw and can include protrusions of the tongue, puffing of the cheeks…..

Question 22

Treatment of schizophrenia
Psychosocial interventions p 507

Answer 22

Talks about the modest at best results of psychoanalytical and psychodynamic approaches where they delve into past trauma.
Talks about the token economy environment which was one of the first to show that people living with schizophrenia can learn to perform some skills needed to live more independently.
Talks about the experienced social skills deficit and the focus on reteaching such as basic conversation, assertiveness and relationship building. Use role playing

Question 23

Treatment- independent living skills program p 508

Answer 23

Focus is on helping people take charge of their own care by such methods as identifying signs that warn of a relapse and learning how to manage their medication.
Preliminary evidence is good however long term outcome research is still needed.

Question 24

Treatment of schizophrenia
Psychosocial interventions p 509
Discuss behaviour family therapy

Answer 24

Resembles classroom education,
Family members are informed about schizophrenia and myths debunked such as they caused the disorder, taught practical facts about antipsychotics and their side effects. They are helped with communication skills so that they are more empathetic and they learn constructive ways of expressing negative emotions to replace the harsh criticism that characterises some family interactions…
Research on social skills training outcome suggests that the effects of behavioural family therapy are significant in the first year but less robust 2 years after intervention. This type of therapy therefore must be ongoing if patients and their families are to benefit.

Question 25

An integrative treatment approach: schizophrenia p 510