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PSYC 337 (psychopathology) > schizophrenia and psychosis > Flashcards

schizophrenia and psychosis Flashcards

1
Q

how were schizophrenia/psychotic disorders first conceptualized? by whom?

A
  • Emile Kraeplin first proposed groupings of psychotic symptoms
  • dementia praecox: a disorder with progressive deterioration beginning at an early age, characterized by disorganized thinking
  • encompassed what later became divided into bipolar and schz
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2
Q

who first introduced the term “schizophrenia”? how was it defined at the time?

A
  • Eugen Bleuler c. 1911
  • challenged Kraepelin’s ideas that dementia praecox was necessarily characterized by deterioration and always appeared at an early age
  • considered schz to be a group of disorders characterized by disorganization of thought and a split from reality
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3
Q

what are the 6 major symptoms of schizophrenia?

A
  1. disturbances in perceptions
  2. disturbances in content of thought
  3. disturbances in form of thought
  4. psychomotor disturbances
  5. disordered relating
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4
Q

what is the difference between illusions and hallucinations?

A
  • illusion: stimulus is present but misperceived
  • hallucination: stimulus is not present but perceived, or present but not perceived
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5
Q

what is a delusion?

A

a firmly held false belief based on incorrect inference, which is maintained despite contradictory evidence

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6
Q

what are the 13 types of delusions?

A
  1. control by outside force
  2. grandiosity
  3. nihilistic
  4. persecutory
  5. jealousy
  6. somatic
  7. delusions of reference
  8. thought withdrawal
  9. thought insertion
  10. thought diffusion/broadcasting
  11. made impulses
  12. made feelings
  13. made volitional acts
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7
Q

what are the 6 forms of disturbances in thought in people with schz?

A
  1. derailment
  2. word salad
  3. alogia (saying little)
  4. neologisms (new word or new meaning)
  5. blocking (stopping abruptly)
  6. illogical thinking
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8
Q

what are the 3 forms of disturbances in affect in people with schz?

A
  1. blunted/flat affect
  2. context-inappropriate affect
  3. problems perceiving others’ emotions
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9
Q

what are the symptoms of catatonia?

A
  1. catalepsy/waxy flexibility (doll-like)
  2. stupor (immobile, unresponsive)
  3. posturing
  4. mutism
  5. catatonic excitement
  6. catatonic negativism (immobile, resists efforts to be moved)
  7. echolalia (repeating words)
  8. echopraxia (repeating movement)
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10
Q

what are the 4 different forms of disordered relating in people with schz?

A
  1. socially withdrawn
  2. preoccupied with fantasy world
  3. disordered volition (acting without purpose)
  4. anhedonia
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11
Q

what is the diagnostic criteria for schizophrenia? (criterion A, how many other symptoms, time period, what needs to be ruled out)

A
  • criterion A: at least one of delusions, hallucinations, or disorganized speech/behaivour; markedly lower level of functioning prior to onset
  • (if only meet 1 of criterion A) + at least one of abnormal motor activity or negative symptoms
  • 6+ months, with at least 1 month of active symptoms
  • cannot be attributed to substance use, unipolar or bipolar depression, or schizoaffective disorder
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12
Q

what is the diagnostic criteria for schizoaffective disorder?

A
  1. must currently meet criteria for depressed mood
  2. must experience delusions or hallucinations for 2+ weeks in the absence of a mood episode
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13
Q

what is the prevalence of schizophrenia?

A

0.7-1%

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14
Q

what is the gender difference in the prevalence of schizophrenia? why does it exist?

A
  • slightly more common in men, childhood onset is far more common in boys
  • possible diagnostic bias: women present with more symptoms of depression and are more likely to be misdiagnosed
  • possible that female sex hormones are protective, which is why we see late onset schizophrenia
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15
Q

how does childhood schizophrenia usually present?

A
  • insidious onset
  • early speech and language problems
  • delayed motor development, poor coordination
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16
Q

how common is it for people with schz to live independently?

A

only 20-30% live alone or have a job

17
Q

according to a 15-year study, how common is recovery in people with schizophrenia, even if only periodic?

A
  • only 40% had one or more periods of recovery
  • this percentage is higher in developing countries, though it’s not clear why
18
Q

what is the avg life span of people which schz? why?

A
  • 20 yrs less than gen pop
  • suicide is main contributor, followed by cardiovascular disease (due to stress, substance use, pharmacological side effects)
19
Q

what prognostic indicators may predict a better outcome in people with schz

A
  1. good premorbid adjustment
  2. acute onset
  3. manic and depressive symptoms
  4. confusion or disorientation during psychosis
  5. family history of mood disorder
20
Q

what prognostic indicators may predict a worse outcome in people with schz?

A
  1. poor premorbid adjustment
  2. insidious, gradual onset
  3. negative symptoms, especially blunted affect
  4. family history of schz
  5. lower IQ (according to some studies)
21
Q

what % of people with schz attempt suicide? how many die by suicide?

A

20% attempt, 5% die

22
Q

what is the relationship between schz and aggression?

A
  • slight increase in risk of violent aggression for people with schz
  • aggression is most common in younger male patients with a history of violence or substance abuse
  • majority of schz patients are more likely to be victims than perpetrators of violence
23
Q

what are the 8 main risk factors for schz?

A
  1. low SES/social status
  2. advanced paternal age at conception
  3. birth complications, especially those leading to anoxia
  4. prenatal exposure to viral infections, especially during 2nd trimester
  5. born during late winter/early spring (more pronounced further from the equator)
  6. malnutrition during pregnancy
  7. disruptions in neural migration during 2nd trimester
  8. decreased brain volume/grey matter deficits
24
Q

what is the dopamine hypothesis of schizophrenia?

A
  • dopamine hypersensitivity can be caused by birth complications, which may increase risk of schizophrenia
  • positive relationship between dopamine levels and psychotic tendencies
  • high dopamine levels associated with aberrant salience, failure to respond to meaningful reward cues, abnormal oral-facial movements and upper-limb dyskinesias, and working memory deficits
25
Q

what is the proposed relationship between cannabis and schz?

A
  • causal relationship is unclear
  • THC increases dopamine synthesis
  • cannabis can exacerbate symptoms in people with the disorder
26
Q

what is the relationship between expressed emotion in families and schz

A
  • families high on EE (criticism, hostility, emotional over-involvement) may worsen outcomes for children with schz
  • high EE families are most likely to see schizophrenic children with odd and disruptive behaviour (while both high and low EE families had children with negative symptoms)
  • high EE is non-specific, as it also predicts worse outcomes in children with bipolar and depression, but seems to be protective for BPD
27
Q

what is the multiple hit model of schz development?

A
  1. genetic factors + prenatal and perinatal effects -> brain vulnerability
  2. brain vulnerability + stress + developmental maturation process -> psychosis
28
Q

what type of treatment sees the most promising effects in schz patients?

A
  • biobehavioural therapy: combines antipsychotic meds with psychosocial treatment
  • medication lessens biological vulnerability, while training in social and independent living skills can reduce behavioural vulnerability
  • family counselling and support services can reduce degree of life stress
29
Q

how do we differentiate between schz and bipolar I?

A
  • schz has no manic episode
  • psychotic symptoms in bipolar respond to lithium, while those in schz do not
30
Q

how do we differentiate between schz and schizoaffective disorder

A

schizoaffective has more prominent mood episodes that occur for the majority of the illness

31
Q

how do we differentiate between schz and cluster A PDs

A
  • cluster A PDs tend to not have as severe positive symptoms; less likely to have full blown delusions or hallucinations
  • cluster A PDs are associated with lower levels of impairment in daily functioning
32
Q

how do we differentiate between schz and delusional disorder?

A
  • delusional disorder’s psychotic symptoms are usually restricted to one or few delusions, in contrast with multiple psychotic symptoms that occur in schz
  • delusional disorder’s delusions are only sometimes accompanied by hallucinations, which are non-prominent, and directly relevant to the delusion
33
Q

how do we differentiate between schz and brief psychotic disorder

A

brief psychotic disorder symptoms occur for <1 month and resolve on their own, returning to a normal level of functioning

34
Q

how do we differentiate between schz and schizophrenoform disorder

A
  • schizophrenoform is diagnosed when a person has schz symptoms for between 1 and 6 months
  • has a better prognosis than schz

PSYC 337 (psychopathology) (8 decks)

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