Schizophrenia and Psychosis Flashcards
Psychosis
The inability to distinguish between reality and unreality
Egen Bleuler’s take on Schizophrenia
Splitting of usually integrated psychic functions of mental associations, thoughts, emotions not splitting of personalities
Psychotic symptoms
- Negative Symptoms
- Delusions
- Hallucinations
- Disorganized thought
- Disorganized behaviour
Schizophrenia Spectrum
Number, severity and duration of symptoms can vary
- Distinguishes the psychotic disorders form one another
- cognitive deficits also common
Delusions
- False, unshakable beliefs that are held with strong conviction despite contradictory evidence
- Inappropriately high meaning and attention to irrelevant events
- Different from self-deceptions (possible, attended to occasionally, acknowledged that could be incorrect)
Hallucinations
- False or inaccurate perceptions that cause one to sense what others do not
- Auditory verbal hallucinations are most common (70-80% of people with schizophrenia)
- Visual hallucinations (24-72 with schizophrenia)
Prevalence of types of hallucinations
MOST COMMON
Auditory
Visual
Somatic, Tactile
Olfactory, Gustatory
LEAST COMMON
Neuroscience and Hallucinations
- Auditory hallucinations produce signals of sound - brain ‘hears’ them
- Activity in Broca’s area (production of sounds, including speech)
- Activity in areas that perceive sound
- Recognized as sounds coming from within
Formal thought disorder
Disorganized thinking
- Not a disorder, thought is in disorder
Loose associations
Slipping from one topic to seemingly unrelated topic
Neologisms
Made-up words that mean something only to the speaker
Clangs
Words associated by sound not content (rhyming)
Disorganized thought and speech
- Formal Thought disorder
- Loose associations
- Neologisms
- Clangs
- Can be incoherent, speaking in ‘word salad’
- Men show more language deficits than women
Disorganized Behavior
- Unpredictable, apparently untriggered agitation
- Difficulty organizing daily routines
- socially unacceptable behavior
- Catatonia
Catatonia
Noticeable psychomotor dysfunction; decreased or excessive peculiar motor activity
- Negativism: lack of response to instructions
- Mutism: lack of verbal or motor responses
- Catatonic excitement: purposeless excessive motor movement
Negative Symtpoms
Loss of certain qualities
- Restricted Affect
- Alogia
- Avolition
- Asociality
More strongly associated with poor outcomes than positive symptoms (more persistent, difficult to treat)
Restricted Affect
Severe reduction or absence of emotional expression
Alogia
Reduction of speech
Avolition
Inability to initiate or persist at common goal-directed activities
Asociality
Lack of desire to interact with people
Cognitive Deficits
- Affecting attention, memory, and processing speed
- Difficulty paying attention to relevant information and suppressing unwanted or relevant information (poor filtering of stimulation and information) (may contribute to positive symptoms)
- Commonly experienced before disorder onset
- Family members commonly experience these symptoms, but to a lesser degree
Chrobak et al. eye tracking study
- Participants asked to keep head still and track a moving object back and forth with eyes
- Patients with schizophrenia scored worse on smooth-pursuit eye movement (may be related to attention problems
Diagnosing Schizophrenia
- Two psychotic symptoms must be consistently and acutely present at least 1 month
- at least one symptom should be hallucinations, delusions, or disorganized speech
- an acute phase
- Other symptoms that impair functioning must be present for at least 6 months
Acute phase
period involving consistent and intense psychotic symptoms
Schizophrenia prevalence
1% lifetime prevalence in Canada
Stages of schizophrenia
Premorbid - no or few symptoms
Prodromal - Attenuated symptoms (6 month period, mild psychotic symptoms causing functional decline)
Syndromal - Psychotic symptoms (acute period - 1 month to 1 year)
Chronic or Residual - Psychotic symptoms, negative symptoms, cognitive symptoms, functional disability (Mild symptoms)
Schizophrenia onset
- Earlier onset = worse prognosis
- Not common to emerge before 13 - onset usually after puberty
- May see cognitive deficits or negative symptoms before
- Rare to have onset after 40
Schizoaffective
- Psychotic symptoms mixed with mood symptoms
- Major depressive OR manic episodes
- At least two weeks of hallucinations or delusions without mood symptoms
What is the order of functionality impairment of schizophrenia related disorders?
MOST IMPAIRMENT
- Schizophrenia
- Schizoaffective
- Brief Psychotic Disorder
- Delusional Disorder
- Schizotypal personality disorder
Schizophreniform
Only 1-6 months of symptoms
- 2/3/ go on to meet criteria for schizophrenia
Brief Psychotic Disorder
Sudden onset of symptoms
- Common after major stressor but doesn’t have to happen
Lasts 1-30 days followed by complete remission - Usually only positive symptoms
- Relapse is common
Delusional Disorder
- Delusions about real-life occurrences for at least one month
- no other psychotic symptoms, no other changes in functioning
- Not a psychotic disorder but puts people at higher risk
Heritability of schizophrenia
41-87%
Biological approach to theories of schizophrenia
- Reduction in gray matter across cortex
- Reduction in white matter in areas associated with working memory (also seen in family members without schizophrenia
- Abnormal activity in PFC
- Enlarged ventricles
- Prenatal exposures and birth complications
- Excess dopamine in PFC and limbic system (increased HPA axis activity may cause changes in dopamine production, antipsychotic medication works to block dopamine receptors)
Psychosocial Contributors to schizophrenia
- More likely to emerge in chronically stressful circumstances
- living in populated areas
- Childhood trauma linked with adulthood psychosis
Goldberg and Morrison study on schizophrenia and SES
- Men with schizophrenia end up with lower SES than their fathers
- Men without schizophrenia end up in similar or higher SES than fathers
- Social drift as a reuslt
