Schizophrenia/Psychosis Flashcards
What are positive symptoms in schizophrenia?
Things that are present but shouldn’t be there.
- Halluzinations -> Perceiving things that aren’t there
- Delusions -> Convictions and certain thoughts that do not aline with the believes that most people in the world would see as valid
What are negative Symptoms in schizophrenia ?
Things that should be present but are not.
- difficulties expressing emotions and planning
- disinterest in activities of daily life
- lack of motivation
- isolating
What are cognitive symptoms in Schizophrenia?
Difficulty with attention and applying information to make decisions.
- eg.: executive functioning, memory
What are the consequences if all of these symptoms occur?
Loss of reality and disconnection with the surroundings.
How is the definition for hallucinations?
= a sensory perception without an external source while being awake
How can you explain bottom-up processing?
Perceiving sensory information (eg.: seeing, hearing,…) and trying to integrate it. (data driven)
-> eg.: “What am I seeing?”
How can you explain top-down processing?
Using previous knowledge, theories, models (background knowledge) to interpret/categorize sensory information.
- eg.: “Is that something that I have seen before?”
- makes processing faster (the more knowledge the faster it is) -> eg.: seeing head of a horse, you immediately know that it is a horse, so you don’t have to see the whole horse to know that
What happens if you have no sensory information for some time (no bottom-up processing)
- sensory deprivation
- Studies showed that individuals who don’t perceive anything (no seeing, no hearing,…) start hallucinating (eg.: Black box study)
What showed the Black box study?
individuals who don’t perceive anything (no seeing, no hearing,…) start hallucinating
- eg.: hearing sounds of traffic (because they expect to hear that)
How can the expectation of something happening influence hallucinations?
eg.: if somebody is expecting a phone call, they can actually feel the phone vibrating or hear it ringing from time to time
Do individuals with a hearing impairment experience hallucinations?
Yes, the worse the hearing impairment the more hallucinations. -> BUT not when they are born blind.
=> the more deprived sensory organs are, the higher the chance/percentage of hallucinations
What types of hallucinations exist?
- Visual hallucinations
- Auditory
- gustatory
- tactile
- olfactory
- proprioceptive -> hallucinating about the position of a body part
- thermoceptive
- nociceptive -> pain
- equilibrioceptive -> balance
What are the most typical hallucinations in psychosis?
Auditory verbal hallucinations (AVH) -> hearing voices
Describe auditory verbal hallucinations (AVH)?
- hearing speech while there is no source
- speech is not recognized as self-derived
- it’s a perceptual phenomenon, not thoughts or ideas
- the voices can be heard inside or outside of the head
Can hallucinations also occur in other psychiatric disorders or healthy individuals?
Yes. eg.: bipolar disorder, lewy-body dementia, anxiety,…
What showed the study of Sommer et al. (2012) about hallucinations in other disorders?
It showed that hallucinations are also common in other psychiatric disorders (but still often taboo topic) and showed the important to differ between hallucinations due to neurological or psychiatric diagnosis:
- Neurological disorders: visual hallucinations are more common
- Psychiatric disorders: auditory hallucinations are more common
- Age of onset: is early in psychiatric disorders
- individuals with neurological disorders often experience also other types of symptoms -> eg.: hearing loss
What is the psychosis continuum?
Psychotic experiences: 8% of population
- Eg.: hearing the door bell ring while waiting for a zalando package
- Psychotic symptoms: 4% of population
- Psychotic disorder: 3% of population
In which age group are auditory hallucinations most prevalent?
In children and adolescents (12%).
How do hallucinations differ in schizophrenia patients and healthy individuals with frequently non-clinical hallucinations (Sommer et al.,2010; Daalmann et al., 2012)?
Schizophrenia patients:
- hallucinations are unpleasant (even threatening)
- Age of onset: on average adolescents
non-clinical hallicinating individuals:
- less frequently and shorter duration than S
- hallucinations are mostly pleasant or neutral
- more controllability than S
- no distress or interruption in their daily life due to the hallucinations
- Age of onset: often young
=> but location, loudness, and number of voices are often similar
What are risk factors to develop a psychosis?
- Genetics
- Social and environmental factors:
○ Immigration
○ Urbanicity
○ Drug abuse (cannabis)
○ Pre- and perinatal infections
○ Stress
- Social and environmental factors:
- Childhood trauma
How much increases the experience of childhood trauma the risk to develop psychosis?
about approx. 3 times
Does childhood trauma only lead to pathological AVH?
No, the early experience of trauma can also lead to non-pathological AVH in individuals.
=> childhood trauma triggers a general vilnerability for AVH
What did the study of Begemann et al. (2022) show about the association of childhood trauma clusters and AVH?
Low trauma cluster:
□ they score low at every type of trauma
□ Mostly even distribution of patients, controls, and non-clinical AVH
Emotion-focused cluster:
□ They showed Intermediate score on physical and sexual abuse, but high scores on emotional neglect and emotional abuse
□ Half of the participants were non-clinical AVH, 35% patients, and 15% healthy controls
□ Voices:
- Greater control over voices (vs. Multi-trauma cluster)
- voices start at an Earlier age (vs. Low trauma cluster)
- Voices are perceived as more benevolent (=wohlwollend)
Multi trauma cluster:
□ They scored high on every or multiple type of trauma
□ 75% of paticipants were patients, 23% non-clinical AVH, barely healthy controls
□ Voices:
- More negative content
- Less control (vs. Emotion-focused cluster)
- Voices are perceived as more malevolent & omnipotent (vs. Low trauma cluster)
- Increased resistance towards voices
What new treatment perspectives are induced due to the childhood trauma findings?
trauma treatment for schizophrenic individuals who experienced childhood abuse
