schizophrenia pt 1 Flashcards
incidence of SZ
<1%
gender differences in SZ
similar numbers
later onset and fewer hospital admissions for women –> therefore higher social role before illness therefore better outcome
ethnicity differences in SZ
higher in ethnic minorities than white
due to racial prejudices for treatment in US
high stress from being in a minority is a trigger
for immigrants from LIDCs the stress and low economic status is a trigger
schizophrenia meaning
splitting of psychic functions
what comes first - pos or neg symptoms
positive - thought to then lead to withdrawals
positive symptoms (8)
hallucinations - auditory and visual
-reality-monitoring deficit (distinguish what did and didn’t occur)
self-monitoring deficit (distinguish between thoughts they generated or others did)
can be aware it isn’t real, others are convinced it is
inappropriate reactions/affective states
delusions & paranoia
psychosis (prolonged)
speech - incoherence or motor issues (speech patterns etc.)
incoherent thought
odd behaviours
violence and aggression - more common in younger boys with history of violence and substance abuse (DSM-5, 2013)
types of speech issues (5)
detrailment/loose associations = drift from one topic to another in speech and thinking
tangentiality = irrelevant answering
clanging = taking word sounds to mean related concepts e.g. rhyming
neologisms = made up words
word salad = no link between phrasing
types of delusions (7)
grandeur, persecution, conspiracy, control, reference (think external events make reference to them), nihilism, erotomanic (think celeb is in love with you)
negative symptoms (5)
social withdrawal
affective flattening (diminished emotions)
avolition (low/no motivation)
catatonia (motionless states - motor control)
anhedonia = inability to react to enjoyable events
types of catatonic state (4)
- catatonic stupor = decreased reactivity to the environment
- catatonic rigidity = staying rigid and immobile
- catatonic negativism = resisting an attempt to be moved
- catatonic excitement/stereotypy = purposeless and excessive motor activity
number of symptoms to lead to a diagnosis
2 frequently occurring for a month when one symptom is delusions, hallucinations, or disorganised speech
causes of SZ (4) (very vague - general list)
genetic
dopamine levels in brain
drug induced psychosis
environmental (stress)
R D Laing’s theory of SZ
antipsychiatry movement
society tells you you have it - distorted ideas of what is normal - “normal” is repressive
link with family - “sanity, madness, and the family” book
Freud’s theory of SZ
paranoid delusions result from repressed sexual urges which are striving for expression
SZ concordance in MZ and DZ twins
MZ = 45%
DZ = 10%
define epigenetics
how behaviours change how genes work
is reversible
DNA sequence is same but is read differently
genes for SZ
no single gene
related genes associated with:
brain development
myelination
transmission at glutaminergic and GABAergic synapses
changes in DA neuron physiology
link to other psychiatric and neurological disorders
impact of stress on SZ
correlation between stress levels and episode severity
environmental stressors
birth complications
maternal stress
prenatal infections
socioeconomic class
urban birth/living in urban setting
childhood adversity
these impact those with a genetic vulnerability
eye movements with SZ
controls have smooth pursuit movements, jerky with SZ
visuomotor deficits, can cause day to day issues e.g. reading maps
cognitive deficits with SZ - prepulse inhibition
startle response is less due to habituation from smaller stimuli in control - SZ don’t habituate and so are as startled as they would’ve been
result of dopaminergic changes
wisconsin card sorting task and SZ
executive function task where cards are needed to be sorted by either colour, symbol, or number
impaired in SZ and frontal lobe damage patients
e.g. perseverance errors - asked to sort by colour and then number but they continue to sort by colour
ToM and SZ vs ASD
differing theories:
some say ASD and SZ are opposite ends of the ToM spectrum (underactive in ASD and overactive in SZ - therefore delusions)
others say the comorbidity with ASD and SZ shows underactive ToM in SZ
cognitive biases in SZ (5)
cognitive - overreport confrontational interactions
attentional - anxiety from attending to negative stimuli
reasoning - jump to conclusions
interpretational - hearing voices
attributional
Seligman’s attributional model and SZ
attributions of negative events by 3 dimensions:
internal vs external
global vs specific
stable vs unstable
external, global, and stable = leads to delusions and paranoia
family impacts on SZ
double-bind and paradoxical communication = verbal message contradicts implied message
communication deviance
expressed emotion
causality is complicated - SZ can also lead to poor communication
SES and SZ
socioeconomic status
social drift = SZ have difficulty with employment and so have lower SES
sociogenic hypothesis = low SES – more stressful life (trigger for SZ)
dispute over whether parental SES at time of birth correlates with SZ
non-drug treatments of SZ
social skills training
CBT - reattribution therapy (learn hallucinations cause)
personal therapy
cognitive remediation training
family interventions - psychoeducation, supportive and applied family management
community care
