Schizophrenia Spectrum Flashcards
Why is schizophrenia considered to be one of the most problematic mental illnesses?
It is poorly understood. It is heterogenous-presents in a variety of different ways (20-30). Severely debilitating, comorbid with depression and substance abuse. Social drift is frequent with many ending up in poverty. Also expensive (around 6.85 billion dollars per year in Canada)
What are the 3 phases of schizophrenia?
Prodromal
Active
Residual
What is the prodromal phase?
Obvious deteriorating in functioning. Pre-diagnosis, disorder is ramping up. Possible development of schizotypal disorder.
What is the active phase?
Happens in late teens, early adulthood. Symptoms like hallucinations (most commonly sends people to hospital), delusions, disorganized speech
What is the residual phase?
Symptoms in the active phase slow down. Schizo is not always chronic or severe-can slow down fast.
What are positive symptoms?
Observable symptoms. Very determinant of the disease, active
What are some of the positive symptoms of schizophrenia?
Hallucinations
Delusions
Disorganized symptoms
Bizarre behaviour
What are hallucinations?
Misinterpretations of sensory perceptions while awake. Usually auditory (voices), commenting on your behaviour in a mean way. True belief that someone is speaking to you. May hear murmurs or laugher of children
What are delusions?
Idiosyncratic, irrational, extreme, rigidly held beliefs defended by patient against all evidence.
What are disorganized symptoms?
Disorganized speech, tangentiality (ideas all over the place), perseveration, loose associations. Speech that is impossible to understand
What is bizarre behaviour?
Catatonia, unpredictable movements, incongruity of affect or behaviour (laughing at sad or hurtful things), grossly disorganized behaviour
What are negative symptoms?
The reason that many people are hospitalized-belief that they have severe depression
What are some affective and emotional disturbances experienced?
Affective flattening (0 reactions). Anhedonia (inability to experience pleasure)
What other negative symptoms can people with schizophrenia experience?
Apathy, avolition, alogia. Social withdrawal, indecisiveness, poverty of thought content, thought blocking
What is clinical apathy?
People continue to do the same thing over a period of time without response to other requests.
What is avolition?
Person seems to have no will
What is alogia?
Inability to make logical connections-poverty of thought content
What is criterion A of the diagnosis of schizophrenia?
Two or more of the following, each present for a specific portion of the time during a one month period (or less if successfully treated). At least one of these must be 1, 2, or 3.
1) Delusions
2) Hallucinations
3) Disorganized speech (Frequent derailment, incoherence)
4) Grossly disorganized such as catatonic behaviour
5) Negative symptoms
What is criterion B in the diagnosis of schizophrenia?
For a significant portion of time since the onset of the disturbance, there has been a decline in social or occupational behaviour for at least 3 months
What is criterion C in the diagnosis of schizophrenia?
Continuous signs of disturbance that persist for 6 months
What is criterion D of the diagnosis of schizophrenia?
Mood disorders have been ruled out. If they have been present, must have been briefly during the active phase or the residual phase
What is criterion E of the diagnosis of schizophrenia?
Not due to the direct effects of a drug, medication, or general medical condition
What is criterion F of the diagnosis of schizophrenia?
If there is autism or another pervasive disorder then prominent hallucinations and delusions must be present for at least a month
What is the lifetime prevalence of schizophrenia?
Between 0.5-1%.
How many people per year get diagnosed with schizophrenia?
1/10000 per year
What is the mean age of onset?
25-40
What percentage of patients experiences their first symptoms by age 25?
71%
What percentage of patients have a favourable prognosis (respond well to medication and therapy)?
50%
What increases the likelihood that the condition is chronic?
If the condition is more severe at the beginning
How many years are taken off life expectancy of someone with schizophrenia?
12-15 years.
What are the gender differences with schizophrenia?
Men and women experience it equally, although men have symptoms 4-5 years earlier, more likely to experience negative symptoms, and have a chronic debilitating course.
What predicts a better prognosis of schizophrenia?
Being female, rapid onset, predominance of positive symptoms, good pre-disorder functioning, personal characteristics, resources.
What are some cultural issues associated with schizophrenia?
People “seeing visions” is considered acceptable and respectable. Less common now. Schizophrenia is a relatively recent diagnosis and emerged with the industrial revolution.
What was discovered in 2014 relating to the biological factors of schizophrenia?
The Psychiatric Genomics Cortisum ID’d 108 loci associated with Schizophrenia. 83 are newly discovered genetic regions
What are the important discoveries that came from the 2014 study?
Many genes involve the functioning of neurotransmitters like dopamine and glutamate
Strongest findings concern Chromosome 6 which is involved in immune functioning
Many alleles that indicate a high risk for schizo are also at a high risk for bipolar disorder
What else was shown about schizophrenia using biological research?
Allele mutations, deletions, and duplications may play a role. Allele deletions and duplications play a role in autism, ADHD, and intellectual disability. Schizophrenia could be a neurodevelopmental disorder
What are some things that were discovered about the neuropathology of schizophrenia?
Based on fMRI, MRI and PET scans, we discovered abnormally reduced frontal brain volumes and frontal brain blood flow. Abnormalities also arise in the left temporal lobe, amygdala, and hippocampus.
What do neuropsychological tests indicate about people with schizophrenia?
Most are cognitively impaired with a low IQ
What is the dopamine hypothesis?
Schizophrenia may be caused by a dysregulation of dopamine (too much dopamine).
What other neurotransmitters may be involved with schizophrenia?
Serotonin and glutamate- people with schizophrenia may have lower levels of glutamate in the prefrontal cortex and hippocampus
What are some developmental factors that could relate to schizophrenia?
Pregnancy complications including virus exposure, prolonged labour, preterm delivery, low birth weight, fetal distress.
What types of impairment do children who are at risk for schizophrenia show?
Motor impairment, cognitive limitations, social withdrawal, aggression
How much do ACE’s increase the likelihood of a psychotic disorder?
Triples the likelihood.
Which SES usually has a higher prevalance of schizophrenia and why is this?
Lower SES. Unsure of whether the disorder causes low SES or low SES causes the disorder. May be one of the stressors that contributes.
Why did the Industrial Revolution bring about a rise in Schizophrenia?
Increased urbanisation under problematic conditions, including abject urban poverty, may have contributed. A Danish study shows that schizophrenia may be associated with urban living-as people live longer, and in larger cities, they are more likely to develop the disorder
What are some of the cognitive problems associated with schizophrenia?
Impaired problem solving, memory deficits, impaired learning and word recall. Patients performance on various neuropsychological tests have been used to ID subtypes.
What is Meehl’s theory of schizophrenia?
There is a biological diathesis (hypokrisia) Expression of gene is affected by other genetics and psychosocial circumstances. Results in cognitive slippage leading to positive symptoms and aversive social encounters. Brain amplifies negativity in social situations and weakens pleasure resulting in an aversive drift that leads to negative symptoms
What are some of the cognitive subtypes of schizophrenia?
Impaired problem solving
Memory deficits-memory impaired
Cognitively impaired
Cognitively normal
What does cognitive slippage + aversive drift lead to?
Schizotypia
What are moderator characteristics (Meehl)?
Intelligence, artistic talent, personality all may determine the emergence of full-blown schizo. People who are psychotic, but not compensated (can control feelings)
What does it mean that someone with schizophrenia is decompensated?
No longer can manage symptoms of their condition, full condition explodes
What are the strengths of Meehl’s theory?
-One of the first detailed psychological theories of schizophrenia. Early integrative theory (integration of biological and social factors)
What are the weaknesses of Meehl’s theory?
- Vague with regard to processes such as hypokrisia
- Does not account well for why schizophrenia would emerge mostly during late adolescence and early adult years
What are some family interactions associated with schizophrenia?
Relapse is associated with high levels of expressed emotion-negative or intrusive attitudes and behaviours directed at the patient.
What is the best explainer of schizophrenia?
Integrative theories-interaction of genetics and psychosocial factors
What are markers?
Individual characteristics that would predict a persons vulnerability to schizophrenia.
What are some examples of marker tests?
- Continuous performance test
- Eye tracking
- Wisconsin card sorting
How do people with schizophrenia generally perform on eye tracking tasks?
Stops and starts erratically
What are endophenotypes?
Characteristic deficiencies that underly an observable symptom and have a genetic component. Various brain problems that underly schizo cause it.
What would the endophenotype for psychotic behaviour be?
Phenotype: Psychotic behaviour
Endophenotype: Lack of sensory gating, poor working memory
Who discovered phenothiazines?
Henri Labont in France. Wanted to help with psychosis in war. Heinz Lehmann further looked into it
What do antipsychotic drugs help with?
Most positive symptoms
How much improvement do patients typically show?
No improvement: 25%
Moderate Improvement: 30-40%
What are some of the side effects of the old antipsychotics?
Extrapyramidal symptoms (shaking) and tardive dyskenia (tongue out of mouth). Can cause permanent damage
What percentage of people will relapse with and without meds?
With: 40%
Without: 90%
How do atypical antipsychotics work?
Less side effects, By targeting the serotonin system. Good mood stabilizers, and will calm hallucinations and delusions
What are some psychosocial treatments for schizophrenia?
Family oriented aftercare-A MUST. Patient is not returned home until family is trained Social skills training Community based treatment CBT Institutional Programs
