Schizophrenia Spectrum and other psychotic disorders Flashcards
Schizophrenia =
cognitive and emotional dysfunctions including delusions, hallucinations, disorganized thoughts and innappropriate emotions
What are the positive symptoms of schizophrenia?
Positive symptoms are usually confined to acute episodes:
Excesses and distortions: hallucinations
- sensory experiences
- auditory hallucinations most common (74%)
Delusions: beliefs contrary to reality and firmly held despite disconfirming evidence
- grandiose delusions
- ideas of reference
- thought insertion
- thought withdrawal
- thought broadcasting
- persecution
- erotomatic (believing another person is in love with you)
- jealous
- somatic
What are the negative symptoms of schizophrenia?
behavioural deficits in motivation, pleasure, social closeness, emotional expression
- avolition (inability to initiate and persist in activities)
- anhedonia (lack of pleasure)
- asociality (lack of interest)
- alogia (speech reduction)
Disorganized symptoms of schizophrenia
disorganised speech
- loose associations
- derailment
disorganized behaviour
- catatonia (purposless overactivity)
- catalepsy (resistance to passive movement)
- waxy flexibility
What are the 3 phases of schizophrenia?
Prodromal: early stage often not recognized
Acute; most visible, positive symptoms
Residual: fewer obvious symptoms, but some still present
Outline schizophrenia criteria
2+ present symptoms for 1 month
- delusions
- hallucinations
- disorganized speech
- grossly disorganized / catatonic behaviour
- negative symptoms
Persistence for at least 6 months - including 1 month of criterion A symptoms, and may include prodromal or residual periods
Schizophreniform
Lasts between 1-6 months- associated with relatively good functioning
Typically the diagnosis you’d give someone before they get diagnosed with schizophrenia
Brief psychotic disorder
involes positive symptoms of schizophrenia and disorganized speech/behaviour
lasts less than 1 month
briefest duration of all psychotic
typically precipated by trauma / stress
schizo affective disorder
schizophrenia plus major mood episode (manic or depressive)
psychotic symptoms must also occur outside the mood disturbance for at least 2 weeks
don’t tend to get better on their own
delusional disorder
- key feature = delusion s
- does not include any other positive or negative or disorganized symptoms
prevalence and stats about schizophrenia
prevalence = 1% of population
- can emerge at any time
- significant morbidity
- only 21.5% diagnosed will be able to keep a job for over 12 months
- 85% wil be on government assistance
- 42-63% will abuse drugs and alcohol
- life expectancy is less than average
Biological causes of schizophrenia
- accounts for 81% of risk
- risk increases with genetic relatedness
- negative symptoms have a stronger genetic component than positive symptoms
- healthy environment is a protective factor
- dopamine hypothesis: drugs that increase dopamine result in positive and disorganized symptoms
- many NTs involved - glutamate, NMDA, GABA
- enlarged ventricles are common
- reduction in grey matter and volume of prefrontal cortex (relates to greater severity of negative symptoms)
Environmental influences of schizophrenia
Stress: delivery complications, starvation, maternal infections, cannabis, low SES, high expressed emotion
Diathesis stress mode
higher rates of schizophrenia observed in lower SES - bidirectional relationship
Treatment:
antipsychotics: first gen –> reduced positive symptoms by blocking D2
common side effects are: extrapyramidal adverse effects and tardive dyskinesia (mouth muscles)
2nd gen meds
compliance is an issue
psychosocial treatment: token economies, cognitive remediation, vocational rehab
