Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
T or F. You cannot be diagnosed with schizophrenia until months have passed, even though you show all the signs of the disorder.
T, six months
T or F. Due to wide differences in cultures, rates of schizophrenia vary among the developed and developing nations throughout the world
F, despite these differences rates are similar
Even if you have two parents with schizophrenia, your chances of developing the disorder are …
less than 1 in 2!
This disorder touches every facet of an affected person’s life
Schizophrenia
Acute episodes of schizophrenia are characterized by:
delusions, hallucinations, illogical thinking, incoherent speech and bizarre behaviour
**between episodes, people may still be unable to think clearly and may lack appropriate emotional responses to people and events in their lives
Emil Kraeplin
- Dementia Praecox
- “the loss of inner unity of thought, feeling, and acting”
- hallucinations, motoric abnormalities, delusions
Who introduced the term Schizophrenia?
Eugen Bleuler ; “split brain”; recognized variability in the course of the disorder
4 A’s according to Bleuler
- Association: loosening of associations
- Affect: being flat or inappropriate emotional responses
- Ambivalence: ambivalent or conflicting feelings toward others, such as loving and hating them at the same time
- Autism: tendency to retreat into oneself and to avoid social contact to a degree that is unusual for that individual prior to the development of the condition
Kurt Schneider
- 4 As overlapped too much with other disorders!
- First- and second-rank symptoms
Schneider’s first- and second-rank symptoms
First:
- central to diagnosis of Sz, initially thought to be unique to Sz
- ABCD (auditory hallucinations, broadcasting of thought, controlling of thought, delusions)
Second:
- frequently associated with Sz, but not exclusively
> mood problems
> non-auditory hallucinations (visual, olfactory, haptic, gustatory)
Controlling of thought (ABCD) subtypes
- Echo: inner thoughts can be heard aloud
- Insertion: somebody planted thoughts into their brain
- Withdrawal: their own thoughts are somehow being removed
Schneider’s second-rank symptoms are …
not 100% necessary for diagnosis but frequently associated with schizophrenia
Likelihood of people with schizophrenia to complete suicide
20x as likely as members of general population
Phases of Schizophrenia:
- Prodromal: gradual decline; before first psychotic episode
- Acute: symptoms develop
- Residual: revert back to the prodromal stage; continued disturbance (negative symptoms)
Early signs of a mental disorder
lack of self-care
Neologisms
new words; not aware of the fact that these words don’t mean anything to other people nor do they care! May combine two or more words as well ; ex shuthead instead of shithead
Perseveration
continued use or persistence on same topic; coming to it over and over again
Clanging and blocking
clanging - like rap; rhyming!!
blocking - abruptly changing from one thing to the next
Word salad
words not unique but sentence structure makes no sense
Theories of what causes hallucinations
- sub-vocal speech: centers in our brain; some indivs may be experiencing it as alien (something else telling them); Listening on their own formative thought ; talking to themselves but don’t realize it’s their own thoughts …
- dopamine hypothesis: dopaminergic receptors are too sensitive!!) hypothesis kind of opposite of sub-vocal ; somewhere along pathway, enough dopamine that results in meaningless stimulation of various sites which as a result – can be experienced as speech or sound perceived by brain in the absence of any verifiable input from outside world
Previous Subtypes of Schizophrenia (NOT in DSM-5)
- Disorganized (speech or behaviour)
- Catatonic: waxy flexibility or rigid
- Paranoid
- Undifferentiated: exhibits behaviours which fit into two or more of the other types of schizophrenia, including symptoms such as delusions, hallucinations, disorganized speech or behaviour, catatonic behaviour
Crow, 1980
Type I (positive symptoms) and Type II (negative) -> premorbid functioning: poorer in type II
Biological Approaches of Treatment
- Antipsychotic drugs: Phenothiazines; Haloperidol (TD)
- Atypical antipsychotics: agranulocytosis
Agranulocytosis
acute condition involving a severe and dangerous leukopenia (lowered white blood cell count)
Tardive dyskinesia
side effect of antipsychotic drugs like Phenothiazines as they tend to be really good at ameliorating positive symptoms but not negative ones!
–> phantom tongue movement, jittering, rocking back and forth, etc.
Blocking
(1) Disruption of self-expression of threatening or emotionally laden material. (2) In people with schizophrenia, a condition of suddenly becoming silent with loss of memory for what they have just discussed.
Hallucinations in people without psychiatric conditions are often triggered by…
unusually low levels of sensory stimulation (lying in the dark in a soundproof room for an extended time) or low levels of arousal
**Unlike psychotic individuals, these people realize their hallucinations are not real and feel in control of them
Blunted affect
significant reduction in emotional expression
Flat affect
absence of emotional expression
T or F. Negative symptoms tend to persist even when positive symptoms have abated and often have a greater effect on the person’s functioning than positive symptoms.
T! They are also less responsive than positive symptoms to treatment with antipsychotic drugs
Dopamine theory
People with schizophrenia do not appear to produce more dopamine. Instead, they appear to use more of it. But why? Research suggests that people with schizophrenia may have a greater than normal number of dopamine receptors in their brains or have receptors that are overly sensitive to dopamine
*associated with positive symptoms; decreased reactivity associated with negative symptoms
What do neuroleptic drugs do?
AKA major tranquilizers (phenothiazines)
Neuroleptic drugs block dopamine receptors, thereby reducing the level of dopamine activity. As a consequence, neuroleptics inhibit excessive transmission of neural impulses that may give rise to schizophrenic behaviour.
Brain abnormalities in people with Sz
enlargements of brain ventricles (the hollow spaces in the brain). Ventricular enlargement is a sign of structural damage involving loss of brain cells. It is found in about three out of four schizophrenia patients. Still, not all people with schizophrenia show evidence of enlarged ventricles or other signs of brain damage; sometimes have something to do with frontal/temporal lobe
Diathesis-stress model
Meehl suggested that certain people possess a genetic predisposition to schizophrenia that is expressed behaviourally only if they are reared in stressful environments
Environmental stressors may include psychological factors such as family conflict, child abuse, emotional deprivation, or loss of supportive figures, as well as physical environmental influences, such as early brain trauma or injury. On the other hand, if environmental stress remains below the person’s stress threshold, schizophrenia may never develop—even in individuals at genetic risk
schizophrenogenic mother
described as cold, aloof, overprotective, and domineering. She was characterized as stripping her children of self-esteem, stifling their independence, and forcing them into dependency on her. Children reared by such mothers were believed to be at special risk for developing schizophrenia if their fathers were passive and failed to counteract the pathogenic influences of the mother. Despite extensive research, however, mothers of people who develop schizophrenia do not fit the stereotypical picture of the schizophrenogenic mother
Double-bind communications contributed to the development of schizophrenia
double-bind communication transmits two mutually incompatible messages. In a double-bind communication with a child, a mother might freeze up when the child approaches her and then scold the child for keeping a distance. Whatever the child does, she or he is wrong. With repeated exposure to such double binds, the child’s thinking may become disorganized and chaotic. The double-binding mother prevents discussion of her inconsistencies because she cannot admit to herself that she is unable to tolerate closeness.
Communication deviance
describes a pattern characterized by unclear, vague, disruptive, or fragmented parental communication and by parental inability to focus in on what the child is saying
Expressed emotion
involves the tendency of family members to be hostile, critical, and unsupportive of their family member with schizophrenia. People with schizophrenia whose families are high in EE tend to show poorer adjustment and have higher rates of relapse following release from the hospital than those with more supportive families
Learning-based treatment
Therapy methods include techniques such as:
(1) selective reinforcement of behaviour (e.g., providing attention for appropriate behaviour while extinguishing bizarre verbalizations through the withdrawal of attention);
(2) the token economy, in which individuals on inpatient units are rewarded for appropriate behaviour with tokens, such as plastic chips, that can be exchanged for tangible reinforcers such as desirable goods or privileges; and
(3) social skills training, in which clients are taught conversational skills and other appropriate social behaviours through coaching, modelling, behaviour rehearsal, and feedback.
