Schizophrenia Spectrum Disorders Flashcards
What is psychosis in terms of schizophrenia?
Psychosis refers to loss of contact with external reality characterised by:
- impaired perceptions
- thought processes
Schizophrenia - ‘Split mind’
- Fragmentation of thoughts
- Splitting of thoughts from emotions
- Withdrawal from reality
What are the DSM criteria for schizophrenia?
A. Two or more of following present for a significant
portion of time during a 1-month period (or less if
successfully treated) & at least one must be (1), (2), or (3) below.
- Delusions
- Hallucinations
- Disorganised Speech
- Grossly disorganized or catatonic behaviour
- Negative symptoms
B. There is a clinically significant impact on functioning
C. Continuous disturbance for min 6 months
D. Not better explained by another diagnosis
What are the 8 schizophrenia spectrum disorders?
- Schizotypal (Personality) Disorders
- Brief Psychotic Disorder (sudden, 1mth
What are the positive and negative symptoms of psychosis?
Positive:
- hallucinations
- delusions
- lack of insight
- behavioural disturbances (movements, catatonia)
Negative:
- Affect: social withdrawal, emotional blunting, confusion/anhedonia
- Avolition: apathy, self neglect, amotivation
- algolia: poverty of speech, of content
Negative symptoms suggest poorer treatment response
What are the characteristics of Schizotypal hallucinations?
A hallucination is a perception-like experience that:
- occurs in absence of any external stimulus
- is vivid, clear, & not under voluntary control
- occurs in clear sensorium
- can occur with any sense
75% of schizophrenics report hallucinations, 60-70% report auditory hallucinations
- voices can be from inside the head or from external sources
- voices can be comforting, derogatory, commentating or ordering
What are the characteristics of schizotypal delusions?
Delusions are:
- False firmly beliefs despite what others believe & despite evidence to contrary
- Beliefs are not culturally accepted
Delusions are categorised by type:
- Paranoid or Persecutory Delusions (most common)
- Delusions of Reference (personal meaning in neutral events)
- Grandiose Delusions (special powers, influence etc)
- Nihilistic Delusions (body or world doesnt exist/has been destroyed)
- Delusions of Guilt (personal responsibility)
- Jealousy Delusions
- Erotomanic Delusions (romantic feelings are returned)
- Misidentification Delusions (imposter replacements)
What are the characteristics of schizotypal formal thought disorder?
Formal thought disorder:
- Disturbances in flow &/or form of speech (as opposed to content as in delusions)
Negative manifestations:
- Reduced stream of thoughts & poverty of speech
Positive manifestations:
- Derailment (comments slipping from one to next)
- Tangential (irrelevant responses)
- Echolalia (acute phase)
- Word salad (incomprehensible stream of words)
- Neologisms (idiosyncratic use of words, meanings)”
What are the characteristics of disorganised behaviour?
Grossly disorganized & abnormal motor behaviour can range from child-like silliness to unpredictable agitation
- Peculiar voluntary movements (posture, repetition, grimacing)
- Mutism; Echolalia; Echopraxia: imitating speech; movement
Catatonic behaviour:
- Extreme negativism (resistance instructions)
- Immobility (“waxy flexibility”)
- Catatonic excitement : Excessive purposeless physical activity
What is the prevalence of Schizophrenia?
Lifetime prevalence of schizophrenia ranges from 1-2%
Male to Female ratio: 3:2
What is the course of schizophrenia?
Onset: typically in late adolescence/early adulthood
- typically preceded by stressful periods
- often preceded by gradual deterioration
- early onset associated with poorer outcomes
Living with schizophrenia:
- course is highly variable
- Most remain chronically unwell with a deteriorating course (50% classed as unable to work,
What are the phases of schizophrenia?
- Prodromal Phase: Median length for symptoms to develop is 2-years but highly variable
- Acute Phase: Typically one year between onset of active symptoms & treatment
- Response to treatment related to duration of untreated psychosis - Early Recovery Phase:
- Late Recovery Phase: Reintegration
- 80%-90% relapse within 2-5 years of treatment
What are the prognostic factors that indicate response to treatment?
Positive:
- Good premorbid functioning
- Acute onset
- Later age of onset (females)
- Precipitating event (e.g., drug induced psychosis)
- Low substance use
- Brief duration of active phase
- Absence of structural brain abnormalities
- No family history of schizophrenia
Negative:
- Poor premorbid
- Slow insidious onset
- Prominent negative symptoms
- Duration of untreated psychosis
- Slower or less complete recovery
- Lower socioeconomic class
- Migrant status
- Social support network
What biological factors contribute to schizophrenia?
Genetic: Genes determine susceptibility, but triggered by other factors
- 7.3% siblings, 9.4% for one parent, 46.3% for two
- 12.1% for DZ twins, 44.3% for MZ twins
Biochemical: Dopamine hypothesis (overproduction or oversensitivity of dopamine receptors)
- Excess L-Dopa can precipitate psychotic episodes
- Response to anti-dopaminergic medication (60%)
- overreactivity to dopamine agonists
- only explains positive symptoms (two sydromes?)
Neuroanatomical: Structural brain abnormalities predate onset & worsens with progressive illness. Early developmental damage?
- Enlarged ventricles in schizophrenia
- loss of mass in prefrontal cortex (negative symptoms)
- smaller left hippocampal volume
Neurodevelopmental: pregnancy/birth/infancy complications
- 40% had birth complication
- nutritional deficits (urban, winter pregnancy)
- early viral infections (winter pregnacy link)
What are the medical treatment options for schizophrenia?
Medication is primary intervention:
- 60% of clients with positive symptoms respond:
- Block D2 & D3 dopamine receptors
- Relapse rates high with 40% relapsing within one year
Medication problems
- non compliance
- side effects (sedation, heart disease, diabetes, trembling, abnormal involuntary movements)
What are the aims of psychological treatment options for schizophrenia?
CBT and Family therapy interventions aim for:
- Social skills training for interpersonal deficits
- Medication compliance
- Managing delusions/hallucinations
- Reduction of stresses
What is the CBT treatment model for schizophrenia
CBT strategies:
- Recognise relapse signs
- Understand relationship between thoughts, feelings & behaviours
- Challenge beliefs about not being able to manage one’s thoughts & behaviours
- Learn strategies to cope with symptoms & stressors
- Evaluate evidence supporting delusional beliefs versus alternative beliefs
CBT reduces severity of symptoms and impairment
What is the Family Therapy model for schizophrenia?
Family Therapy interventions were developed in response to higher relapse rates for patients from families high in Expressed Emotion (EE)
Family interventions provide:
- Education about schizophrenia and its treatment
- Realistic goal setting skills
- Communications training (empathic not critical)
- Problem Solving skills
- Promote social support
Family interventions shown to reduce relapse & enhance family support
