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
