Schizophrenic/Psychotic Disorders Flashcards
Onset of schizophrenia
Gender
Prevalence
What socio-economic levels
15-45 years old
Equal risk between men and women
- Men tend to display symptoms earlier and are more severe
- Women most likely to have onset after 45
1% of pop
Occurs at all socio-economic levels
History of schizophrenia
Lunacy in the past
- But indicated that onset could occur any age
Auditory hallucinations rare in cases before 1700s but are common today
- Industrialization and enviro changed may have caused change
Diagnostic criteria for schizophrenia
During 1 month period, 2+:
- Delusions, hallucinations, disorganized speech, catatonic behav, negative symptoms (anhedonia, apathy)
Types of schizophrenic delusions
Persecutory (Everything is against them)
Referential (Hidden meanings not actually related to them)
Somatic (About body and inner organs)
Religious (Demons, angels)
Grandiose (Belief of divine power)
Catatonia
Waxy flexibility
(Schizophrenia)
Decrease in reactivity to enviro
- Waxy flexibility: Staying in seemingly uncomfortable position for long period of time (now less frequent)
Difference between positive and negative symptoms
(Schizophrenia)
Positive symptoms: Exaggerated and distorted adaptations if normal behav
Negative symptoms: Absence of typical behavs and expression
How to tell that schizophrenia is not schizoaffective disorder, depression, or bipolar disorder?
1) No depressive or manic episodes occur at same time as active-phase symptoms
2) Mood episodes that have occurred during active-phase symptoms are present for minority of total duration
What is the differential diagnosis between:
Schizophrenia and depression w/ psychotic features
Schizophrenia and schizoaffective disorders
MDD only exp psychotic features during mood episodes
Schizoaffective requires min 2 weeks of only psychotic symptoms w/out mood symptoms
Both don’t meed criterion A of schizophrenia
What is the differential diagnosis between bipolar disorder and schizoaffective disorder?
Bipolar w/ psychotic features only exp them during manic episodes
Bipolar would have mood symptoms, which doesn’t match with schizoaffective’s 2-week requirement of only psychotic symptoms
What happens when depressive symptoms occur with manic episode? What happens if this continues?
Bipolar w/ psychotic features
If continued, becomes schizoaffective disorder
Why is subjectivity a drawback of diagnosing schizophrenia?
DSM-5 relies on person’s symptoms and history
- But symptoms are private experiences
- And a reliable diagnosis ≠ valid diagnosis
Endophenotypes
Bio or behav predispositions that make a disorder more likely
What are endophenotypes or markers of schizophrenia that can be seen on cognitive tests?
(6)
Slow processing speed
Impaired sensory gating
Impaired verbal memory
Impaired dichotic listening
Slow phonemic word fluency
Slow detection of specified letters (continuous performance test)
Visual tracking in schizophrenia
Eye movements more erratic
More saccades
- Could be what causes impairments in Continuous Performance Test
Diathesis-Stress Theories of schizophrenia
1) Inherited or fetal injury
2) Switches in the brain turned on by stress
3) Biological vulnerability that’s inherited or acquired early in life
Meehl’s theory of schizophrenia
Hypokrisia
Cognitive slippage
Aversive drift
Schizotype
Hypokrisia occurs thru brain, making nerve cells mire reactive to stimuli
- Causes cognitive slippage: Info becomes more disorganized, causing exaggerated connections between emotions and ideas
- Aversive drift: Cog drift causes more unpleasant social exp and the brain amplifies feelings of pain and weakens pleasure, which causes negative symptoms such as social withdrawal and disinterest
Schizotype: Person experiencing cognitive slippage and aversive drift
Why is the familiarity effect not convincing in schizophrenia?
Incomplete penetrance: Some ppl w/ the dominant gene for schizophrenia don’t show expected effects
Pregnancy complications that may cause schizophrenia
Exposure to flu in utero
- More common for winter babies
Pronged labour or premature delivery
Wisconsin Card Sorting Test
(schizophrenia)
Match one card to key card based on colour, shape, or number (only one principle at a time tho)
- Examiner doesn’t say actual principle but will give feedback on correctness
- Will change principle after some time without telling
Ppl w/ prefrontal brain damage had similar result to schizophrenia:
- Had few correct matches
- Tend to repeat incorrect responses
Brain findings of patients w/ schizophrenia:
CT and MRI
PET and fMRI
What is the problem with these findings?
1) CT and MRI
- Larger ventricles
- Reduced grey matter volume
2) PET and fMRI
- Activation changes in left temporal lobe, amygdala, and hippocampus
Problem: Frontal brain volumes only reduced in 25% cases and blood flow/metabolism only reduced in less than 50% of cases
The dopamine hypothesis (schizophrenia)
Best antipsychotic drugs found were those that blocked dopamine receptors
Schizophrenics had more dopamine receptors than normal (but recent findings are failing to support this)
Multiple hits most likely cause dopamine dysregulation instead, which ends up w/ psychosis in schizophrenia
1st gen and 2nd gen antipsychotic medication
1st gen:
- Promethazine and Chlorpromazine (first antipsychotic medication)
- Had more severe side effects but were very effective in reducing symptoms
2nd gen:
- Risperidone and Olanzapine
- Could control symptoms as long as medication was continued and has less side effects
- Main side effect was weight gain and migraines
Treatments for schizophrenia:
Cognitive behavioural therapy
Social skills training / Cognitive remediation
Family therapy
Cognitive behavioural therapy
- Focus on emotional disturbance, making sense of psychotic symptoms, social disabilities, self-care methods to reduce risk of relapse
Social skills training / Cognitive remediation
- Learning-based
- Promotes independence and reduces stressors
Family therapy
- Conceptualizes patient as member of a famuly
- Aims for involvement of family
- Supports deinstitutionalization
