Sectional 4 Exam Flashcards
Define psychosis.
Psychosis: inability to tell the difference between what is real and what is unreal
Psychotic Disorder: when that inability is distressing and impairing
Distinguish between the positive, negative, and disorganized symptoms that fall within the psychotic spectrum of disorders.
Positive Symptoms (+)Adding symptoms they didn’t have before
- Hallucinations
- Delusions
Negative symptoms: losses/deficits in normal functioning
Negative = absence of behaviors, feelings, experiences, etc. that were there before the onset of the disorder
Disorganized Symptoms:
- Disorganized thoughts/speech
- Disorganized behaviors
- Catatonia (disturbance or absence of motor movement)
Name the most common type of hallucination (which sensory modality) and describe the content (themes) of common types of delusions.
Positive Symptoms: Hallucinations
- Unreal perceptual experiences (i.e. perceptual experiences without external source)
- Hallucinations in schizophrenia are bizarre and are typically extremely distressing & impairing.
Hallucinations (+)unreal perceptual experiences like hearing, seeing, or feeling things that aren’t there
- Auditory -> most common
- Visual
- Tactile (when something is on top of someone’s skin or body, can be under skin)
- Somatic (when things are affecting your organs, or something has happened to your internal organs)
Positive Symptoms: Delusions
Delusions: beliefs/ideas that an individual believes are true, but are highly unlikely or simply impossible
- “fixed beliefs that are not amenable to change in light
of conflicting evidence”
- Outside cultural norms
- MUST take culture into account
- Bizarre vs. Non-Bizarre
- Persecutory: Being persecuted, watched, conspired against
- Reference: Random events are directed at oneself
- Grandiose: Great power, knowledge, talent, or a famous or powerful person
- Guilt or Sin: Committed a terrible act or responsible for a terrible event
- Somatic: Appearance or part of body is diseased, altered
- Being controlled: Thoughts, feelings, behaviors are being imposed, controlled by external force
Describe common negative and disorganized symptoms.
Negative Symptoms:
- Negative symptoms: losses/deficits in normal functioning
- Negative = absence of behaviors, feelings, experiences, etc. that were there before the onset of the disorder
- Affective Flattening: Reduction or absence of emotional expression
- Alogia: Reduction or absence of speech
- Avolition: Reduction or absence of self-initiated goal-directed activities
- Negative symptoms are less obvious, but…
- Negative symptoms are associated with more impairment
- Negative symptoms are less responsive to medication
Disorganized Symptoms:
- Disorganized thoughts/speech
- Disorganized behaviors
- Catatonia (disturbance or absence of motor movement)
Disorganized Thought & Speech:
- Loosening of associations (derailment): shifting from one topic to another seemingly unrelated topic with little coherent transition
- Word salad: speech so disorganized that it is totally incomprehensible
- Clang associations: stringing together of words that rhyme but have no other apparent link
- Neologisms: made-up words
Disorganized: unpredictable & seemingly untriggered
Shouting, swearing, pacing
Repetitive speech and movements
- Echolalia (parroting) and/or echopraxia (repetitive movement)
Catatonic Behavior
Catatonia- group of disorganized behaviors that reflect extreme lack of responsiveness.
- no psychomotor activity
- passively holding single posture
- stereotyped movements
Catatonic Excitement – wild agitation that is difficult to subdue.
Explain the three phases that make up the course of schizophrenia and identify the kinds of symptoms that are likely to characterize each phase.
Prodromal Phase – before onset of full syndrome (psychosis warm-up)
- Often largely consisting of
negative symptoms
Acute – active phase of syndrome (psychosis)
- All: Negative, positive, &
disorganized symptoms
2+ symptoms for at least 1 month:
1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized behavior or catatonia
5. Negative symptoms
At least 1 of them MUST be Hallucinations, Delusions, or Disorganized.
- This is criterion A
Residual Phase – after acute phase (psychosis cool-down)
- Often largely consisting of
negative symptoms
At least 6 months w/ marked impairment
Describe the DSM-5 criteria for Schizophrenia.
A. Acute Phase - 2+ symptoms for at least 1 month:
1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized behavior or catatonia
5. Negative symptoms
At least 1 of them MUST be Hallucinations, Delusions, or Disorganized.
B. Impairment in social, occupational, self-care.
C. Disturbance persists for at least 6 months.
D. Disturbance is not attributable to physiological effects of a substance.
E. Disturbance not better explained by other psychopathology.
Describe the prevalence, demographics, and course of schizophrenia.
Course:
Chronic & episodic
- Most people diagnosed with
schizophrenia experience
multiple psychotic episodes
over the course of the disorder
- High relapse rate (85% have
residual and/or active
symptoms)
Life expectancy is shorter than average
- Higher rates of infectious &
circulatory diseases
- More likely to be victims of
crime
- 10 – 15% die by suicide
Prevalence & Demographics
- 1 to 2% lifetime prevalence
- Twice as common in men vs. women
- Age of onset: 16-24 (men), 20-35 (women)
- Women have better prognosis
& fewer cognitive deficits
- Women have better prognosis
- Black Americans (2-3X) more often diagnosed than white Americans (Bresnahan et al., 2007)
Identify the factors that are associated with better/worse prognosis.
Factors predicting better prognosis:
- Better functioning before disease onset (i.e. better premorbid functioning)
- Acute onset (short prodromal phase prior to first acute episode)
- Later age of onset
- Being female
- Treatment with antipsychotic medications
- Especially during critical period
- Medication compliance
- Better inter-episode functioning
- No family hx of schizophrenia or mood disorders
- Higher SES
Distinguish between (and identify the core criteria of) the different disorders on the psychotic spectrum, namely: Schizophrenia, Schizoaffective disorder, Schizophreniform disorder, brief psychotic disorder, and delusional disorder.
Schizophrenia: 6+ months
Brief Psychotic Disorder: 1 day-1 month
Schizophreniform Disorder: 1-6 months
Delusional Disorder: delusions only (1+ month(s))
Schizoaffective Disorder: schizophrenia plus mood episodes.
- MUST include some psychotic
symptoms outside of a mood
episode.
- If they only ever become psychotic in
the context of a mood disorder, they
are given the diagnosis of that mood
disorder with psychotic features
(e.g., MDD with psychotic features).
Explain biopsychosocial theories of Schizophrenia.
Biological Factors: Genetics ***
Clear genetic component
Concordance rate much higher among MZ twins than DZ twins
- MZ 31%, DZ 6.5%
- Heritability is HIGHER THAN most medical conditions like hypertension and diabetes
- BUT, 63% of people with
schizophrenia have no known family
history of disorder
- Polygenic risk shared with bipolar disorders
Biological Factors: Brain Structure & Functioning
- Enlarged ventricles (fluid-filled spaces in brain)
- Smaller brain volume (reduced grey matter/tissue)
Biological Factors: Neurotransmitters
Dopamine Hypothesis
Mesolimbic pathway
- Excess or overactive dopamine = positive symptoms
- Connects motivation and reward areas
Mesocortical pathway
- Low dopamine = negative and disorganized symptoms
- Connects executive control areas to reward areas
Other Biological Factors
- Birth complications
- Perinatal hypoxia
- Prenatal virus exposure
- 2nd trimester = CNS development
- Drug use as a teenager or young adult (primarily marijuana & hallucinogens)
Social Factors
- Social Drift: Individuals with schizophrenia more likely to drift into lower SES throughout life
- Urban Birth: people with schizophrenia tend to be born in cities
- Low SES associated with chronic stressors (poor nutrition, security) that slightly increase risk for psychosis
Apply the diathesis-stress model to Schizophrenia.
Vulnerability + Stress = Psychological Disorder
*Remember… the stronger the diathesis, the less stress is needed for development of a psychological disorder
Describe the “two-hit” theory and the social drift vs. urban birth theories/explanations.
Birth complications –> Marijuana Use —> Schizophrenia
you have to have two stressful life events to be diagnosed
- Social Drift: Individuals with schizophrenia more likely to drift into lower SES throughout life
- Urban Birth: people with schizophrenia tend to be born in cities
- Low SES associated with chronic stressors (poor nutrition, security) that slightly increase risk for psychosis
Identify biological and psychological treatments for Schizophrenia.
Biological Treatments: Medications
Neuroleptics revolutionized treatment of schizophrenia (1950’s)
- “Typical” (“traditional”) antipsychotics
- E.g., Thorazine, Haldol, Navene
- Dopamine antagonists decrease dopamine activity
- Reduction of positive symptoms
Various issues
- 25% don’t respond
- Only effective for positive symptoms
- Lifelong neuroleptic use
- Side effects
Atypical Antipsychotics:
- (e.g., Clozapine, Olanzapine, Risperidone)
- Act on several NT’s
- Beneficial in treating the positive and negative symptoms of schizophrenia
- Fewer neurological side effects (no akinesia or tardive dyskinesia ),
- BUT still have side effects that include dizziness, nausea, sedation, weight gain, irregular heartbeat, Type II diabetes, seizure, heart arrhythmias…
- Supplement biological treatments
- Cognitive Therapies
- Help individuals recognize and change attitudes
- Help individuals challenge delusions & hallucinations
- Increase medication adherence
- Social Interventions
- Behavioral Therapies
- Social & Living Skills Programs
- Token system
Describe issues with medications (side-effects, effectiveness, factors influencing non-compliance, etc.).
Typical Antipsychotics Side Effects:
Side Effects (of typical antipsychotics)
- Grogginess, dry mouth, blurred vision, drooling, sexual dysfunction, weight gain, depression, etc.
Akinesia:
- Muscle rigidity –> lack of facial
expression
- Reduced speech, monotonous
speaking
Tardive dyskinesia:
- involuntary, repetitive body
movements
- Tics, tremors, spasms
- Irreversible, long-term side-effect
- 20% of individuals
- 25% of people don’t respond
- No good way to predict who will respond to which medication
- Overall, more effective with positive than negative symptoms
- Negative side effects, cost of medication, lack of social support – all contribute to issues with medication compliance
- Discontinuation = 78% relapse
Describe how “personality” differs from “personality disorder.”
Personality
- Personality: style of perceiving, thinking, feeling, and behaving that make each of us unique
- Personality is made up of various personality traits, and it’s the combination of our different personality traits that makes us, us.
- Relatively stable across time and situations
Personality Disorders
- A long-standing pattern of problematic attitudes, thoughts, emotions, and behavior
- Present in a variety of contexts (e.g., romantic relationships, work settings, friendships)
- Maladaptive, socioculturally deviant
- Distress/impairment
- Pattern must appear in adolescence or early adulthood
