Task 8 - Psychosis, Schizophrenia Flashcards
prodromal symptoms
- present before people go into acute phase of schizophrenia
- negative symptoms especially prominent
residual symptoms
- present after they emerge from acute phase
- negative symptoms especially prominent
Positive symptoms
- delusions
- hallucinations
- disorganized thought and speech
- disorganized7catatonic behavior
delusions
- ideas that an individual believes are true but are highly unlikely and often simply impossible
- people tend to be preoccupied with them
- look for evidence, want to convince others
- highly resistant to arguments/facts that contradict delusions
common type of delusions (6)
- persecutory delusions
- delusions of reference
- grandiose delusions
- delusions of being controlled
- delusions of guilt/sin
- somatic delusions
Persecutory delusions
-believe they are being watched/tormented (belästigt)
Delusion of reference
-believe that comments/events are directed at them
Grandiose delusions
-believe that one is a special being/posses special powers
Delusions of being controlled
- believe that thoughts/feelings/behaviors are imposed/controlled by external factors
- thought broadcasting
- thought insertion
- thought withdrawal
delusions of guilt/sin
-believe that one committed terrible act/is responsible for a terrible act
Somatic delusions
-believe that one’s appearance/part of body is diseased or altered
hallucinations
-unreal perceptual experiences
tactile hallucinations
-perception that something is happening to outside of body
somatic hallucinations
-perception that something is happening inside person’s body
disorganized thought and speech
- slip from one topic to seemingly unrelated one
- answering questions with barely related/unrelated comments
- neologism
- clangs: associations on words are based on sounds
- repeating same word
- men -> more severe deficits in language
disorganized/catatonic behavior
- unpredictable/untriggered agitation
- > maybe response to delusions and hallucinations
- trouble organizing daily routines
- engaging in socially unacceptable behavior
Catatonia
- disorganized behavior reflecting unresponsiveness to the world
- catatonic excitement: person becomes agitated for no apparent reason
negative symptoms
- affective flattening/blunted affect
- alogia
- avolition
- less responsive to medication
- involves loss/deficits in certain domains
affective flattening/blunted effect
- reduction/absende of affective (emotional) responses to environment
- face: immobility
- body language: unresponsive
- speak: monotone, avoid eye contact
- may reflect severe anhedonia ( loss of interest in everything)
Alogia
- poverty of speech -> reduction in speaking
- may be caused by lack of motivation
Avolition
- inability to persist at common, goal-directed activities
- trouble completing tasks
- disorganized, careless, unmotivated
cognitive deficits
- deficits in basic cognitive processes (attention and memory)
- difficulty to pay attention to relevant info and suppress unwanted/irrelevant info
- difficulties concentrating, maintain stream of thought or conversation, perform basic task, distinguish real from unreal
- relatives of schizophrenic people -> also show cognitive deficits
- may show deficits before developing acute symptoms
Prognosis
- 50 to 80 percent hospitalized will be rehospitalized sometime
- life expectancy: 10y shorter
- suffer from infectious and circulatory diseases at higher rate
- 10-15 percent commit suicide
- most stabilize within 5-10y after first episode
women
- better predisorder histories
- onset: late 20s/early 30s
- less often hospitalized, briefer periods
- milder negative symptoms
- better social adjustment
- estrogen may affect regulation of dopamine
men
-late teens, early 20s
Psychosis
-experience where one is unable to tell difference between what is real and what is unreal
Sociocultural factors
- more benign (gutartig) in devleoping countries
- social environment there -> facilitate adaptation and recovery better
- > broader family networks
- > families score lower on hostility, criticism. over-involvement
- deviant behavior may be socially acceptable in women ( so they lose less social support)
- women -> better social skills
Genetic contributors
- the more genes you share with a schizophrenic person -> the higher the risk
- 83 percent of variation is due to genetic factors
- epigenetics: MZ twins discordant for schizophrenia (one has it, other doesn’t) -> numerous differences in molecular structure of DNA (particularly on genes regulating dopamine systems)
Enlarged ventricles and Schizophrenia
- suggest detoriation in other brain tissue
- show social, emotional, behavioral deficits long before developing core symptoms of schizophrenia
- more severe symptoms, less responsive to meds (if enlarged ventricles)
- men: more severely enlarged ventricles
- > men in general: greater loss of tissue and increase in ventricles with age
PFC and other key areas
PFC: smaller, less activity, significant structural changes ages 13 to 18
-having negative symptoms -> lower PFC metabolic rates , reduced blood flow when undertaking Wisconsin Card Sort test
- limbic system
- basal ganglia
- temporal lobe
- Hippocampus: formation of LTM -> abnormal activation, volume, shape, abnormalities at cellular level
brith complications
- perinatal hypoxia (oxygen deprivation at birth/few weeks before/after birth)
- 30 percent of schizophrenic people -> history of perinatal hypoxia
- oxygen deprivation interact with genetic vulnerability
prenatal viral exposure
- mothers exposed to viral infection while pregnant
- > 2. trimester of pregnancy particularly bad (development of CNS)
role of Neurotransmitters
- excess activity of dopamine
- > related to positive symptoms
- > mesolimbic PW
- mesocortical PW -> maybe underactive dopamine
- > drugs only block dopamine in mesolimbic
Psychosocial theories - social drift, urban birth
- social drift: symptoms interfere with ability to complete education and hold job
- > drift downwards in social class
- urban birth: schizophrenic people more likely born in large city
- > overcrowding
- > more infectious agents for mother
Psychosocial theories - stress
- before onset of new period
- > experience more stress
- stressful events in adulthood maybe important among people who experienced adverse events in childhood
- immigration: one major stress factor
Psychosocial theories - family - expressed emotions
- high expressed emotions often involve criticism and hostility
- > seems to be robust predictor of relapse in patients with psychotic symptoms
frontal lobe model
- Wisconsin Card Sorting Test -> decreases in blood flow in DLPFC
- appeared to be dependent on behavioral state of patient during experiment
- Hyop-/Hyperactivity during WM in schizophrenia
-Anterior Cingulate Gyrus (ACC) -> reduced activity while performing Stroop task
Temporal Lobe Model
- verbal, spatial, memory tasks
- left hemisphere: verbal, linguistic and analytic functions
- > left hemispheric overactivation
- did not produce laterality effects for verbal tasks
- greater left hemispheric activation during spatial task
- abnormal recruitment of LTMs in hippocampus + abnormal modulation of PFC
- > memory impairments -> disruption of prefrontal integration with hipppocampus
Metacognitive Training (MCT) and schizophrenia
- targets biases in Schizophrenia
- 8 modules
- taught to be aware of cognitive biases and critically reflect on them
- positive effects in reducing psychotic symptoms
cognitive biases - prominent in schizophrenia (5)
- > involved in formation and maintenance of delusions
1) Jumping to conclusions
2) Attributional style and self-esteem
3) Metamemory
4) Bias against disconfirmatory evidence
5) theory of mind
Jumping to conclusions
-40 to 70p of patients with S. gather little info before arriving at strong conclusions
MCT:
- discuss advantages and disadvantages of JTC
- then false and falsifiable ‘urban legends’ are presented
- serve as models for delusions and arguments for and against belief
- > to demonstrate that premature decision making often result in errors
- > decisions should be withheld until sufficient evidence is offered
Attributional style and self-esteem
- S. people often put blame for negative events onto other people
- > helps raise deep-rooted lack of self-esteem
MCT:
- builds on CBT
- concerned with self-esteem
- coping with mood problems
- taking note of positive events
Metamemroy
- patients often show reduced memory vividness, combined with overconfidence
- > especially for incorrect/false memory
MCT:
- teaching to enhance memory retention
- false memory paradigm ( prototypcial scenes are presented, luring p to believe they are plausible)
- > then encouraged to express doubts in their memories and to collect further proof if their recollection is vague
Bias against disconfirmatory evidence
- more likely to endorse their initial interpretation for something despite disconfirming evidence
- familiarized with concept of a confirmation bias
- exercises: encouraged to remain openminded and incorporate disconfirmatory evidence into their judgments.
theory of mind and schizophrenia
- severe deficits in social cognition or theory of mind (ToM) in psychosis
- Cues for social cognition are discussed regarding strength and fallibility
- Cues for social cognition are discussed regarding strength and fallibility
- exercises: identify facial expressions and underlying emotional states or to think what others may think.
Psychotic vs. normal hallucinations
Psychotic:
- less control
- voices talking in 3rd person more frequently
- older when first heard a voice
- higher on frequency, duration, distress and emotional valence (Wertigkeit)
-no differences in perceived location (inside, outside of head)
- high predictive value of emotional content of voices
- > diagnosis of psychotic disorders in individuals hearing voices
Psychotic vs. normal hallucinations
Psychotic:
- less control
- voices talking in 3rd person more frequently
- older when first heard a voice !
- higher on frequency, duration, distress and emotional valence (Wertigkeit)
-no differences in perceived location (inside, outside of head) , loudness, number of voices, personification
- high predictive value of emotional content of voices
- > diagnosis of psychotic disorders in individuals hearing voices
Antipsychotics - drug treatment
- e.g. chlorpromazine
- reduces agitation, hallucinations, delusions
- blocking dopamine receptors
- no reduction in negative symptoms
- 25p show no response
- side effects: dry mouth, sexual dysfunction, blurred vision, weight gain/loss, menstrual disturbance
- Akinesia (slower motor activity, monotonous speech)
- Tardive Dyskinesia (bizarre involuntary movements of tongue, face, mouth or jaw)
- very high relapse rate when discontinued
Atypical antipsychotic drugs ( Neuroleptics)
- e.g. Clozapine
- binds to D4 dopamine receptor and blocks it
- reduces positive and negative symptoms
- less side effects than classical
- still possible: dizziness, nausea, seizures, weight gain
