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Psychopathology > Task 8 - Psychosis, Schizophrenia > Flashcards

Task 8 - Psychosis, Schizophrenia Flashcards

1
Q

prodromal symptoms

A
  • present before people go into acute phase of schizophrenia

- negative symptoms especially prominent

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2
Q

residual symptoms

A
  • present after they emerge from acute phase

- negative symptoms especially prominent

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3
Q

Positive symptoms

A
  • delusions
  • hallucinations
  • disorganized thought and speech
  • disorganized7catatonic behavior
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4
Q

delusions

A
  • 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
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5
Q

common type of delusions (6)

A
  • persecutory delusions
  • delusions of reference
  • grandiose delusions
  • delusions of being controlled
  • delusions of guilt/sin
  • somatic delusions
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6
Q

Persecutory delusions

A

-believe they are being watched/tormented (belästigt)

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7
Q

Delusion of reference

A

-believe that comments/events are directed at them

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8
Q

Grandiose delusions

A

-believe that one is a special being/posses special powers

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9
Q

Delusions of being controlled

A
  • believe that thoughts/feelings/behaviors are imposed/controlled by external factors
  • thought broadcasting
  • thought insertion
  • thought withdrawal
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10
Q

delusions of guilt/sin

A

-believe that one committed terrible act/is responsible for a terrible act

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11
Q

Somatic delusions

A

-believe that one’s appearance/part of body is diseased or altered

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12
Q

hallucinations

A

-unreal perceptual experiences

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13
Q

tactile hallucinations

A

-perception that something is happening to outside of body

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14
Q

somatic hallucinations

A

-perception that something is happening inside person’s body

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15
Q

disorganized thought and speech

A
  • 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
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16
Q

disorganized/catatonic behavior

A
  • unpredictable/untriggered agitation
  • > maybe response to delusions and hallucinations
  • trouble organizing daily routines
  • engaging in socially unacceptable behavior
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17
Q

Catatonia

A
  • disorganized behavior reflecting unresponsiveness to the world
  • catatonic excitement: person becomes agitated for no apparent reason
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18
Q

negative symptoms

A
  • affective flattening/blunted affect
  • alogia
  • avolition
  • less responsive to medication
  • involves loss/deficits in certain domains
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19
Q

affective flattening/blunted effect

A
  • 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)
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20
Q

Alogia

A
  • poverty of speech -> reduction in speaking

- may be caused by lack of motivation

21
Q

Avolition

A
  • inability to persist at common, goal-directed activities
  • trouble completing tasks
  • disorganized, careless, unmotivated
22
Q

cognitive deficits

A
  • 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
23
Q

Prognosis

A
  • 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
24
Q

women

A
  • 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
25
Q

men

A

-late teens, early 20s

26
Q

Psychosis

A

-experience where one is unable to tell difference between what is real and what is unreal

27
Q

Sociocultural factors

A
  • 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
28
Q

Genetic contributors

A
  • 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)
29
Q

Enlarged ventricles and Schizophrenia

A
  • 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
30
Q

PFC and other key areas

A

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
31
Q

brith complications

A
  • 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
32
Q

prenatal viral exposure

A
  • mothers exposed to viral infection while pregnant

- > 2. trimester of pregnancy particularly bad (development of CNS)

33
Q

role of Neurotransmitters

A
  • excess activity of dopamine
  • > related to positive symptoms
  • > mesolimbic PW
  • mesocortical PW -> maybe underactive dopamine
  • > drugs only block dopamine in mesolimbic
34
Q

Psychosocial theories - social drift, urban birth

A
  • 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
35
Q

Psychosocial theories - stress

A
  • 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
36
Q

Psychosocial theories - family - expressed emotions

A
  • high expressed emotions often involve criticism and hostility
  • > seems to be robust predictor of relapse in patients with psychotic symptoms
37
Q

frontal lobe model

A
  • 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

38
Q

Temporal Lobe Model

A
  • 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
39
Q

Metacognitive Training (MCT) and schizophrenia

A
  • targets biases in Schizophrenia
  • 8 modules
  • taught to be aware of cognitive biases and critically reflect on them
  • positive effects in reducing psychotic symptoms
40
Q

cognitive biases - prominent in schizophrenia (5)

A
  • > 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
41
Q

Jumping to conclusions

A

-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
42
Q

Attributional style and self-esteem

A
  • 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
43
Q

Metamemroy

A
  • 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
44
Q

Bias against disconfirmatory evidence

A
  • 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.
45
Q

theory of mind and schizophrenia

A
  • 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.
46
Q

Psychotic vs. normal hallucinations

A

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
47
Q

Psychotic vs. normal hallucinations

A

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
48
Q

Antipsychotics - drug treatment

A
  • 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
49
Q

Atypical antipsychotic drugs ( Neuroleptics)

A
  • 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

Psychopathology (15 decks)

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