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Psychopathology > Task 8 - Schizophrenia > Flashcards

Task 8 - Schizophrenia Flashcards

1
Q

Psychosis

A

= you are unable to tell the difference between what is real and what is unreal

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2
Q

schizophrenia

A

= one of the most severe and puzzling psychotic disorders

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3
Q

Prevalence, Onset, and Prognosis

A
  • late teenage or early adult years
  • onset in women: late twenties - early thirties
  • onset in men: late teens - early twenties
  • 0.5-2%
  • 50-80% will be rehospitalized
  • life expectancy: 10-20 years shorter
  • suicide: 5-10%
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4
Q

Positive Symptoms

A

= overt expressions of unusual perceptions, thoughts, and behaviors

  • delusions
  • hallucinations
  • disorganized thought and speech
  • disorganized or catatonic behavior
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5
Q

Delusions

A

= ideas that an individual believes are true but that are highly unlikely and often simply impossible

  • preoccupations with delusions
  • restraint to any contradictions
  • culturally specific

Subtypes:
- persecutory delusion
- delusion of reference
- grandiose delusion
- delusion of being controlled
- thought or broadcasting
- thought insertion
- thought withdrawal
- delusion of guilt or sin
- somatic delusions

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6
Q

Hallucinations

A

= unreal perceptual experiences

  • more frequent, persistent, complex, bizarre, and entwined with delusions in people with schizophrenia

Subtypes:
- auditory hallucinations: hearing voices, music, etc.
- visual hallucinations
- tactical hallucinations: perception that something is happening to the outside of the person’s body
- somatic hallucinations: perception that something is happening inside the person’s body

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7
Q

Disorganized thought and speech

A

formal thought of disorder = the disorganized thinking of people with schizophrenia

  • loose associations/derailment: the tendency to slip from one topic to a seemingly unrelated topic
  • word salad: totally incoherent speech
  • neologisms: make up words
  • clangs: associations between words based on their sounds
  • repeat words/statements over and over again
  • men have more severe deficits in language
  • in women language is controlled bilaterally
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8
Q

Disorganized or catatonic behavior

A
  • agitation: suddenly shouting, swearing, or pacing rapidly
  • trouble in organizing daily routines
  • impaired attention and memory
  • engagement in socially unacceptable behavior
  • catatonia = disorganized behavior that reflects unresponsiveness to the environment
  • catatonic excitement: the person shows purposeless and excessive motor activity for no apparent reason
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9
Q

Negative Symptoms

A

= the loss of certain qualities of the person

  • associated with poor outcome
  • persistent
  • more difficult to treat than positive symptoms
  • restricted affect and avolition/asociality
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10
Q

Restricted Affect

A

= a severe reduction in or absence of emotional expression in people with schizophrenia

  • fewer facial expressions, avoid eye contact, fewer gestures, flat tone of voice
  • they may experience intense emotions that they cannot express
  • problems with motivation and decision-making
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11
Q

Avolition/Asociality

A

avolition = inability to initiate or persist at common, goal-directed activities, including those at work, school, and home
- physically slowed down and unmotivated
- lacking personal hygiene and grooming

asociality = lack of desire to interact with other people –> socially withdrawn/isolated

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12
Q

Cognitive Deficits

A
  • attention, memory, processing speed
  • working memory –> focusing and maintaining attention
  • unable to filter information
  • delusions and hallucinations may develop as individuals try to make sense of the thought and perceptions bombarding their consciousness

–> cognitive deficits can be an early marker of risk for schizophrenia

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13
Q

DSM-5 Criteria for Schizophrenia

A

A Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2, or 3:
1. Delusions
2. Hallucinations
3. Disorganized Speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms

B For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset

C Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms that meet Criterion A (active-phase symptoms) and may include periods of prodromal (before the acute phase) or residual (after the acute phase) symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form

D Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) nor major depressive or manic episodes have occurred concurrently with the active phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the active and residual periods of the illness

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14
Q

Causes: Gender and Age Factors

A
  • women have a better prognosis: milder symptoms, fewer cognitive deficits
  • estrogen may affect the regulation of dopamine in ways that are protective for women
  • prenatal brain development is slower in males —> may lead to abnormal brain development
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15
Q

Causes: Sociocultural Factors

A
  • schizophrenia has a more benign course in developing countries
  • broader and closer family networks in developing countries
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16
Q

Causes: Genetic

A
  • genetic component –> different genes are responsible for different symptoms
  • as the genetic similarity to a person with schizophrenia decreases, an individual’s risk of developing schizophrenia also decreases
  • 83% of the variation in schizophrenia is due to genetic factors
  • epigenetic factors: DNA can be chemically modified by different environmental conditions, resulting in genes being turned on or off, thereby altering the development of cells, tissues, and organs
17
Q

Causes: Structural and Functional Brain Abnormalities

A
  • neurodevelopmental disorder –> abnormal development of the brain in the uterus/early life
  • reduction in gray matter
  • abnormal activity in the prefrontal cortex
  • abnormal hippocampal activation –> difficulties encoding and retrieving information
  • reductions and abnormalities in white matter –> working memory impairment
  • enlargement of ventricles
18
Q

Causes: Cognitive Disability

A
  • left-hemispheric overactivation model: the left hemisphere is responsible for verbal, linguistic, and analytic functions
  • disrupted frontal-temporal connectivity
  • reduced DLPFC connectivity
  • increased VLPFC connectivity

–> impaired cognitive control could account for DLPFC dysfunction and many of the widespread cognitive impairments exhibited by people with schizophrenia –> working memory and response control

19
Q

Causes: Damage to the developing brain

A
  • perinatal hypoxia = oxygen deprivation at birth or in the few weeks before or after birth
  • viral infections while being pregnant –> active immune system of the mother causes a negative impact on the child’s brain development
20
Q

Causes: Neurotransmitters

A

Original (outdated) dopamine theory:
- the symptoms of schizophrenia are caused by excess levels of dopamine in the brain, particularly the prefrontal cortex and limbic system

Updated dopamine theory:
- there may be excess dopamine activity in the mesolimbic pathway
–> involved in the processing of salience and reward –> hallucinations and delusions
- there may be unusually low dopamine activity in the prefrontal area –> negative symptoms

  • serotonin neurons regulate dopamine neurons
  • glutamate and GABA abnormalities –> cognitive and emotional symptoms
21
Q

Causes: Social Drift and Urban Birth

A

social drift theory = because schizophrenia symptoms interfere with a person’s ability to complete an education and hold a job, people with schizophrenia tend to drift downward in social class compared to the class of their family of origin

urban living: overcrowding increases the risk that a pregnant woman or a newborn will be exposed to infectious agents
–> living in a large city

22
Q

Causes: Stress and Relapse

A
  • stressful circumstances might trigger new episodes in people with schizophrenia
  • immigration (especially recently) is one major stressor linked to increased risk for episodes in schizophrenia
23
Q

Causes: Family

A

double blind = parents of children who develop schizophrenia put their children in a double bind by constantly communicating conflicting messages to their children

expressed emotion = families high in expressed emotion are overinvolved with one another, are overprotective of the family member with schizophrenia, and voice self-sacrificing attitudes toward the family member while at the same time being critical, hostile, and resentful toward him or her

24
Q

Causes: Cognitive

A
  • limited cognitive resources
  • positive symptoms arise from the use of biases to understand the information streaming to their brain –> delusions and hallucinations arise from that
  • negative symptoms arise from expectations that social interactions will be aversive and from the need to withdraw and conserve scarce cognitive resources
25
Q

Treatment: Typical Antipsychotic Drugs

A

Phenothiazines (neuroleptics) appear to block receptors for dopamine, thereby reducing its action in the brain
–> more effective in treating the positive symptoms
–> about 25% do not respond to the drug
–> drug must be taken continuously
–> example: chlorpromazine = calms agitation and reduces hallucinations and delusions

Side effects:
- akinesia = slowed motor activity, monotonous speech, and an expressionless face
- symptoms similar to Parkinson’s disease because dopamine can be decreased too much
- akathesis = an agitation that causes people to pace and be unable to sit still
- tardive dyskinesia = a neurological disorder that involves involuntary movements of the tongue, face, mouth, or jaw

26
Q

Treatment: Atypical Antipsychotic Drugs

A

= more effective in treating schizophrenia than neuroleptics without its neurological side effects
–> example: clozapine = binds to D4 dopamine receptor + influences other neurotransmitters
–> reduce both positive and negative symptoms

Side effects:
- agranulocytosis = deficiency of granulocytes, substances produced by the bone marrow that fight infection
- sexual dysfunction, sedation, low blood pressure, seizures, gastrointestinal problems, vision problems, and problems with concentration

27
Q

Treatment: Behavioral, Cognitive, and Social

A
  • cognitive treatments: helping people with schizophrenia recognize and change demoralizing attitudes they may have toward their illness
  • behavioral treatments: use operant conditioning and modeling to teach persons with schizophrenia basic skills
  • in psychiatric hospitals and residential treatment centers: token economies –> patients earn tokens that they can exchange for special privileges
  • social interventions: increase contact between people with schizophrenia and supportive others
28
Q

Treatment: Family Therapy

A

= combine basic education on schizophrenia with the training of family members in coping with their loved one’s inappropriate behaviors and the disorder’s impact on their lives

29
Q

Treatment: Assertive Community Treatment Programs

A

= provide comprehensive services for people with schizophrenia, relying on the expertise of medical professionals, social workers, and psychologists to meet the variety of patients’ needs 24/7

30
Q

Treatment: Metacognitive Training (MCT)

A

= a recent training approach which targets cognitive biases in people with schizophrenia

–> patients are taught to be aware of their cognitive biases and to critically reflect on these in order to alter their current repertoire of problem-solving skills

–> uses cognitive tasks which provide insight and corrective experiences

31
Q

Cognitive Biases

A

= cognitive biases (jumping to conclusions) are involved in the formation and maintenance of delusions in schizophrenia

  • Jumping to conclusions
  • Attributional style and self-esteem: schizophrenia patients often shift blame for negative events onto other people
  • Metamemory: schizophrenia patients often have reduced memory vividness combined with overconfidence, particularly for incorrect or false memories
  • Bias against disconfirmatory evidence: schizophrenia patients are more likely to endorse their initial interpretation despite disconfirming evidence
  • Theory of mind: there might be severe deficits in social cognition or theory of mind (ToM) in schizophrenia patients
32
Q

Auditory Verbal Hallucinations in Healthy and Psychotic Individuals

A

Differences:
- negative emotional valence of content
- higher frequency of AVHs
- lower degree of control
- later age at onset (21 years of psychotic and 12 years for healthy individuals)

Similarities:
- the perceived location of voices (inside/outside)
- the number of voices
- loudness
- personification

Psychopathology (10 decks)

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