WEEK 11 Flashcards
Schizophrenia Spectrum and other Psychotic Disorder
Psychosis
Psychosis is a state defined by a loss of contact with reality
Psychosis: Hallucinations
sensory experiences in the absence of external events
Psychosis: Delusions
: irrational/false
belief, confused thinking, changed feelings, changed behaviour
Brief Psychotic Disorder
episode lasts for at least 1 day but less than 1 mth
Schizophreniform Disorder
episode lasts for at least 1 but < 6 mths
Delusional Disorder
the presence of 1 (or more) delusions with a duration of 1 mth or longer
–> folie a deux
Schizoaffective Disorder
a major mood episode with concurrent schizophrenia
Schizophrenia- prevalence
- approx. 1% population lifetime risk
- present in all countries and cultures
- peak age: late teens, early adulthood
- female: male: 1: 1 (males earlier onset- poorer outcomes)
- personal and financial costs
- life expectancy- less than average (suicide, health behaviours)
Early Figures
Emil Kraepelin (1856-1926)
- distinguished the disorder
from other conditions
- dementia praecox
Eugen Bleuler (1857-1939) - introduced the term schizophrenia - associative splitting: ‘splitting of the mind’
Heterogeneous
a group of separate
disorders that share
common features
the symptoms,
triggers & course of
schizophrenia vary
greatly
Positive Symptoms
“pathological
excesses”; bizarre
additions to a person’s behaviour
–> DELUSIONS: faulty
interpretations of
reality; disorders of
thought content
–> HALLUCINATIONS: an experience of a sensory event without any input from the surrounding environment
(can involve any of the senses- most common is auditory) (broca area is activated with hallucinations)
Types of delusions
persecution - other people are out to get or
harm you
- being controlled by others
- reference - belief or perception that irrelevant,
unrelated or innocuous phenomena in the world
refer to you directly or have special personal
significance
- grandeur - belief that you are famous or
important
- Capgras syndrome: a familiar person has been
replaced by a double
- Cotard’s syndrome: belief that part of the body
has changed in some impossible way; e.g., you
are dead
motivational view (coping) or deficit view (brain dysfunction)
Negative Symptoms
“pathological deficits”;
characteristics that are lacking in an individual
Negative Symptoms
Avolition
apathy; drained of energy
Negative Symptoms
Alogia
poverty of speech
Negative Symptoms
Anhedonia
general lack of pleasure
Negative Symptoms
Affective flattening
lack of typical emotional responses
Negative Symptoms
Social Withdrawal
Social Withdrawal
Disorganised Symptoms
disordered thinking & speech (‘formal thought disorder’) e.g., flow & form
- Neologisms: new nonsense words
- perseverations: repetition of key words
- clanging: nonsensical rhyming
- catatonia: wild agitations, immobility
Course of Schizophrenia
Premorbid
- risk factors & early indications
Prodromal
- beginning of deterioration; less severe but
unusual behaviours
Onset
- positive, negative & disorganized symptoms
Chronic
- active periods: symptoms are severe
- recovery periods: a return to premorbid or
prodromal levels
Diagnosing Schizophrenia
- DSM-5 : diagnosis after overall signs continue for 6 months or more
- During 6 mth period, 2 or more of the following for at least 1 continuous mth.
- -> delusions
- -> hallucinations
- -> disorganised speech
- -> grossly disorganised or catatonic behaviour
- -> negative symptoms
Causes
Biological Views
Genetic factors:
- family studies: risk increases with genetic relatedness, parents severity increases likelihood for children, general predisposition (risk for a spectrum of psychotic disorders related to schizophrenia)
- Genes: multiple gene variances combine to produce vulnerability
- diathesis stress relationship: people with a biological predisposition will
develop schizophrenia only if certain kinds of
stressors or events are also present
Causes
Neurobiological Views
Neurotransmitters:
- dopamine: while some sites might be overactive others
appear to be less active
- Glutomate also involved
Brain structure:
- dysfunction in frontal lobes
- enlarged ventricles
Viral Problems:
- Brain abnormalities can result from exposure to viruses before birth
Chronic and early use of marijuana
Causes
Psychological and Social Views
Stress
- vulnerability
- increase relapse risk
Family
- Expressed emotion (EE): criticism, hostility, emotional
over involvement, relapse
Treatment
Biological Interventions
Antipsychotic medications (neuroleptics)
- decrease positive symptoms
- side effects: common and can be permanent
- extrapyramidal symptoms
New antipsychotic drugs (2nd generation)
- more effective that conventional drugs especially for negative symptoms
- few extrapyramidal side effects
- carry a risk of a fatal drop in white blood cells, grogginess, blurred vision, dry mouth
Treatment
Psychosocial Interventions
Prodromal and recovery phases:
- early detection and treatment of at- risk individuals
Address social and personal difficulties
- problem solving, coping skills training etc.
- family therapy: communication issues, create better understanding about disorder
Community care: - short term hospitalisation - coordinated services: facilities provide medications, psychotherapy & inpatient emergency care - Proper care: assists in recovery
Consumer recovery model
- hope, personal responsibility, respect from community
- new meaning and purpose of life beyond disorder
