Week 20: Psychopathology II Flashcards

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1
Q

Learning Objectives:

Describe the diagnostic criteria for mood disorders.

Understand age, gender, and ethnic differences in prevalence rates of mood disorders.

Identify common risk factors for mood disorders.

Know effective treatments of mood disorders.

A
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2
Q

___ in 20 women experience depression after the birth of a baby

A

one in 20

5% of all mothers

“perinatal depression”

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3
Q

World Health Organization on depression and bipolar

A

World Health Organization ranks both major depressive disorder (MDD) and bipolar disorder (BD) among the top 10 leading causes of disability worldwide. Further, MDD and BD carry a high risk of suicide. It is estimated that 25%–50% of people diagnosed with BD will attempt suicide at least once in their lifetimes

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4
Q

Mood Episodes

A

Everyone experiences brief periods of sadness, irritability, or euphoria. This is different than having a mood disorder, such as MDD or BD, which are characterized by a constellation of symptoms that causes people significant distress or impairs their everyday functioning.

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5
Q

Major Depressive Episodes (MDE)

A

refers to symptoms that co-occur for at least two weeks and cause significant distress or impairment in functioning, such as interfering with work, school, or relationships. Core symptoms include feeling down or depressed or experiencing anhedonia

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6
Q

Anhedonia

A

Loss of interest or pleasure in activities one previously found enjoyable or rewarding.

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7
Q

You need 5 of these 9 symptoms to be diagnosed with depressive mood disorder

A
  1. depressed mood
  2. diminished interest or pleasure in almost all activities
  3. significant weight loss or gain or an increase or decrease in appetite
  4. insomnia or hypersomnia
  5. psychomotor agitation or retardation
  6. fatigue or loss of energy
  7. feeling worthless or excessive or inappropriate guilt
  8. diminished ability to concentrate or indecisiveness
  9. recurrent thoughts of death, suicidal ideation, or a suicide attempt

These symptoms cannot be caused by the physiological effects of a substance or a general medical condition (e.g., hypothyroidism).

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8
Q

hypersomnia

A

Excessive daytime sleepiness, including difficulty staying awake or napping, or prolonged sleep episodes.

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9
Q

psychomotor agitation

A

Increased motor activity associated with restlessness, including physical actions (e.g., fidgeting, pacing, feet tapping, handwringing).

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10
Q

retardation

A

A slowing of physical activities in which routine activities (e.g., eating, brushing teeth) are performed in an unusually slow manner.

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11
Q

suicidal ideation

A

Recurring thoughts about suicide, including considering or planning for suicide, or preoccupation with suicide.

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12
Q

manic or hypomanic episode

A

Period of abnormally and persistently euphoric, expansive, or irritable mood and persistently increased goal-directed activity or energy. The mood disturbance must be present for one week or longer in mania (unless hospitalization is required) or four days or longer in hypomania.

*Manic episodes are distinguished from hypomanic episodes by their duration and associated impairment; whereas manic episodes must last one week and are defined by a significant impairment in functioning, hypomanic episodes are shorter and not necessarily accompanied by impairment in functioning.

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13
Q

You need 3 of these 7 symptoms to be diagnosed with manic or hypomanic mood disorder in the context of euphoric mood (or at least four in the context of irritable mood):

A
  1. inflated self-esteem or grandiosity
  2. increased goal-directed activity or psychomotor agitation
  3. reduced need for sleep
  4. racing thoughts or flight of ideas
  5. distractibility
  6. increased talkativeness
  7. excessive involvement in risky behaviours
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14
Q

grandiosity

A

Inflated self-esteem or an exaggerated sense of self-importance and self-worth (e.g., believing one has special powers or superior abilities).

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15
Q

Unipolar Mood Disorders
Two Major Types

A
  1. Major depressive disorder
  2. Persistent depressive disorder (PDD; dysthymia)
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16
Q

MDD is defined by one or more MDEs, but no history of manic or hypomanic episodes. Criteria for PDD are feeling depressed most of the day for more days than not, for at least two years. At least 2 of the following 6 symptoms are also required to meet criteria for PDD:

A
  1. poor appetite or overeating
  2. insomnia or hypersomnia
  3. low energy or fatigue
  4. low self-esteem
  5. poor concentration or difficulty making decisions
  6. feelings of hopelessness

Like MDD, these symptoms need to cause significant distress or impairment and cannot be due to the effects of a substance or a general medical condition. To meet criteria for PDD, a person cannot be without symptoms for more than two months at a time. PDD has overlapping symptoms with MDD. If someone meets criteria for an MDE during a PDD episode, the person will receive diagnoses of PDD and MDD.

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17
Q

Bipolar Mood Disorders
Three major types of BDs

A
  1. Bipolar I Disorder (BD I), which was previously known as manic-depression, is characterized by a single (or recurrent) manic episode. A depressive episode is not necessary but commonly present for the diagnosis of BD I.
  2. Bipolar II Disorder is characterized by single (or recurrent) hypomanic episodes and depressive episodes.
  3. Another type of BD is cyclothymic disorder, characterized by numerous and alternating periods of hypomania and depression, lasting at least two years. To qualify for cyclothymic disorder, the periods of depression cannot meet full diagnostic criteria for an MDE; the person must experience symptoms at least half the time with no more than two consecutive symptom-free months; and the symptoms must cause significant distress or impairment.
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18
Q

lifetime prevalence rate for MDD

A

16.6%

nearly one in five Americans will meet the criteria for MDD during their lifetime. The 12-month prevalence—the proportion of people who meet criteria for a disorder during a 12-month period—for PDD is approximately 0.5%

Although the onset of MDD can occur at any time throughout the lifespan, the average age of onset is mid-20s, with the age of onset decreasing with people born more recently. Prevalence of MDD among older adults is much lower than it is for younger cohorts. The duration of MDEs varies widely. Recovery begins within three months for 40% of people with MDD and within 12 months for 80%. MDD tends to be a recurrent disorder with about 40%–50% of those who experience one MDE experiencing a second MDE. An earlier age of onset predicts a worse course. About 5%–10% of people who experience an MDE will later experience a manic episode, thus no longer meeting criteria for MDD but instead meeting them for BD I. Diagnoses of other disorders across the lifetime are common for people with MDD: 59% experience an anxiety disorder; 32% experience an impulse control disorder, and 24% experience a substance use disorder.

Women experience two to three times higher rates of MDD than do men. This gender difference emerges during puberty. Before puberty, boys exhibit similar or higher prevalence rates of MDD than do girls.

MDD is inversely correlated with socioeconomic status (SES), a person’s economic and social position based on income, education, and occupation. Higher prevalence rates of MDD are associated with lower SES

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19
Q

Bipolar Disorders

A

The lifetime prevalence rate of bipolar spectrum disorders in the general U.S. population is estimated at approximately 4.4%, with BD I constituting about 1% of this rate

Adolescents experience a higher incidence of bipolar spectrum disorders than do adults. Making matters worse, those who are diagnosed with BD at a younger age seem to suffer symptoms more intensely than those with adult onset.

Prevalence estimates, however, are highly dependent on the diagnostic procedures used (e.g., interviews vs. self-report) and whether or not sub-threshold forms of the disorder are included in the estimate. BD often co-occurs with other psychiatric disorders. Approximately 65% of people with BD meet diagnostic criteria for at least one additional psychiatric disorder, most commonly anxiety disorders and substance use disorders.

A recent cross-national study sample of more than 60,000 adults from 11 countries, estimated the worldwide prevalence of BD at 2.4%, with BD I constituting 0.6% of this rate (Merikangas et al., 2011). In this study, the prevalence of BD varied somewhat by country. Whereas the United States had the highest lifetime prevalence (4.4%), India had the lowest (0.1%). Variation in prevalence rates was not necessarily related to SES, as in the case of Japan, a high-income country with a very low prevalence rate of BD (0.7%).

As with MDD, adolescence is known to be a significant risk period for BD; mood symptoms start by adolescence in roughly half of BD cases. Longitudinal studies show that those diagnosed with BD prior to adulthood experience a more pernicious course of illness relative to those with adult onset, including more episode recurrence, higher rates of suicidality, and profound social, occupational, and economic repercussions. The prevalence of BD is substantially lower in older adults compared with younger adults (1% vs. 4%).

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20
Q

Depressive Disorders
Factors in development

A
  • genetic factors are implicated in the development of MDD
  • Twin studies suggest that familial influence on MDD is mostly due to genetic effects and that individual-specific environmental effects (e.g., romantic relationships) play an important role, too. By contrast, the contribution of shared environmental effect by siblings is negligible
  • Several genetic variants and environmental factors most likely contribute to the risk for MDD
  • Romantic relationships can affect mood as in the case of divorce or the death of a spouse.
  • stressful life events. In particular, severe stressful life events—those that have long-term consequences and involve loss of a significant relationship (e.g., divorce) or economic stability (e.g., unemployment) are strongly related to depression. Stressful life events are more likely to predict the first MDE than subsequent episodes. In contrast, minor events may play a larger role in subsequent episodes than the initial episodes.
  • A meta-analysis of neuroimaging studies showed that when viewing negative stimuli (e.g., picture of an angry face, picture of a car accident), compared with healthy control participants, participants with MDD have greater activation in brain regions involved in stress response and reduced activation of brain regions involved in positively motivated behaviors
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21
Q

early adversity | Factors in development for MDD

A

Single or multiple acute or chronic stressful events, which may be biological or psychological in nature (e.g., poverty, abuse, childhood illness or injury), occurring during childhood and resulting in a biological and/or psychological stress response.

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22
Q

Chronic Stress |Factors in development for MDD

A

Discrete or related problematic events and conditions which persist over time and result in prolonged activation of the biological and/or psychological stress response (e.g., unemployment, ongoing health difficulties, marital discord).

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23
Q

interpersonal factors |Factors in development for MDD

A

marital dissatisfaction predicts increases in depressive symptoms in both men and women. On the other hand, depressive symptoms also predict increases in marital dissatisfaction.

*People with MDD whose relatives or spouses can be described as critical and emotionally overinvolved have higher relapse rates than do those living with people who are less critical and emotionally overinvolved

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24
Q

attributional styles

A

The tendency by which a person infers the cause or meaning of behaviors or events.

*People with a pessimistic attributional style tend to make internal (versus external), global (versus specific), and stable (versus unstable) attributions to negative events, serving as a vulnerability to developing MDD. For example, someone who when he fails an exam thinks that it was his fault (internal), that he is stupid (global), and that he will always do poorly (stable) has a pessimistic attribution style. Several influential theories of depression incorporate attributional styles

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25
Q

Bipolar Disorders
factors in development

A

Genetic
- There is compelling evidence for biological causes of BD, which is known to be highly heritable. It may be argued that a high rate of heritability demonstrates that BD is fundamentally a biological phenomenon.
- The triggers that determine how and when this genetic vulnerability is expressed are not yet understood; however, there is evidence to suggest that psychosocial triggers may play an important role in BD risk

Biological | Brain
- brain function. Many of the studies using fMRI techniques to characterize BD have focused on the processing of emotional stimuli based on the idea that BD is fundamentally a disorder of emotion. Findings show that regions of the brain thought to be involved in emotional processing and regulation are activated differently in people with BD relative to healthy controls
- Mixed findings are in part due to samples consisting of participants who are at various phases of illness at the time of testing (manic, depressed, inter-episode). Sample sizes tend to be relatively small, making comparisons between subgroups difficult. Additionally, the use of a standardized stimulus (e.g., facial expression of anger) may not elicit a sufficiently strong response. Personally engaging stimuli, such as recalling a memory, may be more effective in inducing strong emotions

Psychosocial
- environmental contributors to BD. A series of studies show that environmental stressors, particularly severe stressors (e.g., loss of a significant relationship), can adversely impact the course of BD. People with BD have substantially increased risk of relapse and suffer more depressive symptoms following a severe life stressor. Interestingly, positive life events can also adversely impact the course of BD. People with BD suffer more manic symptoms after life events involving attainment of a desired goal. Such findings suggest that people with BD may have a hypersensitivity to rewards.

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26
Q

Social Zeitgeber Theory

A

Zeitgeber is German for “time giver.” Social zeitgebers are environmental cues, such as meal times and interactions with other people, that entrain biological rhythms and thus sleep-wake cycle regularity.

*stressors that disrupt sleep, or that disrupt the daily routines that entrain the biological clock (e.g., meal times) can trigger episode relapse. Consistent with this theory, studies have shown that life events that involve a disruption in sleep and daily routines, such as overnight travel, can increase bipolar symptoms in people with BD.

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27
Q

Depressive Disorders
Treatment

A

A number of medications are effective in treating mood disorders. Meditation, exercise, counseling and other therapies also show effectiveness for some disorders.

  • a number of antidepressant medications are available, all of which target one or more of the neurotransmitters implicated in depression.The earliest antidepressant medications were monoamine oxidase inhibitors (MAOIs). MAOIs inhibit monoamine oxidase, an enzyme involved in deactivating dopamine, norepinephrine, and serotonin. Although effective in treating depression, MAOIs can have serious side effects. Patients taking MAOIs may develop dangerously high blood pressure if they take certain drugs (e.g., antihistamines) or eat foods containing tyramine, an amino acid commonly found in foods such as aged cheeses, wine, and soy sauce.
  • Tricyclics, the second-oldest class of antidepressant medications, block the reabsorption of norepinephrine, serotonin, or dopamine at synapses, resulting in their increased availability. Tricyclics are most effective for treating vegetative and somatic symptoms of depression. Like MAOIs, they have serious side effects, the most concerning of which is being cardiotoxic. Selective serotonin reuptake inhibitors (SSRIs; e.g., Fluoxetine) and serotonin and norepinephrine reuptake inhibitors (SNRIs; e.g., Duloxetine) are the most recently introduced antidepressant medications.
  • SSRIs, the most commonly prescribed antidepressant medication, block the reabsorption of serotonin, whereas SNRIs block the reabsorption of serotonin and norepinephrine. SSRIs and SNRIs have fewer serious side effects than do MAOIs and tricyclics. In particular, they are less cardiotoxic, less lethal in overdose, and produce fewer cognitive impairments. They are not, however, without their own side effects, which include but are not limited to difficulty having orgasms, gastrointestinal issues, and insomnia. It should be noted that anti-depressant medication may not work equally for all people. This approach to treatment often involves experimentation with several medications and dosages, and may be more effective when paired with physical exercise and psychotherapy.
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28
Q

Depressive Disorders
biological treatments

A

Other biological treatments for people with depression include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and deep brain stimulation. ECT involves inducing a seizure after a patient takes muscle relaxants and is under general anesthesia. ECT is viable treatment for patients with severe depression or who show resistance to antidepressants although the mechanisms through which it works remain unknown. A common side effect is confusion and memory loss, usually short-term

-Repetitive TMS is a noninvasive technique administered while a patient is awake. Brief pulsating magnetic fields are delivered to the cortex, inducing electrical activity. TMS has fewer side effects than ECT, and while outcome studies are mixed, there is evidence that TMS is a promising treatment for patients with MDD who have shown resistance to other treatments.

Most recently, deep brain stimulation has been examined as a treatment option for patients who did not respond to more traditional treatments like those already described. Deep brain stimulation involves implanting an electrode in the brain. The electrode is connected to an implanted neurostimulator, which electrically stimulates that particular brain region. Although there is some evidence of its effectiveness, additional research is needed.

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29
Q

Depressive Disorders
psychosocial treatments

A

These treatments include but are not limited to behavior therapy, cognitive therapy, and interpersonal therapy. Behavior therapies focus on increasing the frequency and quality of experiences that are pleasant or help the patient achieve mastery. Cognitive therapies primarily focus on helping patients identify and change distorted automatic thoughts and assumptions. Cognitive-behavioral therapies are based on the rationale that thoughts, behaviors, and emotions affect and are affected by each other. Interpersonal Therapy for Depression focuses largely on improving interpersonal relationships by targeting problem areas, specifically unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits. Finally, there is also some support for the effectiveness of Short-Term Psychodynamic Therapy for Depression. The short-term treatment focuses on a limited number of important issues, and the therapist tends to be more actively involved than in more traditional psychodynamic therapy.

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30
Q

Bipolar Disorders
treatment

A

pharmacotherapy
- Antidepressants such as SSRIs and SNRIs are the primary choice of treatment for depression, whereas for BD, lithium is the first line treatment choice. This is because SSRIs and SNRIs have the potential to induce mania or hypomania in patients with BD. Lithium acts on several neurotransmitter systems in the brain through complex mechanisms, including reduction of excitatory (dopamine and glutamate) neurotransmission, and increase of inhibitory (GABA) neurotransmission
- Lithium has strong efficacy for the treatment of BD. However, a number of side effects can make lithium treatment difficult for patients to tolerate. Side effects include impaired cognitive function, as well as physical symptoms such as nausea, tremor, weight gain, and fatigue. Some of these side effects can improve with continued use; however, medication noncompliance remains an ongoing concern in the treatment of patients with BD. Anticonvulsant medications are also commonly used to treat patients with BD, either alone or in conjunction with lithium.

Alternatives
- Interpersonal and social rhythm therapy is a psychosocial intervention focused on addressing the mechanism of action posited in social zeitgeber theory to predispose patients who have BD to relapse, namely sleep disruption. A growing body of literature provides support for the central role of sleep dysregulation in BD. Consistent with this literature, IPSRT aims to increase rhythmicity of patients’ lives and encourage vigilance in maintaining a stable rhythm. The therapist and patient work to develop and maintain a healthy balance of activity and stimulation such that the patient does not become overly active (e.g., by taking on too many projects) or inactive (e.g., by avoiding social contact). The efficacy of IPSRT has been demonstrated in that patients who received this treatment show reduced risk of episode recurrence and are more likely to remain well.

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31
Q

Recently, Zeb has lost his passion for sports. Invitations to play with his friends just don’t excite him. This loss of interest is an example of which symptom of a major depressive episode?

A

anhedonia

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32
Q

Psychomotor ______refers to an increase in activity that is marked by restlessness and fidgeting, pacing, or tapping of the feet.

A

agitation

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33
Q

How can you best distinguish between a manic episode and a hypomanic episode?

A

duration and level of impairment

34
Q

Dr. Scarcliff is seeing a patient with symptoms of euphoria and grandiosity. What question should he ask to determine if the correct diagnosis is bipolar I or bipolar II disorder?

A

Is this patient experiencing a manic episode or a hypomanic episode

35
Q

The way in which a person infers the cause or meaning of behaviors or events around them is called their ______style.

A

attributional

36
Q

Karla takes antidepressants but has been advised that she should stay away from “anything that has tyramine” such as wine, soy sauce, and aged cheese. What kind of drugs does Karla take?

A

a monoamine oxidase inhibitor (MAOI)

37
Q

When someone with bipolar disorder is prescribed lithium, the expected changes include:

A

a decrease of dopamine and glutamate and increase of GABA neurotransmitters

38
Q

Learning Objectives:

Describe the signs and symptoms of schizophrenia and related psychotic disorders.

Describe the most well-replicated cognitive and neurobiological changes associated with schizophrenia.

Describe the potential risk factors for the development of schizophrenia.

Describe the controversies associated with “clinical high risk” approaches to identifying individuals at risk for the development of schizophrenia.

Describe the treatments that work for some of the symptoms of schizophrenia.

A
39
Q

schizophrenia and related psychotic disorders

A

You have probably had the experience of walking down the street in a city and seeing a person you thought was acting in a manner not typical. They may have been dressed in an unusual way, perhaps disheveled or wearing an unusual collection of clothes, makeup, or jewelry that did not seem to fit any particular group or subculture. They may have been talking to themselves or yelling at someone you could not see. If you tried to speak to them, they may have been difficult to follow or understand, or they may have acted paranoid or started telling a bizarre story about the people who were plotting against them. If so, chances are that you have encountered an individual with schizophrenia or another type of psychotic disorder.

40
Q

catatonia

A

Behaviors that seem to reflect a reduction in responsiveness to the external environment. This can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.

41
Q

anhedonia/amotivation

A

A reduction in the drive or ability to take the steps or engage in actions necessary to obtain the potentially positive outcome.

42
Q

Delusions

A

False beliefs that are often fixed, hard to change even in the presence of conflicting information, and often culturally influenced in their content.
*delusions may involve false beliefs about important figures in a person’s culture such as political leaders, popular culture icons, key religious figures, or famous athletes

43
Q

Persecutory Delusions

A

Involve the belief that individuals or groups are trying to hurt, harm, or plot against the person in some way.

44
Q

Grandiose delusions

A

person believes that they have some special power or ability (e.g., I am the new Buddha, I am a rock star

45
Q

referential delusions

A

person believes that events or objects in the environment have special meaning for them (e.g., that song on the radio is being played specifically for me)

46
Q

OTHER Delusions

A

person may believe that others are controlling their thoughts and actions, their thoughts are being broadcast aloud, or that others can read their mind (or they can read other people’s minds).

Abstract groups like the police or the government are commonly the focus of a person with schizophrenia’s persecutory delusions.

47
Q

Hallucinations

A

Perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences. They can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch).

48
Q

Disorganized speech

A

Speech that is difficult to follow, either because answers do not clearly follow questions or because one sentence does not logically follow from another.

Talking to someone with schizophrenia is sometimes difficult because of this
*can also be present in writing

49
Q

Disorganized behaviour

A

Behavior or dress that is outside the norm for almost all subcultures. This would include odd dress, odd makeup (e.g., lipstick outlining a mouth for 1 inch), or unusual rituals (e.g., repetitive hand gestures).

*can include odd dress, odd makeup (e.g., lipstick outlining a mouth for 1 inch), or unusual rituals (e.g., repetitive hand gestures). Abnormal motor behavior can include catatonia, which refers to a variety of behaviors that seem to reflect a reduction in responsiveness to the external environment. This can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.

50
Q

flat affect

A

A reduction in the display of emotions through facial expressions, gestures, and speech intonation.

51
Q

alogia

A

A reduction in the amount of speech and/or increased pausing before the initiation of speech.

52
Q

psychopathology

A

Illnesses or disorders that involve psychological or psychiatric symptoms.

53
Q

diagnostic criteria

A

The specific criteria used to determine whether an individual has a specific type of psychiatric disorder. Commonly used diagnostic criteria are included in the Diagnostic and Statistical Manual of Mental Disorder, 5th Edition (DSM-5) and the Internal Classification of Disorders, Version 9 (ICD-9).

54
Q

Diagnosing schizophrenia

A

Lifetime prevalence: 0.3% to 0.7%

Two or more of following for at least one month:
- hallucinations
- delusions
- disorganized speech
- grossly disorganized
- catatonic behaviour

Impairments in one or more of the following functions:
- social
- occupational
- educational
- self care
For significant period of time since the onset of illness

*Continuous signs of illness for at least 6 months

55
Q

Diagnosing schizophreniform disorder

A

Same as schizophrenia

HOWEVER continuous signs at least a month but under 6 months

56
Q

Diagnosing schizoaffective disorder

A

Symptoms for

+ major depression or manic episode

  • delusions or hallucinations for at least 2 weeks when they are not having major depression or manic episode
  • symptoms for major depression or manic episode for over half of illness duration
57
Q

Delusional disorder

A

lifetime prevalence: 0.2%

  • presence of at least one delusion for a month
  • Person never met criteria for schizophrenia
  • Person’s function not impaired outside the specific impact of the delusion
  • Duration of any depressive or manic episode has been brief relative to duration of delusion
58
Q

Brief Psychotic disorder

A

Lifetime prevalence: unclear

On or more following symptoms present for at least one day, but less than a month:

  • delusions
  • hallucinations
  • disorganized speech
  • grossly disordered
  • catatonic behaviour
59
Q

Attenuated Psychotic Disorder

A

Lifetime presence: unclear

  • one or more of the following in an attenuated for:
  • delusions
  • hallucinations
  • disorganized speech
  • Symptoms must have occurred at least once a week for the past month
    *Must have started and gotten worse in the past year

*Symptoms severe enough to distress or disable individual or to suggest to others that the person needs clinical help
*The person has never met the diagnostic for psychotic disorder, and the symptoms are not better attributed to another disorder, to substance use, to to medical condition.

60
Q

Cognitive Neuroscience of Schizophrenia

A

As described above, when we think of the core symptoms of psychotic disorders such as schizophrenia, we think of people who hear voices, see visions, and have false beliefs about reality (i.e., delusions). However, problems in cognitive function are also a critical aspect of psychotic disorders and of schizophrenia in particular.

61
Q

Functional Capacity | Problems Schizophreniacs face

A

The ability to engage in self-care (cook, clean, bathe), work, attend school, and/or engage in social relationships.

62
Q

Episodic memory | Problems Schizophreniacs face

A

The ability to learn and retrieve new information or episodes in one’s life.

63
Q

Working memory | Problems Schizophreniacs face

A

The form of memory we use to hold onto information temporarily, usually for the purposes of manipulation.

64
Q

Processing speed| Problems Schizophreniacs face

A

The speed with which an individual can perceive auditory or visual information and respond to it.

*tends to be slower for people with Schizophrenia

65
Q

social cognition| Problems Schizophreniacs face

A

problems with the recognition of emotional expressions on the faces of other individuals
Problems inferring people’s intentions
May not be able to detect the meaning of facial expressions or other subtle cues that most other people rely on to navigate the social world.

66
Q

magnetic resonance imaging

A

Or MRI is a brain imaging noninvasive technique that uses magnetic energy to generate brain images (also see fMRI).

*opened up the ability to try to understand the brain mechanisms of the symptoms of schizophrenia as well as the cognitive impairments found in psychosis.

67
Q

positron emission tomography

A

(or PET) An invasive procedure that captures brain images with positron emissions from the brain after the individual has been injected with radio-labeled isotopes.

*opened up the ability to try to understand the brain mechanisms of the symptoms of schizophrenia as well as the cognitive impairments found in psychosis.

68
Q

imaging technology & “salience” detection mechanisms

A

a number of studies have suggested that delusions in psychosis may be associated with problems in “salience” detection mechanisms supported by the ventral striatum
Further, there is good evidence that problems in working memory and cognitive control in schizophrenia are related to problems in the function of a region of the brain called the dorsolateral prefrontal cortex (DLPFC)
These problems include changes in how the DLPFC works when people are doing working-memory or cognitive-control tasks, and problems with how this brain region is connected to other brain regions important for working memory and cognitive control, including the posterior parietal cortex and temporal cortex.
In terms of understanding episodic memory problems in schizophrenia, many researchers have focused on medial temporal lobe deficits, with a specific focus on the hippocampus.
This is because there is much data from humans and animals showing that the hippocampus is important for the creation of new memories. However, it has become increasingly clear that problems with the DLPFC also make important contributions to episodic memory deficits in schizophrenia, probably because this part of the brain is important for controlling our use of memory.

In addition to problems with regions such as the DLFPC and medial temporal lobes in schizophrenia described above, magnitude resonance neuroimaging studies have also identified changes in cellular architecture, white matter connectivity, and gray matter volume in a variety of regions that include the prefrontal and temporal cortices. People with schizophrenia also show reduced overall brain volume, and reductions in brain volume as people get older may be larger in those with schizophrenia than in healthy people. Taking antipsychotic medications or taking drugs such as marijuana, alcohol, and tobacco may cause some of these structural changes. However, these structural changes are not completely explained by medications or substance use alone. Further, both functional and structural brain changes are seen, again to a milder degree, in the first-degree relatives of people with schizophrenia

69
Q

Risk Factors for Developing Schizophrenia

  • Unfortunately, none of these risk factors is specific enough to be particularly useful in a clinical setting, and most people with these “risk” factors do not develop schizophrenia.
A

genetic contributions
- It is clear that there are important genetic contributions to the likelihood that someone will develop schizophrenia, with consistent evidence from family, twin, and adoption studies. (Sullivan, Kendler, & Neale, 2003). However, there is no “schizophrenia gene” and it is likely that the genetic risk for schizophrenia reflects the summation of many different genes that each contribute something to the likelihood of developing psychosis
*Heterogeneous
means that two different people with “schizophrenia” may each have very different symptoms (e.g., one has hallucinations and delusions, the other has disorganized speech and negative symptoms). This makes it even more challenging to identify specific genes associated with risk for psychosis. Importantly, many studies also now suggest that at least some of the genes potentially associated with schizophrenia are also associated with other mental health conditions, including bipolar disorder, depression, and autism

Environmental factors
- problems during pregnancy such as increased stress, infection, malnutrition, and/or diabetes have been associated with increased risk of schizophrenia. In addition, complications that occur at the time of birth and which cause hypoxia (lack of oxygen) are also associated with an increased risk for developing schizophrenia
- Children born to older fathers are also at a somewhat increased risk of developing schizophrenia. Further, using cannabis increases risk for developing psychosis, especially if you have other risk factors
-The likelihood of developing schizophrenia is also higher for kids who grow up in urban settings and for some minority ethnic groups

70
Q

Define neurodevelopmental factors

A

Processes that influence how the brain develops either in utero or as the child is growing up.

71
Q

“clinical high risk” individuals for psychosis

A

individuals who are showing attenuated (milder) symptoms of psychosis that have developed recently and who are experiencing some distress or disability associated with these symptoms. When people with these types of symptoms are followed over time, about 35% of them develop a psychotic disorder, most frequently schizophrenia

72
Q

“Attenuated Psychotic Syndrome” debate

A

Many scientists and clinicians have been worried that including “risk” states in the DSM-5 would create mental disorders where none exist, that these individuals are often already seeking treatment for other problems, and that it is not clear that we have good treatments to stop these individuals from developing to psychosis. However, the counterarguments have been that there is evidence that individuals with high-risk symptoms develop psychosis at a much higher rate than individuals with other types of psychiatric symptoms, and that the inclusion of Attenuated Psychotic Syndrome in Section III will spur important research that might have clinical benefits. Further, there is some evidence that non-invasive treatments such as omega-3 fatty acids and intensive family intervention may help reduce the development of full-blown psychosis in people who have high-risk symptoms.

73
Q

Treatment of Schizophrenia

A

The first line of treatment for schizophrenia and other psychotic disorders is the use of antipsychotic medications. There are two primary types of antipsychotic medications, referred to as “typical” and “atypical.” The fact that “typical” antipsychotics helped some symptoms of schizophrenia was discovered serendipitously more than 60 years ago. These are drugs that all share a common feature of being a strong block of the D2 type dopamine receptor.

Although these drugs can help reduce hallucinations, delusions, and disorganized speech, they do little to improve cognitive deficits or negative symptoms and can be associated with distressing motor side effects. The newer generation of antipsychotics is referred to as “atypical” antipsychotics. These drugs have more mixed mechanisms of action in terms of the receptor types that they influence, though most of them also influence D2 receptors. These newer antipsychotics are not necessarily more helpful for schizophrenia but have fewer motor side effects. However, many of the atypical antipsychotics are associated with side effects referred to as the “metabolic syndrome,” which includes weight gain and increased risk for cardiovascular illness, Type-2 diabetes, and mortality

Unfortunately, as of yet, there are no pharmacological treatments that work consistently to improve cognition in schizophrenia, though many new types of drugs are currently under exploration. However, there is a type of psychological intervention, referred to as cognitive remediation, which has shown some evidence of helping cognition and function in schizophrenia. In particular, a version of this treatment called Cognitive Enhancement Therapy (CET) has been shown to improve cognition, functional outcome, social cognition, and to protect against gray matter loss in young individuals

74
Q

dopamine

A

A neurotransmitter in the brain that is thought to play an important role in regulating the function of other neurotransmitters.

75
Q

Karl has been suffering from the symptoms of schizophrenia for about a year. He has a reduction in his responsiveness to events in his surroundings, and his motor behavior is often slow or aimless. Which of the following best describes these symptoms?

A

catatonia

76
Q

Of the following, which type of delusion is most commonly experienced among those suffering from a psychotic disorder?

A

persecutory delusions

77
Q

What is one of the biggest problems with the negative symptoms of schizophrenia?

A

They may not be apparent to others and thus not get appropriate attention.

78
Q

After she receives an acceptance letter to her top choice university, Brenda says, “I guess that’s good. I’ll go there.” This sort of absence of emotions is called ______.

A

flat affect

79
Q

Which of the following parts of the brain normally activate when important, aka “salient,” events happen? (These areas may under-perform in those with schizophrenia.)

A

the ventral striatum and the anterior prefrontal cortex

80
Q

Both “typical” and “atypical” antipsychotic medications work by blocking a specific type of ______receptor in the brain.

A

dopamine

81
Q

Tyler, who suffers from schizophrenia, has recently developed a series of symptoms that his physician calls “metabolic syndrome.” What type of medication is he likely to be taking?

A

atypical antipsychotics