Week 3: Schizophrenia Flashcards
Who gave the first label to behaviour now referred to as schizophrenia?
Emil Kraepelin in 1899 (Dementia praecox: dementia of the young)
Who first coined the label schizophrenia?
Eugene Bleuler in 1911 - also determined 4 key features (affect, ambivalence, associations, and preference for fantasy over reality) that are reasonably similar to current features
How prevalent is schizophrenia in the general population?
Approximately 1% in general population
When is the peak age of onset for schizophrenia?
Males: Between 15 and 25 years
Females: Between 25 and 35 years
What is considered rare age of onset for schizophrenia?
Below 10, above 50
Are men more likely to develop schizophrenia?
Yes - they are 30-40% more likely
For those diagnosed with schizophrenia, what percentage will attempt suicide?
Approximately 50%
True/False: Schizophrenia is the most expensive of all mental disorders
True - direct treatment costs, loss of productivity, public assistance costs; costly for both the affected and for the government
In the DSM-5-TR, what does criterion A consist of for schizophrenia?
Characteristic symptoms: Two or more of the following each present for a significant portion of time during a 1-month period. At least one must be 1,2,3
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms (affect flattening, alogia, avolition)
In the DSM-5-TR, what does criterion B consist of for schizophrenia?
Social Occupational Dysfunction:
“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 onset”
In the DSM-5-TR, what does criterion C consist of for schizophrenia?
Duration continuous signs for 6 months:
“This 6-month period must include at least 1 month of symptoms that meet criterion A and may include periods of prodromal or residual symptoms
In the DSM-5-TR, what does criterion D consist of for schizophrenia?
Exclusion of Schizoaffective and Mood Disorder
In the DSM-5-TR, what does criterion E consist of for schizophrenia?
Exclusion of Substance/general medical condition
In the DSM-5-TR, what does criterion F consist of for schizophrenia?
Relationship to Autism Spectrum Disorder or a communication disorder
-> as lots of overlap
What are positive symptoms?
“excess” behaviours - adding something to ‘normal’
What are negative symptoms?
“deficits” behaviours - taking away from ‘normal’
For schizophrenia, what are some positive symptoms?
Delusions, hallucinations, loose associations, disorganised behaviour
In schizophrenia, what are some negative symptoms?
Flat affect, apathy, social withdrawal, poor attention
In schizophrenia, disturbances in content of thought are typically…
Delusions
What are delusions?
A fixed false belief in the sense of their culture
What are some common delusions
Persecution, reference, grandeur, delusions of sin, hypochondriacal, nihilistic, somatic passivity, thought insertion, thought withdrawal, thought broadcasting, control, Capgras syndrome (body double), Cotard’s syndrome (impossible bodily change)
In schizophrenia, what is persecution?
Fixed, false beliefs that someone is out to get them
In schizophrenia, what is reference?
The idea that a gesture is specifically targeted, or is a message/reference for them specifically
In schizophrenia, what is thought insertion?
A thought in their head that is not their own (different to hallucination, which is a voice inside their head). There is a strong conviction that it is a thought, but it does not belong to them
In schizophrenia, disturbances of perception are typically…
Hallucinations
What are hallucinations?
Percept like experiences occurring in the absence of appropriate stimulus and not under voluntary control (can be auditory, visual, olfactory, gustatory, or tactile). They are vivid, clear, fully formed, and occur without physical stimulus.
In schizophrenia, disturbances in form of thought are typically…
Disorganisation of speech; loosening of associations
In schizophrenia, what are some overarching disturbances in form of thought
Poverty in speech, poverty in content
In schizophrenia, what are some more specific disturbances in form of thought
Neologisms, Perseveration, word salad, circumstantiality, tangentiality
In schizophrenia, what is neologisms?
Made up words
In schizophrenia, what are perseveration?
Repeating the same words many times
In schizophrenia, what is word salad?
Saying a lot of content, without the words holding meaning/making sense
In schizophrenia, what is circumstantiality?
When asking a question, they start answering, but then get lost and sidetracked, then eventually coming back to the point
In schizophrenia, what is tangentiality?
Starting answering a question, then getting lost and sidetracked, and never getting back to the original point
In schizophrenia, what are disturbances in affect?
Typically reduction of outward expression of emotion (reduction in facial expression, speech porosity, markers in expression) -> can be restricted, blunted, or flat (degrees)
In schizophrenia, what are some disturbances in social behaviour?
Avolition, anhedonia, and asociality
In schizophrenia, what is avolition?
Decreased self-initiated purposeful activities
In schizophrenia, what is anhedonia?
Decreased ability to experience pleasure
In schizophrenia, what is asociality?
Decreased interest in social interactions
How is the severity of schizophrenia rated?
On a 5 point scale - the severity is based on assessment of primary symptoms of psychosis (each symptom category is rated)
Do individuals with schizophrenia experience cognitive impairments?
Yes - over a range of domains (declarative memory, working memory, language function, executive/attention function, sensory processing)
In schizophrenia, can cognitive impairment predict functional outcome?
Yes - Often those with better cognitive resources predict better functional outcome
What are the three phases of schizophrenia?
Prodromal, active, residual
Define the prodromal phase of schizophrenia
The period before a psychotic episode, characterized by subtle changes in behaviour, thinking, and mood, that can precede the onset of schizophrenia
Define the active phase of schizophrenia
Phase where symptoms are most prevalent - characterized by the most prominent and visible symptoms of the disorder, including psychosis, such as hallucinations and delusions, which can significantly impact daily functioning
Define the residual phase of schizophrenia
Phase where a person experiences fewer or less severe symptoms than those seen in the active stage.
What are the two onset types for schizophrenia?
Gradual (slow, increasing symptoms in prodromal phase) and Acute (sharp increase in symptoms)
What are some positive outcome predictors for schizophrenia?
Good premorbid adjustment, no family history, sudden onset, precipitating stress, good response to medication, positive symptoms, later age of onset, female
What are some negative outcome predictors for schizophrenia?
Poor premorbid adjustment, family history, slow onset, no precipitating stress, poor response to medication, negative symptoms, early age of onset, male
What are some other psychotic disorders?
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Psychotic disorder due to another medical condition
Substance/medication-induced psychotic disorder
Catanoia associated with another mental disorder
Catanoia associated with another mental disorder
Unspecified catanioa
Other specified schizophrenia spectrum and other psychotic disorder
Unspecified schizophrenia spectrum and other psychotic disorder
Do genetics play a part in the aetiology of schizophrenia?
Likely to have polygenetic influences (multiple contributions from common and rare genetic variation) - unknown which ones specifically
Why is the dopamine hypothesis for schizophrenia problematic?
Many of the drugs used to treat schizophrenia are effective in treating other disorders; doesn’t capture negative symptoms
What are the limitations of the biological view of schizophrenia?
It is difficult to determine whether the abnormality is related to the disease process or to treatment. Also, a single pathological process in the brain can cause a wide range of phenomena in different individuals.
In schizophrenia, why is it important to ensure the family also gets support?
Better support systems leads to better outcomes - by providing support, resources and assistance to family unit, they can better provide support
What is the best practice for treating schizophrenia?
The multifaceted approach - Anti-psychotic medication combined with CBT, and community care
