Week 3 - Schizophrenia Flashcards
What is dementia praecox? (x1)
The original term for schizophrenia (Kraepelin)
What is the prevalence of schizophrenia?
Age and gender epidemiology? (x2)
Suicide risk?
1% in general population
Male peak onset 15-25 yrs, female 25-35
Men 30-40% more likely to get it
50% attempt suicide, 10% succeed
What is the cultural pattern of schizophrenia? (x2)
Described in all cultures and SES
But disproportionate low SES in industrial nations - potentially downward drift
Why is schizophrenia the most expensive of all mental disorders? (x5)
Direct treatment costs
Loss of productivity
• Some high functioning, but huge cost in lost productivity
Public assistance costs
Shorter average lifespan - poor lifestyle choices, lacking motivation
What are the DSM criteria A for schizophrenia? (x1, x4, x3)
Two or more during one month and at least one needs to be 1, 2, or 3
Positive symptoms:
1. Delusions
2. Hallucinations
3. Disorganised speech (frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
Negative symptoms
5. Affect flattening
6. Alogia
7. Avolition
What are criteria B - F for schizophrenia?
B. Social Occupational Dysfunction – must show downward trend in functioning
C. Duration - continuous signs for 6 months
D. Schizoaffective & Mood Disorder - Exclusion
E. Substance/general Medical Condition – Exclusion
F. Relationship to Autism Spectrum Disorder or a communication disorder – can be co-diagnosed
What are delusions? (x3)
Disturbances in content of thought
Misrepresentation of reality -
Fixed belief that is impervious to reason – they’ll argue that you’re wrong
What is a delusion of persecution? (x2)
Someone or something is out to harm you;
Often try and prosecute those they feel are responsible
What is a delusion of reference? (x2)
Hidden the signals that are directed at you specifically –
Inferring personal curse for random experience
What is a delusion of grandeur? (x2)
Something very special about you –
Magic powers, being Jesus
What is a delusion of sin? (x1)
Belief that you’ve done something evil
What is a hypochondriacal delusion? (x2)
Firm belief in illness, despite all tests saying no
What is a nihilistic delusion? (x1)
That the whole world is about to end, or is not real
What is a delusion of somatic passivity? (x2)
Sensations ‘imposed’)
Being made to feel things
What is a delusion of thought insertion? (x1)
Thoughts put in mind by someone else
What is a delusion of thought broadcasting? (x1)
They can all see what I’m thinking
What is a delusion of ‘made feelings’? (x2)
Your feelings aren’t your own, are being made by something else
What is a delusion of ‘made impulses’ (x2)
Your behaviours aren’t your own, are being made by something else
What is Capgras syndrome? (x3)
Delusion of another being a body double
You’re the only one who knows they have been replaced –
Usually aimed at loved one toward whom they have negative feelings
What is Cotard’s syndrome? (x3)
Delusion of impossible bodily change
eg haven’t got a heart, or a brain
Showing images doesn’t work, may even think they were dead
What are loosening of associations in psychosis? (x2)
Also known as… (x1)
Disturbances in production and organisation of thought -
Revealed by peculiarities of verbal expression
Derailment
What are 5 forms of loosening of associations/derailment?
Neologism – made up words
Perseveration – can’t change topic, get stuck on one concept
Word salad – can’t make sense of what they’re saying
Circumstantiality – following trains of thought waaaaaay off track
Tangentiality – more extreme than circumstance, they don’t find their way back to the point
What are hallucinations? (x3)
Disturbances of perception
Percept like experience occurring in absence of appropriate stimulus,
That aren’t under voluntary control
What forms can hallucinations take? (x5)
Auditory
• Most common type, often sounds like a critical running commentary, maybe command hallucinations. Sometimes know it’s not real, but in deep psychosis, can’t tell (time for hospital)
Visual
Olfactory
Gustatory
Tactile
What are disturbances in affect (schizophrenia)? (x5)
Disturbed expression of outward emotion A continuum from: Restricted affect, Blunted affect, to Flat affect
What is catatonia? (x1, plus e.g. x2)
A collective term for disturbances in psychomotor behaviour,
eg Catatonic stupor – extreme slowness of movement
Catatonic rigidity – maintaining one position, often very uncomfortable ones, waxy flexibility (can move them, and they stay in position)
What are the specifiers for schizophrenia? (x4)
Sub-categories to describe after 1 year
With catatonia
Severity based on primary symptoms of psychosis
No longer distinguishing between Type 1 and 2 - most people don’t fit neatly
What are 5 characteristics of Type 1 schizophrenia?
o Sudden onset o Normal intellect o No brain damage o No negative symptoms o Good drug response
What are 5 characteristics of Type 2 schizophrenia?
o Slower onset o Intellectual deterioration o Brain abnormality o Prominent negative symptoms o Poor drug response
Describe the 3 phases that constitute the course of schizophrenia
Prodromal
o For minority, can be very abrupt onset, but usually a long prodromal phase
o Beginning of issues
o Less hygiene
o Expressing some strange ideas
o Interpreted as phase by others, eventually becomes extreme, can’t be ignored
Active phase
o Eventually in active phase – responding to cues that aren’t real, often hospitalised until managing symptoms
Residual phase
o Back into the community, in residual phase, functioning well
(typically episodic)
What do the many different patterns of the course of schizophrenia tell us? (x1)
That there’s huge heterogeneity in predicted course following diagnosis
Name 8 predictors of good outcomes for those with schizophrenia
o Good premorbid adjustment o No family history of schizophrenia o Sudden onset o Precipitating stress o Good response to medication o Positive symptoms o Later age of onset o Female gender
Name 8 predictors of poor outcomes for those with schizophrenia
o Poor premorbid adjustment o Family history of schizophrenia o Slow onset o No precipitating stress o Poor response to medication o Negative symptoms o Early age of onset o Male gender
Besides schizophrenia, name 11 other psychotic disorders
Shizophreniform disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Psychotic disorder due to another medical condition
Substance/medication induced psychotic disorder
Catatonia associated with another mental disorder
Catatonia associated with another media condition
Unspecified catatonia
Other specified schizophrenia spectrum and other psychotic disorder
Unspecified schizophrenia spectrum and other psychotic disorder
What 6 factors are involved in the biological view of the aetiology of schizophrenia?
Genetics Biochemical abnormalities Structural brain changes Functional brain changes Non-specific indicators of brain dysfunction - don't get same structural diffs across all patients Neurodevelopment
What do gene studies tell us about the aetiology of schizophrenia? (x2)
Is a heterogeneous disorder, therefore likely to have polygenic influences
• Makes it very unlikely that there is a single responsible gene
What do family studies tell us about the likelihood of schizophrenia for biological relatives of a schizophrenic proband? (x3)
48% concordance in MZ twins (so can’t be purely genetic)
46% for offspring
17% for DZ twins/siblings
What do studies of the Genain Quads (‘dreadful gene’) tell us about the aetiology of schizophrenia? (x7)
All diagnosed, raised in same family, but big variations in • Time of onset • Symptoms • Diagnoses • Course of disorder • Outcomes
So despite same family environment, must be heaps of unshared features in environment too
Explain the dopamine hypothesis of the aetiology of schizophrenia (x5)
Found that in Parkinson’s: L-DOPA increases dopamine, and reduces stiffness and tremors
• When take too much L-DOPA, triggers some schizophrenic symptoms
And in schizophrenia: neuroleptics decrease dopamine,
Calming disordered thought/behaviour, but causing stiffness and tremors
These patterns led to idea that excess dopamine is causal of schizophrenia
What are the problems with the dopamine hypothesis of the aetiology of schizophrenia (x5)
Many drugs used to treat schizophrenia are effective in treating other disorders.
Not everyone with schizophrenia respond to traditional antipsychotics
Clozapine primarily blocks serotonin receptors
• Clozapine is weak at lessening dopamine, but very effective for some schizophrenia
All points to a host of biochemical abnormalities, not just dopamine
What evidence is there for a role of structural brain changes in the aetiology of schizophrenia? (x3)
o Enlarged brain ventricles – especially lateral ventricles
o Decreased frontal, temporal, whole brain volume – reduced hippocampal volume too
o Volumetric differences in twins discordant for schizophrenia
What conflicting evidence is there for a role of functional brain changes in the aetiology of schizophrenia (e.g., reduced activity in frontal regions)? (x2)
o When asked to complete cognitive tasks, low frontal metabolism – but some show higher than average levels…
What neurodevelopment factors have been implicated in the aetiology of schizophrenia? (x3)
Fatal neurodevelopment - obstetric complications, maternal infection (colds/flus)
Maternal stress - spouse death during pregnancy, military invasion
Postnatal brain insults - head injury before 10yrs
What are the issues with neurodevelopment factors have implicated in the aetiology of schizophrenia? (x4)
o While likely component, biological abnormality is at most a correlation
o Difficult to determine whether abnormality is related to disease process or treatment
o Pathology identified in one area of the brain doesn’t mean primary area has been defined
o A single pathological process in the brain can cause a wide range of phenomena in different individuals
What limited value does the behavioural view have in explaining the aetiology of schizophrenia? (x2)
Failure to attend to relevant social cues results in bizarre responses to environment
Acquisition of bizarre behaviours through operant conditioning
How is the behavioural view useful in treatment of schizophrenic symptoms? (x2)
Success in modifying problematic behaviours:
Appropriate verbal responses/social behaviours can be learned with systematic ignoring of bizarre behaviours/reinforcement of appropriate responses
What theoretical views of the aetiology of schizophrenia focussed on family views? (x6)
Early ones basically blamed the mothers – inconsistency of treatment,
• Schizophrenogenic mother
• Double-bind communication, eg mother saying she loves you, while looking at you with disgust
Family structure
Communication deviance
Expressed emotion - only one with current credibility
How does the theory of expressed emotion explain schizophrenia relapse, and so provide targets for intervention? (x5)
Family stress = expressed emotion – three particular behaviours linked to likelihood of relapse
• Criticism
• Hostility
• Emotional over-involvement
3.7 times more likely to relapse if living in a High EE family
What are the issues with explaining schizophrenia relapse through expressed emotion? (x6)
Assigns blame to family, when stressful in both directions
(i) Family found the negative symptoms most difficult to deal with – lack of emotions, words etc (ii) Less bothered by hallucinations (which become less over time, while negative symptoms rise)
Families’ reactions
(a) Emotional reactions (e.g., sense of loss of family member)
(b) Family conflict
(i) Daily struggle with patient who won’t get out of bed, bath etc
What are the limitation of family views of the aetiology of schizophrenia? (x5)
Earlier views not empirically based
Many findings are correlational
Family patterns also occur in families of patients with other disorders, e.g. eating, gambling, depression
Reciprocal patient/family relationship not taken into account
Impact of living with a family member with schizophrenia neglected
What are the diatheses in the diathesis-stress model of the aetiology of schizophrenia? (x4)
- Genetic factors
- Physical trauma prenatally or during birth
- Brain or neurotransmitter abnormalities
- Psychosis-prone personality
What are the stressors in the diathesis-stress model of the aetiology of schizophrenia? (x3)
- Physical trauma, prenatally or during birth
- Psychological and social stressors and environmental hazards associated with urban living and poverty
- Family environment with high EE
What 3 treatment areas are available for schizophrenia?
Psychosocial interventions
Somatic treatments
Multifaceted treatment approach
What 3 psychosocial interventions are available for treating schizophrenia?
CBT
Broad rehab approach - symptom management plus daily living training
Family interventions - to supplement drug therapy/reduce relapse
What is involved in CBT for schizophrenia? (x7)
Psychoeducation
Social skills training
Coping strategies enhancement training
• Problem solving
• Strategies for maximising medication compliance
• Identification of relapse warning signals
• Stress management strategies
What somatic treatments are available for schizophrenia? (x1)
But… (x4)
Anti-psychotics (neuroleptics/major tranquillisers)
Positive symptoms respond better than negative symptoms.
About 25% do not improve on classical antipsychotic drugs.
Side-effects of traditional anti-psychotic drugs, eg. tar dive dyskinesia
(but less psychomotor shaking grimacing on new ones, like clozapine)
What is involved in multifaceted treatment for schizophrenia? (x1)
Which requires what in order to be effective? (x5)
Community care - deinstitutionalisation
- Coordinated services
- Short-term hospitalisation
- Partial hospitalisation
- Community houses/half-way houses
- Advocacy
What differentiates schizophreniform disorder from schizophrenia? (x2)
o Duration at least 1 month but less than 6 months
o Impaired social/occupational functioning not required
What differentiates schizoaffective disorder from schizophrenia? (x3)
Symptoms fall on the boundary between schizophrenia and mood disorders
• Often major depression coupled with psychosis
Prominent episode of mood disturbance coexisting with Criterion A schizophrenia symptoms
Delusions/hallucinations for at least 2 weeks in absence of prominent mood disturbance
What differentiates delusional disorder from schizophrenia? (x2)
One or more delusions
And never met Criterion A Schizophrenia
What differentiates brief psychotic disorder from schizophrenia? (x3)
Sudden onset of at least one: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour
Lasts at least one day but less than month and full return to premorbid functioning
Usually preceded by extreme acute stressor
