Week 3 - Schizophrenia Flashcards

Question

What are disturbances in affect (schizophrenia)? (x5)

Answer 1

``` Disturbed expression of outward emotion A continuum from: Restricted affect, Blunted affect, to Flat affect ```

Answer 2

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)

Answer 3

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

Answer 4

``` o Sudden onset o Normal intellect o No brain damage o No negative symptoms o Good drug response ```

Answer 5

``` o Slower onset o Intellectual deterioration o Brain abnormality o Prominent negative symptoms o Poor drug response ```

Answer 6

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)

Answer 7

That there's huge heterogeneity in predicted course following diagnosis

Answer 8

``` 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 ```

Answer 9

``` 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 ```

Answer 10

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

Answer 11

``` 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 ```

Answer 12

Is a heterogeneous disorder, therefore likely to have polygenic influences • Makes it very unlikely that there is a single responsible gene

Answer 13

48% concordance in MZ twins (so can't be purely genetic) 46% for offspring 17% for DZ twins/siblings

Answer 14

``` 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

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

o When asked to complete cognitive tasks, low frontal metabolism – but some show higher than average levels…

Answer 19

Fatal neurodevelopment - obstetric complications, maternal infection (colds/flus) Maternal stress - spouse death during pregnancy, military invasion Postnatal brain insults - head injury before 10yrs

Answer 20

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

Answer 21

Failure to attend to relevant social cues results in bizarre responses to environment Acquisition of bizarre behaviours through operant conditioning

Answer 22

Success in modifying problematic behaviours: Appropriate verbal responses/social behaviours can be learned with systematic ignoring of bizarre behaviours/reinforcement of appropriate responses

Answer 23

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

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

* Genetic factors * Physical trauma prenatally or during birth * Brain or neurotransmitter abnormalities * Psychosis-prone personality

Answer 28

* Physical trauma, prenatally or during birth * Psychological and social stressors and environmental hazards associated with urban living and poverty * Family environment with high EE

Answer 29

Psychosocial interventions Somatic treatments Multifaceted treatment approach

Answer 30

CBT Broad rehab approach - symptom management plus daily living training Family interventions - to supplement drug therapy/reduce relapse

Answer 31

Psychoeducation Social skills training Coping strategies enhancement training • Problem solving • Strategies for maximising medication compliance • Identification of relapse warning signals • Stress management strategies

Answer 32

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)

Answer 33

Community care - deinstitutionalisation * Coordinated services * Short-term hospitalisation * Partial hospitalisation * Community houses/half-way houses * Advocacy

Answer 34

o Duration at least 1 month but less than 6 months | o Impaired social/occupational functioning not required

Answer 35

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

Answer 36

One or more delusions | And never met Criterion A Schizophrenia

Answer 37

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