Week 9 - Schizophrenia Flashcards
What is schizophrenia?
Psychological disorder that involves severely distorted beliefs, perceptions and thought processes
What are the five subtypes of schizophrenia?
- Paranoid subtype (Delusions centred on ideas of grandiosity or persecution)
- Disorganized subtype (Disorganized speech patterns)
- Catatonic subtype (Non-normal activity of motor system)
- Undifferentiated subtype (Signs not fitting any of the three major subtypes)
- Residual subtype (No longer display traditional symptoms of delusions and hallucinations)
Define positive symptoms and describe the positive symptoms of schizophrenia
- Definition: Things that shouldn’t be there and are added to a person
Positive Symptoms of Schizophrenia:
- Delusions
- Hallucinations
- Disorganized thought processes, speech and behavior
Describe the delusions experienced in schizophrenia
- Persecutory delusions (Beliefs about being followed or watched)
- Grandiose delusions (Beliefs about being a famous or special person)
- Delusions of Thought Control
Describe the hallucinations experienced in schizophrenia
- Distorted perceptions of reality which could affect all five senses
- Most common altered perception is hearing voices or other sounds (auditory perception), followed by visual hallucinations
- The hallucinations may tell the person to perform certain acts or may be frightening
Describe the disorganized behaviour experienced in schizophrenia
- Disorganized speech: Lack of associations between ideas and events
- Disordered behaviour: Unusual or repetitive behaviours and gestures
(ex. head-banging, finger-flapping, etc.)
Describe the catatonia experienced in schizophrenia
- Catatonic stupor: Absence of motor behaviors, totally motionless and rigid
- Catatonic excitement: Agitated, fidgety, shouting, swearing or moving rapidly
- Either of the two can last for hours
- Neither a positive nor negative symptom
Define negative symptoms and describe the negative symptoms of schizophrenia
- Definition: Things that should be there but aren’t there in a person
Negative Symptoms of Schizophrenia:
- Flat affect
- Alogia (reduced speech)
- Avolition (lack of follow through)
Describe the flat affect experienced in schizophrenia
- Definition: Lack of emotional expression
- Passive with immobile facial expression
- Vocal tone does not change
- Do not respond to events with emotion
- Speech lacks the inflection that communicates mood
Is schizophrenia temporary or chronic?
- Onset typically occurs during young adulthood
- 25% of those who experience schizophrenia recover completely
- 25% experience recurrent episodes of schizophrenia
- 50% schizophrenia becomes a chronic mental illness, and the ability to function may be severely impaired
Explain the genetic factors (family) in schizophrenia
- Based on family, twin and adoption studies,
*50% risk for a person whose identical twin has schizophrenia
*If biological parent of an adopted individual had schizophrenia, there is a greater risk to develop schizophrenia - Schizophrenia clusters in certain families -> The more closely related a person is to someone who has schizophrenia, the greater the risk of schizophrenia
Explain the genetic factors (chromosomes) in schizophrenia
- Chromosomes associated with genes that influence brain development, memory and cognition seem related
- No specific patterns of genetics can be identified as “cause” of schizophrenia but the presence of variations increase susceptibility
- Bipolar disorder and schizophrenia might share genetic origins
Explain the social factors in schizophrenia
Being raised in a psychologically healthy environment lowers your chances of developing schizophrenia
Explain the effect of paternal age on schizophrenia
- Age of fathers can increase the rate of mutation; The “manufacturing” of sperms in a man gets less and less accurate as he ages, hence the chances of mutation
- 45-49yo: 2x more likely to develop schizophrenia, compared to fathers younger than 25 years
- 50+ years: 3x more likely to develop schizophrenia, compared to fathers younger than 25 years
Explain the biological factors (abnormal brain structures) in schizophrenia
- 50% of people with schizophrenia show some type of brain abnormality
- Most consistent finding: Enlargement of the ventricles
- Loss of gray matter tissue and lower overall volume of the brain (Gray matter = cell bodies, White matter = myelinated axons)
Describe the default mode network and explain its relation to schizophrenia
- Default mode network: Parts of the brain under wakeful rest (ex. the part that is active when you’re zoned out)
- Normally, people would switch between this and executive functioning but for schizophrenics, they tend to stay in the default mode network (difficulty switching between it and the executive functioning)
What are the issues with neurotransmitters in schizophrenia?
- Activity with dopamine neurons
*Dopamine neurons are overactive in schizophrenia in midbrain areas and underactive in higher cortisol areas - Dopamine Imbalance Hypothesis
*Activations influence other brain areas with dopamine projections - Result in more creative thinking
*Increased dopamine D2 receptor densities in the thalamus resulted in a lower gating threshold and thus increased information flow resulting in more creative thinking - Glutamate linked to psychotic-like symptoms
*Excitatory neurotransmitter, blocking of glutamate receptors in normal individuals leads to psychotic-like symptoms (Glutamate hypothesis)
Describe the role of dopamine
- Reward and reinforcement (responsible for feelings of euphoria)
- Motor movements (responsible for feelings of euphoria)
- Produced in brainstem, but has projections which affect activation in the cortex (surface of the brain)
Explain the Dopamine Imbalance Hypothesis
- Leads to both positive and negative symptoms
*Overactivity in midbrain/brainstem -> Hallucinations/delusions
*Underactivity in cortex -> Lack of motivation/flat affect - Changes in dopamine activity results in more creative thinking
*Inability to stop influx of thoughts
*Increased information flow resulting in more creative thinking
Antipsychotic Medications: Chlorpromazine (Thorazine)
- Discovered in 1945
- Reduces dopamine activity in the brain
- Reduces agitation, hostility, aggression, hallucinations, delusions
- Increases time between hospitalisations
- Does not change negative symptoms and cognitive deficits
*Because these are due to the underactivity of dopamine
*Early drugs only target the overactivity of dopamine
Antipsychotic Medications: What are the side effects of Thorazine and other “typical” drugs?
- Weight gain
- Tardive dyskenia (movement disorder)
*Involuntary movement of lower face, limbs
*Affects dopamine neurotransmitters
*“typical” -> first generation of antipsychotic drugs
Antipsychotic Medications: What is the importance of dopamine?
- Imbalance of dopamine activity in the brain
- However, anti-dopamine drugs do not help upwards of 40% of those seeking treatment
- First generation, typical antipsychotics also produce tardive dyskinesia (involuntary motor movements)
- Medications which block dopamine are somewhat effective
- Drugs that increase dopamine cause schizophrenic-like symptoms
- However, typical antipsychotics mainly target positive symptoms like hallucinations and delusions
- Link between dopamine and schizophrenia may be more complicated
What are the advantages of atypical medications?
- Less likely to cause movement-related dopamine side effects
- More effective in treating the negative symptoms of schizophrenia
- Target the dopamine imbalance, rather than just overactivity
What are the disadvantages of atypical medications?
- Weight gain, diabetes, cardiac problems
- No greater improvements than with older antipsychotics
What are the issues with all antipsychotic medications?
- Does not actually cure schizophrenia
- Unwanted side effects
- “Revolving door” patter of hospitalisation, discharge and rehospitalisation
Describe the atypical, second generation antipsychotics for schizophrenia
- Target specific dopamine receptors, not all types of dopamine
- Produces less tardive dyskinesia
- Equal to, or sometimes more, effective than the typical, first generation of antipsychotic medication
Psychosocial Interventions: How does family intervention help in schizophrenia?
- Provide practical emotional support to family members
- Provide information about support services
- Help family develop model of schizophrenia
- Modify unhelpful, inaccurate beliefs about schizophrenia
- Enhance positive communications
- Involve everyone in relapse prevention plan
Psychosocial Interventions: How does Cognitive Behavioral Therapy help in schizophrenia?
- Importance of individual’s interpretations of psychotic events
- Understand client’s interpretations of past and present events
- Normalize and reduce impact of symptoms
Psychosocial Interventions: How does early intervention help in schizophrenia?
- Seek out high-risk individuals
- Develop cognitive skills to increase attention, memory, executive control, and other cognitive processes
What are the environmental origins of schizophrenia?
- Direct brain damage or injury details during early development
- Prenatal complications
*Stress, immune responses and starvation during pregnant
What is the biopsychosocial model in psychology?
- Models the interactions between genetics (biology, personality, psychology) and environment (social) and their impact on mental health
- Proposed by George Engel, who suggested that mental health should be understood from more than just a biological perspective
Explain the biological influences in the biopsychosocial framework
- Biology is important but cannot explain everything; Some clinical disorders do not have reliable biological markers
- ex. Only 50% chance of identical twin developing schizophrenia is other twin has the disorder
Explain the psychological factors in the biopsychosocial framework
- Personality approaches
- Learned patterns of behavior
- ex. Schizophrenia might develop through observational learning of parents with disorder
Explain the social factors in the biopsychosocial framework
Social upbringing and environmental influences on a person’s mental health
How is the biopsychosocial framework applied to evaluate mental health?
- Intervention must address all three factors
- Recognize relationships are central to treatment
- Promote self-awareness among clients
- Find out about the patient’s history and life circumstances
- Decide which aspects of biological, psychological and social domains are most impactful on client’s health
- Provide multidimensional treatment
Explain the social factor of the biopsychosocial model of challenge/threat
- Features in the environment which promote stress
- ex. exam, interview, social interactions, etc.
Explain the psychological factor of the biopsychosocial model of challenge/threat
- How we interpret the situation
- Evaluate the importance of performance
- Determine if we have the ability to succeed
*If we have confidence in our ability = challenged
*If we have no confidence in our ability = threatened
Explain the biological factor of the biopsychosocial model of challenge/threat
- How our body reacts
- Cardiovascular system
*Blood flow (cardiac output)
*Blood pressure (peripheral resistance)
