XII - Schizophrenia Flashcards
Schizophrenia Spectrum and Other Psychotic Disorders
- Schizophrenia
- Other Psychotic Disorders
- Schizotypal Personality Disorder
Note that Schizotypal Disorder is also in Personality Disorders - only disorder that is in two categories
Hallmark of schizophrenia
Psychosis - a significant loss of contact with reality. Symptoms - delusions, hallucinations, disorganized speech, disorganized and catatonic behavior
Etymology - “Split Mind”
Does not refer to multiple personalities. Bleuler believed there is a split from reality. Name refers to split within intellect, between intellect and emotion, between intellect and external reality.
Risk of developing schizophrenia
Around 1%; higher for those with older fathers. Typically starts in late adolescence. Earlier onset, more severe in men than women
Schizophrenia DSM-V Diagnostic Criteria
(A) 2+ of following present for significant portion of 1-month period. At least one from 1-3: (1) Delusions, (2) Hallucinations, (3) Disorganized speech, (4) Disorganized or catatonic behavior, (5) Negative symptoms such as diminished emotional expression or avolition.
(B) Dysfunction in work, interpersonal relationships, or self-care
(C) Signs of disturbance for at least 6 months, with 1+ month of symptoms in (A)
(D) Rule out schizoaffective, depressive, bipolar disorders
(E) Symptoms not from physiological effect of substance or medical condition
(F) If with autism or communication disorder, must have delusions or hallucinations for 1+ months
Delusions
Erroneous belief that is firmly held despite contradictory evidence. Examples include: made feelings or impulses (one’s thoughts/feelings/actions being caused by external agents); thought broadcasting (private beliefs are known to others); thought insertion or withdrawal (thoughts given and taken by outside source); reference (neutral environmental event believed to have special and personal meaning)
Hallucinations
Sensory experience that seems real but occurs in absence of external stimulus. May have personal meaning. Can occur in any sensory modality, but auditory most common. Studies suggest may be misperceived subvocal speech
Disorganized speech
Failure to make sense despite conforming to semantic/syntactic rules of speech. Words and word combinations sound communicative but listener is left without understanding.
Disorganized and catatonic behavior
Impairments of goal-directed activity in areas such as work, social relationships, self-care. Catatonia involves almost no movement, sometimes in an unusual posture.
Positive vs. Negative Symptoms of Schizophrenia
Positive symptoms: excess or distortion in normal behavior or experience (delusions, hallucinations, disorganized speech, disorganized behavior.
Negative symptoms: absence or deficit of certain behaviors (blunted emotions, alogia, avolition)
Other psychotic disorders
Schizoaffective, Schizophreniform, Delusional, and Brief Psychotic Disorders.
Schizoaffective Disorder
Hybrid of schizophrenia and mood disorder. Mood symptoms have met full criteria and present for 50% of illness
Schizoaffective vs. Schizophrenic Disorders
Find info
Schizophreniform Disorder
Like schizophrenia but only 1-6 months long
Schizophreniform vs. Schizophrenic Disorder
Schizophreniform lasts for shorter period of time than schizophrenia (1-6 vs. 6+ months)
Delusional disorder
Have delusions but otherwise with normal behavior
Delusional vs. Schizophrenic Disorder
Schizophrenia requires delusions + another symptom; delusional disorder involves delusions but otherwise normal behavior.
Delusional vs. Schizotypal Personality Disorder
Must find
Brief Psychotic Disorder
Usually lasts only several days
Genetic factors of schizophrenia
Genetic factors clearly implicated - having relative with the disorder significantly increases chances. Revealed by twin studies, adoption studies, molecular genetic studies (unlikely that linked to a single gene). Genetically influenced but not determined - interplay between genetic and environmental factors
Prenatal and Perinatal Factors of Schizophrenia
Prenatal infection, rhesus incompatibility, early nutritional deficiencies, perinatal birth complications
Neurodevelopmental Perspective of Schizophrenia
Thought that a lesion in brain lies dormant until some normal development changes expose the problems that result from brain abnormality. May involve abnormalities in cell migration during second trimester. May notice developmental traits such as motor abnormalities, low positive facial emotion, high negative face emotion
Brain abnormalities
There are abnormalities associated with schizophrenia but they are not found in all patients. Enlarged brain ventricles for ex.
Dopamine Hypothesis
Believed that too much dopamine leads to schizophrenia. Evidence: pharmacological success of Chlorpromazine, amphetamine induced psychosis, L-Dopa, Dopamine and Salience, Increased density of D2 receptors and increased sensitivity.
Glutamate Hypothesis
Schizophrenia involves dysregulation in glutamate systems. Evidence: dopamine inhibits glutamate
Familial hypotheses
Were hypotheses about bad parenting causing schizophrenia but it looks like schizophrenia may cause the communication problems. Critical, hostile, over-involved expressed emotion (of family member about patient) seems to have something to do with relapse.
Psychosocial/cultural factors
Urban living, immigration, cannabis abuse
Diathesis-Stress Model of Schizophrenia
Genetic Factors + Prenatal/Perinatal Factors -> Brain Vulnerability. + Stress/Developmental Processes -> Psychosis
Recovery rate
Antipsychotic drugs improved prognosis. Currently 38% percent function well 15-25 years later. Long-term institutionalization for 12%. Shorter life expectancy and higher suicide rates.
Pharmacological Approaches to Schizophrenia
First-Generation Antipsychotics: Dopamine Antagonists to tackle positive symptoms. Side effects - involuntary movements, tardive dyskinesia, neuroleptic malignant syndrome
Second-Generation Antipsychotics: fewer extrapyramidal (motor abnormality) side effects, no support for belief that these are more effective. Side effects - drowsiness, weight gain, diabetes.
Psychosocial approaches to schizophrenia
Family therapy, case management, social-skills training, cognitive remediation, cognitive-behavioral therapy.
