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abnormal psych > ch 9 (lesson 11): schizophrenia > Flashcards

ch 9 (lesson 11): schizophrenia Flashcards

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1
Q

characteristics of Schizophrenia

A

major disturbances in thought, emotion and behavior
- disordered thinking
- lack of emotional expressiveness
- inappropriate or flat emotion
- disturbances in behavior (or movement)
- disheveled appearance

typically several acute episodes and and less severe, still debilitating symptoms btwn episodes

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2
Q

disordered thinking

A
  • ideas not logically related
  • faulty perception and attention
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3
Q

what might schizophrenia result in/ disrupt

A
  • can disrupt interpersonal relationships, diminish capacity to work/ live independently
  • sig. increased rates of suicide/ death (12x more likely than reg population)
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4
Q

prevalence of schizophrenia (men vs women, onset, ethnic)

A

lifetime prevalence: around 1%

men slightly more than women

  • onset late adolescence, early adulthood. men earlier

diagnosed more in African Americans (diagnostic bias)

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5
Q

DSM 5 criteria Schizophrenia

A

2 or more symptoms last atleast 1 month; one symptom has to be 1,2, or 3:

1) delusions
2) hallucinations
3) disorganized speech

4) abnormal psychomotor behavior (catatonia- staying stationary)
5) negative symptoms (blunted affect, avolition, asociality)

  • functioning in work/relationships/self-care have declined since onset
  • signs of disorder for atleast 6 months (some symptoms); if during a prodromal or residual phase, neg symptoms or 2 or more symptoms 1-4 in less severe forms
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6
Q

three major clusters of schizophrenia symptoms

A
  • positive
  • negative
  • disorganized
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7
Q

Positive symptoms (schizophrenia)

A
  • delusions
  • hallucinations
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8
Q

negative symptoms

A
  • avoliton
  • alogia
  • anhedonia
  • blunted affect
  • asociality
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9
Q

disorganized symptoms

A
  • disorganized behavior
  • disorganized speech
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10
Q

delusions

A

(positive symptom)

  • firmly held beliefs
  • contrary to reality
  • resistant to disconfirming evidence
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11
Q

types of delusions

A
  • persecutory delusions ( ex: cia planted listening device in head)
    • 65% percent of schizophrenia have
    • being persecuted (special)
  • thought insertion (somebody putting thoughts into your head)
  • thought broadcasting (others can hear your thoughts)
  • outside control
  • grandiose delusions
  • ideas of reference (things have special meaning to you- messages)
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12
Q

hallucinations

A

(positive symptom)

sensory experiences that aren’t really there

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13
Q

types of hallucinations

A
  • auditory (74% have this symptom)
  • visual
  • hearing voices
    • increased levels of activity in Broca’s area (speech control)
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14
Q

avolition

A

(negative symptom)
lack of interest, apathy

Neumonic: apathetic owl

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15
Q

asociality

A

(negative symptom)
inability to form close relationships

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16
Q

anhedonia (+ 2 types)

A

(negative symptom)
inability to experience pleasure

  • consummatory pleasure
  • anticipatory pleasure
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17
Q

blunted affect

A

(negative symptom)
exhibits little or no affect in face or voice

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18
Q

alogia

A

(negative symptom)

reduction in speech

less context, less details

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19
Q

negative symptoms 2 domains

A

experience domain (avolition, asociality, anhedonia)

  • motivation
  • emotional experience
  • sociality

expression domain (blunted affect, alogia)

  • outward expression of emotion
  • vocalization
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20
Q

disorganized speech (formal thought disorder) (2 types)

A

(disorganized symptom)

  • incoherence
    • inability to organize ideas
  • loose associations (derailment)
    • rambles, difficulty sticking to one topic
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21
Q

disorganized behavior

A

(disorganized symptom)

odd or peculiar behavior
- silliness, agitation, unusual dress

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22
Q

movement symptoms

A
  • catatonia
    • motor abnormalities
    • repetitive complex gestures (hands or fingers)
    • excitable flailing
  • catatonic immobility
    • mantain unusual posture for long time
  • waxy flexibility
    • limbs can be manipulated and posed by another person
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23
Q

other psychotic disorders (similar to schizophrenia)

A
  • schizophreniform disorder
  • brief psychotic disorder
  • schizoaffective disorder

also : delusional disorder, attenuated psychosis syndrome

24
Q

schizophreniform disorder

A
  • same symptoms as schizophrenia
    • must include either hallucinations, delusions, or disorganized speech
  • symptom duration greater than 1 month but less than 6 months
25
Q

Brief Psychotic Disorder

A

symptom duration of 1 day to 1 month

  • must include either hallucinations, delusions, or disorganized speech
  • often triggered by extreme stress, such as bereavement
26
Q

Schizoaffective disorder

A
  • symptoms of both schizophrenia and mood disorder
    • requires either a depressive or manic episode
  • symptoms of major mood episode present for majority of the duration of the illness
27
Q

Delusional Disorder

A
  • delusions, no other schizophrenia symptoms

delusions may include:
- persecution
- jealousy
- being followed
-erotomania (belief that someone loves you, usually a stranger, or celebrity).
-somatic delusions
- grandiosity

28
Q

Attenuated Psychosis Syndrome (APS)

A

in DSM-5, but needs further research to be included

  • young “prodromal” people with mild positive symptoms that might later develop into schizophrenia)

10-30% prodromal ppl develop schizophrenia, 0.2% of general population develop it

29
Q

Etiology of Schizophrenia- Genetic Factors (association studies and genome wide scans)

A

Genetically heterogenous - not likely caused by single gene

association studies-
two genes associated w schizophrenia
- DTNGP1
- NGR1
two genes associated w cognitive deficits
- COMT
- BDNF

genome-wide scans
- identified several gene mutations
- needs to be replicated

30
Q

etiology of schizophrenia- genetic studies- behavior genetic research (family, twin, adoption studies)

A

family studies:
- relatives are at increased risk
- neg symptoms have stronger genetic component

twin studies
- 44% risk for MZ twins, 12% risk DZ twins

adoption studies
- increased likelihood of developing psychotic disorders

familial high-risk studies
- differing negative vs positive symptomatology (neg more genetic, pos more environmental

31
Q

etiology of schizophrenia- neurotransmitters (dopamine theory + revision)

A

Dopamine theory
- disorder due to excess dopamine levels
- drugs that that alleviate symptoms reduce dopamine activity (amphetamines can induce psychosis)

Revision:
- excess # dopamine receptors, or oversensative receptors

  • localized mainly in mesolimbic pathway
    • mesolimbic dop. abnormalities related to POS symptoms)
    • underactive dop. activity in mesocortical pathway mainly related to NEG symptoms
32
Q

dopamine theory doesn’t completely explain schizophrenia

A
  • antipsychotics block dopamine rapidly but symptom relief takes several weeks
  • to be effective, antipsychotics must reduce dopamine activity to BELOW normal levels

-other neurotransmitters involved in schizophrenia

33
Q

other neurotransmitters involved in schizophrenia

A
  • serotonin
  • GABA
  • Glutamate
    • medications that target glutamate shows promise
34
Q

Etiology or schizophrenia: brain structure and function

A
  • enlarged ventricles
  • prefrontal cortex
  • temporal cortex
35
Q

Etiology or schizophrenia: brain structure and function– - enlarged ventricles

A

enlarged ventricles
- implies loss of brain cells
- correlate w/
- poor performance on cog tests
- poor premorbid (before schizophrenia) adjustment
- poor response to treatment

36
Q

Etiology or schizophrenia: brain structure and function– prefrontal cortex

A

prefrontal cortex issues

  • many behaviors disrupted by schizophrenia governed by prefrontal cortex
  • ppl w/ schizophrenia show impairments on neuropsychological tests of prefrontal cortex
  • ppl w schiz. show low metabolic rates in prefrontal cortex
    • failure to show frontal activated related to neg symptoms ( not normal activity levels)
  • DISCONNECTION SYNDROME: disrupted communication among neurons due to loss of dendritic spines
37
Q

Etiology or schizophrenia: brain structure and function– Temporal cortex

A

structural and func. abnormalities in temporal cortex
- temporal gyrus
- amygdala
- anterior cingulate

  • reduced grey matter and volume evident in temporal cortex
38
Q

Etiology or schizophrenia: brain structure and function– environmental factors (to brain)

A

damage during gestation or birth
- obsetrical complications rates high in patients w schizophrenia
- reduced supply of oxygen during delivery may result in loss of cortical matter

viral damage to fetal brain
- presence of parasite, toxoplasma gondii, associated w 2.5x risk of schiz.

  • in finnish study, schiz. rates higher if mom had flu in 2nd trimester
39
Q

Etiology or schizophrenia: brain structure and function– developmental factors

A

may explain why symptoms appear in late adolescence but brain damage occurs early in life:

-prefrontal cortex matures in adolescence/early adulthood (which is when schiz. develops)

  • dopamine activity also peaks in adolescence
  • stress activates HPA system which triggers cortisol secretion
    • cortisol increases dopamine activity
  • excessive pruning of synaptic connections
  • use of cannabis during adolescence associated w increased risk
40
Q

Etiology or schizophrenia: psychological stress

A

reaction to stress:
- ppl w schiz. and 1st degree relatives more reactive to stress
- show greater decreases in pos mood and increases in neg mood

socioeconomic status
- highest rates of schiz. among urban poor

-SOCIOGENIC HYPOTHESIS- stress of poverty causes disorder

  • SOCIAL SELECTION THEORY- downward drift in socioeconomic status (as generations w schiz.)
    • research supports it
41
Q

etiology of schizophrenia: family factors

A

Shizophrenogenic mother

  • cold domineering, conflict-inducing
  • no support for this theory

Communication Deviance (CD)

  • hostility and poor communication
  • inconclusive at this time
42
Q

Etiology of schizophrenia- families impacting relapse

A
  • family environment impacts relapse
  • Expressed Emotion (EE)
    • hostility critical comments, emotional overinvolvement
  • Bidirectional association
    • unusual patient thoughts –> family critical comments –> unusual patient thoughts etc/ vice versa
43
Q

etiology of Schizophrenia: developmental studies

A
  • use of retrospective/ “follow-back” studies
  • developmental histories of children who later developed schizophrenia
    • lower IQ
    • boy: delinquent behavior, girls: withdrawn
  • coding of home movies
    • poorer motor skills
    • more expression of neg emotion
44
Q

Etiology of Schizophrenia: 3 prospective developmental studies

A

New Zealand study:

  • cognitive deficits evident at early age

Australian study (high risk study)

  • Reduced gray matter volume predicted development of psychotic disorder

North American Prodrome Longitudinal Study

  • Identified factors associated w development of psychosis
    • having bio relative w schiz.
    • recent decline in functioning
    • high levels of pos. symptoms
    • high levels of social impairment
45
Q

Treatment of Schizophrenia: medications- first gen antipsychotical meds

A

first-generation antipsychotic meds (neuroleptics: 50’s)

  • phenothiazines (Thorazine), butyrophenones (haldol), thioxanthenes (Navene)
    • reduce agitation, violent behavior (positive and disorganized symptoms)
    • block dopamine receptors
    • little effect on neg symptoms

have extrapyramidal side effects
- tardive dyskenesia (movement tics)
- neuroleptic malignant syndrome
- text book adds: dystonia (muscle rigidity), akathesia (inability to be still)

maintenance dosages (after acute episode) to prevent relapse

46
Q

second-generation antipsychotics

A
  • clozapine (clozaril)
    • impacts serotonin receptors
    • fewer motor side effects
    • less treatment noncompliance
    • reduces relapse
      side effects of second gen antipsychotics
  • can impair immune system func.
  • seizures, dizziness, fatigue, weight gain

newer meds may improve cog function:
- Olanzapine (zyprexa)
- risperidone (risperdal)

47
Q

Clinical Antipsychotic Trials of Intervention Evectiveness (CATIE) study

A
  • second-gen drugs NOT more effective than older, first-gen drugs
  • 2nd-gen DIDN’T produce fewer unpleasant side effects
  • ~ 3/4 stopped meds before end of study

2nd-gen antipsychotics serious side effects
- weight gain, diabetes, pancreatitis

disturbing trend for ppl of color:
- not prescribed 2nd gen antipsychotics

48
Q

Psychological treatment- Patient Outcomes Research Team (PORT) treatment recommendation

A
  • recommends meds PLUS psychosocial intervention
  • Social Skills training
    • teach skills for managing interpersonal situations (job application, bus schedules, make appointments)
    • involves role-playing and other practice exercises, both in group and in vivo
49
Q

psychological treatment- social skills training for schizophrenia

A
  • teach skills for managing interpersonal situations (job application, bus schedules, make appointments)
    • involves role-playing and other practice exercises, both in group and in vivo
50
Q

Psychological treatments for Schizophrenia- Family therapy to reduce Expressed Emotion (EE)

A
  • educate family about causes, symptoms, signs of relapse
  • stress importance of meds
  • avoid blaming patient
  • improve family communication/ problem-solving
  • encourage expanded support networks
  • instill hope
51
Q

Psychological treatments

A
  • social skills training
  • family therapy (for EE)
  • cognitive behavioral therapy
  • cognitive remediation training or Cognitive Enhancement therapy (CET)
  • Case Management
  • Residential treatment
52
Q

Cognitive Behavioral therapy for Schizophrenia

A
  • recognize and challenge delusional beliefs
  • recognize and challenge expectations associated w neg symptoms
53
Q

Cognitive remediation training or Cognitive Enhancement Therapy (CET

A
  • improve attention, memory, problem solving and other cognitive-based symptoms
54
Q

case management

A

multidisciplinary team to provide comprehensive services

55
Q

residential treatment

A

vocational rehabilitation

56
Q

Prodromol

A

The period of subclinical signs and symptoms that precedes the onset of psychosis

abnormal psych (16 decks)

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