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507 final > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Schizophrenia- defined

A
  • “Split mind”
  • Fundamental break with reality that is out of the range of normal experience
  • not multiple personality
  • not destined to be violent

a psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.

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2
Q

DSM criteria for schizophrenia

A
  • 6 mo with 1+ mo of active phase
  • 2 or more of the following:
    • delusions
    • hallucinations
    • disorganized speech
    • abnormal motor activity
    • negative symptoms
  • social/occupational dysfunction
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3
Q

Positive schizophrenia symptoms

A
  • delusions
    • jealousy
    • persecution
    • grandeur
    • reference (attaching special meaning to a person, place, object)
    • control
  • hallucinations
    • auditory is most common
  • disorganized speech
    • loose associations, tangentiality, derailment
    • neologisms (new words)
  • bizarre/disorganized behavior
    • appearance
    • affect
    • actions
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4
Q

Types of delusions

A

jealousy, persecution, grandeur, reference, control

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5
Q

Negative schizophrenia symptoms

A
  • alogia (poverty of speech)
  • affective flattening
  • avolition
  • anhedonia
  • social withdrawal
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6
Q

Other deficits common in schizophrenia

A
  • attention
    • dysphoria
    • memory
    • poor emotion recognition
    • absence of insight
    • sleep disturbance
    • suicide attempts
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7
Q

Course of schizophrenia

A

Prodromal, active, residual

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8
Q

Prodromal phase of schizophrenia

A

peculiar behavior, social isolation/withdrawal, decreased role function, not unlike social phobia

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9
Q

Residual phase of schizophrenia

A

decrease positive symptoms, negative symptoms remain

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10
Q

Brain differences in schizophrenic brain

A
  • increase in size of ventricles
  • decrease in size of subcortical structure
  • asymmetry
  • interconnectivity theory
  • hallucinating brain
    • activity in visual and auditory areas of brain
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11
Q

Neurochemistry in schizophrenics

A
  • dopamine
    • increase in number of D2 receptors, also release is more prominent
    • positive symptoms result from D2
    • negative symptoms result from underactive dopamine (D1) in prefrontal cortex
  • other neurochemical hypotheses
    • serotonin: well supported
    • glutamate- explains cognitive deficits and developmental changes, provide causal mechanism for DA
    • GABA- explains glutamate dysfunction
    • Glycine- explains glutamate dysfunction and offer potential environmental agitator
    • neurotensin- master modulator
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12
Q

Synaptic pruning

A
  • process occurring in adolescence where number of synapses decrease based on use, 30-40% in frontal lobes
  • in schizophrenia, excessive and/or inappropriate synaptic pruning may take place
    • frontal lobes- problem solving, organized thought
    • temporal lobes-auditory hallucinations
    • thalamus- sensory gating
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13
Q

Environmental influences on etiology of schizophrenia

A
  • viral infection
  • birth complications
  • major life stressors/trauma?
  • parental influences? (expressed emotion)
    • high levels of expressed emotion are bad (parents expressing resentment, hostility toward their children, yet being over involved)
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14
Q

Schizophrenia symptom relapse

A
  • social withdrawal early warning sign, isolation as precipitant
  • increase in psychosocial stressors
  • dramatically increased risk with alcohol and other substance use
  • can be effectively managed (meds) to avoid hospitalization and other fallout
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15
Q

Typical antipsychotics

A
  • chlorpromazine (1952), Thioridrazine, Haldol
  • Mechanism of action: Block DA receptors in CNS- only act on dopamine
  • Reduce positive symptoms, ignore or exacerbate negative symptoms
  • Side effects
    • difficulty initiating movement
    • tardive dyskinesia- involuntary facial movements
  • used in severe cases and for crisis intervention
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16
Q

Atypical antipsychotics

A
  • clozapine, risperdal, geodon, zyprexa etc
  • mechanism of action: decrease sensitivity of DA and serotonin receptors in specific pathway, may alter physiology of neurons
  • Reduce positive symptoms, indirectly reduce negative symptoms
  • less risk for tardive dyskinesia
  • VAST improvements for many patients, less side effects, de-institutionalization
17
Q

Inpatient treatment for schizophrenia

A
  • Very expensive
  • Temporary (7-30 days) stays for psychotic breaks
  • private hospitals; some are state funded
  • strict rules, various levels of security
  • mixed-gender community activities, token economies
18
Q

Residential treatment centers for schizophrenia

A
  • typically non-descript homes in residential neighborhoods
  • step down level of care
  • state/local funds to house patient previously kept in hospitals
  • idea is to teach patients skills necessary for independent living
    • cooking, cleaning, medication, hygiene
    • communication, social problem-solving, etc.
19
Q

Effective psychosocial treatments for schizophrenia

A
  • behavior therapy
  • vocational rehab
  • social skills
  • case management
  • supportive family management
  • behavioral/applied family management
20
Q

Major issues in family based treatments for schizophrenia

A
  • beliefs and attitudes toward patient and mental illness
  • reduce shame and guilt
  • stress management
  • family interaction style (EE)
  • coping skills
  • community resources
21
Q

Schizophreniform Disorder

A
  • Same primary symptoms of schizophrenia
    • differs in duration and dysfunction
    • symptomatic for 1 to 6 months
  • Over 1/2 of those diagnosed will eventually qualify for schizophrenia diagnosis
22
Q

Schizophreniform Specifiers

A
  • Specifiers:
    • good prognostic features
      • psychotic features begin within four weeks of the first noticeable change in functioning or behavior
      • confused or perplexed when most psychotic
      • premorbid social and occupational functioning are good
      • affect is neither blunted or flattened
    • without good prognostic features (two or more above have not been present)
23
Q

Schizoaffective disorder

A
  • MDE or Manic episode in addition to psychotic symptoms
  • Psychotic symptoms must also exist in absence of mood symptoms (otherwise, MDE severe with psychotic features)
  • Cognitive functioning and prognosis usually better than schizophrenia
  • little research
  • treatment may include antidepressants or mood stabilizers in addiction to antipsychotics
24
Q

Delusional disorder

A
  • delusions
    • bizarre content
    • non-bizzare (within the realm of possibility)
  • lack other symptoms of schizophrenia
  • onset in middle adulthood
  • many patients remain semi-functional
  • relatively rare
  • requires serious consideration of rule-outs
  • Tx: usually hospitalization, brief use of meds, and therapy for resolution of psychosocial stressor
25
Q

Formal thought disorder

A
  • a disturbance in the production and organization of thought.
    • loose associations: a common thinking disturbance in schizophrenia, characterized by rapid shifts from one topic of conversation to another. (derailment)
26
Q

Catatonia

A

a pattern of extreme psychomotor symptoms

27
Q

Multicultural factors in etiology of schizophrenia

A

more common in African Americans, less common in developing nations where there is more social support and less judgment.

28
Q

Social labeling

A

Once someone is labeled “schizophrenic” it may be hard for them to be seen as a person outside that label

29
Q

Developmental psychopathology view of schizophrenia

A

genetically inherited predisposition leads to schizophrenia if there are environmental factors and stressors.

30
Q

milieu therapy

A

a humanistic approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity.

31
Q

token economy programs

A

a behavior-focused program in which a person’s desirable behaviors are reinforced systematically by the awarding of tokens that can be exchanged for goods or privileges.

32
Q

tardive dyskinesia

A

extrapyramidal effects involving involuntary movements that some patients have after they have taken antipsychotic drugs for an extended time.

33
Q

extrapyramidal effects

A

unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness sometimes produced by antipsychotic drugs.

34
Q

neuroleptic malignant syndrome

A

improper functioning of the autonomic nervous system, can be fatal

35
Q

cognitive remediation

A

a treatment that focuses on the cognitive impairments that often characterize people with schizophrenia, particularly their difficulties in attention, planning and memory.

507 final (8 decks)

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