Chapter 14/15 Flashcards
(17 cards)
Schizophrenia
Psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities
- 1 of 100 experience during lifetime
- 21 million worldwide, 3.6 million in U.S.
- Equally distributed between men & women
- Average age at onset: 23 for men, 28 for women
Checklist
- For one month, individual displays two of more of the following symptoms frequently:
- Delusions
- Hallucinations
- Disorganized speech
- Very abnormal motor activity (including catatonia)
- Negative symptoms
- At least one of individual’s symptoms must be delusions, hallucinations, or disorganized speech
- Individual functions much more poorly in various life spheres than they did prior to symptoms
- Beyond 1 month of intense symptoms, individual continues to display some degree of impaired functioning at least 5 additional months
Psychosis
- State in which person loses contact w/ reality
- Hallucinations (false sensory perceptions) an/or delusions (false beliefs)
- If majority if people don’t have a belief, believe them over minority (class context) - May be substance-induced, caused by brain injury, or produced by other psychological disorders, but most commonly appears in form of schizophrenia
Positive Symptoms of Schizophrenia
- Symptoms someone with schizophrenia has that others don’t, excesses of or additions to normal thoughts/behaviors/emotions
Delusions
- Ideas they whole heartedly believe with no basis in fact
- Some hold one delusion, others hold many
Disorganized Thinking & Speech
- Loose associations/derailment: rapid shift between topics
- Neologisms: made up words
- Perseveration: repeat words/statements again and again, scatter in coco
- Clang: rhymes used for expression (rhyme-like speech)
Inappropriate Affect
- Situationally unstable emotions (laughing at funeral)
Heightened Perceptions and Hallucinations
- Problems of perception/attention: in distracting background speech, schizophrenia less likely to identify target syllable than controls
- Deficiencies: in smooth pursuit eye movement
- Hallucinations: perceptions in absence of external stimuli, often auditory but can involve any other sense
Hallucinations and delusional ideas often occurs together
Negative Symptoms of Schizophrenia
- Things people do that individuals w/ schizophrenia don’t, pathological deficits
Poverty of speech (alogia)
- Reduction/quantity of speech or content of speech
- May say a lot but convey little
Restricted affect
- Less emotion than most
- Avoid eye contact, immobile/expressionless face, monotone voice
- Reflect inability to express emotions
Loss of volition`
- Drained of energy and interest in normal goals
- Inability to start/follow thru on actions
- Ambivalence: conflicted feelings on most things
Social withdrawal
- People w/ schizophrenia may withdraw from social environment
- Leads to breakdown of social skills
Psychomotor Symptoms of Schizophrenia
- Many people w/ schizophrenia move relatively slowly, and a number make awkward movements or repeated grimaces/odd gestures that seem to have private purpose
- ~10% of people w/ schizophrenia experience some degree of catatonia
Course of Schizophrenia
Schizophrenia usually first appear between late teens and mid-thirties
- Three phases, can each last for days or years
- Prodromal: beginning of deterioration; mild symptoms
- Social isolation, unusual thoughts, problems with communication and perception, less emotion
- Active: symptoms become apparent
- Sometimes triggered by stress
- Residual: return to prodromal-like levels
- May retain some negative symptoms
Diathesis-Stress Relationship
People w/ a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present
Biological View of Schizophrenia
Inheritance and brain activity play key roles in development of schizophrenia
- Genetic factors
- Relatives of people w/ schizophrenia
- Direct genetic research and molecular biology
- Variety of different genes
- Dopamine hypothesis: certain neurons using dopamine fire too often, produces symptoms of schizophrenia
- Evidence in support
- Antipsychotic drugs can cause Parkinson’s disease-like tremor response in patients
- Parkinson’s disease associated with abnormally low levels of dopamine
- Some people w/ Parkinson’s disease develop schizophrenia-like symptoms if they take too much L-dopa, a med that raises dopamine levels
- Amphetamines psychosis - Problems
- Atypical antipsychotics, more effective than traditional antipsychotics, also bind to receptors for other NT’s
- Evidence in support
- Viral problems
- Exposure to viruses prior to birth may trigger immune response in the mother and developing fetus, enter the brain, and interrupt proper brain development
- Microglia are especially active in brains of people w/ schizophrenia
Sociocultural View of Schizophrenia
Multicultural factors
- Racial and ethnic group differences in rates of schizophrenia
- African Americans more likely (2.1%) than non-Hispanic white Americans (1.4%) to receive this diagnosis
- More prone to disorder; biased diagnoses; effects of economic hardship
- Key country-to-country differences
- Stable prevalence, varied course and outcomes
- Patients in developing countries have better recovery rates than developed countries
- Genetic differences among populations?
- Psychosocial environments?
- More family and social support
Antipsychotic Drug
First-generation (Neuroleptics)
- 1950s-1980s
- Block excessive dopamine activity
- Often produces undesired movement effects
Second-generation
- Atypical antipsychotics
Since 1950s, medicines have shortened hospitalization periods
Effectiveness of Antipsychotics
- Symptoms reduce in ~70% of patients diagnosed w/ schizophrenia
- More effective than any other approach used alone
- In most cases, brings about clear improvement within weeks and produce a max level of improvement w/in first 6 months
- Symptoms may return if patient stops taking drug too soon - Reduces positive symptoms more completely (or more quickly) than negative symptoms
Unwanted Effects of First-Generation Antipsychotics
Parkinsonian symptoms
- At least 1/2 of patients on conventional antipsychotic drugs have muscle tremors/rigidity at some point during treatment
- Result of medication-induced reductions of dopamine activity in striatum
Neuroleptic malignant syndrome
- Muscle rigidity, fever, altered consciousness, and improper functioning of ANS
- 1% of patients, particularly elderly
Tardive dyskinesia
- Don’t unfold till person has taken 1st generation antipsychotic for more than 6 months
- Involuntary writhing or ticlike movement of tongue, mouth, face, or whole body
- Most cases: mild and single symptom
- 15% of those who take drug for extended time develop this to some degree
Psychotherapy
Antipsychotic drugs allow people w/ schizophrenia to learn about disorder, participate actively in therapy, think more clearly about selves and relationships, make changes in behavior, and cope w/ stressors in their lives
- Cognitive-behavioral therapies
- Sociocultural interventions: family therapy and social therapy
Cognitive-Behavioral Therapies for Schizophrenia
Cognitive remediation
- Focuses on difficulties in attention, planning, and memory
- Moderate improvement in attention, planning, memory, and problem-solving
- Surpass those w/ other interventions
- Extend to everyday client life and social relationships
Hallucination reinterpretation and acceptance
- Therapists help change how clients view and react to their hallucinations
- Reduces fear and confusion produced by delusional misinterpretations
Family Therapy for Schizophrenia
Providing family members w/ guidance, training, practical advice, psychoeducation about disorder, and emotional support and empathy
- Relatives develop more realistic expectations and become more tolerant, less guilt-ridden, and more willing to try new patterns of communication
- Helps person w/ schizophrenia cope w/ pressures of family life, make better use of family members, and avoid troublesome interactions
Relapse rates and hospital re-admissions go down, particularly when combined w/ drug therapy
Community Approach
In 1963, Congress passed Community Mental Health Act —> deinstitutionalization
- Ordered that patients w/ variety of psychological disorders should be released and treated in community
- Inadequate quality of community care creates “revolving door” pattern for many patients
Community Treatment Failure
In any given year, 30-60% of all people w/ schizophrenia receive no treatment at all
- Two contributing factors
- Poor coordination of services
- Solutions: community therapists as case managers
- Shortage of services
- An inadequate number of community programs are available to people w/ schizophrenia
- Some community mental health centers that do exist generally fail to provide adequate services for people w/ severe disorders, focusing on people w/ less severe problems
