Chapter 9: Schizophrenia Flashcards by Alexandria Leland

Schizophrenia (term translate as )

schizo: split
phrenia: mind

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Schizophrenia

Influences the way a person thinks, feels, and behaves
Disordered thinking
Ideas not logically related
Faulty perception and attention
Lack of emotional expressiveness
A blunted affect
Mood incongruent affect – the way a person feels is not the way they feel
Disturbances in movement or behavior
Widespread disruptions in life:
Maintaining jobs, living independently, having close relationships

Onset typically in late adolescence/early adulthood
Men diagnosed at a slightly earlier age

Often experience several acute episodes with less severe symptoms between episodes

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Three major clusters of symptoms:

Positive : hallucinations and delusions, an addition to what normally experience in life
Negative :taking away things normally experience in life. Subtracting it
Disorganized : seen a lot in verbal communication, person appears to be very confident in what they are talking about, jumping from one sentence to the next

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Delusions

-types of delusions

-a Positive Symptom

Beliefs contrary to reality

Firmly held despite disconfirming evidence

Types of delusions: 
Thought insertion
Thought broadcasting
Feelings or behaviors are controlled by external force
Grandiose delusions
Ideas of reference

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Hallucinations

-a Positive Symptoms

Sensory experiences in the absence of sensory stimulation

Most often auditory and visual
Hearing thoughts spoken by another voice
Voices arguing or commenting on behavior

People who have auditory hallucinations may misattribute their own voice as someone else’s voice

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Negative Symptoms

behavioral deficits in motivation, pleasure, social closeness, and emotion expression

Endure beyond an acute episode

Have profound effects on the lives of people with Schizophrenia
Strong predictor of a poor quality of life

Representing two domains:
Motivation and pleasure: Motivation, emotional experience, sociality
Expression domain: Outward expression of emotion, vocalization

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5 Types of Negative Symptoms ***

Avolition: Lack of motivation; apathy

Asociality: Little interest in being around others and close relationships

Anhendonia: Inability to experience pleasure
Appears to be in anticipating pleasure, not experiencing pleasure in the presence of pleasurable things

Blunted affect: Lack of outward expression of emotion

Alogia: Significant reduction in speech

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Avolition def

Avolition: Lack of motivation; apathy

a type of negative symptom

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Anhendonia:

Anhendonia: Inability to experience pleasure
Appears to be in anticipating pleasure, not experiencing pleasure in the presence of pleasurable things

-a negative symptom

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Disorganized speech (formal thought disorder)

Problems in organizing ideas and in speaking coherently
Loose associations (derailment)
Difficulty sticking to one topic

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Neologism

-falls under the loose associations of disorganized speech.
a word that does not exist – makes it up
(it sounds like a made up word haha)

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disorganized symptoms

disorganized speech and disorganized behavior

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Disorganized behavior

Difficulty organizing behaviors and conforming to community standards

Catatonia
Peculiar, increased, repeated gestures or immobility
Seldom seen today due to effective medications

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DSM-5 Criteria: Schizophrenia

Two or more of the following symptoms for at least 1 month; one symptom should be either 1, 2, or 3:

(1) delusions
(2) hallucinations
(3) disorganized speech
(4) disorganized (catatonic) behavior
(5) negative symptoms (diminished motivation or emotional expression)

Functioning in work, relationships, or self-care has declined since onset

Signs of disorder for at least 6 months; or, if during a prodromal or residual phase, negative symptoms or two or more of symptoms 1-4 in less severe form

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Do you need negative symptoms present to give a dx of schizophrenia?

YES

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Medications: First-Generation Antipsychotics

Reduce positive and disorganization symptoms

Little or no effect on the negative symptoms

30% of people don’t respond
Many stop quit due to side effects

Maintenance dosages help to prevent relapse

*Side Effects
Sedation, dizziness, restlessness, sexual dysfunction
Extrapyramidal side effects (e.g., tremors, shuffling gait)
Tardive dyskinesia

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Medications: Second-Generation Antipsychotics

Equally as effective as first-generation at reducing positive symptoms and disorganization
Modestly more effective at reducing negative symptoms
More effective at improving cognitive functioning

Also produce unpleasant side effects: Weight gain
Associated with other serious health concerns (e.g., Type 2 diabetes)

Many people also stop taking these medications

African Americans often do not receive these medications

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Medications: Evaluation of Drug Treatments

A Review of over 60 years of clinical trials:
Just over half of people with schizophrenia had a minimal response compared to placebo
-Only 23% had a good response

*Even though these drugs work better than placebo, they do not work well for many people

More work is needed to develop better medications for schizophrenia

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Psychological Treatments of schizophrenia

Patient Outcomes Research Team (PORT) treatment recommendation:
Social Skills Training
Family Therapy

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Psychological Treatments: Social Skills Training

Teach skills for managing interpersonal situations

Completing a job application
Reading bus schedules
Make appointments

Involves role-playing and other practice exercises, both in group and in vivo

Associated with fewer relapses, better social functioning, and a higher quality of life

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Psychological Treatments: Family Therapy

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Goal: reduce expressed emotion
Components common across family therapies for schizophrenia:
Education about schizophrenia
Information about antipsychotic medications
Blame avoidance and reduction
Communication and problem-solving skills within family
Social network expansion
Instilling hope

Psychological Factors: Families and Relapse

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*Family environment impacts relapse

Expressed Emotion (EE)
Hostility, critical comments, emotional overinvolvement
Associated with greater relapse
Cultural differences in the impact of EE

Psychological Factors: Family Factors

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*Schizophrenogenic mother
Cold, domineering, conflict-inducing parent causes schizophrenia
No support for this theory

*Family relationships do not cause schizophrenia, but may influence course of the illness
E.g., unclear communication, high levels of conflict
Plausible that these factors are a response to having a family memory with schizophrenia

Psychological Treatments: Cognitive behavioral Therapy

Study These Flashcards

Recognize and challenge delusional beliefs

Reduces negative symptoms
Challenging belief structures tied to low expectations for success and pleasure
Currently most effective treatment

Cognitive-behavioral social skills training (CBSST)
Combines social skills training and cognitive behavioral therapy
Focuses on reducing symptoms and improving functioning

The earlier treatment begins the better

Other Psychological Treatments

* Cognitive remediation or cognitive training - Include hours of computer-based training in attention, memory, and problem solving - Associated with a reduction in symptoms and an improvement in everyday functioning *Psychoeducation Educate people about their illness Effective in reducing relapse and rehospitalization and increasing medication compliance *Residential treatment Vocational rehabilitation Residents learn marketable skills thereby increasing community functioning

Brain Structure and Function: Enlarge Ventricles

Implies loss of brain cells Correlated with: Poor performance on neuropsychological tests Poor functioning prior to onset of disorder Poor response to medication treatment Not specific to schizophrenia

Brain Structure and Function: Factors Involving Prefrontal Cortex

Plays a role in speech, decision making, emotion, goal-directed behavior Reduction in gray matter and overall volume Antipsychotic may contribute to loss Poorer performance on neuropsychological tests designed to tap into functions of prefrontal region Lower glucose metabolism when performing neuropsychological tests Less activation associated with more severe negative symptoms

Behavioral Genetics Research : family studies -are positive or negative symptoms have a stronger genetic component?

* Relatives at increased risk - Risk increases as genetic relationship becomes closer *Negative symptoms have stronger genetic component * Incidence highest among children with both parents with a schizophrenia or bipolar disorder diagnosis - Suggests some shared genetic vulnerability - The role of environment cannot be discounted

. In schizophrenia research, prodrome refers to a) neurobehavioral functioning in the disorder. b) positive symptomatology in the disorder. c) intellectual functioning in the disorder. d) the period before a person meets diagnostic criteria for schizophrenia but nonetheless shows some symptoms.

d) the period before a person meets diagnostic criteria for schizophrenia but nonetheless shows some symptoms.

A recent review of 37 longitudinal studies of people after their first episode of schizophrenia found that a) psychosocial treatments predicted no benefit above and beyond medication. b) medication was useless in treating the disorder over long periods of time. c) the combination of medication and psychosocial treatment predicted the best outcome. d) medication alone predicted the best outcome.

c) the combination of medication and psychosocial treatment predicted the best outcome.

Lifetime prevalence of schizophrenia

~1%

for schizophrenia : t/f substance use, suicide, and mortality rates are high

true Substance use, suicide, and mortality rates are high

schizophrenia and gender

Affects men slightly more often than women

schizophrenia and race

Diagnosed more frequently in African Americans | May reflect bias among clinicians

T/F ASD is very predictive of who develops PTSD

FALSE ASD is not very predictive of who develops PTSD | Less than half develop PTSD within 2 years

PTSD and gender

1.5 to 2 times more likely in women Consistent with gender ratio in other anxiety disorders May be related to different life circumstances of women

Alogia:

-a negative symptom of schizophrenai | Alogia: Significant reduction in speech

Domains of Negative symptoms of expression

Representing two domains: Motivation and pleasure: Motivation, emotional experience, sociality Expression domain: Outward expression of emotion, vocalization

PORT

Patient Outcomes Research Team (PORT) treatment recommendation: Medication PLUS psychosocial intervention Social skills training, cognitive behavior therapy, and family-based treatments Combined treatment is associated with: Lower rates of relapse and treatment discontinuation Greater improvements in functioning

Effects of high dose of alcohol (how much is this)

Effects of high dose (.08 blood alcohol content) of alcohol: Significant motor impairment Difficulty monitoring errors and making decisions People at the legal limit of alcohol may make poor decisions about driving and not realize they are making mistakes

75. If hoarding symptoms develop as part of schizophrenia, hoarding disorder ________ A. should not be diagnosed. B. probably will be considered instead. C. must be listed as a co-morbid diagnosis. D. should not be diagnosed unless the individual is particularly unaware of the problem.

A. should not be diagnosed.

True or False? Hoarding Disorder is commonly comorbid with Obsessive-Compulsive Disorder.

TRUE -how idk

people with BDD: how do they look at their body

Instead of looking at the whole, they examine one feature at a time

when was DID first put in the DSM

Increased rates since 1970s Appearance of DID in popular culture DSM-III (1980) defined DID for the first time

T/F in illness anxiety disorder a mild somatic symptom may be present

TRUE: No more than mild somatic symptoms are present (no significant somatic symptoms)

somatic symptom disorder vs illness anxiety disorder

Generally speaking, people with somatic symptom disorder do complain of physical symptoms. People with illness anxiety disorder usually do not have physical symptoms, or if symptoms are present, they are mild. (google)

39. The drug disulfiram helps people abstain from drinking alcohol by a. causing alcoholic drinks to taste bitter. b. interfering with the body's metabolism of alcohol. c. making people allergic to alcohol. d. reducing the pleasurable feelings that are associated with alcohol.

b. interfering with the body's metabolism of alcohol.

38. Which of the following is an example of the agonist substitution type of treatment for substance abuse? a. The use of methadone to treat heroin addiction b. A nicotine patch or nicotine gum to treat addiction to cigarette smoking c. Both of these d. Neither of these

c. Both of these

Jessica spends much of her day counting or saying certain words to herself. When she is not doing this, she is checking whether she left her doors unlocked. These symptoms illustrate ________ compulsions. obsessions. both obsessions (the counting and saying words) and compulsions (the checking). neither obsessions nor compulsions.

compulsions.

When a person incorporates unimportant events within a delusional framework and reads personal significance into trivial activities of others, it is called a) grandiose delusions. b) hallucinations. c) ideas of reference d) absence of logic.

) ideas of reference

Sensory experiences in the absence of any relevant stimulation from the environment are called a) delusions. b) ideas of reference. c) hallucinations. d) flights of thought.

c) hallucinations.

18. Among women seeking plastic surgery, approximately __________ percent meet the criteria for diagnosis with body dysmorphic disorder. a) 1-2 b) 3-4 c) 5-7 d) 8-10

c) 5-7

Chapter 9: Schizophrenia Flashcards

(52 cards)