L10: schizophrenia Flashcards
(98 cards)
1
Q
what is schizophrenia
A
a brain disorder affecting how ppl think, act, feel and perceive.
- deprives rational thought
- impacts perception
2
Q
what is the defining feature of schizophrenia?
A
psychosis
- possibly with hallucinations and/or delusions
3
Q
what are hallucinations?
A
stimuli inconsistent with objective reality
-ie. hearing voices no one else can hear
4
Q
what are delusions?
A
fixed false beliefs that are inconsistent with objective reality
5
Q
what is the prevalence of Schizophrenia ?
A
- M : F = 1.4:1
- generally agreed upon worldwide.
6
Q
what population has the lowest lifetime prevalence of Schizophrenia?
A
Asian populations
7
Q
lifetime prevalence of schizophrenia + schizophrenic disorders
A
0.55 + 1.45, respectively
8
Q
Prevalence in Canada
A
~1%
9
Q
Why is prevalence higher in Canada? (2 theories)
A
- higher prevalence of people who immigrate = likely relates to stress
- Less sunlight = low VitD in pregnancy = prenatal risk factor.
10
Q
age of onset for schizophrenia
A
- late teens to mid 30s
- early to mid 20s for MEN
- late 20s for WOMEN
11
Q
course of schizophrenia?
A
from healthy, normal functioning to more ill.
- gradual onset of subsyndromal symptoms.
12
Q
what is prodromal period?
A
when subsyndromal symptoms begin to arise - before the onset of full schizophrenia.
- perhaps capture this state + intervene before schizophrenia arises.
13
Q
chidhood onset? yay or nay?
A
possible but unlikely
14
Q
late onset - when? characterized by?
A
after 40yoa
- psychotic symptoms + paranoia
15
Q
co-morbidity?
A
50% have another psychiatric disorder.
- 50% use substances ie. cigarettes.
- others have anxiety, ocd depression
16
Q
how many commit suicide?
A
10%
17
Q
why do people use substances with schizophrenia?
A
biological effects of nicotine.
- give a lift, break down antipsychotics = more energy.
18
Q
cognitive deficits in schizophrenia?
A
often precede psychosis + remain stable
19
Q
is there a reliable way to predict the course of schizophrenia?
A
no reliable way.
- some improve, few recover.
- most require support + are chronically ill.
- some have exacerbations + remissions.
- some progressively deteriorate.
20
Q
what features may relate to good prognosis?
A
- late onset
- acute onset
- (+) premorbid social, sexual, work histories
- mood disorder symptoms
- married
- family history
- good support system
- (+) symptoms
21
Q
what features may relate to poor prognosis?
A
- young onset
- insidious onset
- poor premorbid social, sexual, work histories
- withdrawn, autistic behaviour
- single, poor support systems
- family history of schizophrenia
- negative symptoms
- perinatal trauma
22
Q
psychiatric hospitalization of schizophrenics??
A
31% are with schizophrenia
23
Q
5 elements required for diagnosis?
A
H(u)SB(a)ND Hallucinations Speech disorganization Behaviour disorganization Negative symptoms Delusions
24
Q
what is diagnosis based on?
A
psychiatric history
mental status exam
clinical diagnosis
– no lab test/imaging
25
strategy to get psychiatric history?
get full psychiatric assessment
| - thorough, objective assessment of life + mental state
26
what is psychosocial backgroun?
gender, life experiences
27
5 S's of history of presenting illness?
```
Situation
Stressors
Symptoms
Safety (suicide/homicide/self harm)
Substance use
```
28
what are the elements of a Psychiatric history?
- psychosocial background
- history of presenting illness
- medical history
- family history
- medical psych history (diagnoses, treatments, hospitalizations, suicide attempts)
- medications
- social and personal history.
29
elements of social + personal history?
birth (prenatal experience may increase schizophrenia)
- development
- family
- school
- abuse
- work
- relationship
- supports
- legal
30
what is acute onset often related to?
ingestion of substance
31
why are relapses important in prognosis?
each time you relapse, you come back to "normal" worse off + clozer to a schizophrenic episode.
32
major risk factors in schizophrenia?
place/time of birth
- infection
- prenatal elements
- obstetric conditions.
33
what are positive symptoms?
presence of too many behaviours not found in most people (added behaviours)
- hallucinations, speech + behaviour disorganization, delusions
34
what are negative symptoms?
absence of behaviours found in most people (lost something)
| - 5A's.
35
what are hallucinations?
false perceptions that feel real, without sensory input
| - most are auditory (hear voices or thoughts of others)
36
contrast hallucinations and illusions?
h: false perception - no sensory input
I: miscerception of real sensory input.
37
describe what disorganized speech may be like?
tangential, mocking others, lack of connectedness, quickly changes topics
- reflection of thought pattern in mind
38
what is Linear thought form?
completes given idea before moving on to the next.
39
what is circumstantial thought form?
moves on to related topics but eventually returns to original topic
40
what is tangential thought form?
moves on to related topics but never returns to original topic
41
what is "Loosening of associations" thought form
no logical connection between sequence of thoughts
42
what is "word salad" thought form
no logical connection between words
43
what is "flight of ideas" thought form
rapid movement from topic to topic without completing each train of thought
44
perseveration?
persistent inappropriate repetition of same thoughts
45
what are delusions?
fixed false beliefs
46
what are persecutory delusions?
paranoid that others will persecute them, threaten them, conspire against them
47
what are referential delusions?
neutral event that's not meant to have special meaning, does.
48
what are grandiose delusions
narcissistic-type delusions
49
what are erotomanic delusions
thoughts that never stop
50
what are nihilistic delusions
nothing exists, everything is false/imposter.
51
somatic delusions?
feeling in the body that isn't real
52
thought withdrawal delusion?
someone taking thoughts out of your mind
53
thought insertion delusion?
thoughts didn't originate from you; someone adding thoughts to your head.
= compensatory behaviours.
54
what are delusions of control?
belief that dont have control over own body.
55
what are the 5 A's of negative symptoms?
```
Anhedonia
Avolition
Alogia
Asociality
Affective flattening
```
56
what is anhedonia
lack of interest/enjoyment.
| - looks like depression.
57
what is avolition
lack of motivation to initiate purposeful activities
58
what is alogia
lack of speech
59
what is asociality
lack of interest in social interactions
60
what is affective flattening
lack of facial expression
61
course of (+) and (-) and cognitive symptoms?
(+): diminish with age
(-): persist with age
cognitive: affect memory + problem solving
62
what is catatonia?
unusual movements in the body
| - inability to move/rigid. no logical connection to this.
63
morel + idea about schizophrenia
- demence precoce: mental deterioration that began in adolescence
64
kraepelin + idea about schizophrenia?
dementia precox: schizophrenia pre-cursor, chronic + deteriorating.
manic depression: psychotic symptoms that come and go
65
bleuler + idea about schizophrenia?
named it.
- split mind: split btw real and not real.
- didn't believe it had to be early onset
- didn't believe it progressed to dementia
66
what are prefrontal lobotomies?
disrupting neural connections from prefrontal cortex to stop schizophrenia
- reduced difficult behaviours, left blunted behaviours
67
DSM-IV : 5 subtypes of schizophrenia?
```
paranoid
disorganized
catatonic
undifferentiated
residual
```
68
DSM-5 changes in diagnosis of schizophrenia
subtypes eliminated bc limited diagnostic stability, low reliability, poor validity.
no identifiable/consistent treatment among the subtypes.
69
is schizophrenia a continuum or category
continuum for many symptoms
70
genetic etiology of schizophrenia
- evidence for over 100 genes
| - genetic data suggests schizophrenia, depression, bipolar, autism + adhd share genetic similarities.
71
prevalence of schizophrenia when MZ twin has schizophrenia?
47%. very much heritable. perhaps other factors impact too.
72
genetics: relatives of schizophrenics at greater risk for?
greater risk for Cluster A PDs, especially schizotypal PD
| -- suggests schizotypal is phenotype of schizophrenia genotype
73
what are endophenotypes?
variable expression of traits that are aspects of a symptom/disorder
(ie. psychosis is combo of prepulse inhibition + sensory gating + others)
74
what is prepulse inhibition?
ability to inhibit startle response
75
what is sensory gating
filtering unnecessary sensory information
76
DA and psychosis?
too much DA from excess release, excess receptors or hypersensitive receptors = psychosis.
77
dopamine agonists?
stimulants = cocaine, amphetamines
- induce psychosis
78
dopamine agonists?
antipsychotics, reduce psychosis
79
Da and parkinsons
too little Da activity
- nigrostriatal da pathway controls + regulates movement
- Da antagnosists can induce parkinsons.
80
risk/benefit to antipsychotics?
- safety, lucidity, increase quality of life
| - decrease physical health, + side effects
81
adherence of antipsychotics?
low. 50% quit within 1st year, 75% quit within 2 years.
82
what are side effects of antipsychotics
- sedation, weight gain, diabetes
- dystonia (muscle rigidity)
- akathisia : motor restlessness
- tardive dyskinesia: involuntary repetitive movements
- neuroleptic malignant syndrome: excessive DA blockage can be fatal..
83
what are some serotonin agonists?
psychedelics:
LSD
psilocybin mushrooms
DMT
84
what are serotonin antagonists
antipsychotics
| seroqual = sedation, neuroleptic syndromes
85
brain differences in schizophrenics
ventricles enlarged
pfc: reduced volume + metabolism
- decreased synapses
86
relapse of schizophrenia?
medication noncomplianse most associated w relapse. = vicious cycle, deterioration with relapse
- long acting injectable forms improve compliance. side effects more tolerable
87
homelessness of schizophrenics?
hard to quantify.
- in US, small proportion of homeless are mentally ill, but many schizophrenics are homeless.
- in canada, large proportion of homeless are mentally ill.
88
risk factors for homelessness with schizophrenia?
male, substance use, comorbid conditions
89
employment of schizophrenics?
desire to work, benefit from working (self-esteem, purpose, income)
- hesistant to hire.
90
vocational interventions are?
integrating mental health team + supported employment team
| - work together with person
91
social skills training intervention?
teach behaviours to function in variety of settings
- help adapt better to situations
- taught the basic of interactions
92
family as intervention tool?
family psychoeducation lowers risk of relapse.
| - when families express emotions heatedly, but learn to deal with that , relapse decreases
93
CBT as intervention?
- effectiveness is similar to medication
- ID triggers/responses and come up with strategies to cope.
- reduce stress + arousal = reduce stress-diathesis model
94
overall purpose of cbt?
question core beliefs and cognitive distortions
95
effect of CBT?
decreased (+) symptoms: severity, hospitalization + relapse
| - decreased (-) symptoms: greater mood, motivation + enagagment
96
what is assertive community treatment?
community based, multidisciplinary treatment teams.
| 10:1, provide housing, meds, employment
97
outcomes of assertive community treatment?
reduces admissions, improves functioning, quality of care.
| - does not decrease cost of care
98
what is cognitive remediation
skills to compensate for cognitive deficits
- drills to strengthen memory, problem solving skills, social-cognitive skills
= moderate improvement of cog performance
