Lecture 3 (Schizophrenia) Flashcards
(17 cards)
History and Myths about schizophrenia
Kraepelin (1899) -> formulated dementia praecox
Bleuler (1911) -> developed schizophrenia classified under four disturbances
-> affect
-> ambivalence
-> associations
-> preference for fantasy over reality (vivid experiences without external stimulus)
Myths:
-> People with schizophrenia are dangerous
-> People with schizophrenia have split personality
Schizo = discoordination of thought
Epidemiology
1% prevalence
Peak onset in males 15-25, females = 25-35
<10 or >50 onset is rare
Men more likely to develop schizophrenia
Men usually show more positive symptoms, leading to earlier diagnosis, whereas women show more negative affect symptoms -> less likely to get immediate diagnosis
50% attempt suicide
most are low SES
most expensive mental disorder
shorter lifespan
DSM criteria A
two or more for significant portion of 1 month, 1 symptom has to be at least delusions, hallucinations, or disorganised speech (positive symptoms)
other criteria:
Disorganised speech
Negative symptoms -> affect flattening, alogia (reduction in amount, content, or elaboration of speech), avolition (loss of interest in goal directed behaviour)
DSM Criteria B/C and exclusions
Social occupational dysfunction -> effecting over significant portion of time since onset of disturbance, function has to be much worse now then it was before disturbance
Duration -> 6 month period must include 1 month of symptoms that meet criteria A (intense symptoms) may include prodromal or residual symptoms
Exclusions -> schizoaffective and mood disorders, substance use or medical condition, relationship to ASD (symptoms not explained by social processing disorders)
Characteristic symptoms (hallucinations)
Experience occurring in the absence of stimulus and not under voluntary control
Auditory -> most common
visual, olfactory, gustatory, tactile
Need to differ hallucinations just before sleeping and after waking up (may be sleep paralysis)
Characteristic symptoms (delusions)
Delusions are a fixed false belief that is not normal and has a functional consequence (think about culture)
Persecution -> someone is harassing you
Reference -> an event happening in the world is something related to you (e.g. world is sending you signals that arent true)
Grandeur -> thinking have extraordinary beliefs e.g. super powers or rich
Thought insertion -> someone is inserting thoughts into your head (not someones voice) just thoughts that arent yours
Characteristic symptoms (form of thought/ disorganised speech)
Disturbances in production and organisation of thought revealed by disorganisation in speech -> need to develop trust in interviews to get the person to speak to make diagnosis
Loosening of associations:
-> neologism (made up words)
-> preservation (repeating same thing a lot of times)
-> word salad (saying a lot but not structured)
-> circumstantiality (begin to answer get off track then answer)
-> tangentiality (going off on tangent)
Characteristic symptoms (disturbance in affect / social behaviour)
Restricted, blunted, flat affect
Diminished emotional expression
Diminished speech prosody = expression and tone of speech more sad
Need to measure if there is a change of emotional expression that matches what they are talking about
Associality = decreased interest in social interactions
Duration and specifiers / severity
duration specifier used after 1 year
combination of first/multiple episode and acute episode, partial remission, full remission or continuous
Specifier of catatonia -> disturbance in psychomotor behaviour
Catatonic stupor -> slow movement
“ Rigidity
“ Excitement -> more
Severity specifier -> related to impact on functioning
Cognitive impairments
impairments to cognition usually predicts of how people function -> not part of DSM but still measure
Declarative and working memory
Language function
Executive function
Sensory processing
Course and prognosis
Prodromal phase -> prior to diagnosis
Active phase -> greatest severity of symptoms
Residual phase
Negative symptoms and cognitive deficits usually remain stable during residual phase
During active phase positive symptoms up and down but decrease in residual phase
Gradual onset of symptoms more common
Prognosis
-> 20-30% experience minimal impact
-> 20-30% moderate symptoms
-> 40-60% remain significantly impaired
Predictors of schizophrenia
Good outcome predictors -> good premorbid adjustment e.g. good family relationship and social relationships prior to diagnosis
No family history
Good response to medication
Other psychotic disorders
Schizophreniform -> duration for at least 1 month but less than 6, impaired functioning not required
Schizoaffective -> falls on boundary of schizophrenia and mood disorder
Need to have episodes of mood disturbance concurrent with criterion A symptoms
Delusions/hallucination occur in the absence of mood disturbance
Delusional disorder -> one or more delusions never meeting criteria A
Brief psychotic disorder -> sudden onset of at least one positive symptom, at least one day but less than a month
other ones are usually associated with substance use
Aetiology biological view
Twin, adoption and family studies -> likely that it has a polygenic influence from genetic variations
Family studies show high rate in MZ twins and offspring
Dopamine hypothesis -> D2 receptor target for anti-psychotics , but problems are that this med does not capture the full symptoms may need to tap into serotonin system, and GABA
Aetiology psychosocial view
behavioural view: failure to attend to social cues in bizarre responses to environment, acquisition of bizarre behaviours through conditioning
Expressed emotion:
fam with expressed emotion e.g. stress may precipitate relapse
Person with disorder more likely to relapse in high emotion expression family
target family environment through intervention
Focus on family members having support as well, help them try to maintain social connection with person who has disorder -> reciprocal family dynamics
Burden of blame -> family members thinking they are the cause for the illness
Diathesis stress model
Diathesis: genetics, trauma, brain abnormality’s
Stressors: trauma, social stressors, family environment and emotion expression, drug use
Interaction forms disorder
Treatment
use CBT approach -> psychoeducation -> learn about disorder and try to learn signs of relapse, and vulnerability
-> coping strategies
Family interventions
Social skills training -> providing methods on how to build a social network, and daily living skills
Meds first line treatment
use of multifaceted approach is necessary with co-ordinated services
Early intervention important for identifying pre-cursors of diagnosis, and identifying early who is high at risk
