Psychopathology 2: Schizophrenia, Depression & Bipolar disorder Flashcards
(47 cards)
1
Q
Scizophrenia definition
A
- Defined by its effects in altering: Perception, thoughts & consciousness and categorised into positive and negative symptoms
2
Q
Positive symptoms
A
Changes in behaviour/ thoughts :
- Hallucinations & Delusions
- Bizarre behaviour (e.g. Unusual clothing + appearance, inappropriate social + sexual behaviour, aggressive + agitated behaviour, repetitive + stereotyped behaviour
- Thought disorder including abnormalities of speech
3
Q
Negative symptoms
A
A withdrawal or lack of function:
- Flattened affect
- Apathy / indifference/ lack of energy
- Anhedonia – lack of ability to express emotion
- Attentiveness – i.e. lack of both socially and cognitively
4
Q
Hallucinations
A
Experience a seemingly real perception of something not actually present’ (Oxford Dictionary, 2018)
5
Q
Delusions
A
An idiosyncratic belief or impression maintained, despite being contradicted by reality or rational argument’ (Oxford Dictionary, 2018)
6
Q
Types of hallucinations
A
Pseudo – hallucination is to do with awareness
Common hallucinations between the awake/sleep boundary
Hypnagogic - occur on falling asleep.
Hypnopompic - occur on waking up.
These can be sounds, moving objects or seeing a person standing at the end of your bed….causes people to think they have seen a ghost.
7
Q
Auditory hallucinations
A
Hallucinations are the most common e.g. ‘voices’, affecting over 70% of people with Schizophrenia (Hugdahl et al., 2007).
8
Q
Tactile hsllucinations
A
Hallucinations involve the feeling of movement or touch in the body i.e. burning or tingling sensations.
9
Q
Olfactory hallucinations
A
- Foul odours from the persons body may be perceived, under researched & poorly understood area ( Langdon , 2011). May ‘serve as an “early warning” sign of disease vulnerability or onset’ ( Bruce et al., 2010)
10
Q
Visual hallucinations
A
- Hallucinations can be persistent such as small children or animals that frequently appear or follow them around
11
Q
Delusions
A
- Beliefs are rigidly held in spite of their preposterous nature, (Mahler 2017).
- Delusions typically personal
Common delusions include:
- Thoughts are being inserted into head
- Other people are reading the patients thoughts
- Patient being controlled by mysterious external forces
- Usually based on sensory experience that the person misinterprets
12
Q
DSM IV recognised subtypes: Paranoid
A
Preoccupation with delusions or auditory hallucinations
13
Q
DSM IV recognised subtypes: Disorganised
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Incoherence, bizarre behaviour, flat affect disturbance
14
Q
DSM IV recognised subtypes: catatonic
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Motor behvaiour, motionless
15
Q
DSM IV recognised subtypes: Residual
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Patients who dont meet the criteria for active phase but continue to show symptoms
16
Q
DSM IV recognised subtypes: Undifferentiated
A
Cant fit easily into any category but display variety of symptoms
17
Q
DSM-5- TR (2022) Recognised Symptoms – No subtypes
A
- Delusions
- Hallucinations
- Disorganised speech
- Disorganised or catatonic behaviour
- Tried to be more tolerant of combinations of symptoms in the individual
- Symptoms cause significant social or occupational dysfunction.
- For a diagnosis, symptoms present for 6 months
- DSM-5 raises the symptom threshold to exhibit at least two of the specified symptoms
18
Q
Risk factor
A
- Early studies showed risk correlated with degree of shared genes
- Concordance rate in MZ twins much higher than in DZ twins
- ROBERTS (2000): some diagnoses are taken from hospital notes + not confirmed
-But, 89% patients have no known relative with schizophrenia
19
Q
Aetiology of Schizophrenia-Medical Model
A
- Genetics- a persons risk increases with number of sufferers in the family
- Lifetime risk much greater for first degree relatives of sufferers.
- As degree of genetic similarity increases between patient and relative, risk to that relative increases.
20
Q
Neuropathology
A
- Brain imaging studies suggested schizophrenia associated with structural and functional irregularities in the brain
- Frontal cortex and limbic system show irregularities
- Arguments must be viewed with caution as many other patients with other psychiatric and neurological disorders show similar changes in the brain.
Meehl (2009) ‘ it is unlikely that a disorder as complex as schizophrenia will be traced to a single site in the brain.
21
Q
Neurotransmitters & The Dopamine Hypothesis
A
- Connection between neurotransmitters and schizophrenia
- Drugs that alter levels of neurotransmitters in the brain known to relieve some of the symptoms of schizophrenia
- Dopamine hypothesis argues schizophrenia is caused by increased reaction to dopamine in the brain
- Could be because there is too much dopamine in the brain
- Model says the excess sensitivity to dopamine in the brain causes the symptoms of schizophrenia.
22
Q
Evidence to support Dopamine Hypothesis
A
- Amphetamine use increases DA & produces experiences that mimic symptoms of schizophrenia
- Most effective drugs for treating schizophrenia are the phenothiazine’s (antipsychotics; neuroleptics), which block DA transmission by preventing uptake at the postsynaptic receptor site and help reduce DA levels
- Post-mortem evidence shows marked increase in DA receptor sites in schizophrenia, suggesting DA super sensitivity
23
Q
Antipsychotic drugs
A
2 groups of antipsychotic drugs
- Older ‘typical’ drugs such as haloperidol and chlorpromazine.
- Newer ‘atypical’ drugs, introduced since 1990’s Clozapine, Olanzapine, Risperidone, etc.
- Main difference between 2 groups is the side effects they may cause and their price
24
Q
Less supportive evidence
A
- Effective treatment using Clozapine works on the serotonin system only, not the DA system
- Substantial proportion are resistant to neuroleptics in treatment
- Antipsychotics/ Neuroleptics only partially alleviate negative symptoms of schizophrenia
25
NICE guidance-typical or atypical?
- Atypical antipsychotic drugs considered in the choice of first-line treatments for individuals with newly diagnosed schizophrenia.
- Not recommended individuals change to one of the oral atypical antipsychotic drugs if they are currently achieving good control of their condition without unacceptable side effects
- Atypical drugs considered in individuals where typical antipsychotics are causing unacceptable uncontrollable side effects
26
Bola et al (2009)
- 261 participants diagnosed with schizophrenia
- Drug treatments delayed for a set period of time.
- Patients provided with psychological and social support ie family therapy
- Outcomes compared between 1-3 years' later with patients who were treated with drugs straight away
- Among patients whom drug treatment was delayed, 1/3 ended up recovering without needing to take medication at all
- Longer-term outcomes tended to be superior to those patients who were treated with drugs immediately
27
Depression
Mood disorder involving emotional, motivational, behavioural, physical and cognitive symptoms
28
Major depression
Lasting sad, anxious, or “empty” mood
Loss of interest in almost all activities
Appetite and weight changes
Changes in sleep patterns, such as inability to sleep or sleeping too much
Slowing of physical activity, speech, and thinking OR agitation, increased restlessness, and irritability.
29
Bipolar disorder (with mania)
Periods of mania that alternate with periods of depression
30
Risk factor
Concordance rates in twin studies of bipolar disorder, (% probability that if one twin is a sufferer the other twin will also)
Sharing all the genes as opposed to half the genes more than doubles the risk of developing a mood disorder
31
New gene for Bipolar
Mühleisen, Leber, Schulze et al. (2014)
- Large scale ‘unparalleled’ study on 9747 patients compared with genetic data from 14,278 healthy persons
- Two new genes discovered "ADCY2" on chromosome five and "MIR2113-POU3F2“ region on chromosome six
32
Neurochemical factors
- Condition regularly associated with altered levels of serotonin and noradrenalin
- Mania in bipolar disorder associated with high levels of noradrenalin
- Serotonin is the neurotransmitter that has profound effect on a persons mood
- Low Serotonin = low mood
- Over 100 neurotransmitters in CNS, depression is unlikely to be caused by only one
33
Nuerotransmitters
- Most recent research suggests rather than low / high levels of these neurotransmitters being important, it is more likely to be an imbalance/interaction of many of these chemicals that is implicated in depression (Rampello, et al 2009)
- Developments in cognitive neuroscience suggest that abnormalities exist in brain areas associated with depression
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Risk factors show us that it's not all about Biology
- Social & Psychological factors
- Major Life Changes and Stress
- Little or No Social Support
- Low Socioeconomic Status
- Factors such as perfectionism, low self esteem
- Gender
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Psychodynamic Theories
- Psychodynamic explanations of Freud (1963), Abraham (1960) argue depression comes from loss real or imagined
- Loss — complex reaction to real loss/grief 'gone haywire"
- Depression from 'Symbolic Loss' where an individual imagines being abandoned by loved ones/ close family
- Affectionless control (Garber & Flynn, 2001)
- Empirical support from studies that show people who report childhood needs were not adequately met are more likely to experience depression after a loss, (Goodman 2002).
36
Social Factors & Major Depression
- Impact of stressful life events has been the main focus of research
- Research shows people who become clinically depressed experience an increased number of stressful life events, (Marshall, 2010)
- Life events involving loss of important people seem to be particularly important for precipitating depression
- Most major depression is not caused by 'daily hassles'
37
Social Factors and Bipolar Disorder
- Less research has been done in this area
- Some researchers found in the weeks preceding a manic episode more stressful life events have occurred
- Life events different here
38
Psychological Factors /Major Depression
- Many people who experience severe life events do not become depressed
- People are psychologically vulnerable to their life events
- Cognitive vulnerability'-how people respond to their circumstances will influence whether they become depressed
- Arran Beck (1987) very influential -replacing negative thoughts with positive beneficial schemas, CBT
39
Treatments-Drug Therapy-major depressio
- 1950's saw development of anti- depressants
- Tricyclic antidepressants
amytriptyline.
- MAO's - phenelzines problems with food avoidance, certain foods may interact with the drug and raise BP
- Tricyclics & MAO's act on both serotonin & noradrenalin to increase levels
- SSRI's - Selective Serotonin Reuptake Inhibitors
40
Drug treatment for Bipolar - Mood stabilizers
- Lithium: oldest and most well-known mood stabilizer
- Highly effective for treating mania
- Lithium takes from one to two weeks to reach its full effect
41
Common side effects of lithium
- Weight gain & Drowsiness
- Tremor, Weakness or fatigue
- Excessive thirst; increased urination &Stomach pain
- Thyroid problems
- Memory and concentration problems
- Nausea, Vertigo & Diarrhea
42
Lithium dissadvantages
- Swonger & Constantine 1983; Ghaemi et al 1999; Lenox & Hahn 2000;
Disadvantages - toxic substance levels near to alleviating symptoms can be close to toxic levels & can prove dangerous
Compliance -patients often stop taking it due to side effects -memory loss, weight gain, nausea, impaired coordination.
43
Anticonvulsant mood stabilizers for bipolar disorder
- Vampiric acid (Depakote)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Valproic acid often the first choice for rapid cycling, mixed mania, or mania with hallucinations or delusions
Common side effects include:
- Drowsiness & Weight gain
- Dizziness, Tremor, Diarrhoea & Nausea
44
Antipsychotic medications for bipolar disorder
- Loss of touch with reality during a manic or depressive episode - an antipsychotic drug may be prescribed.
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ariprazole (Abilify)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
Side effects include:
- drowsiness, weight gain, blurred vision, constipation, sexual dysfunction
45
ECT- electro-convulsive therapy
- Proved beneficial for patients suffering from major depression and Bipolar conditions
- Most patients show improvement after 8-10 sessions
- 70-130 volts through the head for half a second
- Studies shown effective for severely depressed patients.
46
Treated with psychotherapy
- Helps indiv. achieve insight into repressed conflict, feelings of loss etc and release the anger directed in on oneself
- Free association /Dream therapy
- Both used to recall early experiences
47
Suicide rates
- Men 4x more likely to commit suicide than women (Holmes)
- Women 3x more likely to attempt suicide.
