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Psychopathology PSYC 340 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

public perception

A
  • public believes that it is usually caused by biology and genetics
  • lots of people believe that schizophrenics are dangerous and violent
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2
Q

schizophrenia spectrum and psychotic disorders

A
  • schizophrenia
  • schizophreniform disorder
  • brief psychotic disorder
  • delusional disorder
  • schizoaffective disorder
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3
Q

psychosis/psychotic symptoms

A

impaired sense of reality

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4
Q

schizophrenia

A

severe end of schizphrenia spectrum
1. anosognosia
- inability of those with the condition to recognize their own mental confusion
- challenge to assessment and treatment
2. psychosis is highly distressing
- because hallucinations seem real + logical

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5
Q

positive symptoms

A

presence of unusual symptoms (50-70% experience positive symptoms)
- delusions
- hallucinations

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6
Q

hallucination

A

perception of nonexistent or absent stimulus
1. auditory (most common)
2. visual
3. olfactory
4. tactile
5. gustatory

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7
Q

delusion

A

false belief firmly held despite disconfirming evidence or logic

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8
Q

types of delusions

A
  1. persecution
  2. grandeur
  3. reference
  4. control
  5. thought broadcasting
  6. thought withdrawal
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9
Q

delusions of persecution

A
  • others are plotting against them
  • mistreating them
  • trying to kill them
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10
Q

delusions of grandeur

A
  • special powers, talents or abilities
  • is famous, important or powerful
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11
Q

delusions of reference

A
  • center of attention
  • everything that happens revolves around them
  • insignificant remarks, events or objects in environment have personal meaning
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12
Q

delusions of control

A

other people, animals, objects are trying to control them

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13
Q

delusions of thought broadcasting

A

others can hear their thoughts

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14
Q

delusions of thought withdrawal

A

someone or something is removing thoughts from their mind

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15
Q

negative symptoms

A
  • absence of B present in most people (15-25% of individuals display primarily negative symptoms)
  • types
    1. flat affect
    2. asociality
    3. anhedonia
    4. avolition
    5. alogia
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16
Q

negative symptoms: flat effect

A
  • less emotional expressiveness
  • voice intonation, facial expression, gestures
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17
Q

negative symptoms: asociality

A
  • loss of interest in social relationship, few friends
  • poor social skills
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18
Q

negative symptoms: anhedonia

A

inability to experience pleasure

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19
Q

negative symptoms: avolition

A
  • lack of energy or will, profound apathy
  • e.g. lack of attention to personal hygiene
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20
Q

negative symptoms: alogia

A

loss of meaningful speech, poverty of speech (amount, content)

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21
Q

cognitive symptoms

A
  1. disordered think, communication, speech
  2. loose associations
    - series of ideas presented with loosely apparent/unapparent/logical connections
  3. overinclusiveness
    - abnormal categorization
  4. word salad
    - random words/phrases linked together in unintelligible manner
    common symptoms, generally present before psychotic episode
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22
Q

psychomotor abnormalities: catatonia

A

marked disturbance in motor activity, either extreme excitement or immobility

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23
Q

psychomotor abnormalities: withdrawn catatonia

A
  • extremely unresponsive
  • hold rigid pose for hours
  • waxy flexibility
  • another person can move the person’s limbs into strange positions that they can maintain for extended hours
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24
Q

psychomotor abnormalities: excited catatonia

A
  • agitation
  • constant hyperactive motoractivity
  • stereotypies (repeated movements)
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25
Q

DSM5 criteria for schizophrenia

A
  • at least 2 of the following during a 1 month period (>1 must be 1, 2, or 3)
    1. delusions
    2. hallucinations
    3. disorganized speech
    4. grossly disorganized or catatonic B
    5. negative symptoms
  • significant decline in functioning in 1+ major areas (work, interpersonal relations, self-care)
  • continuous signs of the disturbance persist for at least 6 months
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26
Q

lifetime prevalence

A

about 1%

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27
Q

course: premorbid functioning

A
  • prior to major symptom onset
  • usually impaired
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28
Q

course: prodromal phase

A

onset and build up of symptoms

29
Q

course: active phase

A

full blown symptoms

30
Q

course: residual phase

A

symptoms no longer prominent

31
Q

other prevalences of schizophrenia

A
  • 50% comorbid with another disorder (usually SUD, depression or anxiety)
  • high mortality rate (10% by suicide)
  • account for about 30% of stays in psychiatric hospitals
  • cognitive impairment and abolition = make employment difficult
  • can be isolating
32
Q

optimistic course: follow up study results

A

follow-up study
- 5 year: 50% in remission
- 20 year: 63% in remission (never had negative symptoms)

33
Q

optimistic course: positive outcome factors

A
  • female
  • higher education, married, network of support
  • higher premorbid leel of functioning
  • integrated and comprehensive treatment
  • less negative symptoms
34
Q

myth busting

A

“People with schizophrenia are violent”
- majority of individuals are not aggressive (usually reaction, NOT spontaneous or random assault)
- risk of violence mediated by substance abuse comorbidity
- risk similar to patients with SUD without psychosis
- more frequently victimized

35
Q

etiology: biological view

A
  • excessive synaptic pruning
  • genes and endophenotypes
  • neurotransmitter dysregulation
  • structural differences in brain
  • prenatal or birth complications
36
Q

genetic factors

A
  1. family, twin and adoption methods suggest genetic predisposition (interaction of large number of genes)
  2. C4 gene abnormalities
    - excessive pruning leads to symptoms
  3. endophenotypes
    - irregularities in working memory, executive function, sustained attention, verbal memory
37
Q

neurostructures

A
  • enlarged ventricles (loss of brain cells)
  • smaller cortex volume, especially prefrontal cortex
  • may influence cognitive functioning
38
Q

biochemical factors

A
  • dopamine hypothesis
  • use of cocaine, amphetamines, alcohol, cannabis increases risk of developing a psychotic disorder
  • estrogen protective against psychotic symptoms
  • conditions influencing prenatal or postnatal neurodevelopment have been associated with schizophrenia
39
Q

biochemical factors: dopamine hypothesis

A
  1. schizophrenia results from excess dopamine activity in certain areas of the brain
  2. phenothiazines (antipsychotic med) will block receptor sites
  3. L-dopa
    - increase in dopamine levels, can produce schizophrenic-like symptoms
  4. amphetamines
    - produce similar symptoms to paranoia
40
Q

biochemical factors: use of cocaine, amphetamines, alcohol, cannabis

A

cannabis use associated with structural changes in brain similar to those seen in schizophrenia

41
Q

biochemical factors: estrogen protective against psychotic symptoms

A
  • age of onset: 4-6 years earlier in men
  • women more vulnerable to psychosis during lower estrogen phases
  • estrogen impacts dopamine reactivity
42
Q

biochemical factors: conditions influencing prenatal or postnatal neurodevelopment have been associated with schizophrenia

A
  • pregnancy and birth complications
  • prenatal infections
  • head trauma
43
Q

etiology: psychological

A
  • childhood trauma
  • drug abuse
  • unusual thoughts
  • lacking theory of mind
  • early cognitive difficulties
44
Q

cognitive deficits

A
  1. deficits in theory of mind
    - can contribute to communication and interpersonal problems
  2. early cognitive difficulties
    - e.g. developmental
  3. misattributions/negative appraisals may lead to or maintain negative symptoms + delusions
45
Q

etiology: social factors

A
  • bullying
  • exposure to abuse
  • dysfunctional family interactions
  • expressed emotions
46
Q

exposure to abuse

A
  • early adversities, maltreatment, chronic bullying, phyical abuse
  • risk of psychotic symptoms increase when exposed to early stressors
  • GxE (children at risk of psychosis may be more susceptible to early adverse experiences)
47
Q

psychological stress interaction with biological vulnerability

A

increased life stress increases likelihood onset and relapse

48
Q

expressed emotion

A
  • negative communication pattern
  • characterized by criticism among relatives of schizophrenics
  • critical comments, statements of dislike/resentment, emotional overinvestment, overprotectiveness
  • increased EE increases likelihood of relapse
49
Q

etiology: sociocultural

A
  • gender
  • race and ethnicity
  • immigration and migration
  • low SES, poverty, social adversities
  • culture
50
Q

sociocultural factors: gender

A

sex differences

51
Q

sociocultural factors: race and ethnicity

A
  • hispanics and african americans = 2-3x increased rate
  • unclear if clinician bias or actual differences in rates
  • higher expose to stressors
  • possible that previous discriminatory experiences lead to cultural mistrust and a healthy paranoia misinterpreted by clinicians
52
Q

sociocultural factors: immigration and migration

A

increased stressors

53
Q

sociocultural factors: low SES, poverty, social adversities

A
  • more common in low SES
  • sociogenic hypothesis: stressors associated with being in low social class may contribute to dev of schizophrenia
  • social selection hypothesis: people with schizophrenia may drift into low SES living areas (generally more support for this)
54
Q

sociocultural factors: how culture impacts the view of schizophrenia

A
  • culture affects how people view or interpret symptoms
  • differing views on etiology influence receptiveness to treatment approaches
55
Q

recovery model

A
  • focus on illness and deficit has shifted to one of recovery
  • recovery does not require complete remission
  • learn to productively engage in important life roles
56
Q

EBT goal and possible treatments

A

goal: help individuals function in the community
treatments:
1. antipsychotic meds for acute psychotic symptoms
2. psychosocial treatments
3. CBTs
4. social skills training
5. cognitive enhancement therapy
6. family psychoeducational
7. assertive community treatment
8. integrated psychological treatment

57
Q

EBT: holistic approach

A

antipsychotic meds + psychotherapy/psychosocial treatment

58
Q

antipsychotics: neuroleptics

A

goal: reduce intensity of symptoms
1st generation (conventional antipsychotics)
- block dopamine receptors
2nd generation (atypical antipsychotics)
- act on both dopamine and serotonin receptors
- greater therapeutic benefits
- fewer side effects
- lower likelihood of morbidity and mortality

59
Q

side effects of neuroleptics

A
  1. contribute to high nonadherence
  2. excessive sedation
  3. extrapyramidal symptoms (dyskinesia and dystonic reactions)
60
Q

tardive dyskenisia

A

involuntary and rhythmic movements of the tongue

61
Q

CBT

A
  • learn coping skills that allow clinets to manage positive/negative symptoms
  • help increase motivation + engagement in social and vocational activities
  • identification of negative beliefs and cognitive restructuring
  • learn to let go of angry or fearful responses to psychotic symptoms, decatastrophize
62
Q

specific CBTs: Social Cognition and Interaction Training (SCIT)

A
  • learn communication and social skills
  • address negative social cognitions
63
Q

specific CBTs: Integrated Psychological Therapy (IPT)

A
  • remediation of neurocognitive impairments and related social cognitive deficits
  • building social, self-care and vocation skills
64
Q

specific CBTs: Work-focused Cognitive Behavioural Therapy

A
  • increased positive attitudes toward work
  • bolster coping and problem solving skills
  • improving social interaction skills
65
Q

specific CBTs: Social Skills Training

A
  • increase self-care B, meds adherence, conversational skills, job skills
  • learn to break down task to make them less overwhelming
66
Q

specific CBTs: Assertive Community Treatment (ACT)

A
  • goal: help integrate individual into community
  • provided with community services by multidisciplinary team
  • team available 24/7
  • research found ACT helps with stable housing, decrease in homelessness/hospitalizations and reduction of symptoms
67
Q

family psychoeducation

A
  1. educating family members about disorder
  2. advice on monitoring effects of antipsychotic meds
  3. teaching family members to cope with symptoms and its repercussions on family
  4. develop skills in solving problems and managing stress
  5. strengthen communication skills and reduce EE
68
Q

cognitive remediation and enhancement

A
  • improve cognitive deficits
  • e.g. training attention, memory, problem-solving
  • protection against grey matter loss in the brain

Psychopathology PSYC 340 (14 decks)

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