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schizophrenia Flashcards

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1
Q

schizophrenia

A

psychotic disorder characterized by many disturbances in thought, emot, behav

  • disordered thinking, faulty perception and attention
  • flat/inappropriate affect
  • bizarre motor activity

onset: late adolesence or early adulthood
- earlier in men than women

10% suciide, 50% comorbidity

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2
Q

prevalence of schizo

A

worldwide variations

africcan highest auditory hallucinations
asian pops lowest rate
higher psychotic immigrants fro caribbean and bermuda

incidence men > women

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3
Q

mortality and comorbidity

A

20-25yr life expectancy decrease
- assoc w drug use, low family involvement, longer time to initial symptom remission

comorbidity
- 37% subs abuse
- 40% depression
- high anx, esp social anx

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4
Q

course of schizo

A

early treatment is vital to inc success and reduce LT disability

sometimes occurs in childhood

ppl typically have ACUTE EPISODES w intense symptoms
- in b/w episodes: still debilitating, less severe

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5
Q

hospitalization

A

occasional hospitalization, mainly CTO
- inc hospitalization men 20-24, women 40-49

30% of psych hosp patients have schizo

in canada, 20% young men in gen hospitals

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6
Q

remission

A

rates vary w studies

more than 1/3 remission
- assoc w mild initial symptoms
- better premorbid functioning
- early treatment
- shorter duration of untreated psychosis

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7
Q

why is diagnosing schizo unique

A

greater variability of symptoms

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8
Q

positive symptoms

A

TOO much of a behav not present in reg ppl

disorganized speech/thought disorder: difficulty organizing ideas and speaking coherently

loose associations: don’t stick to one topic

derailment

delusions: beliefs contrary to reality
- recepient of bodily sensations or thoughts imposed by external force
- believe others hear thoughts
- thoughts stolen by agency
- more than 1/2 of patients have delusions, also mania and delusions depression

hallucinations: distorted reality
- 74% report auditory i.e. own thoughts by other voice, arguing, comments on behav

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9
Q

negative symptoms

A

absence of behav ppl should have

includes:
- attentional deficits that reduce WM and impact entire life

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10
Q

alogia

A

lack speech, or inc speech w/o meaning

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11
Q

anhedonia

A

lack interest in ppl, sex, activities

acknowledge symptoms

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12
Q

asociality

A

few friends, poor soc skills, little interest in ppl

also reported in childhood

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13
Q

avolition

A

lack energy, cannot keep routine

dec hygiene, etc.

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14
Q

flat affect

A

lack of emotional expressiveness

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15
Q

negative symptoms not from schizo

A

some from alternative factor i.e. antipsychotic meds

flat affect in most schizo patients

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16
Q

catatonic immobility

A

unusual postures maintained over long time
- called waxy flexibility (resistance to moving)
- limbs strange, rigid, move and stay in one spot

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17
Q

inappropriate affect

A

i.e. laugh when someone dies, enraged at simple question

rapid emot shift w/o explanation

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18
Q

other symptoms of schizo

A

similar to mania
- inc in activity, excited, flailing arms

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19
Q

impact of symptoms on life

A

leads to solitude bcs lack social skills

unemployment and homelessness due to avolition and cog impairments

distress from hallucinations and delusions

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20
Q

kraepelin

A

thought 2 types of endogenous pyshcoses
- manic-depressive illness
- dementia-praecox: older term of schizo

believed dementia-praecox from early onset and deterioration of ment functioning

suggested 3 classes of schizo

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21
Q

blueler

Study These Flashcards
A

first to use schizophrenia

22
Q

DSM-IV-TR schizo classes

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A

disorganized/hebephrenic:
- disorganized speech, invent new works
- flat affect, shift emotions
- no goals

catatonic:
- alt b/w catatonic immobility and excitement
- one symptom dominates
- more sudden catatonic onset

paranoid:
- hallucinations and delusions of persecution
- grandiose, jealous
- incorporate unimportant events into delusions
- can be violent, still emotionally respond
- alert and verbal, can be employed

kraepelin’s hebephrenic schizo –> disorganized

23
Q

Delusional disorder

Study These Flashcards
A

Delusions of persecution WITHOUT hallucinations or thought disorder

Not scizo

24
Q

DSM-5 classifications

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A

Got rid of subtypes and refused alternatives
- subtypes not used diagnosticaally, low reliability and vali
- now use dimensional rating of symptoms

25
Genetics and schizo
Negative symptoms have STRONG genetic component Relatives at risk - 90% ppl w schizo don't have parents e it -60-80% don't have siblings w it Identical twins greater than frat, but not 100% - concordance Inc w severity - common environment could be cause...intrauterine likely to have same blood supply Copy number varianrs: ID twins can have diff numbers of genes bcs of mutation Adoption studies: kids hrowimg up away from schizo mother still at inc risk
26
Cross disorder group
Stem from genetic variations and neural complexity - schizo have up to 40 protein altered genes and fewer synapses - schizo - autism - MDD - bipolar - ADHD
27
Dopamine hypothesis
Inc sensitivity dopamine receptors causes schizo - evidence: effective drugs Dec dopamine - give side effects like Parkinsons, which is caused BY dopamine excess
28
amphetamine psychosis
resembles paranoid schizo and can inc schizo symps amphetamines release NE and DOPAMINE, thought to cause symps
29
HVA
dopamine metabolite is NOT excessive in schizo patients proposal: excess/oversensitive dopamine RECEPTORS is factor of schizo
30
brains of schizo patients
enlarged ventricles, struct issues of hippocampus dec vol basal ganglia and limbic system DEC GRAY MATTER in temp/frontal lobe - prefrontal cortex (decisions, speech) has dec gray matter and lower metabolic rates
31
developmental factors
complications during birth for schizo mothers - dec o2 to brain viruses impact fetal development low birthweight and childhood CNS infection
32
sociogenic hypothesis
stressors assoc w low SES environ contribs to schizo - bio factors assoc w low SES i.e. lack nutrition
33
social selection theory
while developing psychosis, ppl w schizo drift into areas of poverty - growing cog issues may impair work
34
schizophregenic mother
early theories: cold and dominant conflict-inducing parent causes schizo
35
EE
expressed emotion high EE: critical, demanding, emotional over-involvement and lack warmth
36
relapse and EE
10% low EE family relapse 58% high EE family relapse cause NEGATIVE SYMPS bcs critical comments dec belief to control symps schizo may be caused by high EE, or cause high EE
37
pre-onset schizo features
boys: disagreeable girls: passive both: lower IQ, poor motor skills, negative affect, withdrawn
38
high risk kids
mother has chronic schizo have attentional dysfunctin, low IQ, poor concentration and verbal activity MRI: dec gray matter (PREDATES onset)
39
schizo therapies
schizo patients lack insight abt condition - likely to deny treatment and drugs - esp paranoid schizo antipsychotic meds control acute symps - also strats for maintaining adherence treat comorbid disorders inc soc skills
40
early schizo treatments
insulin coma therapy: large dose to induce coma, ineffective and bad ECT shock
41
rTMS
repetitive transcranial magnetic stimulative non-invasive, alleviates auditory hallucinations
42
1st gen antipsychotics
30-50% don't respond - can treat NEGATIVE symps, not rlly positive ones side effects: sexual dys, dizzy, blurry eyes extrapyramidial side effects: nerve dysfunction resembling parkinson's half ppl quit after 1 yr
43
extrapyramidial side effects
due to drug action that antagonizes doapmine - dyfunction of nerve tracts from brain to SC - causes shuffle gait, drooling
44
akathesia
disturbing inner restlessness, inc suicide
45
dyskinesia
abnormal motion of vol/invol muscles chewing and other lip, leg, finger mvmnts
46
tardive dyskenisa
mouth muscs involuntary suck, lip smack, chin wag when severe, entire body moves invol 10-20% will dev it - no treatment
47
neuroleptic malignant syndrome
occurs 1% sometimes fatal musc rigidity followed by fever - inc BP, racing hear, coma
48
2nd gen antipsychotics
clozapine: therapeutic gains in MANY ppl who don't respond to trad antipsychotics - greater gains olanzapine and risperidone: fewer motor side effects - risperidone assoc w lower length of 1st hospitalization
49
psych treatment
social skills training: skills, processing, behav in social settings family therapy: to reduce EE - educate bio vulnerability for schizo - teach cog issues and symps - signs of relapse - inc communication and problem solving - w meds, will dec relapse for 1-2yrs CBT: motivation and engage in social activities - address delusions/hallucinations - moderate inc of cog perf assertive community treatment: teams give community services - treat subs abuse - employment help treat issues w attention, memory, social adaptation
50
homeless MI
assoc w male gender, younger age when first homeless - alc use and daily drug use - prolongued homelessness can lead to 2+ disorders schizo want to work - employment can dec MI symptoms shortage of subsidized housing for psych clients
51
MH pros vs general practitioners
MH pros: endorse destigmatizing attitudes gen practitioners: endorse stigma and beliefs of dangers

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