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Psyc337 - Psychopathology > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

What is a characterizing symptom of all psychotic disorders

A

A profound disconnect with reality

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2
Q

How was schizophrenia first conceptualized by Emil Kraepelin

A

Named Dementia Praecox
A disorder with progressive deterioration; unlike other dementias, begins at an early age
Bipolar and schizophrenia as distinct disorders
Evidence for common genes and continuum of dysfunction

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3
Q

Emile Kraepelin was the first to propose groupings of _______ instead of groupings of ______

A

Psychotic syndromes; symptoms

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4
Q

While Kraepelin suggested a progressive deterioration in dementia praecox, what did Eugen Bleuler suggest in this regard

A

People did not always deteriorate, symptoms plateau and it could emerge at a later age

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5
Q

Starting in 1911, Eugen Bleuler used the term schizophrenia which referred to a split mind. What else can we say about the emergence of this term

A

Disorder characterized primarily by disorganization of thought process
A split from reality
There is a distinction between multiple personality disorder/dissociative identity disorder
Schizophrenia considered as a group of disorders, not a single disease state
Led to very broad definition, more subjective

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6
Q

True or false: schizophrenia is among the most devastating forms of psychopathology, with a chronic course that usually beings in adolescence and people used to be institutionalized

A

True

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7
Q

What are the six major signs/symptoms of schizophrenia

A

Perceptions
Content of thought
Form of thought
Affect
Psychomotor
Disorder of relating

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8
Q

How would we characterize positive from negative hallucinations

A

Positive hallucinations: there is no stimulus but there is a perception
Negative hallucinations: there is a stimulus but there is no perception

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9
Q

How can hallucinations present themselves and what are the most common

A

Visual, olfactory, tactile, somatic, gustatory
Audible thoughts - echoing of your own thoughts but not coming from you
Voices conversing about patient
Voices commenting on your behaviour
Somatic passivity experiences

Most common: voices

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10
Q

The perceptual sign/symptom of schizophrenia occurs on a continuum from _____ to ______

A

Illusions; hallucinations

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11
Q

What was found in the study by Johns & McGuire looking at the % of misattributed words in hallucinators, non-hallucinators and controls

A

The hallucinators were much more likely to misattribute the derogatory words; they were more likely to say that those words came from someone else

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12
Q

What is the most common perceptual sign/symptom of schizophrenia

A

Hallucinations

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13
Q

What is the most common content of thought sign/symptom in schizophrenia and define it

A

Delusions: false belief based on an incorrect inference which is fairly believed despite contradictory evidence

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14
Q

How can the mild end of the delusions continuum be characterized

A

Over-valued idea
- a false belief but willing to entertain the idea that it’s false
- common in schizotypal PD and in prodromal schizophrenia

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15
Q

What are the delusions that someone with schizophrenia may experience

A

Controlled by outside forces
Grandiose delusions
Delusions of jealousy
Nihilistic delusions
Persecutory delusions (broad persecution)
Delusions of reference
Somatic delusions (ex: you think your hand is someone else’s hand)
Thought withdrawal, insertion and diffusion/broadcasting
Made impulses and feelings (an external force is playing a role)

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16
Q

How can we characterize the form of thought sign/symptom of schizophrenia

A

Formal thought disorder/speech disorder
Derailment - flight of ideas like mania but is not pressured, similar to loose associations
Word salad
Alogia - poverty of speech or poverty of content of speech
Neologisms
Blocking - abrupt stop in speech; illusion of thought withdrawal
Illogical thinking

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17
Q

How would the affect sign/symptom of schizophrenia be categorized

A

Blunted and flat affect
- anhedonia is pervasive and we’re not sure if it’s actually reflective of their internal state
Inappropriate affect
- not in line with the social situation; can be chilling
Problems perceiving others’ emotions

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18
Q

What would we expect to see in the psychomotor sign/symptom of schizophrenia

A

Catatonia - much rarer now
Catalepsy/waxy flexibility: people are immobile but can be “molded” into different positions
Stupor: awake but immobile
Posturing
Mutism
Catatonic excitement: looks like psychomotor agitation but is purposeless; looks like the movement are happening to the person
Catatonic negativism: resisting being moved; not aware of this
Echolalia: verbal repetition
Echopraxia

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19
Q

Characterize the disorder of relating in schizophrenia

A

Very withdrawn
Preoccupied with a fantasy world
Disordered volition: little motivation to do anything and feel like they have very little will
Anhedonia

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20
Q

What is being described: the presence of symptoms that should not be there

A

Positive symptoms

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21
Q

What are examples of positive symptoms

A

Hallucinations, delusions, inappropriate affect

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22
Q

What is being described: the absence of something that should be there

A

Negative symptoms

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23
Q

What are some examples of negative symptoms

A

Blunted affect, alogia, avolition

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24
Q

True or false: positive and negative symptoms of schizophrenia are equally easy to treat

A

False: positive symptoms respond better to medication but negative symptoms are often very hard to treat

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25
True or false: the positive/negative distinction used to be used to classify but very few people only have the negative symptoms
True
26
To qualify for a DSM diagnosis of schizophrenia, people must exhibit two symptoms that are listed in the DSM, 1 out of those 2 symptoms needs to be either….
A first rank symptom - delusions, hallucinations, disorganized speech and behaviour
27
Besides the first rank symptoms, what are other symptoms that someone with schizophrenia exhibit
Glossy disorganized or catatonic behaviour Negative symptoms Level of functioning markedly lower that prior onset Symptoms present for six months and include at least one month of active symptoms Unipolar, bipolar and schizoaffective are ruled out Not attributable to a substance
28
How can we characterize schizoaffective disorder
People present with schizophrenic features and severe mood disorder The mood disorder can be unipolar or bipolar but must currently meet criteria for depressed mood Delusions or hallucinations for 2+ weeks in the absence of a mood episode during lifetime duration of illness Not attributable to the effects of a substance
29
True or false: schizoaffective disorder has poor reliability, it has been controversial since its introduction in 1933 and there it is not clearly a distinct diagnosis
True
30
It is not clear if schizoaffective disorder is an atypical form of ___________
Mood disorder/schizophrenia
31
True or false: the prognosis for schizoaffective is somewhere between schizophrenia and mood disorders
True
32
Is long-term prognosis better for schizoaffective disorder or schizophrenia
Schizoaffective
33
Onset of schizophrenia is _____
Gradual
34
True or false: overall schizophrenia is a rare disorder but is more common among females
False: it is rare but more common among males
35
How might women with schizophrenia present and what is a consequence of this
Present with more depressive symptoms Consequence: can be written off as a mood disorder instead of schizophrenia
36
Late-onset schizophrenia is more common in women, why might this be the case
Female sex hormones (estrogen) may be protective and when it drops post menopausal we see an increase in schizophrenia in women
37
When does schizophrenia onset tend to peak for males
Initial peak: 15-19 years old until 24 years old and then goes down
38
When does prevalence of schizophrenia peak in females
Initial peak between 20-29 years old, decreases and then peaks again at 45-49 years old
39
True or false: childhood schizophrenia is common
False; it is rare
40
What are some signs/symptoms that we might see in children under 13 that go on to develop schizophrenia
Early speech and language problems Delayed motor development and poor coordination
41
What has been seen during a long-term follow up of children with schizophrenia
Continue to show symptoms and signs of A small % remit and some remain continuously psychotic
42
What disorders are common to see in the relatives of children who develop schizophrenia
Schizotypal PD and Schizophrenia
43
True or false: the large majority of individuals with schizophrenia experience severe impairments for the rest of there lives while only a small number of individuals are able to live independently and maintain a job
True
44
What did researchers find in a 15-year study looking at the course of schizophrenia
Only about 40% had one or more period of recovery People with schizophrenia have poorer clinical and functional prognoses that those with other psychotic and non psychotic mental disorder
45
What is the general pattern of life expectancy for individuals with schizophrenia
A shorter life expectancy by about 20 years
46
What are good prognostic indicators for schizophrenia
Good premorbid adjustment Acute onset Manic and depressive symptoms Confusion or disorientation during psychosis Family history of mood disorders
47
What are bad prognostic indicators of schizophrenia
Poor premorbid adjustment Insidious and gradual onset Negative symptoms - especially blunted affect Family history of schizophrenia In some studies, a lower IQ
48
What are 2 comorbidities that are extremely common in schizophrenia
Substance abuse and suicide
49
What are the most commonly used substances by people with schizophrenia and why
Alcohol and nicotine especially Maybe for self-medication May improve cognitive functions of those with schizophrenia
50
True or false: substances may play a role in triggering schizophrenia
True
51
Who would be most at risk of suicide in the context of schizophrenia
Young men Those with the best premorbid functioning prior to the onset because the shift from baseline is dramatic and abrupt
52
True or false: despite the perception that schizophrenics are extremely violent and aggressive, we only see a very slight increase in the the risk of violence population wide
True
53
Why is agression most common in younger male patients with a history of violence
They have a tendency to stop taking their meds, act impulsively and abuse substances - drug use and abuse alone increases the risk more which could be the cause for violence and not the schizophrenia itself
54
True or false: the majority of people with schizophrenia are more likely to be the victims of violence than the perpetrators. Explain why
True Because of the environments perception that there people are violent, others retaliate with subsequent violence
55
What is the greatest causal/risk factor for being diagnosed with schizophrenia and considering this who would be at highest risk
The closer you are genetically to the proband with schizophrenia, the more likely you are to develop schizophrenia which suggests and additive genetic component Monozygotic twins would be at the highest risk
56
True or false: twin studies have shown that the concordance for Mz twins is higher than Dz twins for schizophrenia showing that there is a heritability component
True
57
What did Fisher’s study reveal looking at the rate of schizophrenia in the offspring of Mz twins with and without schizophrenia
Because Mz twins have identical genes, the children of the twin without schizophrenia has an elevated risk of developing schizophrenia even if their parent did not suffer from the condition
58
What are dichorionic twins?
They have separate placentas and fetal circulation and can be either dizygotic or monozygotic
59
What are monochorionic twins
They have a single placenta and shared circulation and are always monozygotic
60
True or false: schizophrenia heritability is stronger among monochorionic twins?
True
61
A study was done looking at normal and abnormal eye tracking of the sinusoidal wave by Gillian O’Driscoll. What were the results of the study and what does this tell us about the endophenotype of schizophrenia?
The average person can track the wave properly with little deformations. Someone with schizophrenia will follow the general pattern but the wave will be very deformed suggesting an eye tracking dysfunction in schizophrenia Endophenotype explanation: we see this abnormal eye tracking pattern in the unaffected first degree relatives of people with schizophrenia
62
What are the risk factors of schizophrenia
SES and social status Advanced paternal age Birth complications Prenatal exposure Season of birth Malnutrition in pregnancy
63
What can we say about social selection as a risk factor for schizophrenia
We are looking for SES background and find that the family of the affected person does not have a low SES but the affected person does
64
Immigrants to the UK and the Netherlands from the Caribbean and Africa tend to report higher levels of schizophrenia even though the prevalence in their countries of origin is low. What risk factor of schizophrenia can explain this and what is a potential contributing mechanism?
Social causation risk factor; stress as a mechanism
65
Why is advanced paternal age at conception a potential risk factor for schizophrenia
The exact cause is unknown Two hypotheses: - 1. Mutations: Sperm cells develop spontaneous maturations with age - 2. Personality: Men with schizotypal PD / prodromal schizophrenia are more likely to have kids later in life
66
How can birth complications lead to an increased risk for schizophrenia
Breech delivery, prolonged labour, umbilical cord around the neck can all result in hypoxia and anoxia Anoxia may lead to dopamine supersensitivity
67
What are the prenatal exposure conditions that would make someone more at risk for developing schizophrenia
Viral infections - influenza during the 2nd trimester Ecologically fallacy - not a direct exposure Antibodies during pregnancy providing direct evidence - Herpes Simplex II, rubella, influenza
68
How is the season of birth a risk factor for developing schizophrenia
More rates of schizophrenia in those born late winter and early spring in the north and south hemispheres further away from the equator - more viruses circulating at this time
69
The Dutch Hunger Winter and the famine in China from 1959-1961 provided evidence for malnutrition in pregnancy as a risk factor for schizophrenia. What are some possible explanations as to why malnutrition is a risk factor?
Hypotheses: - general lack of nutrition - specific lack of folate or iron - extreme stress of living through a famine
70
Why is neurodevelopment in the 2nd trimester of pregnancy crucial predicting schizophrenia onset
Neural migration is important at this stage to form the lamination of the cortex Disruptions can affect neural connectivity - particularly cortical connectivity (synapses) Could result in decreased gray matter Could result in cell death
71
True or false: there is evidence pointing to decreased whole brain volume in schizophrenia even in recent-onset suggesting that it is not a result of treatment.
True
72
How would the whole brain volume in schizophrenic patients relate to Kraepelin’s idea of dementia praecox
There is a progressive loss of gray matter over time and progressive deterioration also continues for many years into the illness
73
MRI scans that have been repeated over 5 years show a progressive gray matter loss in schizophrenia. What brain areas have been shown to be affected
It starts in the parietal cortex, spreads to the temporal and frontal cortex
74
True or false: gray matter deficits have been evident in discordant Mz twins of schizophrenics
True
75
Gray matter deficits in schizophrenia cannot be explained by …
Antipsychotic medications or other treatments Damage from the illness itself (adapted lifestyle due to the illness)
76
What has been posited as the best evidence for the dopamine hypothesis
There is excess dopamine transmission in the striatum, and reduced dopamine transmission in the frontal lobes which leads to increased sensory signalling and the inability to down regulate signals
77
What have CSF studies found looking at the dopamine hypothesis
They have not found increased dopamine metabolites in the CSF of people with schizophrenia
78
Antipsychotic drugs work on which dopamine receptors
D2 receptors
79
In line with the dopamine hypothesis of schizophrenia, increased dopamine may cause patients to attend more to irrelevant stimuli and struggle to make sense of everyday experiences. What is this referred to as
Aberrant salience
80
True or false: in lab tasks, schizophrenics have been shown to fail to respond to meaningful reward cues, demonstrating anhedonia and negative symptoms
True
81
What are some abnormal movements that we may see in schizophrenics in line with the dopamine hypothesis
Oral-facial movements Upper limb dyskinesias - hyperkinetic movements
82
Which brain area’s activity is heavily regulated by dopamine
DLPFC
83
True or false: working memory may have nothing do to with schizophrenia
False, WM may be involved in schizophrenia cognitive deficits are consistent
84
A study by Park & Holzman looked at the dopamine hypothesis by testing working memory deficits in schizophrenics, healthy controls and bipolars. What did they find
The working memory deficits were unique to the schizophrenics
85
Follow up studies were done in relation to the Park & Holzman study looking at working memory and the dopamine hypothesis. What did those studies find?
The working memory deficits were evident: -when the person was ill and healthy -in college students with schizotypal symptoms -in 1st degree relatives
86
People with schizophrenia are 2x more likely to smoke weed. What can this tell us about the disorder more broadly
It may predict the onset of schizophrenia even when controlling for childhood symptoms of psychosis THC increases dopamine synthesis Cannabis use exacerbates symptoms in people with schizophrenia
87
What can we say about the brain volume of schizophrenics using cannabis compared to schizophrenics not using cannabis and healthy controls
Showed more gray matter loss over the course of 5 years
88
During the deinstitutionalization of schizophrenic patients, some went on to live with their families and others lived alone. Which group did better and why?
Those who lived alone did better because the families of those with schizophrenia were often high on expressed emotion
89
What are the three main traits of EE
Criticism, hostility, emotional overinvolvement
90
True or false: expressed emotion has repeatedly been shown to predict relapse rates, regardless of the patient’s characteristics and when EE is lowered, relapse rates decrease showing that EE may be playing a causal role
True
91
A study by Rosenfard et al., 1995 looked at how patients with schizophrenia expressed themselves and how their environment reacted to these claims. What did they find?
The high EE increased the number of odd/disruptive behaviours, not the negative mood
92
What is the cycle that happens with patients go back into a family that is high in EE
1. The patient says something strange 2. Family member criticizes 3. Increases the probability of another strange remark Increases the probability of more criticism
93
What are some exceptions to EE
It is non-specific - predicts worse outcomes in depression and bipolar Seems to be protective in BPD
94
What model would help to explain the onset of schizophrenia and how does it differ from the traditional diathesis-stress model
Multiple hit model Difference: diathesis-stress is 1 diathesis and 1 stressor, this is multiple diatheses and multiple stressors

Psyc337 - Psychopathology (18 decks)

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