Schizophrenia Flashcards
(23 cards)
Schizophrenia Characteristics
● Serious and pervasive disturbances in thought, emotion, and behavior.
● Disordered thinking
● Perceptual changes (e.x., hallucinations)
● Motor activity differences
● Flat emotional affect
● Withdrawal from relationships
Schizophrenia Phases
● Prodromal phase
○ Onest of issues that include difficulty with focusing, lack of motivation, and isolation from others
● Active phase
○ One or more psychotic symptoms emerge
■ Hallucinations or delusions
● Residual phase
○ After psychotic episode, someone continues to be withdrawn and may have some milder symptoms from the active phase
○ Can continue with cycle, and go back into active phase
○ No “cure,” but people can have relief from symptoms with right treatment
Impact- Schizophrenia
● Relational impact
○ Decreased social skills and awareness
● Vocational Impact
○ High rate of unemployment & homelessness
● High suicide risk (especially wtih substance
use)
Demographics- Schizophrenia
● Affects men slightly more often than women
○ Men have more severe symptoms and worse prognosis
● Onset is often late adolescence or early
adulthood
Bleuler’s Perspective
● Eugene Bleuler first termed “schizophrenia”
● Argued that this condition can happen at any time of life
● Believed some people can get better over time, and remission can occur
Classification of Symptoms- Schizophrenia
● Bleuler described two different classes of symptoms:
● Primary: Manifestation of the underlying biological problem.
● Secondary: Symptoms that are a reaction to the primary symptoms, such as social withdrawal.
Kurt Schneider
● Categorized first-rank, core (Schneiderian) symptoms of schizophrenia
○ Delusions, hallucinations, and other aspects of thought disorder that are easily observable
DSM Classification
● Symptoms of schizophrenia include (2 or more for at least a month):
○ Delusions
○ Hallucinations
○ Disordered speech
○ Disorders of behavior
○ Negative Symptoms
Negative vs. Positive Symptoms
● Negative symptoms= the absence of a character trait
○ Ex., Flat affect, absence of normative emotional expression, anhedonia, avolition
● Positive symptoms= the presence characteristics that are abnormal
○ The presence characteristics that are abnormal
○ Ex., Hallucinations, delusions, thought disorder
Positive Symptoms
● Delusions
○ Beliefs not grounded in reality
○ Persecutory delusions are common
● Hallucinations
○ Sensory experiences in the absence of sensory input
○ Types of hallucinations
■ Audible thoughts
■ Voices
● Increased levels of activity in Broca’s area during hallucinations
Negative Symptoms
● Avolition
○ Lack of interest
○ Apathy
● Alogia
○ Reduction in speech
● Anhedonia
○ Loss of pleasure
● Flat affect
○ Little to no facial expression or voice changes
● Asociality
○ Decreased social interest and interactions
Disorganized Symptoms
● Disorganized speech (Formal thought disorder)
○ Incoherence
○ Loose associations (derailment)
● Disorganized behavior
○ Odd or peculiar behavior
Other Symptoms
● Catatonia
○ Motor abnormalities
● Catatonic immobility
○ Maintain unusual posture for long periods of time
● Waxy flexibility
○ Limbs can be manipulated and posed by another person
Schizophrenia Subtypes
● Paranoid Subtype
○ Delusions or hallucinations, usually involving themes of persecution.
● Disorganized Subtypes
○ Grossly inappropriate speech, inappropriate affect, disorganized behavior, hallucinations and delusions that lack themes.
● Catatonic Subtype
○ Typically associated with catatonia but can also be associated with periods of aimless hyperactivity and other movement disorders.
● Undifferentiated Type
○ Fits most patients. Those who do not meet criteria for any of the above.
● Residual Type
○ Individuals with at least one prior episode who are not currently displaying serious manifestations of positive symptoms
Social Risks
● People who have experienced trauma, dysfunctional family patterns, and abuse are more at-risk
Social Drift Theory
● People with schizophrenia are rejected,
often seen as crazy, unstable, out of mind
● Individual is avoided, and this can
create social isolation with schizophrenia
● Illness “drifts” them from society,
further exacerbating symptoms
Season-of Birth Effect
● Correlation studies find that most people with schizophrenia are born in winter and early spring months
○ Maternal response to infections
could impact fetus development
Dopamine Hypothesis
● Increase in dopamine in the brain, producing psychosis
● Support for position:
○ Drugs that increase activity of the dopamine system can induce similar symptoms to schizophrenia
○ Drugs that decrease the functioning of the Dopamine system decrease the symptoms of schizophrenia
Brain Structural Differences
● Enlargement of the lateral ventricles
● Structural abnormalities
○ Decreased gray matter in medial temporal, superior temporal, and prefrontal areas
● Diminished blood flow, decreased metabolism, and decreased mass
The Side Effects of Neuroleptics
● Dizziness, muscle stiffness, blurred vision, restlessness, and confusion.
● Extra-pyramidal side effects
○ Serious movement disorders, grimaces, ticks, muscle rigidity, drooling, trembling fingers and hands.
● Neuroleptic use can lead to Tardive Dyskinesia
○ A movement disorder similar to Parkinson’s Disease
Medication in the
Treatment of Schizophrenia
● First generation antipsychotic medications
(Neuroleptics; 1950s)
○ Neuroleptics are major tranquilizers and can affect dramatic reductions in positive symptoms of schizophrenia
○ Targets treatment for positive symptoms of schizophrenia
■ Some positive symptoms tend to persist.
■ Does not target negative symptoms
Atypical Antipsychotics
● Second generation antipsychotics:
○ Clozapine (Clozaril)
○ Olanzapine (Zyprexa)
○ Risperidone (Risperdal)
○ Effective against both the positive and negative symptoms of schizophrenia.
● Newer medications may improve cognitive function:
○ Effective against both the positive and negative symptoms of schizophrenia.
● Block dopamine and at times serotonin receptors
Therapeutic Support
● Various therapies can be beneficial for the treatment of schizophrenia
○ Psychotherapy to manage symptoms
○ Cognitive Behavioral Therapy (CBT) to understand what are true voices/thoughts compared to inaccurate or harmful thoughts
○ Social skills training to help manage symptoms in social contexts and how to have healthy relationships despite symptoms
