Schizophrenia Flashcards
(13 cards)
What is psychosis and how are symptoms categorised?
Loss of contact with external reality characterised by impaired perceptions and thought processes.
Positive symptoms = hallucinations, delusions, thought disorder, motor disturbances, lack of insight
Negative symptoms = poor eye contact, anhedonia, confusion, emotional flattening, loss of motivation, self-neglect, poverty of speech (alogia)
What are the symptoms of schizophrenia?
2+ of: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour and negative symptoms. At least one of the symptoms must be hallucinations, disorganised speech, delusions.
Clinically significant impairment of functioning
Continuous signs of schizophrenia for 6+ months - may include a gradual deterioration in functioning and must include at least 1 month of psychotic symptoms. Not better accounted for by schizoaffective disorder, substance-induced, autism.
What are the types of psychotic disorders?
Schizotypal PD: odd, eccentric ways of behaving, dressing but have no delusions
Brief Psychotic Disorder: disburbance
What are common features of hallucinations?
Hearing voices inside head, own thoughts are spoken aloud, can be comforting/derogatory/insulting, commands to perform unacceptable behaviours
What are the risk factors for aggression in schizophrenia?
Younger males with history of violence, non-adherence with medication, substance use, impulsivity
What are delusions and the different types?
False beliefs about reality that are firmly held despite what others believe, and the evidence to the contrary.
Paranoid/persecutory
Delusions of reference: event has personal meaning
Somatic delusions: false belief about appearance or functioning of body part
Grandiose delusions: have powers, abilities, influence, achievements or alternative identity (usually in manic episodes of BD1)
Nihilistic delusions: belief that one is dead or parts of body or environment do not exist
Delusions of guilt: personal responsibility for events
Delusions of jealousy: usually about partner infidelity
Erotomanic delusions: belief that romantic feelings for a famous person are reciprocated
Misidentification delusions: identity of someone they know has been stolen
What is thought disorder and what are the positive and negative symptoms?
Disturbances in the flow and form of speech.
Negative symptoms: deficits in thought processes - poverty of speech
Positive symptoms:
- Circumstantiality (indirect, long-winded speaking)
- Tangentiality (irrelevant responses)
- Derailment (comments slipping from one topic to another)
- Echolalia (repeat what others are saying)
- Clang associations (phrases linked through sound)
- Produce false words (neologisms)
What are examples of disorganised behaviour?
Peculiar movements e.g. rigid posture, waxy flexibility, no response to stimuli, agitation, repeating the same movements without a goal, grimacing, echolalia, echopraxia
What is the prevalence of schizophrenia and when does it begin?
1-2%, male to female 3:2
Usually starts in late adolescence and early adulthood during stressful time. There is a gradual deterioration in functioning, then presence of acute symptoms.
Describe the course of schizophrenia.
Many remain chronically unwell with a deteriorating course - 50% are unable to work, duration of untreated psychosis relates to response to treatment
Early recovery phase: rule out medical conditions; symptoms slowly improve, symptoms of depression and social anxiety emerge
Late recovery phase: re-integration into society, find work. 80-90% relapse when antipsychotic medication stops, they use drugs, and have high conflict relationships.
Which factors determine the prognosis of a person diagnosed with schizophrenia?
Good prognosis if they had good premorbid functioning, acute onset of symptoms, onset was later (esp. females), an event led to the psychosis, they do not use substances, no structural brain damage, no family history of schizophrenia.
Poor prognosis if there was a long duration of untreated psychosis, lower SES, migrant, lack social support, prominent negative symptoms (avolition, alogia, affective flattening).
What are the causes of schizophrenia?
Genetic: risk is 46.3% if children have two schizophrenic parents. Identical twins are more likely to develop the disorder than non-identical twins. Children with schizophrenic biological parents but adopted by parents without schizophrenia were more likely to have schizophrenia than children who were genetically dissimilar from their parents.
Biochemical: abnormally large responses to low amphetamine doses + oversensitivity of dopamine receptors -> positive symptoms. Drugs that reduce dopamine activity are effective in treating positive symptoms.
Neuroanatomical: enlarged ventricles (2x normal) - loss of tissue. Loss of GM, WM in PFC linked to negative symptoms. Smaller left hippocampal volume in people with first episode of schizophrenia. Smaller hippocampus overall in people with chronic schizophrenia, have family history. The abnormalities exist before the illness and get worse as it progresses.
Birth trauma, maternal viral infections: nutritional deficiencies and birth complications (caesarean birth) are risk factors, more likely in winter or spring, lower SES
Social: living in urban environment, social exclusion, childhood abuse. Early experiences lead to formation of dysfunctional cognitive style that increases vulnerability to psychosis.
Outline the treatments for schizophrenia.
Medication: 60% of positive symptoms improved but 10-20% of people do not show improvement. 40% relapse. Commonly prescribed antipsychotics but people do not comply due to side effects e.g. weight gain, blood abnormalities, reduced white blood cell count, tremors, shuffling, drooling, grimacing.
Psychological treatments: social skills training, improve medication compliance, manage symptoms, reduce stress. CBT changes the way they appraise their symptoms and challenge their delusional beliefs. Learn to cope with symptoms. CBT reduces relapse, symptoms, hospitalisation rates, improves social integration.
Family Therapy: psychoeducation, realistic goal setting, communication training, problem solving, promote social support for coping with stress. Reduces relapse and improves the experience of caregivers who can identify risks of relapse.
