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PSYC 100 - clinical > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

what is psychosis

A

cluster of disorderds, delusions, hallucinations and/or loss of contact with reality
schizophrenia is a type of psychosis

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2
Q

annual cost of schizophrenia

A

$65 billion anually

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3
Q

historical background of schizophrenia

A

haslam - a form of insanity, pinel working at same time
Kraeplin - dementia praeox (premature loss of mind). focused on onset and outcomes. combined symptoms which had been considered separate - spotte shared similar underlying features
Bleuler - introduced term schizophrenia meaning splitting the mind

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4
Q

facts about schizophrenia

  • course
  • gender
A

generally chronic
16-25 yo onset = young phenomena
moderate-to-severe lifelong impairment
life expectancy is slighty less than average - suicide, poverty, homelessness etc
equal gender distribution but women =better long term prognosis and different onset (men diagnosed earlier and women later)

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5
Q

rule of thirds in schizophrenia

A 
1/3 = psychotic then back to functioning
1/3 = stay psychotic but just about independent
1/3 = downwards spiral
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6
Q

recent findings about schizophrenia

A

not a single disorder
8 genetically based variations
symptoms include clusters linked to different variations

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7
Q

DSM5 schizophrenia

A 
2 or more
-delusions
-hallucinations
-disorganised speech
-disorganised or catatonic behaviour
-negative symptoms (eg flat affect)
impaired functioning
6 months (1 month of active symptoms)
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8
Q

dimensional assessment of schizophrenia

A 
used to have subtypes but elimiated for DSM5
focus on symptom pattern and severity
dimensions
-hallucinations
-delusions
-disorganized speech
-psychomotor behaviour (catatonia)
-negative syptoms
-cognition
-depression
-mania
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9
Q

positive symptoms of schizophrenia

A

active manifestations of abnormal behaviour or distortions of normal behaviour
delusions (90%)
hallucinations

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10
Q

types of delusions

A 
somatic
grandeur
persecution
manifestation
delusion - strong belief that are misinterpreted as reality
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11
Q

what are hallucinations

A

sensory events without environmental input
auditory are the most common (can be any sensory modality)
normal volume, known, external, negative

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12
Q

brain studies of auditory hallucinations

A

broca’s area is active - speech production not wernicke’s (hearing bit)
= its their own inner voice

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13
Q

negative symptoms of schizophrenia

A

absence or insufficiency of normal behaviour
avolition (apathy) - inability to initiate and persist in activities
alogia - a relative absence of speech
anhedonia - inability to experience pleasure or engage in pleasureable activities
flat affect - show little expressed emotion, but may still feel emotion

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14
Q

define associative splitting

A

a separation among basic functions of human personality seen by some as the characteristic feature of schizophrenia
does not mean multiple personalities

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15
Q

capgras and cobards

A

Capgras - friend / family member has been replaced by a double
cobards - person believes they are dead, delusions

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16
Q

disorganised symptoms of schizophrenia

A

severe and excessive disruptions in
speech
affect - inappropriate eg crying at a funeral
behaviour

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17
Q

speech disordered in schiophrenia

A

cognitive slippage - ilogical and incoherent
tangentiality - going off on a tangent
loose associations or derailment

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18
Q

behaviour disordered in schizophrenia

A

disruption in goal directed behaviour
devline in routine daily functioning
catatonia - spectrum from wild agitation, waxy flexibility to complete immobility

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19
Q

can you spot schizophrenia signs in at risk children

A

studied at risk kids eating luncha nd interacting
then followed up 2 years later
those who later went on to develop schizophrenia typically displayed a less poisitve and more negative affect = so emotional affec could be a way to spot schizophrenia potentail in at risk children

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20
Q

how did we use to classify schizophrenia

A

paranoid
disorganized - silly, immature emotionality
catatonic - alternate mobility, excited agitation
dropped for DSM5
but in practice clinics often their own way of categorizing based on symptoms to aid recovery eg positive symptoms = good prognosis, largely negative or disorganised = poor prognosis

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21
Q

problems with diagnosis of schizophrenia

A

heterogeneity of symtoms
-symptoms change as dis develops
-schizophrenics can slip back into reality
treatment response varies
unitary disorder?
is it distinct from normal experince? yes
one of the most studied disorders but still not well understood

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22
Q

delusional disorder

A

delusions without other major schizophrenia symptoms
may show other negative symptoms
types of delusions = erotomanic (soulmate belief), grandiose (JC picked me), jealous (spout is cheating), persecutory (gov is after me), somatic
so a persistent belief that is contrary to reality. delusions are long standing and persisting
rare
late onset
more females than males
do function
aspects of hereditable personality traits

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23
Q

brief psychotic disorder

A

one or more positive symptoms of schizophrenia
usually precipitated by extreme stress or trauma
lasts less than a month

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24
Q

schizotypal personality disorder

A

odd beliefs and behaviour but reality testing generally intact
may reflect a less severe form of schizophrenia

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25
schizophreniform disorder
schizophrenic symtpms for less than 6 months associated with good premorbid functioning 2/3 go on to develop schizophrenia
26
schizoaffective disorder
schizophrenia with mood disorder symptoms during the psychosis so need 2 weeks without mood symptoms major mood episode
27
shared psychotic disorder
a psych disturbance in which inidividuals develop a situation similar to that of a person whom they share a close relationship in DSM5 included under delusional disorder
28
atteniated psychosis syndrome
a diagnosis under study that would be given to a person who is beginning to experience one or more of the symptoms of schizophrenia, such as hallucinations or delusions but is aware these are unusual experiences high risk of developing schizophrenia - may be an prodomal stage
29
early schizophrenia signs
more severe symptoms first occur in late adolescence / early adulthood but may even be signs in early childhood physical abnormalities poor motor coordination mild cognitive and social problems but cannot be sure a child will develop schizophrenia
30
prodomal stage
perios of 1-2 years before serious symptoms of schizophrenia occur but when less severe but unusual behaviours start to appear
31
schizotypal personality disorder
a personality disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with and reduced capacity for close relationships as well as cognitive or perceptual distortions
32
culture and schizophrenia
some argue it isnt real and just a derogatory label for people who behave outside of cultural norms but emotional pain = it is real course and treatment outcomes vary from culture to culture (worse outcomes in Asis) in london blacks = more likley to be detained against their will etc
33
natural course of schizophrenia
premorbid prodromal onset / deterioration chronic / residual
34
genetic influences from family studies
inherit a tendency for schizophrenia - any type not a specific type schizophrenia increases risk in other family members. also more severe = more risk
35
genetic influences from twin studies
risk in MZ twins rhighest | so definitley genes but also big environment
36
genetic influences from adoption studies
risk remain high in adopted children with a biological parent suffereing from schizophrenia but highly supportive / good adoption fmaily = protective
37
summary of genetic research
risk increases as a function of genetic relatedness multiple genes involved one need not show symptoms of schizophrenia to pass on relevant genes schizophrenia has a strong genetic component, but genes alone are not enough paternal age = more cell divisions in sperm
38
Genain quads
4 women, all schizophrenic. same genetics and same dysfunctional family but different onset, symptoms, course and outcomes
39
de novo mutations
gene mutations that occur as a result of a mutation in a germ cell
40
how can identical siblings have different environmens
different prenatal and faimly experiences = unshared environemtns eg diff treatment by fam different nutrients in womb as have to compete for them differeing traumatic birth experiences
41
implicated genes / chromosomes
``` 15 / 23 have been implicated neuroreglin 1 = NMDA, GABA, Ach receptors synaptic plasticity DA metabol G72 - regulates glutamatergic activity mylenation, glial function ```
42
smooth pursuit eye movement
tracking a moving object visually with head kept still | tracking is impaired in persons with schizophrenia including their relatives
43
offspring of twins study
identical twin pairs plus frat twin pairs wanted to determine relative likelihood childs risk data showed you can have genes that predisopose you to schizophrenia, not show dis yourself, but still pass dis onto your children
44
what genetic methods can we use
genetic linkage studies - known genes as marker points endophenotyping - find basic processes that contribute to the behaviours or symptoms of the dis and find the gene / genes that cause these difficulties (eg smooth eye pursuit movements)
45
dopamin hypothesis
overactivity of dopamine DA neurons in the brain causes schizophrenia
46
support for dopamine hypothesis
drugs (eg neuroleptics) that block dopamine receptors reduce positive symptoms, acting on D1 and D2 amphetamines which increase dopamine = create positive symptoms high number of D2 receptors in schizophrenic brains so dopamine agonist = schizophrenic activity up, dopamine antagonist = schizophrenic activity down
47
problems with dopamine hypothesis
dopamine antagonists don't treat negative symptoms new drugs = poor dopamine antagonists but work really well time lapse - immediately in brain but no improvement for 2 weeks parkinsons neuroleptics increase D2 receptors PET scans = inconclusive
48
revised dopamine hypothesis
overactivity of dopamine neruson in the mesolimbic pathway may cause the symtptoms -anitpsychotics which block dopamine receptors lessen positive symptoms but underactivity of dopamine neurons in the mesocortical pathway in the prefrontla cortex may cause negative symtoms -anitpsychotics have little or no effect on the negative symptoms and glutamate hypofunctioning - especially hallucinations
49
structural and funcitonal abnormalities in the brain
enalrged ventricels and reduced tissue volume = there has been atrophy inverse relationshup between ventricle size and response to medication abnormal neural migration (fetus brain) gray metter loss in adolesence hypofrontality - less active frontal lobes (major dopamin pathway)
50
what is the hypofrontality hypothesis
discordant twins = low blood flow only in afected twin cognitive flexibility -schizophrenics cant shift sttention to other criterion -functional imaging = frontal lobe activity lower at rest esp in right hemisphere, does not increase during task -drug treatment increased activation of frontal lobes
51
influenza and schizophrenia
individuals with schizophrenia and exposed to influenze prenatally = more likely to have enlarged ventricles
52
marijuana use and schizophrenia
chronic and early use of marijuana is a potential influence high doses = increased lieklihood of developing schizophrenia but also schizophrenics are more likely ot have a cannabis use disorder but correlations = unclear why and how
53
stress and schizophrenia
may activate underlying vulnerabilty and/or increase risk of relapse large city = increased risk engage in combat in war = display temporary symptoms of schizophrenia high number of stressful events reported in 3 weeks prior to showing disorder shown in many research centres but is retrospective
54
california earthquake study
assessed schizophrenics, bipolar and healthy controls both patient groups = more stress related symtoms than controls schizophrenics = lower leveles of self esteem and more liekly to engage in avoidance coping
55
schizophrenergic mother
obselete and unsupported theory | mum was cold, dominating and rejecting = caused schizophrenia in heroffspring
56
double blind communication
obselet, unsupported theory | practice of transmitting conlicting messages that was thought to cause schizophrenia = again all parents fault ...
57
expressed emotion
hostility, criticism and over-involvement demonstrated by some families towards a fmaily member with a psych dis. can contribute to relapse so high EE = see symptoms as controllable cultural variations = variations in high EE
58
role of pscyh factors in schizophrenia
likely to exert only a minimal effect in producing schizophrenia
59
how did we used to treat schizophrenia
huge insulin doses = to induce comas risk of serious illness and death psychosurgery and ECT (we still use ECT in last ditch cases)
60
antipsychotic (neuropleptic meds)
dopamine atagonists are often the first line of treatment most reduce or elimnate positive symptoms acute and permament extrapyramidal and parkinson's like symptoms are common poor compliance is common atypical (risperdal, olazapine) have better side effect profiles than Thorazine
61
what do we mean by extrapyramidal symptoms
work on neurotransmitter symptoms akinesia - expressionless face, slow motor activity, monotomous speech tardive dyskinesia - involuntary movements of tongue, face, jaw. tends to be from long term high does useage dont tend to be reversible
62
one way tried to get round poor med compliance
inject every few weeks | still would just not rock up for next injection
63
psychosocial approaches for schizophrenia
behavioural (ie toekn economies) on impatient units community care social and living skills behavioural family therapy vocational rehabilitation are usually a necessary part of treatment self-help groups seem to do well (maybe just the kind of people who attend though) ACT - wide ranging multidiscplinary training sadly country differences ie lock up in some cultures
64
prevention of schizophrenia
identify and treat high risk children instability of family rearing environment = can trigger onset so poor parenting = strain on already vulnerability attenuated psychosis syndrome might help

PSYC 100 - clinical (13 decks)

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