Flashcards in Schizophrenia (Exam 3) Deck (126):
What is schizophrenia called?
severe mental illness (SMI)
What does the "schiz" mean?
split: between thoughts and reality
How long do the problems have to be present for the diagnostic criteria for schizophrenia?
How long does the active period with psychotic episode have to last for the diagnostic criteria of schizophrenia?
Does the course include a prodromal stage for the diagnostic criteria of schizophrenia?
course may or may not include a prodromal stage
Can it be due to a substance for the diagnostic criteria of schizophrenia?
What is the course of schizophrenia?
not every patient diagnosed with schizophrenia manifests symptoms for life (but will always carry diagnosis)
What is the one-third rule?
-1/3 deteriorate for life
-1/3 have chronic episodes of schizophrenia
-1/3 show substantial improvement
How many people only have ONE EPISODE and no impairment in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?
22% one episode - no impairment and improved functioning
How many people are likely to have LASTING impairment
in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?
78% several episodes and varying degrees of lasting impairment
How many people are likely to have MINIMAL impairment in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?
35% minimal impairment
How common is it that a person would have ONE PSYCHOTIC EPISODE and never return to normal functioning in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?
8% no return after first episode
How common is it that a person would have SEVERAL EPISODES and never return to normal functioning in the research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989?
35% no return after several episodes
What are the prevalence rates in the US for schizophrenia?
What are the SES backgrounds for prevalence rates of schizophrenia?
all different SES backgrounds
Do you have to look at cultural sensitivity issues for prevalence rates of schizophrenia?
may need to look at cultural sensitivity issues
What are the prevalence rates of schizophrenia for elderly?
difficult issues with this population
What is the age of onset for schizophrenia?
late adolescence to early adulthood
What are the age ranges for schizophrenia?
Is schizophrenia shown earlier in men?
Do we see schizophrenia in middle age?
What happens if we see schizophrenia past middle age (45)?
possibly indicative of organic damage (dementia or stroke)
What are the gender differences in prevalence for men and women for schizophrenia?
roughly similar prevalence rates
Are males diagnosed earlier or later in life with schizophrenia?
Does age of onset have potential prognostic value?
Are there pathognomonic signs for the symptoms of schizophrenia?
What are the symptoms of schizophrenia during a 1-month period?
-grossly disorganized or catatonic behavior
What are positive symptoms?
-behavior being produced
-better response to medications (less permanent disability)
What are examples of positive symptoms?
-formal thought disorder
What are negative symptoms?
-not editing behaviors we expect to see
-correlated with more problems (higher rates of permanent disability)
What are examples of negative symptoms?
What are thought disorders?
-"hallmark" of schizophrenia
How do thought disorders manifest?
manifest in content and form
How do thought disorders manifest in content?
what the thought is about
How do thought disorders manifest in form?
how the production of thought appears
What is affective flattening? (negative symptom)
What is alogia? (negative symptom)
What is avolition? (negative symptom)
no bold directed behavior
What is apathy? (negative symptom)
What is anhedonia? (negative symptom)
loss of pleasure in doing things
What is asociality? (negative symptom)
What is the major content for thought disorders?
What is the major form for thought disorders?
-formal thought disorders
What is delusion persecution?
belief that agency, group, or individual is out to get person (most common)
What is delusion grandiosity?
person is extremely special, capable of special feats (ex: god, not based on reality)
What is delusion reference?
events, objects, or people given unusual significance (ex: nurse may be Angel of Death)
What are formal thought disorders for thought disorder forms?
how the thought is expressed
What are loose associations for thought disorders of form?
person jumps from one topic to topic with no awareness that the topics are not related
What are the problems with perception for schizophrenia?
disturbances of perception (positive symptom)
What are the most common disturbances of perception for schizophrenia?
What are hallucinations?
perception of a stimulus where one does not exist
How long do disturbances of perception last for schizophrenia?
may be ongoing throughout problem and into remission
What are the key differentials for disturbances of perception for schizophrenia?
different types indicate different problems (psychological, substance induced, neurological)
What are the most common types of hallucinations for schizophrenia?
What are auditory hallucinations?
-hear sounds someone sitting next to person cannot hear because there is no sound
-may be sounds or voices
What are command hallucinations?
can dictate what a person should do
What are tactile hallucinations?
feeling something that is not present (ex: tingling, burning)
How are tactile hallucinations induced?
ex: meth, crack cocaine
What are visual hallucinations?
seeing what it isn't there
How are visual hallucinations induced?
substance induced psychosis
What can visual hallucinations be a sign of?
organic (neurological) mental disorder
What are olfactory hallucinations?
perception of odors which are not present
How can olfactory hallucinations be induced?
-preictal phase of seizure
What is the most uncommon type of hallucination?
What is disturbance of affect?
-disturbance in emotional experience or expression
What are the different types of disturbance of affect?
-restriction of affect
-blunting of affect
What is restriction of affect?
reductio in range of emotions
What is flattened affect?
complete absence of affective expression in the face or voice
What is blunting of affect?
reduction in intensity of affective expression
What is inappropriate affect?
responsiveness is inappropriate to the subject being discussed
What are disturbances of psychomotor behavior?
What are catatonic features?
problems with movement
What is catatonic stupor?
no movement, non-respondent
What is catatonic excitement?
agitated, intense, or exaggerated movements
What are disturbances in volition?
-marked cessation of goal directed behavior
accompanied by apathy and a loss of a sense of meaning
-gross impairment of work and other role-functioning
What are impairment in relationships for schizophrenia?
-tendency to withdraw from other people
What is the premorbid stage?
time prior to psychotic episode
What is the prodromal stage?
clear pattern of deterioration in premorbid level of functioning prior to psychotic episode
What is the poor prognosis of the prodromal stage?
-long, insidious downhill course
-over many years
-no clear precipitating stress
-no real time for premorbid adjustment
What is the better prognosis of the prodromal stage?
-if sudden onset of active psychotic episode
-may be clear precipitating stress
-longer period for good level of premorbid functioning
What is the active stage?
-active psychotic episode
-presence of psychotic behaviors/symptoms
What is the residual stage?
-gradual improvement in functioning (some impairment will follow)
-level of functioning expected for return is similar to prodromal stage
-features of the active stage will persist (not as strong)
-problems with social withdrawals remains
-compliance with and continued response to meds will predict how long this phase lasts
What is prognosis based on?
What are some complications associated with schizophrenia?
-shorter life expectancy
-increased suicide rate
-general decrease in self-care/hygiene
-delusions can be self-threatening (command hallucinations)
-deprived economic circumstances
-victims of violent crime
Are patients diagnosed with schizophrenia dangerous?
-tend to be less violent than general population
-patients diagnosed who are paranoid can be dangerous
What are the schizophrenia spectrum disorders?
-brief psychotic disorder
What is schizophreniform disorder?
psychotic symptoms lasting between 1-6 months (longer than 6 months = schizophrenia)
What is brief psychotic disorder?
psychotic symptoms lasting <1 month
What is schizoaffective disorder?
symptoms of schizophrenia + additional experience of a major mood episode (depressive, manic)
What are some predisposing factors for schizophrenia?
-lower socioeconomic status levels (SES) associated with increased prevalence rates
-downward drift hypothesis
What is the downward drift hypothesis?
person with SMI will drift down to lower SES levels with progression of disorder regardless of which SES level you begin with
What are the concordance rate for monozygotic twins?
What does psychotic spectrum disorders include?
other disorders such as BD and MDD
Are concordance rates impacted by definition of schizophrenia?
yes (psychotic spectrum disorders)
What are the etiological theories of schizophrenia?
-Dopamine (DA) Hypothesis
What is the most popular etiological theory of schizophrenia?
Dopamine (DA) Hypothesis
What does the Dopamine (DA) hypothesis state?
schizophrenia caused by excessive amounts of dopamine
What are the challenges to the DA hypothesis?
-can have psychotic symptoms in Parkinson's disease
-some patients will not respond to any antipsychotic drugs
-newer antipsychotics drugs address many more neurotransmitters than DA
What are the family based theories of schizophrenia?
-Expressed Emotion (EE)
What is the theory of a Schizophrenogenic Mother?
-mothering type (ex: overly protective of child)
Is there research data that supports the Schizophrenogenic Mother theory?
There are NO research data supporting that mothers cause schizophrenia
What is expressed emotion?
refers to the type of communication patterns between family members
Does data support that high EE causes first episode of schizophrenia?
Data does NOT support that high EE causes first episode of schizophrenia
What does the data support for high EE families?
higher relapse rates when patients released from hospital into high EE families
What are the different types of EE?
Should you look at high and low EE families?
What are the earlier treatments for schizophrenia?
-insulin shock coma
-psychosurgery -> lobotomies (1930s-1950s)
Were the earlier treatments for schizophrenia effective?
What are the drug treatments for schizophrenia?
thorazine discovered as antipsychotic medication
How do thorazine and antipsychotic medications work?
-major tranquilizing properties
-DA receptor blocker
How do the dopamine antagonists work?
block post-synaptic receptors
What are the potent side effects of these drugs?
Parkinsonian symptoms (tardive dyskensia, TD)
What is tarive dyskensia (TD)?
-irreversible damage to nervous system
-involuntary facial movement, grimacing, tongue protrusion
-very distracting and distressing to patient
What are the efficacy of these drugs?
-noticeable decrease in positive symptoms
-more able to engage in social activity
What are the atypical antipsychotics?
-tend to act on 5-HT and DA
-some have specific bindings on DA receptors
Are these drugs actually "atypical"?
MOST are not "atypical" many are traditional in new brand
What is the efficacy of atypical antipsychotics?
NOT more effective than first generation meds
What are the side effects of atypical antipsychotics?
still have the same side effects as original antipsychotic
What is Family Therapy for the psychological approaches of schizophrenia?
focus on interaction of family members with patient (teach more effective family interactions)
Is Family Therapy effective at preventing relapse?
What is the cognitive behavioral approaches for the psychological approaches of schizophrenia?
-daily living skills
-avoiding substance use
Are the cognitive behavioral approaches effective for preventing relapse?
What is compliance therapy for the psychological approaches of schizophrenia?
aimed at understanding schizophrenia and medication compliance
Is compliance therapy helpful?
some indication this is helpful
What is milieu therapy for the psychological approaches of schizophrenia?
put person in healing therapeutic environment