Task 8 Flashcards
(39 cards)
DSM-5 refers to schizophrenia spectrum to refer to the five domains of symptoms that define psychotic disorders
Five domains – Four types of positive symptoms (delusions, hallucinations, disorganized thought/speech, disorganized or abnormal motor behavior) & negative symptoms (restricted emotional expression/affect).
Also, schizophrenia shows cognitive deficits that were showed to be linked to declines in functioning, but these are not part of diagnostic criteria
DELUSIONS
Ideas that individual believes are true but are unlikely & often impossible. Different from self-deception in that:
1. Self-deceptions are possible, whereas delusions often are not.
2. People with self-deceptions think about beliefs occasionally, people with delusions are preoccupied with them.
3. People with self-deceptions acknowledge that their beliefs may be wrong, people with delusions often are highly resistant to arguments or compelling facts that contradict delusions.
There are several types of delusions, the most common are persecutory delusions. See last page of summary for list.
Odd or impossible beliefs that are part of culture’s shared belief system cannot be considered delusions.
HALLUCINATIONS
Unreal perceptual experiences that are frequent, persistent, complex and sometimes bizarre. It can involve any sense:
Auditory hallucinations – Most common. Involve hearing voices, music & other sounds. These could be about commands & instructions or talking about individual on 3rd person. They often have negative quality, criticizing or threatening individuals, telling them to hurt themselves or others.
Visual hallucinations – Often accompany auditory ones. This could be for example, seeing a figure while hearing satanic words. One’s hallucinations may be consistent with one’s delusions.
Tactile hallucinations – Perception that something is happening outside person’s body (bugs crawling up one’s back).
Somatic hallucinations – Perception that something is happening inside person’s body (worms eating intestines).
Hallucinations also occur in people diagnosed with depression (25%) & bipolar disorder (15%).
DISORGANIZED THOUGHT/SPEECH
Disorganized thinking in schizophrenia is referred to as ‘formal thought disorder’.
Derailment – Tendency to slip from a topic to an unrelated topic, with little coherent transition. Most common form of disorganization.
Word salad – Form of speech that is disorganized and sounds incoherent to listener.
Neologisms – Made-up words that mean something only to the individual with schizophrenia.
Clangs – Made-up associations between words based on sounds of words, rather than on content.
Since women can use both sides of brain to compensate for deficits, their language & thought is not as much affected as in men
DISORGANIZED or CATATONIC BEHAVIOR
People with schizophrenia may display unpredictable and untriggered agitation, such as suddenly shouting, swearing or pacing rapidly.
They often have trouble organizing daily routines (bathing, dressing properly, eating regularly).
Due to memory impairments, it takes great deal of concentration to accomplish simple tasks (brushing teeth).
Schizophrenic people may engage in socially unacceptable behaviors, such as public masturbation.
Catatonia – Disorganized behavior that reflects unresponsiveness to environment. It ranges from negativism (lack of response to instructions), to showing rigid/inappropriate/bizarre posture, to mutism (lack of verbal or motor responses).
Catatonic excitement – Purposeless and excessive motor activity for no apparent reason.
positive symptons
delusions
hallucinations
disorganized Thougt/ Speech
disorganized or catatonic behaviour
Negative symptons
restricted affect
avolition/ Asociality
RESTRICTED
AFFECT
Refers to severe reduction in or absence of emotional expression in people with schizophrenia.
Fewer facial expressions of emotion, may avoid eye contact and are less likely to use gestures to communicate emotional information.
Tone of voice may sound flat, little change in emphasis, intonation, rhythm, tempo or loudness to indicate emotion/social engagement.
People with schizophrenia who show no emotion may be experiencing intense emotion they cannot express.
They have trouble predicting future emotional experience, which can lead to problems in motivation and decision-making.
Do people with schizophrenia really experience less affect than those without disorder?
o People with schizophrenia report significant anhedonia (= loss of ability to experience pleasure), but laboratory studies have found that when faced with positive stimuli, they report as much positive affect as those without disorder.
AVOLITION/
ASOCIALITY
Avolition is an inability to initiate or persist at common, goal-directed activities, including those at work, school and home.
Person is physically slowed down and seems unmotivated; Personal hygiene and grooming are lacking.
Asociality is a lack of desire to interact with other people.
They are often withdrawn and socially isolated, in part due to stigma of schizophrenia (family and friends reject them).
Asociality is only diagnosed when person has access to welcoming family and friends but shows no interest in that.
COGNITIVE DEFICITS
People with schizophrenia show deficits in basic cognitive processes, including attention, memory and processing speed. These deficits together contribute to hallucinations, delusions, disorganized thought & behavior, and avolition of people.
They have difficulty focusing and maintaining their attention at will & show deficits in WM (= ability to hold information in memory and manipulate it).
This makes it difficult for them to pay attention to relevant information and to suppress unwanted/irrelevant information.
They are unable to filter out what is irrelevant or to determine source of information.
Immediate relatives of people with schizophrenia also show these deficits to a less severe degree, even if no symptoms are shown.
CRITERIA A
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2 or 3: (1) Delusions; (2) Hallucinations; (3) Disorganized speech; (4) Grossly disorganized or catatonic behavior; (5) Negative symptoms.
CRITERIA B
For significant amount of time, since onset of disturbance, level of functioning in one or more major areas (work, interpersonal relations, self-care) is belo Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2 or 3: (1) Delusions; (2) Hallucinations; (3) Disorganized speech; (4) Grossly disorganized or catatonic behavior; (5) Negative symptoms.
CRITERIA C
Continuous signs of disturbance persist for at least 6 months. This period must include at least 1 month of symptoms that meet criterion A and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, signs of disturbance may be manifested by only negative symptoms or by two or more symptoms listed in criterion A present in attenuated form (odd beliefs, unusual perceptual experiences).
• Prodromal symptoms – Negative symptoms, with milder forms of positive symptoms BEFORE ACUTE PHASE.
• Residual symptoms – Negative symptoms, with milder forms of positive symptoms AFTER ACUTE PHASE.
CRITERIA D
Schizoaffective disorder & depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with active-phase symptoms or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the active and residual periods of illness.
CRITERIA E
Disturbance is not attributable to physiological effects of substance or another medical condition.
CRITERIA F
If there is history of autism spectrum disorder or communication disorder of childhood onset, additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations in addition to other required symptoms of schizophrenia are also present for at least 1 month (or less if successfully treated
Schizoaffective disorder
Mix of schizophrenia and mood disorder. People simultaneously experience psychotic symptoms and prominent mood symptoms, meeting criteria for major depressive or manic episode. It also requires at least 2 weeks of hallucinations/delusions without mood symptoms.
Schizophreniform disorder
Diagnosed when symptoms of schizophrenia are present for at least a month, but signs of disturbance are not present for the full six months required for the diagnosis.
Brief psychotic disorder
Core feature is sudden onset of at least one of main psychotic symptoms. This change from non-psychotic state to appearance of symptoms occurs within 2 weeks and is associated with emotional turmoil.
Delusional disorder
They experience one of more delusions lasting at least 1 month. Psychological functioning in these individuals seems quite normal. But depending on type of delusional beliefs, this may often give rise to social, marital or work problems.
GENETIC
FACTORS
Psychotic symptoms appear to run in families, suggesting there may be some form of inherited predisposition.
Concordance studies – Estimate probability with which a close family member will also develop disorder. This is dependent on how closely related the two family members or relatives are.
Twin studies – Heritability estimate of around 80% which makes schizophrenia one of the most heritable psychiatric disorders.
Adoption studies – Adopted children who developed psychotic symptoms were significantly more likely to have biological relative with diagnosis of schizophrenia.
MOLECULAR GENETICS
Much effort has been directed at attempting to identify specific genes through which risk may be transmitted.
Linkage analyses – Compare inheritance characteristics for which gene location is well known, with inheritance of psychotic symptoms. For example, if inheritance of eye color follows same pattern in family as psychotic symptoms, then maybe the gene controlling psychotic symptoms is found on same chromosome as gene controlling eye color.
Genome-Wide Association Studies – Allow researchers to identify rare mutations in genes that might give rise to psychotic symptoms. Mutations resulting in DNA deletion, as well as those causing DNA duplications, have been found to be associated with schizophrenia. But different diagnosed people may not have same underlying genetic factors & genes may influence different aspects of functioning.
BRAIN NEURO-TRANSMITTER
Cognition & behavior are very dependent on efficient working of brain NTs & symptoms may be caused by malfunctions in these.
Dopamine hypothesis – Symptoms of schizophrenia are related to excess activity in neurotransmitter dopamine.
Drugs like Phenothiazines block dopamine receptor sites and are found to reduce dopamine activity, therefore alleviating psychotic symptoms. Excess of dopamine receptors seems related to positive symptoms.
Excess of dopamine seems localized in mesolimbic pathway, while mesocortical pathway (projects from PFC) may be characterized by underactive dopamine system.
Dopamine may account for both positive and negative symptoms, but since antipsychotic drugs block dopamine receptors only in mesolimbic pathway, drugs only affect positive symptoms.
Brain
Brain of people with schizophrenia shows number of structural differences to those of non-sufferers.
They tend to be smaller & the ventricles are enlarged, which is associated with overall reduction in cortical grey matter.
Grey matter reduction is also found in PFC which plays role in a number of cognitive processes like executive functions.
People with negative symptoms show lower PFC metabolic rates and have reduced prefrontal blood flow when undertaking decision-making tasks such as Wisconsin Card Sort Test.
Other studies suggest that deficits in FC are not due to reduction in neurons, but to disrupted synaptic connection.
Brain imaging studies also show abnormalities in temporal cortex (including limbic system) and abnormalities in activity in temporal lobe-limbic system are more associated with positive symptoms.
Impaired hippocampal function can underlie range of symptoms, since it has role in memory for events and facts.
ABNORMALITIES IN DIFFERENT AREAS OF BRAIN MAY BE ASSOCIATED WITH DIFFERENT SYMPTOMS OF PSYCHOSIS
