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Clinical Psychology > W10: Schizophrenia & Psychotic Disorders > Flashcards

W10: Schizophrenia & Psychotic Disorders Flashcards

1
Q

What is psychosis?

A

A ‘break with reality’

It is a symptom, not an illness. Caused by a variety of conditions

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2
Q

What are the five key features of psychosis?

A
  1. Hallucinations
  2. Delusions
  3. Disorganised thinking (speech)
  4. Grossly disorganised or abnormal behaviour (catatonia)
  5. Negative symptoms
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3
Q

What is the most severe of the schizophrenia spectrum and other psychotic disorders listed in the DSM?

A

Schizophrenia

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4
Q

What is typically diagnosed when someone has psychotic symptoms but not severely enough to be included in this part of the DSM?

A

Schizotypal Personality Disorder

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5
Q

What is a positive symptom?

A

Things that are ‘added’ or new things experienced that they didn’t before

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6
Q

What is a negative symptom?

A

Something ‘subtracted’

A loss or absence of normal traits of abilities

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7
Q

What positive symptoms are involved in schizophrenia and psychotic disorders?

A

Hallucinations
Delusions
Bizarre behaviour
Positive formal thought behaviour

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8
Q

What negative symptoms are involved in schizophrenia and psychotic disorders? (5)

A 
Alogia 
Affective flattening 
Avoilation-apathy
Anhedonia-asociality 
Attentional impairment
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9
Q

Alongside positive and negative symptoms, what is the 3rd grouping of symptoms?

A

Disorganisation

chaotic speech, thought and behaviour

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10
Q

What does the DSM say about schizophrenia?

A 
Need to have 2 or more of the following - for most of one month - with at least one being one of the top 3
Delusions 
Halluncinations 
Disorganised speech 
Disorganised or atatonic behaviour 
Negative symptoms

Level of functioning in one or more areas (work, self care) is below the level achieved prior to onset

Persists for at least 6 months (including one month of symptoms that meet the first point)

Schizoaffective disorder and depressive or bipolar disorder have been ruled out (no depressive or manic episodes have occurred)

Not attributable to a substance or another medical condition

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11
Q

What if there is a history of autism or a communication disorder in a schizophrenia diagnosis?

A

Diagnosis should only be made if prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia are present for at least one month

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12
Q

What are delusions?

A

Strange beliefs that are maintained despite evidence to the contrary

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13
Q

Can people with schizophrenia rationalise their delusions?

A

Some people, particularly high functioning people, can rationalise their delusional beliefs

BUT it may be a constant struggle because while they can rationally see that their belief is not supported by evidence, it just doesn’t ‘feel’ right

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14
Q

What are hallucinations?

A

Perception in the absence of sensory stimulation

May be: 
Auditory 
Visual 
Somatic/tactile 
Olfactory

Not just like imagining someones voice - like you are hearing actual voices.

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15
Q

What are the different kinds of disorganization symptoms?

A

Means disturbances in the logical process of thought - apparent in speech and behaviour

Positive thought disorder
Bizzare behaviour

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16
Q

What is positive formal thought disorder?

A 
Derailment 
Tangentiality (go off on tangents)
Incoherence 
Illogicality 
Circumstantiality 
Pressure of speech 
Distractable speech 
Clang associations (grouping words together)
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17
Q

What is bizarre behaviour?

A

Bizarre clothing and appearance
Bizarre social and sexual behaviour
Aggressive and agitated behaviour
Repetitive or stereotyped behaviour

18
Q

What is affective blunting?

A

Unchanged facial expression
Decreased spontaneous movements
Poor eye contact
Lack of vocal inflections

19
Q

What is alogia?

A

Poverty of speech
Blocking
Increased latency of response

20
Q

What is avolition-apathy?

A

Poor grooming and hygiene
Impersistence
Physical anergia

21
Q

What is anhedonia-asociality?

A

Decrease in recreational interests and activities
Decrease in sexual interest
Decreased ability to feel intimacy and closeness
Diminished relationship with friends and peers

22
Q

What factors promote a good prognosis?

A

Late onset

Obvious precipitating factors (identified trigger = management plan)

Good pre-morbid social, sexual and work history

Acute onset

Married (if male)

Mood disorder symptoms

Good support systems

Fewer psychotic episodes

Continued use of medications

23
Q

What factors contribute to a poor prognosis?

A

Young onset

No precipitating factors

Insidious onset

Poor social, sexual and work history

Withdrawn, autistic behaviour

Single, divorced, widowed

Family history of schizophrenia

Poor support systems

Negative symptoms (lead to withdrawal)

Many psychotic episodes

Inconsistent use of medication

24
Q

Explain the bio-psycho-social model of schizophrenia

A

Genetic: family history, inheritance of certain gene variants

Neuro-developmental: prenatal, obstetric complications

Environmental/social: childhood trauma, low SES backgrounds (access to timely interventions), substance use

Psychological: information processing biases, maladaptive self and world schemas (core beliefs)

25
Q

What are some key cognitive processes that are involved in schizophrenia?

A

Distorted information processing: biased reasoning contributing to symptom formation and maintenance

Jumping to conclusions: hasty decision making, drawing inferences based on limited data

Bias against disconfirmatory evidence: difficulty disengaging from initial faulty interpretation

Impaired TOM and monitoring of own and others mental states and behaviours

26
Q

What is the most important part of treatment in psychosis?

A

Medication - pharmacotherapy

27
Q

What are first generation antipsychotics?

A

Oral or depot (none of better efficacy)

80% of people respond to them but there are common significant side effects such as:

  • restlessness/anxiety
  • cramping of face, tongue and neck
  • antipsychotic induced Parkinsonism (rigidity and tremor) although reversible
  • tardive dyskinesia (sometimes irreversible) which is chronic involuntary movements of the tongue, face and neck, extremities or trunk
  • sedation
28
Q

Explain second generation antipsychotics

A

They have different receptor profiles with more specific mechanisms of action (blocks D1 not D2 receptors)

29
Q

What are some second generation antipsychotics?

A

Amisulpride, aripiprazole, clozapine etc

30
Q

What makes second generation antipsychotics better than the first generation antipsychotics

A

There are fewer motor symptoms less Tadive dyskinesia

There is also a positive affect on cognitive symptoms

31
Q

Are there any side-effects to 2nd generation antipsychotics

A

Serious weight gain is a significant side-effects

32
Q

What are third-generation antipsychotics

A

They are a different mechanism of action with a partial agonist against D2 receptors

33
Q

What are the advantages of third-generation antipsychotics

A

Minimal potential weight gain glucose intolerance and anti-cholinergic effect

34
Q

What mild potential do 3rd generation antipsychotics bring?

A

Muscle tension type symptoms and tardive dyskinesia

35
Q

Finding the right medication for a client is…

A

A process of trial and error

36
Q

What can psychological interventions such as therapy provide someone with psychosis or schizophrenia with

A

Coping mechanisms especially those that reduce stress important

Provides a secure base which is important as it becomes a part of the social support network it may help you to catch symptoms earlier to allow intervention

37
Q

What is the goal of using CBT For schizophrenia

A

The goal is to live with it not to eliminate

38
Q

What is the process of CBT for someone with schizophrenia

A

Motivation building

psycho education - learning about your illness and learning about triggers and relapse symptoms

Life skills development such as managing treatment and medications

Exploring evidence against thoughts and hallucination so you can learn to recognise them and filter them out especially command hallucinations

39
Q

How can CBT be used for negative symptoms of schizophrenia

A

Psycho education in normalisation

Re-engaging with meaningful life goals via activity scheduling with pleasure and mastery activities such as goalsetting and graded task assignments in small achievable goals

40
Q

Explain family intervention For people with schizophrenia

A

Works on that idea of a social support network

Include psychoeducation so that everyone is on the same page

Emotional processing of grief loss and anger to normalise it and then reframe it

Communication skills training

To reduce expressed emotion reduce criticism hostility and over involvement or anything that is stopping the person with the condition from self managing

Problem solving skills for problems that are existing or may arise, setting realistic goals, self-care family members and carers who are directly involved in providing care for family members with the condition

Clinical Psychology (15 decks)

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