Ab Psy Ch. 12 - Schizophrenia Spectrum
attenuated psychosis syndrome
(preschizophrenic) -aware of that these are unusual experiences
What are the distinctions among the positive, negative and disorganized symptoms of schizophrenia?
-Schizophrenia is characterized by a broad spectrum of cognitive and emotional dysfunctions that include delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions. -The symptoms of schizophrenia can be divided into positive, negative, and disorganized. Positive symptoms are active manifestations of abnormal behavior, or an excess or distortion of normal behavior, and include delusions and hallucinations. Negative symptoms involve deficits in normal behavior on such dimensions as affect, speech, and motivation. Disorganized symptoms include rambling speech, erratic behavior, and inappropriate affect.
prevalence and onset of schizophrenia
-affects about 1% of population (1 out of every 100 people) -roughly equal in men and women -occupy half of all beds in mental hospitals -cost: 65 billion annually -up to 18% college students -onset before age 45 and often in late adolescence
schizophrenic timeline
-attenuated psychosis syndrome (prodromal) -brief psychotic disorder (less than a month) -shizophreniform (a few months) -schizophrenia (six months)
atypical antipsychotics
-atypical/second generation antipsychotics (late 1980s): risperdal, zyprexa, seroquel, abilify -why atypical?: greatest effects on serotonin rather than dopamine; consequently, fewer Parkinsonian-like side effects (because you aren't focusing on lowering dopamine)
token economy
-basically social reinforcement
summary of schizophrenia
-biological, psychological, and social factors are involved in schizophrenia: both in the etiology and the potential impact of the disorder on functioning -various degrees of impairment -successful treatment rarely includes complete recovery
delusions in delusional disorder vs. schizophrenia
-delusions less bizarre in Delusion Disorder: imagined events could be happening but aren't and don't have any evidence that would suggest that they might be - being followed; coworkers poisoning you -more bizarre delusions in schizophrenia: imagined events typically are not possible - aliens living inside your brain; thoughts broadcasted -delusional disorder can include one bizarre delusion, but schizophrenia requires more than one bizarre delusion
mood symptoms of schizophrenia spectrum disorders
-depression -manic -possible suicide
psychological and social influences
-diathesis-stress model: predisposition to schizophrenia (through genes); experience of stressful life events; how much and what kinds of stress? -families: parenting style not supported as causal; expressed emotion in families - high level of criticism, hostility, and emotional over involvement by family members; good predictor of relapse for those with chronic schixophrenia
importance of positive vs. negative symptoms of schizophrenia
-difference response to drug treatment: positive respond better to typical antipsychotic drugs than negative symptoms -differences in the course of the two types of symptoms: negative tend to persist even when positive symptoms are in remission
disorganized symptoms of schizophrenia
-disorganized speech: tangentiality, illogical speech -inappropriate affect (along with hebephrenia?) -disorganized behavior: agitation, catatonia
cons of atypical antipsychotics
-don't work for everyone -not without side effects of its own: weight gain, sexual dysfunction, clozapine only (type of drug) - small risk of agranular cytosis (fatal; lowered white blood cell count)
dopamine (DA) hypothesis for schizophrenia
-dopamine system is too active -evidence: drugs that increase DA (agonists) result in schizophrenic like behavior, L-Dopa which is used for Parkinson's disease (side effects of LDopa - confusion, emotional variability, hallucinations, impaired social behavior); drugs that decrease DA (antagonists) reduce schizophrenic like behavior - neuroleptics (antipsychotic drugs) -dopamine hypothesis is overly simplistic: current theories several neurochemical abnormalities (glutamate, NMDA receptors) and activity of DA in different brain regions
pros of atypical antipsychotics
-effective for many not helped by typical antipsychotic meds -reduced risk for tardive dyskinesia -no need for side effect medication (because of less Parkinsonian like side effects/TD) = better cognition -helps with positive and negative symptoms
types of delusions in delusional disorder
-erotomanic: loved by another (higher status) person (ie celebrity) -grandiose: inflated power, knowledge, identity, etc. -jealous: sexual partner is being unfaithful -persecutory: being badly treated in some way -somatic: physical defect or medical condition -mixed; unspecified
types of delusions in schizophrenia
-grandeur -persecution -reference -being controlled
disorganized behavior
-hoarding objects -wild agitation (pacing back and forth) -immobility (catatonia) -speech and inappropriate affect
adoption studies on schizophrenia
-if the biological mother had schizophrenia, child had 5% change of having the disorder (vs. 1% in the general population) -yet, 1.7% of children without schizophrenic parents developed the disorder
alternatives and adjuncts to medication
-less than 30% of patients are taking their medication correctly: impairments related to the disorder; chaotic lifestyles or living situations; poor doctor patient relationships -need for education, behavioral, and psychosocial interventions to manage symptoms and improve lives -family focused interventions: educate family on illness and medication; improve communication among family members - teach families about lower Expressed Emotion (EE)
motivational view of delusion vs. deficit view
-motivational view of delusions would look at these beliefs as attempts to deal with stress and relieve anxiety; preoccupation with the delusion distracts an individual from the upsetting aspects of the world -deficit view of delusion sees the beliefs as resulting from brain dysfunction that creates these disordered cognitions or perceptions
effects on cognitive functioning in schizophrenia spectrum disorders
-new learning -memory -attention -concentration -executive functioning
problems with neuroleptic and first generation antipsychotics
-not very effective for negative symptoms -extrapyramidal symptoms (Parkinsonian-like side effects): this is because in Parkinson's the main drug treatment is increasing dopamine, but for schizophrenia we lower dopamine so, as in Parkinson's they have too little dopamine so these two people with different diseases, but both with lack of dopamine, are showing similar symptoms -tardive dyskinesia (TD): (jerking of face) tongue, lips, face, trunk, extremities (permanent side effect) -often need additional meds to reduce side effects (these often cause cognitive dulling)
history of treatment of schizophrenia
-phenothiazines: first antipsychotics -we've come a long way from blood letting in 1800s -blood letting, purging, exorcism, lobotomy, insulin coma, ECT, first antipsychotics and on
what are the domains of disturbance in schizophrenia spectrum disorders
-positive symptoms (additive symptoms) -negative symptoms (absence of) -cognition -mood symptoms all effect functioning
course of schizophrenia
-premorbid (birth-10 years): mild motor, cognitive and social impairments; social withdrawal -prodromal (10-20 years): unusual psychotic like behaviors; looks like schizotypal -onset/deterioration (20-30 years old): positive, negative, cognitive, and mood symptoms -chronic/residual (age 30 and on): positive, negative and cognitive symptoms case of progression: Frank -prodromal -auditory hallucinations -acute phase
schizoaffective disorder DSM-V
-symptoms of schizophrenia + additional experiences of a major mood episode (depressive or manic) -delusions or hallucinations must also occur outside the mood disturbance (because you can have delusions during a manic episode of bipolar) -prognosis is similar for people with schizophrenia: not likely to get better on their own; need for continued treatment
neuroleptic treatment for schizophrenia: 1950s to present
-typical/conventional/first generation antipsychotics (1950s-60s): effective in reducing some patient's symptoms (in particular the positive symptoms)
How is schizophrenia defined, and what symptoms are included in its diagnosis?
Schizophrenia is a complex syndrome that has been recognized for many years. Perhaps the earliest and best description of this disorder was published in 1809 by John Haslam in his book "Observations on Madness and Melancholy." A number of historic figures during the 19th and early 20th century contributed to the evolving definitions and possible causes of this spectrum of disorders.
schizotypal personality disorder
a cluster A (odd or eccentric) 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 and eccentricities of behavior
alogia
a deficiency in the amount or content of speech, a disturbance often seen in people with schizophrenia -poverty of speech
catatonia
a disorder of movement involving immobility or excited agitation -considered disorganized behavior symptom of schizophrenia
catatonic immobility
a disturbance of motor behavior in which the person remains motionless, sometimes in an awkward position, for extended periods of time -the person may strike a pose and stand there for hours
negative symptoms
a less outgoing symptom, such as flat affect or poverty of speech, displayed by some people with schizophrenia -negative symptoms describe behavioral deficits or absence of normal behavior or feelings -affective blunting/flattening (blunted intensity of emotional affect; no show of emotion, monotone) -alogia (poverty of speech) -social withdrawal -avolition (decrease in motivation; inability to intiate and persist in activities) -anhedonia (inability to feel pleasure or interest); this is different from amenorrhea which is the cessation of a period in which is seen in other disorders
positive symptoms
a more overt symptom, such as a delusion or hallucination, and disorganized thought displayed by some people with schizophrenia -additive symptoms -disorganized speech and behavior -inappropriate emotions -presence of excessive or distorted forms of thinking and behavior -50-80% of those with schizophrenia experience persistent hallucinations, delusions, or both
delusional disorder
a psychotic disorder featuring a persistent belief contrary to reality (delusion) but no other symptoms of schizophrenia -schizophrenia criteria of two or more delusions, hallucinations, disorganized symptoms are NOT MET
schizophreniform disorder
a psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months -associated with relatively good functioning; most patients resume normal lives
shared psychotic disorder (folie a deux)
a psychotic disturbance in which individuals develop a delusion similar to that of a person with whom they share a close relationship
brief psychotic disorder
a psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than one month; often occurs in reaction to a stressor -associated with relatively good functioning; most patients resume normal lives (schizophrenic symptoms less than a month; whereas schizophreniform a couple months)
delusion
a psychotic symptom involving disorder of thought content and presence of strong beliefs that are misrepresentations of reality; belif that is contrary to evidence -a positive symptom
hallucination
a psychotic symptom of perceptual disturbance in which something is seen, heard, or otherwise sensed although it is not actually present -a positive symptom -sensory events without input from the environment
associative splitting
a separation among basic functions of human personality (cognition, emotion, and perception) seen by some as the defining characteristic of schizophrenia
psychotic behavior
a severe psychological disorder category characterized by hallucinations and loss of contact with reality
disorganized speech
a style of talking often seen in people with schizophrenia, involving incoherence and a lack of typical logic patterns -tangentiality: jumping from topic to topic -illogical speech: if someone speaks in rhyme without any real meaning
smooth pursuit eye movement
ability to follow moving targets visually -deficits in this skill can be caused by a single gene whose location is known -this problem is associated with schizophrenia and, thus, may serve as a genetic marker for this disorder -also known as eye tracking
schizophrenogenic mother
according to an obsolete, unsupported theory, a cold, dominating, and rejecting parent who was thought to cause schizophrenia in her offspring
double bind communication
according to an obsolete, unsupported theory, the practice of transmitting conflicting messages that was thought to cause schizophrenia -ex: a mother responds coolly to her child's embrace but says, "don't you love me anymore?" when the child withdraws - producing guilt in parents who are persuaded that their early mistakes caused devastating consequences
flat affect
an apparently emotionless demeanor (including toneless speech and vacant gaze) when a reaction would be expected
inappropriate affect
an emotional display that is improper for the situation -laughing or crying at inappropriate times
anhedonia
an inability to experience pleasure, associated with some mood and schizophrenic disorders
avolition
an inability to initiate or persist in important activities; also know as apathy (lack of interest, enthusiasm, concern) -decrease in motivation
Cameron has started to hear voices, which is very disturbing to him. He told his parents and recognizes that he needs to see a mental health professional for help. What disorder may he have?
attenuated psychosis syndrome
Alice usually holds an unusual posture and is sometimes seen grimacing. What type of symptom may this be?
catatonic
Greg's cognitive skills and affect are relatively intact. However, he often has delusions and hallucinations that convince him enemies are out to persecute him. What disorder may he have?
delusional disorder
Lately Dom has become more isolated because he believes his coworkers are conspiring to get him fired. He becomes agitated whenever he sees a group of employees talking and laughing, because he believes that they are plotting against him. What type of psychotic disorder is this?
delusional disorder
grandeur delusions
great power, knowledge, or talent, or that one is a famous and powerful person ("I am Jesus")
Most people with schizophrenia:
have multiple episodes, with different degrees of impairment between episodes
expressed emotion (EE)
hostility, criticism, and over involvement demonstrated by some families toward a family member with a psychological disorder -this can often contribute to the schizophrenic person's relapse
Research on cultural factors and schizophrenia suggests that African Americans:
may have higher rates than other ethnic groups because of misdiagnosis
Which sibling of an individual with schizophrenia is most likely to develop schizophrenia?
monozygotic twin raised in the same home
Emotional and social withdrawal, apathy, and poverty of speech and thought are examples of what type of symptoms in schizophrenia?
negative
Difficult cases of schizophrenia seem to improve with a serotonin and dopamine antagonist called:
olanzapine
delusion of being controlled
one's thoughts, feelings, or behaviors are being imposed or controlled by an external force
Rhonda fears that her employer is trying to poison her with gas emitted from the overhead lights in her office. Given what you know about Rhonda's thoughts, what symptom of schizophrenia is she likely to have?
paranoia
delusion of reference
random events are directed at oneself (if the news caster on the TV is talking to you, about you, or giving you instructions)
Natalie reveals to her therapist that she hears numerous voices talking to her and giving her orders. Her doctor has just sent her to this therapist for what he believes to be a major depressive episode. She has begun to sleep all the time and contemplates suicide often. What type of psychotic disorder is this?
schizoaffective disorder
Drew has experienced hallucinations and bizarre delusions for the past four months. What disorder may Drew have?
schizophreniform disorder
If Shawn's schizophrenic symptoms disappeared after about 4 months and he returned to his normal life, what diagnosis might he have received?
schizophreniform disorder
Which disorder is characterized by symptoms similar to those seen in schizophrenia but of shorter duration, often with successful remission of symptoms?
schizophreniform disorder
persecution delusion
self or loved ones are being persecuted, watched, or conspired against by others (FBI is following you)
hebephrenia
silly and immature emotionality
Jane has spent the past half hour staring in the mirror. As you approach her, she turns away and giggles. When you ask what she's laughing at, she answers but you're having difficulty understanding what she says. What kind of schizophrenic symptom is this?
disorganized symptom
brocas area active during auditory hallucinations (speech production not language comprehension) - hearing inside their head, not hearing an external thing
this supports the idea that people are not hearing the voices of others but are listening to their own thoughts and cannot recognize the difference between their thoughts and what they perceive to be voices in their head
Which type of psychosocial treatment has been most effective for treatment the behavioral problems seen in schizophrenia?
token economies
Aside from social skills training, two psychosocial treatments for schizophrenia, behavioral family intervention (teaching family members to be supportive) and vocational rehabilitation (teaching meaningful jobs), may be helpful.
true
Because antipsychotic medications may cause serious side effects, some patients stop taking them. One serious side effect is called extrapyramidal symptoms, which may include parkinsonian symptoms.
true
In social skills training, clinicians attempt to reteach such behaviors as basic conversation, assertiveness, and relationship building to people with schizophrenia.
true
Raised in a home other than that of their biological parents, adopted children of parents with schizophrenia have a higher chance of having the disorder themselves. Children of people with schizophrenia adopted into families without schizophrenia have a higher than average chance of having schizophrenia.
true
Recent studies sometimes indicate that the relationship of the neurotransmitters dopamine and serotonin may explain some positive symptoms of schizophrenia.
true
Setting up an elaborate token economy in which patients are fined for disruptive or inappropriate behavior and rewarded for appropriate behavior is beneficial for hospitals.
true
The likelihood of a child's having schizophrenia is influenced by the severity of the parent's disorder. One may inherit a predisposition for general schizophrenia that is the same or different from that of the parent.
true
auditory hallucination most common type of hallucination
true
The greatest risk of having schizophrenia is in those who have an identical twin or fraternal twin with schizophrenia. Any relative with schizophrenia will make your chances of developing the disorder higher than those of the general population.
true -especially high in MZ twin 46-48% and offspring of two parents with schizophrenia 46% -DZ 17%
schizophrenia DSM-V
two or more of the following (including at least one of the delusions, hallucinations, or disorganized speech) for at least one month -delusions -hallucinations -disorganized speech (poverty, tangentiality, illogicality, perseveration, thought blocking) -negative symptoms (diminished motivation or emotional expression) functioning of self care has declined since onset signs of disorder for at least 6 months (if less then schizophreniform) other disorders ruled out
What are the potential genetic, neurobiological, developmental, and psychosocial risk factors for schizophrenia?
A number of causitive factors have been implicated for schizophrenia, including genetic influences, neurotransmitter imbalances, structural damage to the brain caused by a prenatal viral infection or birth injury, and psychological stressors. Relapse appears to be triggered by hostile and critical family environments characterized by high expressed emotion. -brain structure: enlarged ventricles (bc brain matter is atrophied and ventricles filling in space) -brain function: abnormalities in activity in a number of brain regions -prenatal viral exposure: influenza (caused enlarged ventricles) -intrauterine environment: birth complication (hypoxia during labor); twins "compete" for nutrients
What are the clinical characteristics of schizophrenia and other psychotic disorders?
Psychotic behaviors, such as hallucinations and delusions, characterize several other disorders; these include schizophreniform disorder (which includes people who experience the symptoms of schizophrenia for less than 6 months); schizoaffective disorder (which includes people who have symptoms of schizophrenia and who exhibit the characteristics of mood disorders, such as depression and bipolar affective disorder); delusional disorder (which includes people with a persistent belief that is contrary to reality, in the absence of the other characteristics of schizophrenia); and brief psychotic disorder (which includes people with one or more positive symptoms, such as delusions, hallucinations, or disorganized speech or behavior over the course of less than a month). A proposed new disorder - attenuated psychosis syndrome - includes one or more of the symptoms of schizophrenia such as hallucinations or delusions, but the individual is aware that these are unusual experiences and are not typical for a healthy person. This is included in the Appendix of DSM-V as a disorder in need of further study.
What are the goals of therapy for schizophrenia? What biological and psychosocial treatments for schizophrenia are available?
Successful treatment for people with schizophrenia rarely includes complete recovery. The quality of life for these individuals can be meaningfully affected, however, by combining antipsychotic medications with psychosocial approaches, employment support, and community based and family interventions. Treatment typically involves antipsychotic drugs that are usually administered with a variety of psychosocial treatments, with the goal of reducing relapse and improving skills in deficits and compliance in taking the medications. The effectiveness of treatment is limited, because schizophrenia is typically a chronic disorder.
Which statement is true about antipsychotic medications and the treatment of schizophrenia?
different medications are effective with different people and to a different degree
Which two psychosocial interventions appear to be most helpful for people with schizophrenia?
family education and vocational rehabilitation
studies of offspring of twin parents
people can be a "carrier," but not develop schizophrenia
paranoia
people's irrational beliefs that they are especially important (delusions of grandeur) or that other people are seeking to do them harm -or persecutory delusion
prodromal stage
period of one to two years before serious symptoms of schizophrenia occur but when less severe yet unusual behaviors start to appear -unusual psychotic like behaviors -looks like schizotypal
One distinction used to characterize symptoms of schizophrenia divides them into what two broad categories?
positive and negative
dementia praecox
the Latin term meaning premature loss of mind; an early label for what is now called schizophrenia, emphasizing the disorder's frequent appearance during adolescence
psychotic disorder associated with another medical condition
the presence of hallucinations and/or delusions resulting from a medical condition other than schizophrenia
substance induced psychotic disorder
the presence of hallucinations and/or delusions resulting from the ingesting or withdrawal from psychoactive substances or medications
