Ch 12: Schizophrenia Spectrum Disorders
schizophrenia occurs in what percentage of the general population?
.3-.7%
What percentage of individuals diagnosed with schizophrenia report complete recovery of symptoms
20%
If one identical twin develops schizophrenia, there is a _____ chance that the other will as well within their lifetime. What about for fraternal twins?
48%; 17%
What is the psychological intervention used to treat schizophrenia spectrum disorders?
CBT
What have neuroimaging studies found in individuals with schizophrenia compared to healthy controls?
a significant reduction in overall and specific brain region volumes
early onset of schizophrenia is generally predictive of what?
a worse overall prognosis
what 2 factors are believed to be the key to the onset of psychosis in prodromal patients?
abnormal brain structures and persistently increased levels of glucocorticoids in brain structures
reduction in emotional expression
affective flattening
6 main types of negative symptoms
affective flattening, alogia, anhedonia, apathy, asociality, avolition
poverty of speech or speech content
alogia
what part of the brain is involved in emotion regulation?
amygdala
what three structures of the brain are found in the medial temporal lobe?
amygdala, hippocampus, and the neocortical surface of the temporal lobes
inability to experience pleasure
anhedonia
there is increase in what kind of disorders among individuals with schizophrenia than compared to the general public? what two specific disorders in particular?
anxiety-related disorders; OCD and panic disorder
general lack of interest
apathy
lack of interest in social relationships
asociality
how long does at least one delusion have to last for in order for a diagnosis of delusional disorder?
at least one month
lack of motivation for goal-directed behavior
avolition
3 psychomotor symptoms
awkward movements, ritualistic/repetitive behavior, and they are often unpredictable and overwhelming, severely impacting their ability to perform daily activities
When is the onset of schizophrenia? how is it different for males?
between late teens and mid-30s; the onset is slightly earlier for males
What is the main similarities between those with schizophrenia and their relatives?
brain abnormalities
the decreased or complete lack of reactivity to the environment
cataonic behavior
what is the most commonly seen disorganized motor behavior in schizophrenia?
catatonic behavior
the individual experiences hyperactivity of motor behavior, in a seemingly excited or delirious way
catatonic excitement
thoughts and speech patterns may appear to be _____ or ______
circumstantial, tangential
What 3 atypical antipsychotic drugs appear to be more effective in managing both positive and negative symptoms than first-generation drugs?
clozpine (Clozaril), risperidone (Risperdal), and aripiprazole (Abilify)
the three chemical messengers involved with the HPA axis that respond to stressful situations
corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and glucocorticoids
what are glucocorticoids more commonly referred to?
cortisol
fixed beliefs that are not amenable to change in light of conflicting evidence, meaning they are unable to distinguish their thoughts from reality
delusions
the neurotransmitter that is released last in the HPA axis and is responsible for the physiological change that accompanies stress to prepare the body to "fight" or "flight"
glucocorticoids
the conviction of having great talent or insight. They may also take on religious affiliation, as people believe they are prophets or even God
grandiose delusion
for a diagnosis of schizophrenia, the individual must present at least two of the following four symptoms for at least one month
hallucinations, disorganized speech, disorganized/abnormal behavior, negative symptoms
which part of the brain is involved in memory?
hippocampus
What is the prevalence rate for schizoaffective disorder, schizophreniform disorder, and delusional disorder?
less than .3%
which 2 structures of the brain have been shown to be smaller in those with schizophrenia?
medial temporal lobe; orbitofrontal regions of the brain
What type of symptoms are common among individuals with schizophrenia?
mood disorder symptoms
what schizophrenia symptoms do women present with more often?
mood-related symptoms
complete lack of verbal and motor responses
mutism or stupor
How many patients stop taking antipsychotic drugs to the harsh side effects?
nearly 1/2-3/4
What symptom is indicative of a poor prognosis and the worse the symptom, the worse the prognosis?
negative symptoms
What symptom is often present before positive symptoms and remain once positive symptoms remit?
negative symptoms
the inability or decreased ability to initiate actions, speech, express emotion, or feel pleasure
negative symptoms
the inability or decreased ability to initiate actions, speech, expressed emotion, or to feel pleasure
negative symptoms
what schizophrenia symptoms do men present with more often?
negative symptoms
what type of symptoms appear to be more predictive of a prognosis of schizophrenia than other symptoms?
negative symptoms
resistance to instruction
negativism
What are the 6 steps that Beck proposed in the diathesis-stress model that explains the development of schizophrenia?
neurocognitive impairment, aversive life events, dysfunctional attitudes, cognitive distortions, hyperactivation of HPA, schizophrenia
What is the goal of CBT when treating schizophrenia spectrum disorders?
not to reduce symptoms but to improve the interactions and understandings of these symptoms (and experiences) which will reduce associated distress
a part of the frontal lobe that is responsible for response inhibition
orbitofrontal regions of the brain
2 types of "subthreshold" forms of psychotic symptoms that do not cause significant impairment in functioning
prodromal and residual symptoms
What type of prodromal often precedes the active phase of schizophrenia and residual symptoms that follow it
prodromal symptoms
What are two common features of CBT for schizophrenia patients?
psychoeducation and challenging and replacing the negative thoughts/behaviors with their coping strategies to deal with their unpleasant symptoms
What is the most effective treatments for schizophrenic spectrum disorders but rarely do they restore a patient to premorbid levels of functioning?
psychopharmacological, psychological, and family interventions
a loss of contact with reality that makes it difficult for individuals to perceive and respond to environmental stimuli, causing a significant disturbance in everyday functioning
psychosis
one symptom of schizophrenia that must be present
psychosis
What are conventional antipsychotics like Thorazine and Chlorpromazine effective in managing?
psychotic symptoms
what is the overall goal of family interventions when treating schizophrenia?
reduce the stress on the individual that is likely to elicit the onset of symptoms
maintaining a rigid or upright posture while resisting efforts to be moved
rigidity
disorder characterized by the psychotic symptoms included in schizophrenia A of schizophrenia and a concurrent uninterrupted period of a major mood episode, either a depressive or manic episode
schizoaffective disorder
What is the distinguishing feature between schizoaffective disorder and MDD with psychotic features?
schizoaffective disorder includes psychotic symptoms that continues for at least two weeks in the absence of a major mood disorder
symptoms of this disorder create significant impairment in an individual's ability to engage in normal functioning such as work, school, relationships with others, or self-care and symptoms must persist for a minimum of 6 months
schizophrenia
a disorder that is considered an "intermediate" disorder as the symptoms are present for at least one month but not longer than six months
schizophreniform disorder
what type of drugs were developed due to the harsh side effects of conventional antipsychotic drugs that appear to act on both dopamine and serotonin receptors, as opposed to only dopamine receptors in the conventional antipsychotics
second-generation or atypical antipsychotic drugs
What is the most common cognitive impairment displayed in patients with schizophrenia?
disorganized thought, communication, and speech
What four factors affect the presentation of delusions?
social, emotional, educational, and cultural background
involves delusions regarding bodily functions or sensations
somatic delusions
What is another common cognitive symptom in those with schizophrenia?
speech retardation
the model that suggests that individuals have a genetic or biological predisposition to develop the disorder and symptoms will not present unless there is a stressful precipitating factor that elicits the onset of the disorder
stress cascade or stress-vulnerability model
there is a high comorbidity rate between schizophrenia-related disorders and what other disorders?
substance abuse disorders
causes involuntary movements isolated to the tongue, mouth, and face and only 10% of patients report having this symptom
tardive dyskinesia
What is the reason many do not prescribe conventional antipsychotics like Thorazine and Chlorpromazine?
they produce significant side effects similar to that of neurological disorders, muscle tremors, involuntary movements, and muscle rigidity
What percentage of patients with schizophrenia report auditory hallucinations? Visual? tactile?
50%, 15%, 5%
the area of the brain that is the likely responsible neurobiological component responsible for it
HPA axis
the structure of the brain that mediate stress that involves the regulation of three chemical messengers
HPA axis
what is among the first antipsychotic medications used for the treatment of schizophrenia that is a derivative of antihistamines that is also the first line of treatment that produced a calming effect on even the most severely agitated patients and allowed for the organization of thoughts
Thorazine
belief that others control their thoughts/feelings/actions
delusions of control
belief they have exceptional abilities wealth, or fame; belief they are God or other religious saviors
delusions of gradneur
belief that specific gestures, comments, or even larger environmental cues are directed directly to them
delusions of reference
belief that one's thoughts are transparent and everyone knows what they are thinking
delusions of thought broadcasting
belief that one's thoughts have been removed by another source
delusions of thought withdrawal
five main symptoms of schizophrenia spectrum disorders
delusions, hallucinations, disorganized thinking (speech), disorganized or abnormal motor behavior, negative symptoms
the illogical connection in a chain of thoughts
derailment
when an individual reports a delusion of another person being in love with them. Generally, the individual whom the convictions are about is of higher status, such as a celebrity
erotomanic delusion
what are the 2 sociocultural causes of schizophrenia spectrum disorders?
families high in expressed emotion and family dysfunction
Which gender is more often diagnosed with schizoaffective disorder?
females
revolves around the conviction that one's spouse or partner is/had been unfaithful, generally based on incorrect inferences that lack evidence
jealous delusion
involves the individual believing that they are being conspired against, spied on, maliciously maligned, harassed, or obstructed in pursuit of their long-term goals
persecutory delusion
of all the subtypes of delusional disorder, those experiencing what kind of delusions are the most at risk of becoming aggressive or hostile
persecutory delusion
symptoms that are an over-exaggeration of normal brain processes; these symptoms are also new to the individual
positive symptoms
holding odd, awkward postures for long periods
posturing
what is the cognitive theory of schizophrenic-related disorders?
premorbid neurocognitive impairment places individuals at risk for aversive work/academic/interpersonal experiences. These experiences, in turn, lead to dysfunctional beliefs and cognitive appraisals, ultimately leading to maladaptive behaviors such as delusions/hallucinations
What is the key distinguishing feature that sets schizophreniform disorder apart from schizoaffective disorder?
the fact that impaired functioning is not essential for a diagnosis
what is distorted thought patterns often related to?
the individual being focused on one aspect of a concept or thing and neglects all other aspects
Why do distorted thought patterns make treatment difficult?
the individual lacks insight into their illness and symptoms
which part of the brain is involved in the processing of auditory information?
the neocortical surface of the temporal lobes
which gender is more often diagnosed with schizophrenia, schizophreniform, and delusional disorders?
they are diagnosed equally between genders
the use of what may place an individual at an increased risk of developing schizophrenia if the genetic predisposition is also present
various substances, particularly marinuana
What part of the brain is enlarged in those with schizophrenia?
ventricles
What is the most common type of auditory hallucination?
voices talking to the patient or various voices talking to one another
those diagnosed with a schizophrenia-related disorder are also at an increased risk for associated medical conditions such as what 4 medical problems?
weight gain, diabetes, metabolic syndrome, and cardiovascular and pulmonary disease
