Schizophrenia - Exam 3
4 core symptoms of Dementia Praecox
Emile Kraeplin ○ four core symptoms: ambivalence, disturbances of affect, disturbance of association and preference for fantasy over reality
Positive Symptoms
presence of an abnormal behavior within the individual unusual thoughts, feelings, and behaviors, vary in intensity and in many cases are responsive to tx. Delusions + Hallucinations
Magical thinking
belief that thinking about something can make it happen
Ideas of reverence
interpret causal events as being directly related to you.
Visual hallucinations
(14%) less common - often in those with the most severe form of the disorder. ■ common examples include seeing the devil or a dead relative/friend
Auditory Hallucinations
(71%) most common - can range from simple noises to one of more voices of either gender. Commonly negative in quality and content, but can be comforting and kind. ■ exclusive to schizophrenia - keep a running commentary on the individuals behavior or several voices having a conversation.
Disorganized speech
(disorganized) Word salad, loose associations, neologisms, preservations, clanging
Disorganized behavior
(disorganized) catatonia and other unusual behaviors
Disorganized affect
(disorganized) inappropriate emotional behavior o Stare
Avolition
(negative) apathy - the inability or initiate or follow through on plans - sometimes interpreted as laziness or a deliberate unwillingness to improve their life - an erroneous interpretation that can create distress and discord in the family environment.
Affective flattening
(negative) little expressed emotions o Absence of normally expected emotions o Flat and toneless manner of responding
Asociality
(negative) severe relationship impairment o Few friends, little interest in others, poor social skills
Alogia
(negative) the decreased quality and/or quantity of speech
Anhedonia
(negative) the lack of capacity for pleasure; a condition in which a person does not feel joy or happiness
Psychomotor retardation
(negative) ○ a condition in which a person has slowed mental or physical activities ○ speech can be slowed to the point that it is difficult or impossible for others to follow the person's conversation
Delusions
(positive) a false belief
Waxy flexibility of catatonia
(positive) moving body part and it won't move back
Catatonia
(positive) ○ a condition in which a person is awake but is non responsive to external stimulation ○ patient may not move or make eye contact with others - may be mute - muscularly rigid
Genain Quadruplets
- A famous case of identical quadruplets, all of which developed schizophrenia - Manifested differently in them ■ One has one episode, was cured, went on to live normal life ■ Other was frequently in hospital but could still function ■ Other was more chronic and has catatonia ■ Other was hospitalized repeatedly to the point where she is an in-patient ● First to develop ● Traumatic female circumcision story ● Age 18 onset
negative symptoms
- absence of behaviors that exist in the general population - treatment-resistant; tend to persist and restrict the person's ability to hold a job, go to school, or even take care of personal responsibilities such as bathing or dressing - behaviors, emotions, or thought processes (cognitions) that exist in people without a psychiatric disorder but are absent (or substantially diminished) in people with schizophrenia. - common: diminished emotional expression, anhedonia, avolition, alogia, and psychomotor retardation
Typical antipsychotics
- before 1990s - Effectively reduced the positive symptoms of schizophrenia but produced serious side effects ● muscle stiffness ● tremore ● tardive dyskinesia
Thought delusions of insertion
-Delusion that my thoughts are put in my head by some outside force -I can't generate my own thinking
Thought delusions of withdrawal
-Ones thoughts being sucked out of the mind by some other thought -Mind is always blank
Prevalence of Schizophrenia
1% of adults, 0.1% of people under 18
Tactile hallucinations
15% touch
Percent of cases of Schizophrenia that develop after 40
23%
Synaptic Pruning
A process in which weaker synaptic contacts in the brain are eliminated and stronger connections are enhanced.
Racial Discrepancies
Blacks far more likely to receive diagnosis than whites and Latino people - especially when Dx based on unstructured clinical interviews. Due to racial and ethnic bias, misinterpretation of patient reports due to a lack of understanding of cultural features, and racial differences in the presentation oh psychiatric sx may bias clinicians interpretation of patients sx.
Thought delusions of broadcasting
Delusion that ones thoughts are being broadcast out loud so everyone can hear what they're thinking
Capgras syndrome
Delusion that someone I know has been replaced by an evil double
Medical Tx
Historic precursor: Frontotemporal lobotomy Antipsychotic (neuroleptic) medications side effects common
Delusions of reference
Relating irrelevant things to ones self
Sex, Race, Ethnicity Differences
Women develop schizo at later age than men. Women have milder form and experience fewer hospital admissions and better social functioning. Sex difference in age of onset may be related to the hormonal/sociocultural factors Female hormone estrogen has a strong protective influence on brain development - hypothesized to lessen abnormal brain development commonly seen among those with schizophrenia. symptoms of psychosis consistent across racial and ethnic groups.
Shared psychotic disorder
a condition in which 2 or more persons who have a close relationship share the same delusional belief. Begins when one person (inducer or primary case) develops a psychotic disorder with delusional content. If the relationship is interrupted, the delusional beliefs of the second person quickly disappear.
Schizoephreniform disorder
a condition with symptoms that are identical to those of schizophrenia except that its duration is shorter (less than 6 months) and it results in less impairment in social or occupational functioning
Hallucinations - positive
a false sensory perception
Tardive dyskinesia
a neurological condition characterized by abnormal and involuntary motor movements of the face, mouth, limbs, and trunk - caused by old typical medications
Schizoaffective disorder
a pervasive pattern of social detachment and a limited expression of emotion in interpersonal contexts - considered to have both schizophrenia and an affective disorder - patient also suffers from MDD, Manic, or mixed episode disorder at some point during the illness
Thought blocking
an unusually long pause or pauses in a patient's speech that occurs during a conversation
Biological treatment of schizophrenia
antipsychotics - block dopamine receptors at four different receptor sites labeled D1, D2, D3, D4. ■ blocking may be temporary, permanent, partial, or complete, and the type of blocking affects how well the drug works ■ do not improve negative symptoms or the cognitive deficits found among people with schizophrenia.
Developmental factors related to Schizophrenia
as children, may have situational anxiety, nervous tension, depression, and "psychotic like" experiences such as perceptual disturbances, magical thinking , and referential ideas. ○ usually less social as children ○ had more subtle general neuromotor abnormalities as children. ○ usually begins in late adolescence or early adulthood
Premorbid phase of schizophrenia
before the illness - features can exist for many years before the actual psychotic symptoms emerge
Somatic delusions
belief that one's body is rotting away
Neurodevelopmental model of schizophrenia
etiological factors --> affect brain pathophysiology --> negatively affect brain anatomy and functioning --> negatively affect cognitive functioning and processing --> symptoms of schizophrenia
Somatic hallucinations
feelings of pain or deterioration of parts of ones body or the feeling that things are crawling on, or in, the skin or the body
Acute phase of schizophrenia
in which he exhibits the positive symptoms including hallucinations, delusions, and thought disorder. Negative symptoms also present, but they are overshadowed by the psychotic behaviors.
Common themes of delusions of delusional disorder
jealous, erotomanic, persecutory, gradeur, somatic
Persecutory Delusions
most common - belief that someone is harming or attempting to harm the person.
Dementia Praecox
original name for schizophrenia from kraepelin to highlight pervasive disturbances of perceptual and cognitive faculties (dementia) and its early life onset. (praecox) to distinguish it from the dementia associated with old age.
Catatonic excitement
over-activity that is uncontrollable
Psychoeducation treatment of schizophrenia
process that educates patients and family members about the disorder. ● the goal is to reduce family distress and allow clinicians' to increase the effectiveness of their work with the patient and caregiver. ● reduces relapse rates and shortens length of hospitalization
Early detection of schizophrenia
prodromal phase slow gradual pattern of onset, sneaks up over time "Leading in phase" Social withdrawl
Disorganized symptoms
severe and erratic disruptions in speech, behavior, and emotion
Prodromal phase of schizophrenia
social withdrawal or deterioration in personal hygiene, such as not bathing or not changing clothes, may occur. The person may also have difficulty functioning at work or school.
Clang associations
speech is governed by words that sound alive rather than words that have meaning, rendering communication meaningless
Social skills training treatment of schizophrenia
teaches the basics of social interaction including nonverbal skills such as eye contact, vocal tone, voice volume, and verbal skills such as initiating and maintaining conversations, expressing feelings, and acting assertively.
Supported employment intervention for schizophrenia
the ability to maintain full-time competitive employment is associated w/ higher rates of symptom improvement, enhanced leisure and financial satisfaction, and enhanced self-esteem. ● psychosocial intervention that provides job skills to people with schizophrenia. ● help to find and maintain competitive employment
Social Cognition
the ability to perceive, interpret, and understand social information including other people's beliefs, attitudes, and emotions. People with schizophrenia often deficient in the basic skills necessary for positive social interactions including the ability to perceive social nuances and engage in basic conversations.
Olfactory and gustatory hallucinations
the least common (11%)
Erotomanic delusions
the person believes that someone of a higher status is in love with him - sometimes found among "celebrity stalkers"
Jealous delusions
the person's sexual partner is unfaithful
Residual phase of schizophrenia
the psychotic symptoms are no longer present, but the negative symptoms often remain. The continuing presence of negative symptoms sometimes prevents the person from being successfully employed or having satisfying social relationships
Gene by environment correlation
the same person who provides a patients genetic makeup also provides the environment in which that person lives. This individuals who are at increased genetic risk for schizophrenia may also be exposed to environments that increase risk of developing symptoms of schizophrenia.
Brief psychotic disorder
the sudden onset of any psychotic symptom that may resolve after 1 day and does not last for more than a month
Psychoeducation
the teaching of a patient and families about the patient's disorder in order to reduce familial distress and equip them to work effectively with the patient.
Dopamine hypothesis biological etiology of schizophrenia
the theory that a cause for schizophrenia is the presence of too much Dopamine in the neural synapses. emerged from clinical observations that chemical compounds such as amphetamines and levodopa (a drug used to tx parkinsons) ^^ the amount of dopamine available available in the neural synapse, which, in turn, can lead to the development or worsening of psychotic sx, substance that decreases dopamine seem to be associated with the lessening of psychotic sx
echolalia
the verbal repetition of what others say
Loose associations
thoughts that have little or no logical connection to the next thought
Psychosocial Tx:
used as supplemental interventions that seek to further reduce primary sx and to decrease daily stress and on the patient and/or family, increasing the patient's social skills and helping the patient find and maintain employment when possible.
Psychosocial treatment of schizophrenia
used as supplemental interventions that seek to further reduce primary symptoms and to decrease daily stress on the patient and/or family, increasing the patient's social skills and helping the patient find and maintain employment when possible.
Delusions of influence (control)
• Ones thoughts/actions are not their own, but controlled by someone else • Commonly devil controlling
Delusions of Grandeur
• You are someone famous or of historical significance • Having special powers no one else has
Brief Psychotic Disorder
■ 1 or more positive symptoms for less than a month ■ Precipitated by stress and remits on its own (brief)
Influence of expressed emotion on schizophrenia
■ High EE ■ Low EE
Influence of family interactions on schizophrenia
■ High expressed emotion = critical, hostile, over-involved ■ Predicts relapse
Adoption studies of genetic vulnerability to schizophrenia
■ High risk when biological parent has schizophrenia ■ Better differentiation between genetics and environment ■ Children of mothers with schizo, whom were adopted are 5X more likely to develop than normal
Sociocultural differences in schizophrenia
■ In the US, diagnosed more frequently in African Americans than in whites ■ Associated with low SES → Downward drift
Linkage studies of genetic vulnerability to schizophrenia
■ Inconclusive ■ GWAS: 7 Loci (MIR137)
Family studies of genetic vulnerability to schizophrenia
■ Inherit tendency for schizophrenia/psychosis ■ Risk increases with relatedness ● Closer to proband = more likely ■ Stronger symptoms = more likely ■ What seems to be inherited is a predisposition to psychosis, not schizophrenia itself
Schizotypal Personality Disorder
■ Less severe form of schizophrenia ■ Much more long-standing (persists throughout lifetime)
Twin studies of genetic vulnerability to schizophrenia
■ MZ twins: 44-48% concordant ■ DZ twins: 12-17%
Viral/prenatal etiology of schizophrenia
■ Maternal genital or reproductive infections during the time of conception ■ influenza during 1st or 2nd trimester ■ nutritional deprivation during early gestation ■ lead exposure during the 2nd trimester ■ bleeding during pregnancy ■ severe prenatal maternal stress
Influence of stressful life events on schizophrenia
■ May activate vulnerability ■ May increase risk of relapse
Offspring of twins studies of genetic vulnerability to schizophrenia
■ One twin has history of schizo, other doesn't ● MZ normal same as MZ schizo for risk of children ● DZ normal far less than DZ schizo for risk of children
Gender differences in schizophrenia
■ Slightly more common in men ■ Age of onset: ● Males = 18-25 ● Females = 25-35 (higher risk as life goes on) ■ Females have better long-term prognosis (better outcome)
Behavior Therapy for schizophrenia
■ Token economics on inpatient units ■ Social and living skills training
Neuroanatomy etiology of schizophrenia
■ enlargement of the brain ventricles ■ reduction in cortical (gray matter) areas of the brain ■ mild structural disorganization at the level of the individual brain cells and altered neuronal connections in multiple brain areas
Genetic biological etiology of schizophrenia
■ genetically the risk of developing schizophrenia is 15% if one parent has the disorder and 50% if both do. ■ monozygotic twins - 60 - 84% ■ nine chromosomes and seven candidate genes have been identified as potentially contributing to the development of schizophrenia
Atypical antipsychotics
■ since 1990s ■ preferred for treatment in children and adults ■ much less likely to produce tardive dyskinesia ■ have some effects on negative symptoms and cognitive impairments in addition to positive ■ Have side-effects as well ● fewer ● weight gain ● lowering of white blood cell count (agranulocytosis) ■ controversial if they represent a significant improvement
DSM-V criteria for schizophrenia
○ 2 active phase symptoms for a month or more ■ Delusions* ■ Hallucinations* ■ Disorganized speech* ■ Disorganized or catatonic behavior ■ Negative symptoms ○ Continuous signs for at least 6 months
Psychological treatments for schizophrenia
○ Case management ○ Behavior therapy ○ Cognitive-behavioral therapy ○ Family therapy ○ Vocational rehabilitation
Expressed emotion
○ a concept used to describe the level of emotional involvement and critical attitudes that exist within the family of a patient with schizophrenia ○ patients with schizophrenia who live in family environments that are high on EE variables ( which include high levels of emotional over-involvement and critical attitudes ) are more likely to relapse and have higher rates of rehospitalization
Delusional Disorder
○ a condition in which a person has a non bizarre delusion, no other psychotic symptoms, and few changes in overall functioning other that the behaviors immediately surrounding the delusion. ○ Because people with delusional disorder do not believe that they need tx, it is not clear how many people suffer from the disorder
Early onset schizophrenia
○ a form of schizophrenia that develops in childhood or adolescence (usually before 18) ○ Biologically, children with EOS lose more cortical gray matter than children without a psychological disorder over a 5 year period - occurs on both sides of the brain and progresses from front to back indicating significant biological deterioration in brain functioning - maintain IQ after onset however ○ Behaviorally, only between 8-20% of those with EOS ever achieve full symptom remission - most have persistent symptoms throughout their lifetimes
Psychosis
○ a severe mental condition characterized by a loss of contact with reality ○ usually takes the form or a delusion or hallucination or both
Negative symptoms of Schizophrenia
○ absence of behaviors that exist in the general population Avolition, alogia, affective flattening, anhedonia, asociality
Epidemiology of share psychotic disorder
○ equally common among men and women and affects younger and older patients ○ 90% married, siblings or parent-child dyads (many of whom were socially isolated from others) ○ Dementia, depression, and mental retardation common features among those with the disorder.
Positive Symptoms of Schizophrenia
○ presence of an abnormal behavior within the individual Disorganized speed, disorganized affect, disorganized behavior, delusions, halucinations
Cognitive impairment of schizophrenia
○ the diminishment in visual or verbal learning and memory, inability to pay attention, decreased speed of information processing, and the inability to engage in abstract reasoning, any or all of which may be found in different psychotic disorders. ○ long lasting and strongly correlated with functional impairment
Epidemiology of Schizophrenia
○ worldwide prevalence is the same in all cultures. ○ lifetime prevalence averages 1% ranging from 0.3% to 1.6% of the US population ○ in any given year 16 - 40 of every 100,000 people develop schizophrenia ○ higher incidence associate with people who live in an urban setting (more complex lifestyle?), who move to a new area/country (perhaps resulting in social isolation/discrimination), and who are male ○ onset can be acute or gradual ○ premorbid features exist for many years before the actual psychotic symptoms emerge.
Gene by environment conclusions of genetic vulnerability to schizophrenia
● Likely involves multiple genes ● Results from gene-environment interactions