PSYCH EXAM 3 (schizophrenia)

gender differences in schizophrenia typical symptoms

men= More negative symptoms; more withdrawn and passive women= More hallucinations and paranoia; more emotional and impulsive

gender differences in schizophrenia chronic? can it be treated

men= More often chronic; poorer response to treatment women= Less often chronic; better response to treatment

gender differences in schizophrenia age of onset

men= earlier, 18-25 women= later, 25-35 late adolescence or early adulthood

gender differences in schizophrenia premorbid functioning, adjustment

men= poor social functioning, more schizotypal traits women= Good social functioning; fewer schizotypal traits

newer second gen antipsychotics may __________

improve cognitive function

prognosis for schizophrenia patients

improved and relatively independent - 25% completely recovered - 25% deceased (mostly suicide) - 10% hospitalized and unimproved - 15% improved but extensive support needed - 25%

what causes Extrapyramidal side effects

in 1st gen antipsychotics. they block dopamine receptors too much causing parkinsons like symptoms

anhedonia

inability to experience pleasure

social skills training psychological treatments for schizophrenia

- Teach skills for managing interpersonal situations - Involves role-playing and other practice exercises, both in group and in vivo

types of hallucinations

- auditory - visual - hearing voices

Schizophrenia affects men _________ than women

more

Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study what did this study fibd?

- 2nd gen drugs were not more effective than the older, first-generation drug - 2nd gen drugs did not produce fewer unpleasant side effects - Nearly three-quarters stopped taking the medications before study ended

side effects Second-generation antipsychotics

- Can impair immune symptom functioning (agranulocytosis) - Seizures, - dizziness - fatigue - drooling - weight gain (very high gain) - diabetes - pancreatitis FEWER motor effects than 1st gen

Teach skills for managing interpersonal situations schizophrenia psychological treatments

- Completing a job application - Reading bus schedules - Make appointments

Family therapy to reduce Expressed Emotion psychological treatments for schizophrenia

- Educate family about causes, symptoms, and signs of relapse - Stress importance of medication - Help family to avoid blaming patient - Improve family communication and problem-solving - Encourage expanded support networks - Instill hope

dellusions

- Firmly held beliefs - Contrary to reality - Resistant to disconfirming evidence

what areas are related to positive and negative schizophrenia symptoms revised dopamine theory of schizophrenia

- Mesolimbic dopamine abnormalities mainly related to positive symptoms - Underactive dopamine activity in the mesocortical pathway mainly related to negative symptoms

damage during gestation or birth

- Obstetrical complications rates high in patients with schizophrenia - Reduced supply of oxygen during delivery may result in loss of cortical matter

types of delusions

- Persecutory - Thought insertion - Thought broadcasting -Outside control - Grandiose delusions - Ideas of reference

enlarged ventricles is correlated to

- Poor performance on cognitive tests - Poor premorbid adjustment - Poor response to treatment

viral damage to fetal brain (parasite/sickness)

- Presence of parasite, toxoplasma gondii, associated with 2.5x greater risk of developing schizophrenia • In Finnish study, schizophrenia rates higher when mother had flu in second trimester of pregnancy

Adoption studies and schizophrenia

-Adoptee risk for developing schizophrenia remains high if a biological parent has schizophrenia - healthy environment is a protective factor

negative symptoms of schizophrenia (behavioral deficits)

1. avolition 2. asociality 3. anhedonia 4. blunted affect 5. alogia

the DSM-5 says you must have symptoms present for how long to be diagnosed with Schizophrenia

1 month

Lifetime prevalence of schizophrenia

1%

names of Second-generation antipsychotics

1. Clozapine (Clozaril) 2. Aripiprazole (abilify) 3. ziprasidone (geodon) 4. quetiapine (seroquel) newer ones - Olanzapine (Zyprexa) - Risperidone (Risperdal)

names of First-generation antipsychotic medications

1. Phenothiazines (Thorazine) 2. butyrophenones (Haldol) 3. thioxanthenes (Navane) 4. fluphenazine decanoate (prolxin) 5. trifluoperazine (stelazine)

Other Psychotic Disorders

1. Schizophreniform Disorder 2. Brief Psychotic Disorder 3. Schizoaffective Disorde 4. Delusional Disorder

postive symptoms of schizophrenia (Behavioral Excesses and Distortion)

1. delusions 2. hallucinations 3. thought disorder (content or form) 4. bizarre or disorganized behavior (i.e. wearing all their clothes at once)

why is the age of onset so late for schizophrenia if the brain abnormalities are present at birth

1. injury to brain early in life in prefrontal cortex which hasn't finished developing yet 2. dopamine neurons under active in prefrontal cortex (negative symptoms) 3. release of mesolimbic dopamine neurons from inhibitory control (postive symptoms)

how can stress in adolescence cause schizophrenia

1. stress activates HPA system which causes cortisol secretion 2. cortisol increases dopamine activity

at least __________ of homeless people are psychotic

1/3

first degree relatives of someone with schizophrenia is __________ times more likely to have it also

10

____% of those who take FIRST-generation drugs develop this in comparison to ____% of those who take SECOND-generation drugs will develop this

15% 5%

DSM-5 Schizophrenia

2 or more of the following for one month, one symptom must be 1,2, or 3 (1) delusions • (2) hallucinations • (3) disorganized speech • (4) disorganized (catatonic) behavior • (5) negative symptoms (diminished motivation or emotional expression) - Functioning in work, relationships, or self-care has declined since onset - Signs of disorder for at least 6 months; if during a prodromal or residual phase, negative symptoms or two or more of symptoms

Genetic effects account for approximately _____% of the liability for schizophrenia.

80

Assertive community treatment:

A community approach for people with severe mental disorders in which a multidisciplinary team provides interventions ranging from medications and therapy to residential and vocational guidance

Milieu therapy

A humanisitc approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity -Institutionalized people deteriorate because they are deprived of opportunities to engage in meaningful activities

Agranulocytosis

A life threatening drop in white blood cells. This condition is sometimes produced by the second-geenration antipsychotic drug clozapine

Aftercare

A program of posthospitalization care and treatment in the community

Day center

A program that offers hospital-like treatment during the day only. Also known as a day hospital

Neuroleptic Malignant Syndrome

A severe, potential fatal reaction consisting of muscle rigidity, fever, altered consciousness and improper functioning of the autonomic nervous system

Sheltered workshop

A supervises workplace for people who are not yet ready for competitive jobs

Coordinated Speciality Care (CSC)

A treatment approach for people with severe mental disorders in which clinicians provide interventions ranging from therapy and practical advice to medication monitoring, housing guidance and vocational counseling -Adressing social and personal difficulties in their lives

Community mental health center

A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatments in the community

Cognitive remediation

A treatment that focuses on the cognitive impairments that often characterize people with schizophrenia; particularly their difficulties in attention, planning and memory -Required to complete increasingly difficult information processing tasks on a computer

disorganized symptoms for schizophrenia

ALSO can be included in positive symptoms 1. Disorganized speech 2. Disorganized behavior

Unwanted effect of Second-Generation Antipsychotic Drugs

Agranulocytosis Weight gain (mostly in women), dizziness, metabolic problems, sexual dysfunctions, cardiovascular changes and significant elevations in blood sugar

Disorganized behavior

Odd or peculiar behavior • Silliness, agitation, unusual dress - e.g., wearing several heavy coats in hot weather

people who have hallucinations of hearing voices have more activity in __________ during hallucination

Broca's area

twin study schizophrenia

DZ= 17% MZ=48% chance of having the disorder if your twin does... high heritability not 100% because environment also plays a role

Cogntive-Behavioral Therapies

Cognitive remediation the treatment is designed to help change how people view and react to their hallucinations Provide clients with education and evidence about biological causes of hallucinations Help clients learn more about the "comings and goings" of their own hallucinations and delusions Challenge the clients inaccurate ideas about the power of their hallucinations Teach clients how to reattribute and more accurately interpret their hallucinations -"It's not a real voice, it's my illness" Teach clients techniques for coping with their unpleasant sensations (hallucinations) -Special breathing and relaxing techniques Help people feel more in control over their hallucinations and reduce their delusional ideas

Community Approach

Deinstitutionalization, Assertive community treatment, Community mental health center, Aftercare, Day center, Half-way houses, Sheltered workshop

example of gene-environment interaction schizophrenia

Differential effect of cannabis on risk of schizophrenia based on COMT Val/Met allele

Schizophrenia movement or behavior

Disheveled appearance disturbances in movement/ behavior

________ appear to be more effective treatment for schizophrenia than any of the other approaches used alone, such as psychotherapy, milieu therapy, or electroconvulsive therapy

Drugs

reason for dopamine theory of schizophrenia

Drugs that alleviate symptoms reduce dopamine activity Amphetamines, which increase dopamine levels, can induce a psychosis

Antipsychotic drugs

Drugs that help correct grossly confused or distorted thinking

revised dopamine theory of schizophrenia

Excess numbers of dopamine receptors or oversensitive dopamine receptors

side effects of First-generation antipsychotic medications

Extrapyramidal side effects - Tardive dyskinesia - Neuroleptic Malignant Syndrome

first generation drugs are more effective than second gen T or F

FALSE equally effective

there is a low rate of suicide/ death for those with Schizophrenia T or F

FALSE high rates 50% of people with the disorder will attempt suicide

Schizophrenia is genetically homogenous T or F

FALSE it is heterogeneous- Not likely that disorder caused by single gene

when someone has a family member with schizophrenia, they are passed the certainty of having it T or F

FALSE there are passed the genetics, but there is an environment; factor that will make you have the disorder

Neuroleptic drugs

First-generation antipsychotic drugs, so called because they often produced undesired effects similar to the symptoms of neurological disorders

schizotypal traits

Peculiar, eccentric or unusual thinking, beliefs or mannerisms

Supervised residences:

Half-way houses & Sheltered workshop

Second-generation antipsychotics does what?

Impacts serotonin receptors Reduces relapse

Asociality

Inability to form close personal relationships

disorganized speech (schizophrenia)

Incoherence - Inability to organize ideas Loose associations (derailment - Rambles, difficulty sticking to one topic

Brief Psychotic Disorder

Symptom duration of 1 day to 1 month, no negative symptoms Often triggered by extreme stress, such as bereavement

PORT recommends medication ___________

PLUS psychosocial intervention

__________ are characterized by exaggerations or excesses of normal functions __________ are disturbances in normal functions, they are diminished or absent

POSITIVE symptoms NEGATIVE symptoms

Toxoplasma gondii

Parasite found in cat litter.

PORT

Patient Outcomes Research Team (PORT)

How has community treatment failed?

Poor coordination of services Shortage of services Consequences: -Homeless, jail/prison, nursing homes, unsupervised living

Schizophreniform Disorder

Same symptoms as schizophrenia, has negative symptoms duration = greater than 1 month but less than 6 months

Schizoaffective Disorder

Symptoms of both schizophrenia and mood disorder DSM-5 likely to require appearance of major depressive or manic episode

other NT that may be involved in schizophrenia

Serotonin, GABA, Glutamate (medications that target glu show promise)

Use of cannabis during adolescence associated with increased risk of schizophrenia T or F

TRUE

Children of the non-schizophrenic twin in a MZ twin pair are still more likely to develop schizophrenia T or F

TRUE (9.4% vs. 1% in general population)

both genetic and environmental factors play a role in the etiology of schizophrenia T or F

TRUE but genes are needed, if you do not have the genes for the disorder nothing can cause you to get it

Deinstitutionalization

The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs

twin studies what are they

Twin studies rely on comparison of concordance rates (the extent to which both members of pairs of twins either do or do not express a trait) between monozygotic and dizygotic twins. MZ= 100 % genetic overlap DZ= 50% genetic overlap

74% of hallucinations are of what type?

auditory

To be effective, antipsychotics must reduce dopamine activity to________________

below normal levels

diathesis of schizophrenia

biological predisposition

enlarged ventricles means we are losing

brain cells

second generation antipsychotics

cl

environmental factors of schizophrenia during gestation

damage during gestation or birth viral damage to fetal brain

thought disorder of content

delusions - this is a firmly held belief contrary to reality - person is renitent to evidence against their delusion i.e. I cant walk past a microwave because the microwave is going to suck out my brain cells

dementtia vs schizophrenia nature of the disorder

dementia= neurodegenerative - brain = normal at first - pathology develops overtime schiz= neurodevelopment - brain= atypically develops from birth - pathology manifests slowly over time, or is delayed until relevant brain regions attain maturity

dopamine theory of schizophrenia

disorder due to excess dopamine

thought disorder of form

disorganized speech i.e. the marshmallow sauce on top of the airplane were very fine MAKES NO SENSE

dopamine hypothesis of schizophrenia has been challenged because of what discovery

effective new drugs suggest abnormal NT activity of Serotonin, glu, GABA, and dopamine

blunted affect

exhibits little or no affect in face or voice

you only need one dose of First-generation antipsychotic medications T or F

false Maintenance dosages to prevent relapse - if they take them off person may have psychotic break and relapse

if you did not share the environment with your relative, and they have schizophrenia, then your chances of having the disorder are NOT increased T or F

false your chances of having the disorder increases if a family member has it, even if you do not know them

diathesis-stress model schizophrenia

genetic factors are necessary but not sufficient for the development of schizophrenia

significantly higher rate of concordance for MZ than DZ twins indicates __________________ of the disorder

genetic transmission

cannabis and risk of schizophrenia

having the two VAL genes increases risk of schizophrenia associated with cannabis

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs

Schizophrenia emotional expressiveness

lack of expression inappropriate or flat emotions

avolition

lack of interest; apathy

Second-generation antipsychotics has ________ treatment noncompliance

less

Half-way houses

many people do not require hospitalization but are unable to live alone or with their families. Have live in staff, who receive training and ongoing supervision from outside mental health professionals A residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals. Also known as a group home or crisis home

________ symptoms have stronger genetic component

negative

which type of symptoms are hardest to treat and cause the most issues

negative - they are hard to treat - they make it hard to integrate individuals into society - hard for their family members to deal with

First-generation antipsychotic medications

neuroleptics; 1950s - Reduce agitation, violent behavior Block dopamine receptors - Little effect on negative symptoms

Delusional Disorder

only delusions delusions can be... - persecution - jealousy - being followed - erotomania - somatic delusions

65 % of delusions are ..... how does this alter their relationships

persecutory example = "The CIA planted a listening device in my head, theyre out to get me" this hurts their relationships with others because they are scared of other people, making them hostile (so they appear dangerous)

Types of Schizophrenia symptoms

positive, negative, disorganized

what explains why symptoms appear in late adolescence but brain damage occurs early in life

prefrontal cortex is developing through adolescence

Alogia

reduction in speech may be mute

Antipsychotics block dopamine rapidly and symptom relief takes _______________

several weeks

psychological treatments for schizophrenia

social skills training Family therapy to reduce Expressed Emotion

gene-environment interaction

some people have genetically influenced sensitivity to the environment - so some individuals are more vulnerable to a given environmental stress factor than others, based on their genotype.

Erotomania

the delusional belief that a famous person is in love with them (this is unattainable)

Dopamine theory doesn't completely explain disorder T or F

true

exposure to viral agents in utero may be implicated in schizophrenia T or F

true

black people are given second gen antipsychotics less T or F

true this may be because people of color are at higher risk of diabetes, and there is high rates of weight gain and diabetes associated with this drug

when is the onset of schizophrenia

typically late adolescence or early adulthood but, men diagnosed at a slightly earlier age

is schizophrenia found around the world

yes, dr. gooding goes to a conference in italy where there is people from all over the world

issue with corollary discharge and schizophrenia

you're brain is creating things that you do not know are not real - i.e. you are hearing voices, your brocas area is over active and you are essentially having thoughts you do not know are thoughts

Schizophrenia Disordered thinking

• Ideas not logically related • Faulty perception and attention