psy 339 exam 2
The proportion of people who develop a condition during a particular time period is referred to as the _____ of that condition:
incidence
Childhood onset schizophrenia is associated with:
- comorbid anxiety disorders - learning disabilities - comorbid mood disorders
According to qualitative research, which of the following is a major theme identified within young peoples' experiences of police involvement during the initiation of involuntary psychiatric holds and transport?
- Poor communication - Criminalization and disciplinary framing of psychological distress -Perceived aggression and callousness
How does this affect schizophrenia and its relation with genetics?
- Specifically, focusing on the "form" of the symptoms rather than the "content" provided an avenue to explore the idea of a continuum or spectrum of schizophrenia-related phenotypes - This becomes especially powerful when you begin to think about this in terms of genetics... -It provided an explanation for why different disorders (i.e. schizophrenia and manic-depression) tend to cluster among biological relatives
the Neurodevelopmental Hypothesis of schizophrenia
- fostered the notion that people who developed schizophrenia were "doomed from the womb"- reflected the idea that schizophrenia had a genetic origin -was supported by post-mortem studies that failed to show evidence of neurodegeneration
The Dopamine Hypothesis of schizophrenia:
- is supported by the fact that every medication approved by the FDA to treat psychosis acts as a dopamine antagonist - paved the way for the Glutamate Hypothesis of schizophrenia - resulted from a chance finding that chlorpromazine effectively treated psychotic symptoms
incidence is increasing- why?
-Cannabis use and potency of cannabis have increased during the past 2 decades -Given the numerous substances of abuse, the one most strongly related to schizophrenia risk is cannabis.
mesocortical pathway: what is it responsible for
-Cognitive and executive function -Negative symptoms (hypodopaminergic): --Alogia --Affective flattering --Avolition
Dopamine (DA) and Glutamate (Glu) - What are they? Where are the cells responsible for them located in the brain?
-Dopamine (DA): reward, motivation, movement, -Glutamine (Glu): learning, memory in the midbrain and the striatum
Kurt Schneider Determined the First Rank Symptoms (FRS) - What were they?
-First Rank Symptoms: (FRS): drove much of the effort to understand the etiology of schizophrenia for the latter half of the 21st century -Auditory hallucinations, Thought broadcasting, thought withdrawal, insertion and interruption, Somatic hallucinations, Delusional perception, and Feelings or actions experienced as made or influenced by external agents
Initial Treatment:
-First signs of psychosis do not tend to show up with a specialist. They tend to show up in emergency rooms or primary providers. -Vast majority of people 15-29 are diagnosed in the emergency room
Karl Jaspers Flexible psychiatric taxonomy: "Form" over Content". This led to our current system of Descriptive Psychopathology - What is it?
-He basically invented our current diagnostic system, which might best be referred to as Descriptive Psychopathology -This approach relies exclusively on the information communicated by the patient (or a relative) and on what is directly observed by the examiner -This represented a dramatic change from the interpretive methods that were the primary focus of psychoanalytic approaches...
What is the Kraepelin Dichotomy?
-He is the first to classify 2 broad classes of psychotic disorders, which you know has been referred to as the "Kraepelinian Dichotomy" -Dementia Praecox (what we eventually call schizophrenia) -Manic Depression (what we eventually call bipolar disorder)
Several Factors: Intrinsic versus Extrinsic - What are they?
-Intrinsic factors (e.g., symptom severity, patients' attitudes) -Extrinsic factors (e.g., access to care, insurance, culture)
what is the average age of onset LOS
-Late adolescence to early adulthood!!! -18-25 for men, 25-35 for women; Critical developmental period
Given the Manhattan Plot (What is it?) You can tell that schizophrenia is a polygenic disorder.
-Manhattan Plot: A scatterplot that plots the statistical significance (log10 is a p-value) of a given SNP ordered by chromosomes -Polygenic Disorder: (when a condition requires multiple genetic factors to manifest)
What is progressive versus acute?
-Progressive: over months or years -Acute: over days or weeks
What did Huckins find in his project regarding genes related to SZ?
-Schizophrenia Genetic Variation and the Brain -He found that genes associated with SZ were active in pretty specific regions of the brain during very specific periods of development. --Region 1: Early Prenatal --Region 2: Early to mid Prenatal --Region 3: Mid Late Prenatal --Region 4: Late Prenatal
How does this affect a patient's psychosocial function before/after their first hospital visit?
-She found that those with longer DUP experience greater losses of psychosocial function before their first hospital admission than those with shorter DUP -However, those with shorter DUP Experience greater psychosocial Function after their first hospital admission Than those with longer DUP
What is the Psychosis Prodrome? What "stage"? When? What is it characterized by?
-Suggested to be the first stage of schizophrenia -Occurs before noticeable psychotic symptoms appear -Characterized by changes in behavior and cognition -Not all people with SZ experience this stage of illness (only ~75%)
The role of Glutamate in the etiology of schizophrenia is believed to involve:
-The effects of glutamate on the shape and function of dendritic spines -The effects of glutamate on the number of dendritic spines present in the brain -The effects of glutamate on dopamine signaling
Tim Crow Type I versus Type II symptoms - What were they?
-Type I Hallucinations, delusions, thought disorder (positive symptoms), acute schizophrenia -Type II Affective flattening, poverty of speech, loss of drive (negative symptoms), chronic schizophrenia the "defect" state
comorbidity and schizophrenia About half of individuals with schizophrenia have comorbid psychiatric diagnoses - What are the explanations for such a high rate of comorbidity?
-We found that among individuals with schizophrenia, comorbid psychiatric diagnoses were associated with more hospitalizations, and that the greater the number of comorbid diagnoses, the greater the number of hospitalizations. -Depression, OCD, panic, and substance use disorders co-occur with schizophrenia at significant rates
Mesolimbic Pathway: what is it responsible for
-regulation of emotional behavior -Positive symptoms (hyperdoaminergic): --Delusions --Hallucinations --Disorganized thought, speech, behavior --Dopamine levels in the mesolimbic pathway are increased, causing the positive symptoms of schizophrenia --Simultaneously, the dopamine levels in the mesocortical pathway are decreased, leading to negative and cognitive symptoms
what was the problem with FRS
A lot of people incorrectly diagnosed with schizophrenia
deletion
A segment of chromosome is missing
The Odds Ratio (OR) - What is it?
An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.
cortex: glutamate signaling
Antipsychotics are "dirty drugs" and affect all dopamine levels. Understanding relationships between medical conditions and schizophrenia is made more difficult by the effects of antipsychotic drugs on physical health.
Grey Matter in childhood/adolescence:
Cortical thickness decreases, synapses rearrange and pruned, greater efficiency
Which version of the DSM defined schizophrenia as a "reaction", which was meant to imply an environmental cause?
DSM-1
A key innovation of the _______ was its explicit separation of diagnostic criteria from speculation about etiology.
DSM-lll
What is Dementia Praecox and Manic Depression?
Dementia Praecox literally means "early dementia" He believed that dementia was primarily a disease of the brain
where are we now?
Despite decades of research on neurotransmitter function, genetic variability, increasingly advanced brain imaging techniques and environmental risk factors, we STILL do not have any diagnostic test that allows us to unequivocally determine that someone has schizophrenia Even the idea that schizophrenia reflects a specific brain disease is still just a hypothesis! The general sense in the field is that we should be talking in terms suggested by Bleuler over 100 years ago... "The Shizophrenias" The DSM-5 recognizes this in at least a small way by incorporating a bit more of a dimensional view...
what is COS (child-onset schizophrenia)
Despite the relatively high rates of subclinical psychotic symptoms in childhood, the onset of schizophrenia in children 12 years old or younger is very rare •Approximately 30 to 50% of patients with affective or other atypical psychotic symptoms are misdiagnosed as COS •Over 90% of referrals to the NIMH study of COS receive alternate diagnoses •It is generally accepted that the incidence is less than 0.04% •This is not a "special" diagnosis •Possibly reflects a more homogeneous disease •More severe •Worse outcome •Likely linked to genetics •Among children with confirmed schizophrenia: •67% premorbid disturbances in social, motor, and language domains and are often diagnosed with learning disabilities •More than half have comorbid mood or anxiety disorders •27% met criteria for Autism Spectrum Disorders prior to the onset of their psychotic symptoms
Chlorpromazine and how it moved psychiatry from philosophy to medicine What hypothesis did this lead to?
Dopamine Hypothesis
Brain Imaging: CT scan
Earliest studies involved CT scans and found an increase in the size of the lateral ventricles, suggesting loss of matter
What did early MRI studies show regarding brain size?
Early MRI studies detect reductions in overall brain size..
Eugen Bleuler
First to coin... schizophrenia What phrase?
Duration of Untreated Psychosis: What is DUP?
Generally defined as time from first psychotic symptom to first psychiatric hospitalization
urban living
Higher population density and higher levels of poverty... Incidence lowers with age in both sexes, but is higher in men early and higher in women later - Why? Think about prevalence!- 56% of the worlds population
The positive symptoms of schizophrenia are thought to be due to:
Hyperdopaminergic function in the mesolimbic pathway
Research Domain Criteria (RDoC): What is it? Remember, this is NOT meant to be a diagnostic guide or system!
It integrates many levels of information (from genomics and circuits to behavior and self-report) to explore basic dimensions of functioning that span the full range of human behavior from normal to abnormal RDoC is not meant to serve as a diagnostic guide, nor is it intended to replace current diagnostic systems. The goal is to understand the nature of mental health and illness in terms of varying degrees of dysfunction in general psychological/biological systems
compare and contrast: which is more prevalent
LOS
What did later MRI studies show regarding the cortex?
Later MRI studies demonstrate reductions in the "thickness" of the cortex that is present at the onset of illness and gets worse with disease progression
Short versus Long DUP:
Majority of work suggests a longer DUP is associated with more negative outcomes
onset and initial presentation: prevalence by age
Males tend to be diagnosed before females, and females have a lower mortality rate. Therefore, prevalence is higher in young males than females, and higher in elderly women than men.
High levels in the mesolimbic leads to what symptoms, and low levels in the mesocortical leads to what symptoms?
Mesolimbic pathway: (High levels- positive symptoms) Mesocortical pathway: ( low levels- negative symptoms)
White Matter in childhood/adolescence:
Myelination increases, greater connectivity, greater efficiency
What is the Neurodegenerative Hypothesis?
Neurodegenerative Hypothesis: Schizophrenia results from the progressive deterioration of brain structure and function
What is the Neurodevelopmental Hypothesis?
Neurodevelopmental Hypothesis: Schizophrenia is the behavioral outcome of an aberration in developmental processes that begins long before the onset of clinical symptoms and is caused by a combination of environmental and genetic factors
Initial Presentation:
No typical presentation!
According to the Developmental Stage model of schizophrenia described by Insel (2010), during Stage 1 of schizophrenia, a researcher is likely to observe:
Not much of anything - not disability, abnormal thought, or social deficits
which of the following is NOT an instrument used to identify individuals at clinical high risk for psychosis?
PANSS
Evidence for neurodevelopmental disruptions in schizophrenia include all of the following except:
Reductions in synapse pruning
Stage I, II, and III of Schizophrenia - What are they characterized by?
Schizophrenia has three phases: prodromal (or beginning), active and residual.
insertions
You have 2 sections that are identical Insertion: You have a segment that doesn't go there
Brain changes during adolescence: What is synaptic pruning and myelination? What do they do?
Synaptic pruning: the clearing away of underutilized synapses; reflected in the thickening of the cortex Myelination: the development and extension of axons; reflected in increases in white matter
Early childhood: Synaptogenesis - What is this?
Synaptogenesis -Once in place, neurons start to make connections Send out projections to nearby neurons -Rapid period of synapse formation begins, contributing in part to growth of grey -Having all those synapses is expensive Young Children's brains work harder and less efficiently than adults
Neurodevelopmental Hypothesis Remember what this is?
The influential neurodevelopmental hypothesis of schizophrenia proposes that pathological neurodevelopmental processes, beginning as early as the first and second trimesters, result in neuronal circuits that are primed to generate psychotic symptoms during adolescence or young adulthood, often in the context of heightened biological and psychological stress
Relative to male individuals with schizophrenia, female individuals with schizophrenia:
are diagnosed later
what is adolescence the "age of opportunity"?
The brain's malleability in response to experience enables us to learn and strengthen abilities. It is more easily and reliably accomplished before adulthood. A brain with plasticity learns new skills easier, but it also is more sensitive to disruptions
what is plasticity
The capacity of the brain to change in response to experience.
define dopamine hypothesis
The dopamine hypothesis of schizophrenia suggests that a dysregulated dopamine system contributes to positive, negative, and cognitive symptoms of the disease.
To conclude that an individual has made the "transition" from a clinical high-risk state to actual psychosis, the individual must at the very least demonstrate:
The emergence of at least 1 positive psychotic symptom
Extrinsic factors that might contribute to a long duration of untreated psychosis (DUP) include all but:
The patient's attitudes about mental illness
Chlorpromazine alters the way dopamine changes in the brain - What does this suggest?
This observation led the field to essentially conclude that dysfunction in the brain's dopamine system was the "cause" underlying the symptoms of schizophrenia
What is LOS (Late- onset diagnosis)
Typically defined as after age 45 •Prevalence ~0.6% •"Very Late Onset" defined as after age 60, prevalence 0.1% - 0.5% •LOS more common in females (around the time of menopause) •Associated with: high levels of occupational functioning •Being married •more severe paranoid delusions •more visual, tactile, and olfactory hallucinations •less severe disorganization •less severe negative symptoms •Evidence suggests that risk factors for late-onset include: •negative life events •history of psychotic symptoms •poor social networks •cognitive impairment •functional limitations
Across childhood and adolescence, the structure of the healthy human brain changes such that:
White matter increases and gray matter decreases
duplication
You have 2 sections that are identical
The Basic Model: Genes, Cells, Systems, Behavior - What can go wrong at each stage?
deletion, duplication, insertion
Eugen Bleuler argued that Dementia Praecox was misleading! Why?
did not always emerge in 'early' life (i.e., late-onset schizophrenia) was not always associated with the deterioration typically observed in dementia
onset and initial presentation: difficult to determine
difficult to obtain due to clinical and methodological factors such as the complexity of diagnosis, overlap with affective disorders, and variation in diagnostic methods...
first rank symptoms (FRS)
drove much of the effort to understand the etiology of schizophrenia for the latter half of the 21st century
which one of the following is NOT an example of a Schneiderian First Rank Symptom
failure to achieve an age- appropriate level of functioning
Karl Jaspers coined the term "schizophrenia"
false
The earliest brain imaging studies of individuals with schizophrenia reported reductions in the size of the lateral ventricles.
false
The incidence of schizophrenia is constant both geographically and temporally.
false
the vast majority of individuals with schizophrenia are first diagnosed during an office visit with a psychiatrist or psychologist
false
the population- attributable risk fraction (PARF)
is an estimate of the proportion of cases of schizophrenia that would have been prevented if no individuals had been exposed to cannabis use disorder
The mesocortical dopamine pathway is believed to be primarily involved in which symptoms of schizophrenia?
negative symptoms
Type I schizophrenia was thought to be characterized by the presence of ____________ symptoms while Type II schizophrenia was thought to be characterized by the presence of ______________ symptoms.
positive; negative
The proportion of people who have a condition at a particular time period is referred to as the _________ of that condition:
prevalence
onset and initial presentation: what is prevalence
refers to proportion of persons who have a condition at or during a particular time period
what is incidence
refers to the proportion or rate of persons who develop a condition during a particular time period
Eugen Bleuler was the first to describe?
symptoms as "positive" or "negative" (Remember what they are?) He called it basic (obligatory) and accessory (supplemental)
Contemporary support for the Neurodegeneration Hypothesis of schizophrenia comes from evidence that indicates that delays in the start of treatment for individuals experiencing psychosis has deleterious effects on treatment response and long-term outcomes.
true
Despite the availability of criteria allowing reliable diagnostic identification, schizophrenia essentially remains a broad clinical syndrome defined by reported subjective experiences
true
Emil Kraepelin believed that dementia praecox was primarily a disease of the brain
true
In a healthy brain, a balance between inhibitory and excitatory neural activity does not fully emerge until late adolescence.
true
MRI is typically believed to be safer than CT and/or PET scans.
true
One possible explanation for the emergence of schizophrenia long after some neurodevelopmental insult has occurred is that the brain was initially able to compensate for the insult, but cannot continue to do so.
true
