Abnormal Psyc- Chapter 9

Front 1

Heterogenity

Back 1

Tendency for people with disorder to differ from each other in symptoms, family and personal background , response to treatment and ability to live outside of hospital.
- difficult to predict how person will be affected by schizophrenia and prospects for future and whether condition will improve, stabilize or worsen.

Front 2

Prevalence

Back 2

Total number of cases with the disorder at given point in time, changes depending on how diagnosis is made. Men and women equal risk, Strike men earlier and more severe later and more emotional for women

Front 3

Negative Symptoms

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Absence or loss of typical behaviours and experiences

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Avolition

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Apathy and loss of motivation

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Anhedonia

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Inability to feel pleasure and lack of emotional responsiveness

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Hallucinations

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Misinterpretations of sensory perceptions while awake and conscious and absence or corresponding external stimuli.

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Delusions

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Implausible beliefs that persist despite reliable contradictory evidence. They reflect disorder of thought content.

Front 8

Persecutory Delusions

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"Paranoid", believe being pursued or targeted. Most common.

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Referential Delusions

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Common meaningless occurrence have significant and personal relevance.

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Somatic Delusions

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Beliefs related to patient's body.

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Religious Delusion

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Belief that biblical or other religious passages offer way to destroy or save the world.

Front 12

Delusions of Grandeur

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Belief in divine or special powers that can change course of history or provide communication channel to god.

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3 Expectations of Persecutory Delusions

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1. Develop in people who make interpretations of experience too quickly and jump to conclusions.
2. Bias in reasoning so that negative events are always perceived as coming from environment or form other people
3. Persecutory delusions reflect inability to imagine feeling, perspectives and experiences of other people

Front 14

Loosening of Associations

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Logical connections between ideas, shifts from one topic to another quickly. Answers to questions are hardly related.

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Alogia

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Deficit or decrease in communication. No elaboration.

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Affective Flattening

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Lack of emotional expressiveness. Grossly disorganized; trouble with goal-directed behaviours.

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Catatonic Behavior

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Decreased responsiveness to environment, assume unusual and rigid postures, resistant to change.

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Waxy Flexibility

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Allowing others to make their body and maintaining position.

Front 19

6 Criteria

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A. Characteristic symptoms
B. Social or occupational dysfunction
C. Persistence of disturbance for at least 6 months
D. Exclusion of concurrent schizoaffective or mood disorders
E. Exclusion of substance use or medical conditions
F. Consider history of autistic disorder or another pervasive developmental disorder.

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Mood congruent

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Consistent with a person's emotional state and reflect a mood disorder rather than schizophrenia.

Front 21

Paranoid type

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Prominent delusions or auditory hallucinations and the absence of markedly impaired cognitive functioning or affect.
- Absence of symptoms including disorganized speech and behaviour, catatonia and flat or inappropriate emotions.
-Least disabling
- Most common

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Disorganized Type

Back 22

Most disabling
- Disorganized speech and behaviour as well as flat or inappropriate affect.
- Absence of goal orientation and may present impaired functioning

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Catatonic Type

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Acute psychomotor disturbance
- Immobility
- Extreme negativism and rigidity
- Peculiarities of voluntary movement

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Undifferentiated Type

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Meeting Criterion A but without sufficient characteristics to satisfy criteria for the paranoid, disorganized or catatonic subtypes.

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Residual Type

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Patient with at least one prior episode of schizophrenia and with negative symptoms as well as attenuated positive symptoms.
- Not currently experiencing prominent positive psychotic symptoms.

Front 26

Disease Markers

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Objective diagnosis is possible if measurable disease markers can be identified.
- MArkers that occur in virtually all people with the illness
- Any physical, psychological or biological characteristics or trait.

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Sensitivity

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A true marker must be very common among patients with diagnosis for the disorder.

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Specificity

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Marker occurs very infrequently among healthy people or people with other disorders.

Front 29

Vulnerability Marker

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Vulnerability marker is a stable and enduring sign or trait of the disorder that occurs before a person actually succumbs to the disorder and experiences symptoms.
- Reflects inherent predisposition

Front 30

Endophenotype

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Intermediate between the microscopic world of genes and nerve cells and the experiential and psychological world or symptoms.

Front 31

Cognitive Marker

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Impairment on Continuous Performance Test.

Front 32

Eye Tracking

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Irregular eye movements
- Neurological impairments
- Better suited as potential marker for a specific variant of schizophrenia or for broader classification of impairment that includes other psychiatric disorders.

Front 33

Cognitive Subtypes

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Patients with schizophrenia could be separated into cognitively impaired, cognitively normal and verbal memory-impaired subtypes.

Front 34

Schizophrenogenic

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Severely rejecting mother

Front 35

Collective Unconscious

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Carl Jung, Universal symbols existed in the unconscious mind an erupted into waking life in the course of dreams and mental illnesses like schizophrenia.

Front 36

Social Drift

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People from lower socio-economic classes could not rise economically if they had a predisposition for schizophrenia.

Front 37

Hypokrisia

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Meehl, occurs throughout the brain, making nerve cells abnormally reactive to incoming stimulation. A single gene inherited from either parent.

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Cognitive Slippage

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Information is disorganized, incoherent and "scrambled"

Front 39

Aversive Drift

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Related to negative symptoms like social withdrawal and disinterest. Unselective neural firing that causes cognitive slippage, gives rise to a gradual increase in punitive, unpleasant social experience.

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Schizotype

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Experiencing cognitive slippage and aversive drift.
- Person may be spared full-blown psychotic disorder.

Front 41

Compensated Schizotype

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Able to function in everyday life, although usually at a cost to him or herself or to other people. Meehl mentioned Adolf Hitler as an example.

Front 42

Neurodevelopmental Diathesis-Stress Theories

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Subtle brain injuries during fetal development or birth could become diathesis.
-Stress of maturational demands on weakened brain that precipitates psychotic disorder

Front 43

Genetic Contribution

Back 43

Schizophrenia is observed to recur in some families with a risk of about 13 % to the children of a parent with schizophrenia.

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Incomplete Penetrance

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Proportion of people with a dominant gene will fail to show the effect of that gene. Lack of expression may be due to the environment or to other factors.
- Penetrance of schizophrenic gene is less than 100%, may be closer to 50%.

Front 45

Birth-related Complications

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Medical and delivery related problems at birth may be key environmental and biological events that interact with genetic diathesis and further predispose a person to schizophrenia.

Front 46

High Risk Children

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A child of a parent with schizophrenia has at least 10 times the normal risk of developing the disorder.
- "follow back" approach, begins with patients known to have schizophrenia in adulthood.
- Look back in time and find evidence of disturbed mental life and behaviour during infancy and childhood.

Front 47

Expressed Emotion

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Negative itnerpersonal communications directed at family members with the disorder.
- Also occurs in families with mood and eating disorders.
- Neg family attitudes may make adjusting to psychological problems difficult in general rather that only in relation to schizophrenia.

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Cumulative Liability

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Shows itself early in behaviour and increases with adverse environmental events and stresses over the course of childhood and adolescence.

Front 49

Neuropsychological Tests

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Frontal or prefrontal lobe of the brain.
- Believed that psychological capacities ascribed to the frontal brain were impaired in schizophrenia.

Front 50

Wisconsin Card Sorting Test

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Object of this test is to discover the new principle each time it changes and to respond with correct matches.
- Easy for healthy people
- Prefrontal damage abnormally few successfully correct matches.

Front 51

Structural Magnetic Resonance Imaging

Back 51

Clear detailed images of many brain structures, volume and shape of different brain regions in patients and healthy people.

Front 52

Finding from CT and MRI studies

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Complex patterns of structural abnormalities in patients with schizophrenia.
- CT suggests structural alterations in brains of patients, ventricle are larger. Compression or loss of nerve tissue.
- MRI shows reduced grey matter volumes

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Positron Emission Topography

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Displays or readout changes in blood flow, metabolism or rate at which energy is used, or the location and density of nerve cells containing specific kinds of chemical receptors.

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Functional Magnetic Resonance Imaging

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Detecting the changes in blood oxygenation and flow that occur in response to neural activity.

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Findings in PET and fMRI sutdies

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Functional activation changes
- Different patterns of frontal brain activation and deactivation in schizophrenia rather than just overall reduction.
- Left temporal lobe involved in attention, understanding of speech and written language, and interpretation of visual world.
- Amygdala and hippocampus, colour these interpretations with emotion and store them in memory.

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Dopamine Hypothesis

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- Antipsychotics block effects of dopamine
- Especially dopamine D2 receptor site
- Cocaine and amphetamine increase DA
- Neurotransmitters byproducts found in cerebral spinal fluid

Front 57

Ligands

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Chemical receptors that bind selectively with specific receptor sites
- Could find out density and distribution of various receptors.

Front 58

Early Treatment

Back 58

Insulin coma
Psychosurgery
- Frontal lobotomies
- Leukotomies

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Henry Laborit

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Interested in syndrome of circulatory shock that occurred during and after surgery.

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Chlorpromazine

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First genuine antipsychotic medication.
- Mood influencing effects
- Antipsychotic effects took several weeks to develop fully

Front 61

Risperidone and Olanzapine

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Symptom control with fewer side effects than the older chlorpromazine family of drugs.
- Return of symptoms if drugs discontinued

Front 62

Cognitive Behavioural Therapy

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At least one form of psychotherapy may indeed be helpful. Focus on four principle problems:
1. Emotional Disturbances
2. Psychotic Symptoms
3. Social Disabilities

Front 63

Normalization

Back 63

Form of psycho-education, understand symptoms by comparing their experiences to those of mentally healthy adults.

Front 64

Stages of CBT

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1. Generate trusting and collaborative relationship
2. Record and monitor thoughts
3. Focus in individual's unique clinical presentation, test validity of symptoms, consider influence on daily life, develop alternative explanations for delusions and hallucination. Do not confront
4. With negative symptoms id sources of inactivity or withdrawal.
5. Try to direct cognitive skill development toward preventing symptom relapses and sever illness episodes.

Front 65

Social Skills Training

Back 65

Learning based intervention
- Rehab to develop practical social and living skills.
- Promotes independence and reduces stressors
- More effective in other patients

Front 66

Cognitive Remediation Programs

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Target specific thinking skills, teach compensatory strategies, providing practice exercises and holding group discussions.

Front 67

Family Therapy

Back 67

Conceptualizes the patient as a member of a family system.
- Aims for active involvement of each member of the family in the treatment process.
- Focus in deinstitutionalization
- Psycho-education

Front 68

Early Intervention

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People considered at high risk for developing schizophrenia as well as those in the prodromal and first episode phases of the disorder.

Front 69

Prodrom

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Period before the appearance of psychotic symptoms when the vulnerable adolescents often become withdrawn and suspicious.

Front 70

"First Episode" Patients

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Experience their first episode of intense unmistakable symptoms.

Front 71

Neologisms

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Made up words

Front 72

Persevation

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Stuck on topic

Front 73

Thought Insertions

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Make them believe things

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Thought Withdrawal

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Thoughts being stolen form their head

Front 75

Echolalia

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Repeat back what others say

Front 76

Ecopravia

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Imitate actions of other people

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3 Phases

Back 77

1. Prodromal: Start symptoms at low levels, unusual behaviour, no full delusions and hallucinations
2. Active: Psychotic symptoms, episodic
3. Residual: Not full psychotic symptoms anymore

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D2

Back 78

Positive symptoms, too much DA

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D1

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Negative symptoms, too little DA

Front 80

Frontal Lobe

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Avolition, flexibility, motivation

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Left Temporal Lobe

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Disorganized speech, thought disorder

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Right Temporal Lobe

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Process emotion, lack of affect

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Aprosodia

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Recall meaning from tone of voice

Front 84

Basal Ganglia

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Motor, could explain catatonia

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Neuroleptic

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Anti-psychotics