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45 Cards in this Set
- Front
- Back
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Positive (Psychotic ) Symptoms
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1. Functions that are present that should not be
2. approximately 50-70% experience them 3. Hallucinations 4. Delusions |
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Hallucinations
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1. Heightened sensory experiences that are not due to external stimuli
2. Experienced by 5 senses 3. Auditory is the most common Broca's Area Own vs. other voices |
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Delusions
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1. Rigidly held beliefs that are inaccurate or inconsistent with how people experience reality
2. 5 types: persecutory, referential, grandiose, somatic, religious 3. Can be bizarre or non-bizarre 4. Etiological view Motivational Deficit |
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Negative (Psychotic) Symptoms
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1. Aspects of normal behavior that should be present but are absent
2. Experienced by 25% 3. Anhedonia 4. Alogia 5. Avolition 6. Blunted/Flat Affect |
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Anhedonia
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Lack of pleasure or interest
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Alogia
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Lack of spontaneous speech
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Avolition
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Lack of will power
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Blunted/Flat Affect
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Lack of Expressiveness
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Disorganized (Psychotic) Symptoms
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1. Do not fit catagories of negative or positive
2. Disorganized Speech 3. Grossly Disorganized/Bizarre Behaviors 4. Catatonic Motor Behaviors |
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Disorganized Speech
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1. Tangential Speech, very difficult to follow
2. conveys little meaning due to poor context maintenance(word salad) |
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Grossly Disorganized/Bizarre Behaviors
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Ranges from childlike silliness to unpredictable agitation
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Catatonic Motor Behaviors
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1. Moving like you have Parkinson's
2. Can't move at all sometimes |
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Progression of Schizophrenia
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1. Premorbid: mild motor, social, and cognitive impairments
2. Prodromal: unusual psychotic-like behaviors 3. Onset/Deterioration: positive, negative, cognitive, and mood symptoms 4. Chronic/Residual: positive, negative, and cognitive symptoms |
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Criteria for Schizophrenia: Active Phase
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1. Person must have impairent in functioning
2. TWO or more of the following *Delusions *Hallucinations *Negative symptoms *Disorganized Speech *Grossly Disorganzied Behavior *Catatonic Behavior |
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Criteria for Schizophrenia: Prodromal and Residual Phases
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1. May only have negative symptoms
2. May have other symptoms in less severity |
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Excluding Related Disorders (Schizophrenia)
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1. Before a diagnosis of schizophrenia can be given, disorders with similar symptoms must be ruled out
*Mood Disorder with Psychotic Symptoms *Schizoaffective Disorder *Brief Psychotic Disorder *Delusional Disorder |
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Schizophrenia vs. Mood Disorders with Psychotic Symptoms
Schizophrenia With Mood Symptoms |
If depression and mania symptoms are present, duration must be brief in relation to active and residual schizophrenia symptoms
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Schizophrenia vs. Mood Disorders with Psychotic Symptoms
Mood Disorders with Psychotic Symptoms |
The psychotic symptoms occur only during a manic or depressive episode
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Schizophrenia vs. Schizoaffective Disorder
Schizoaffective Disorder |
1. Mood symptoms must be present for a substantial portion of the psychotic disturbance
2. Delusions and hallucinations must be present for at least 2 weeks without prominent mood symptoms |
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Schizophrenia vs. Delusional Disorder
Delusional Disorder |
1. Non-bizarre delusions are the prominent psychotic feature
2. other schizophrenic symptoms, such as hallucinations, disorganized and negative symptoms are largely absent |
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Duration: Brief psychotic disorder, schizophreniform disorder, schizophrenia
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1.BPD=1 day-1 month
2.Schizophreniform= 1 month-6 months 3.Schizophrenia=6 or more months |
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Difference between:
Mood Disorder w/ Psychosis Schizophrenia Schizoaffective Disorder |
The duration of mood and psychotic symptoms
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Difference between:
Schizophrenia Schizophreniform Disorder Brief Psychotic Disorder |
Duration of entire disturbance
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Difference between:
Schizophrenia Delusional Disorder |
Type of delusion and presence/absence of other symptoms
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Schizophrenia Subtypes
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1.Paranoid
2.Disorganized 3.Catatonic 4.Undifferentiated 5.Residual |
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Paranoid Schizophrenia
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One or more delusions OR frequent hallucinations
No prominent disorganized behavior/speech, catatonic behavior, or flat/inappropriate affect |
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Disorganized Schizophrenia
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Disorganized speech and behavior
AND Flat/inappropriate affect |
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Undifferentiated Schizophrenia
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Met criterion A but does not fit the other symptoms
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Residual Schizophrenia
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Attentuated symptoms in criterion A
OR Presence of negative symptoms |
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Prevalence of Schizophrenia
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.2-1.5%
Course = chronic *moderate to sever lifetime impairment *life expectancy = less than average (suicide) Female:Male = 1:1 *females have later age of onset and typically better outcomes |
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Gender Differences in Schizophrenia
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*Age of onset is younger for men
*Pre-morbid social functioning is better for women *Men have more negative symptoms *Men have a more chronic course and poorer response to treatment |
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Etiology of Schizophrenia
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*Before birth: genes, maternal exposure to virus, complications/illness during pregnancy
*During birth: complications during delivery *At various times during development: brain abnormalities *Childhood/Adolescence: socioeconomic status, family factors |
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Schizophrenia and Genes
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*Adoption and twin studies indicate that there is a genetic influence
~Pair-wise concordance rates show ~~MZ (identical) = 48% ~~DZ (fraternal) = 17% *twin concordance rate implicates other factors beyond genetics |
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Schizophrenia and Neurobiological Influence: Dopamine Hypothesis
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The Dopamine Hypothesis:
*Agonists (causes action): increased schizophrenic-like behavior *Antagonists(inhibits action): Reduce schizophrenic-like behavior **increased dopamine is present in schizophrenia *Problems: ~over simplistic ~Antagonists don't always work ~Slow response to meds ~Little impact on negative symptoms |
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Schizophrenia and Neurobiological Influence: Brain Structure
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*Enlarged ventricles
*Reduced tissue volume *Hypofrontality: dorsolateral prefrontal cortex |
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Prenatal and Perinatal (Schizophrenia)
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*Viral infections
~influenza *Pregnancy and delivery complications ~Rh incompatitbility ~Anoxia: total depletion in oxygen level *likely interact with genetics and environment |
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Socioeconomic Status and Schizophrenia
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*Highest prevalence of Schizophrenia found in those with lower SES
~Hypothesis 1: "Social Causation" Negative factors related to low SES lead to development of illness ~Hypothesis 2: "Social Selection" Cognitive/Social impairments associated with the illness leas a person to drift down the SES ladder |
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Family Factors: Expressed Emotion and Schizophrenia
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*EE = family member's negative, critical, and hostile attitudes and behavior toward patient AND/OR emotional over-involvement and intrusiveness of family
*Patients likely to relapse ~family may exibit high EE after relapse |
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Schizophrenia Relapse
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Return of positive symptoms, increased medication dosage, or re-hospitalization
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Schizophrenia Treatment: Older Antipsychotic Medications
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*Target dopamine receptors
*Work well for positive symptoms *Induce side-effects similar to Parkinson's ~extrapyramidal symptoms: tremors, agitation, involuntary posturing, motor rigidity, inertia ~tardive dyskinesia: involuntary movements of mouth and face and spasmodic body movements |
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Schizophrenia Treatment: Newer Antipsychotics
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*Better at treating negative symptoms
*Also have side effects (Clozapine has 1% chance of lethal blood condition) *Affect other neurotransmitters like serotonin and norepinephrine *Relapse rates are high if medication stops, some relapse even if medication is continued |
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Schizophrenia Treatment: Psychosocial
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*Long-term strategies to improve aspects of a patient's life other than the reduction of psychotic symptoms
~improve social competence ~housing stability ~employment *Types ~family therapy ~social skills training ~vocational rehabilitation ~assertive community treatment |
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Assertive Community Treatment (Schizophrenia)
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*A comprehensive team works together to meet the needs of the client
~psychiatrists ~nurses ~social workers ~vocational counselors *Staff to client ration is high, staff available 24/7 *Good outcomes |
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Family Therapy (Schizophrenia)
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*Most effective if the family is high in expressed emotion
*Some psychosocial treatments aim to improve family coping skills and reduce relapse ~eliminate unrealistic expectations ~improving communication and problemsolving skills of family members |
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Cognitive-Behavioral Therapy (Schizophrenia)
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*Goals
~Decrease conviction of delusional beliefs ~Promote more effective coping ~Reduce distress *Teaches skills to challenge and modify beliefs *Effectiveness ~Superior to control ~Significantly decrease positive symptoms ~Continued improvement |
