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19 Cards in this Set
- Front
- Back
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Schizophrenia Associated Features
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• Inappropriate affect
• Loss of interest or pleasure in activities previously enjoyed (anhedonia) • Disturbance in sleep patterns • Lack of or refusal to eat • Psychomotor agitation or retardation • Difficulty with attention, concentration or memory • Poor insight into the presence of symptoms • Depersonalization, derealization, and somatic concerns that may reach delusional proportions • Odd ritualistic or stereotypes behaviors • Assaultive, violent, or unpredictable behaviors • Anxiety and phobias High comorbidity rates with substance related disorders, anxiety disorder, and personality disorders (schizotypal, schizoid, and paranoid) |
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Assessment/MSE: history, appearance, attitude, behavior
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• Longitudinal history of symptoms and comorbid variables (medical history, substance abuse)
• Appearance: often disheveled – because of symptoms – interfere with personal hygiene - Inappropriate clothing – disorganization or paranoia - Not diagnostic • Attitude: potentially hostile, annoyed, angry with paranoid type • Behavior: bizarre mannerisms, stereotyped movements - Catatonia, waxy flexibility, slow/lack of movements - Agitation |
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Assessment/MSE: eye contact, speech (rate, tone, volume), mood and affect
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• Eye Contact
- Paranoid: hypervigilant – scanning room, glancing suspiciously at therapist - Psychotic: poor eye contact, look away, responding to internal stimuli – may look toward a voice or image - Nystagmus (eye blinking); substance abuse, MS, or other GMC • Speech: rate, tone, volume - Pressured speech may be present – esp. if acute sx - Lack of prosody - negative symptoms = monotone speech - Volume – loud may imply agitation/psychosis or hearing loss; soft – anxiety/suspicion • Mood and affect: constricted, flat - Inappropriate – with positive symptoms or Disorganized type - Depression or indifference is common |
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Assessment/MSE: thought process, thought content
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• Thought process:
- Extrapolated from organization of speech - Looseness of associations - Tangentiality – weak connection of ideas - Circumstantiality – over inclusiveness to the point of loss of the theme • Word salad – words and phrases with no relation to grammatical rules - Echolalia - Related to neg sx: thoughts stop abruptly, absence of thoughts, delayed response to questions • Thought content - Thought insertion, broadcasting, or withdrawal - Ideas of reference - Paranoid ideation - Preoccupations, obsessions - Suicidal, homicidal ideation • May be related to auditory hallucinations |
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Assessment/MSE: perceptions, consciousness and orientation, judgment and insight
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• Perceptions
- Illusions and hallucinations - Auditory: human voices, background noise, sounds • Running dialogue between two or more voices, commentary on behavior • Seen as originating outside of person’s head • Consciousness and orientation - Disoriented, distracted - Attention/concentration problems • Judgment and insight - May be emotionally disconnected, lack of insight |
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Genetic Factors
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• Twin studies show that concordance rates for identical twins are significantly higher than for fraternal twins or siblings
• Schizophrenia is "genetically influenced" but not "genetically determined" • Adoption studies show that children are at higher risk for developing schizophrenia when a biological parent has the disorder than when an adoptive parent has the disorder. |
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Schizophrenia Gene?
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• Schizophrenia probably involves several genes working together (polygenic)
• Chromosomes 6, 8, 13, and 22 are currently receiving research attention |
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Prenatal Exposure
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• Studies have found a link between maternal influenza and subsequent schizophrenia in the offspring
• Famine and fetal malnutrition have also been linked to schizophrenia |
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Neuro-developmental Perspective
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• Many believe that vulnerability to schizophrenia stems from some kind of brain lesion that occurs in early development.
• The lesion lies dormant until the brain matures and problems from the lesion appear |
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Early Childhood Precursors
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Observed in children who later develop schizophrenia:
• Early motor abnormalities • Less positive facial emotion • More negative facial emotions • Disturbances in the movement or motor activity may also be an early indicator |
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Brain Structure
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• Brain imaging studies ave consistently found enlarged lateral ventricles to be associated with schizophrenia
• Studies show that parts of the brain are smaller in those with schizophrenia • There tends to be diminished blood flow and metabolism in these structures • Decreases in brain matter may be more progressive |
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Neurochemistry: Dopamine Hypothesis (DH)
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DH states people w/schizophrenia have much higher rates of dopamine.
DH of schizophrenia came about because: • Drugs that block dopamine receptors benefit patients with schizophrenia • Abuse of amphetamines can lead to a psychosis that resembles schizophrenia • Treatment of Parkinson’s with L-DOPA may trigger psychotic symptoms |
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Dopamine and Psychosis
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• Dysregulation in the dopamine system may make us pay more attention to stimuli that are not especially important
• Experiences that should be in the background become inappropriately important and worthy of attention |
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Family Factors
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• Double-bind interactions occur when the parent presents the child with ideas, feelings, or demands that are contradictory. (e.g. "Go away - Stay here;" "I want you - I hate you"
• The "schizophrenogenic" mother is described as being cold and distant • The "schizophrenogenic" mother and double bind interactions are not very well supported as etiological factors and few accept these as plausible explanations |
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Express Emotion
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• Express Emotion is characterized by families that are critical, hostile, and over involved with the patient
• High levels of EE have been shown to predict relapse |
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Harvey Article: An Open Trial of Cognitive Therapy for Chronic Insomnia (Overview)
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• Development of a cognitive therapy model for chronic insomnia
• Therapy is based on a cognitive model which suggests that the processes that maintain insomnia include: 1. worry and rumination; 2. additional bias and monitoring for sleep-related threat; 3. unhealthy beliefs about sleep; 4. misconception of sleep and daytime deficits; 5. the use of safety behaviors that maintain unhealthy beliefs • Aim was to reverse all five maintaining process during both night AND the day. • 19 patients meeting insomnia criteria • Assessments @ 3, 6, and 12 months followup • Significant improvement in both nighttime and daytime impairment was retained up to 12 month followup |
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Harvey Article: An Open Trial of Cognitive Therapy for Chronic Insomnia (Interventions)
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Intervention to:
• Reduce worry and rumination (taught to identify and evaluate sleep-related worrisome thoughts) • Reduce additional bias and monitoring for sleep related threat (e.g., monitoring the clock, for signs of fatigue and concentration lapses during the day) • Reduce unhelpful beliefs about sleep (e.g., plan day carefully in order to conserve energy) • Reduce misperception (i.e., overestimate how long it takes to fall asleep and underestimate how long they have slept) • Reduce the use of safety behaviors (an overt or covert action that is adopted to avoid fear outcomes; e.g, canceling important appointments at work) |
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Harvey Article: An Open Trial of Cognitive Therapy for Chronic Insomnia (Relevant Points)
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• Outcome measures: At pretreatment assessment, 100% of the participants met criteria for primary insomnia. At posttreatment, 3,6,12mo followup, no participant met criteria.
• Average # of sessions: 14 • Hypothesis is that one pathway to reduce insomnia is to reverse cognitive maintaining processes. • There was also a significant reduction in daytime impairment. Hence, cog therapy also holds promise as an intervention for improving daytime function in insomnia • Significant reductions across all process measures were retained to 12 months. • Limitations: no control group, small sample, not possible to compare these results with CBT-I studies B. improves sleep C. improves daytime functioning • Overall, the results were strongest on measures of daytime functioning and moderate for measures derived from the sleep diary |
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Harvey Article: An Open Trial of Cognitive Therapy for Chronic Insomnia (Conclusions)
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• Cog therapy for insomnia awaits evaluation in a controlled trial.
• Preliminary results suggest it is: A. acceptable to patients with insomnia B. improves sleep C. improves daytime functioning • Overall, the results were strongest on measures of daytime functioning and moderate for measures derived from the sleep diary |
