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62 Cards in this Set
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Schizophrenia
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disturbances in thought, emotion, and behavior-disorganized thinking, faulty perception and attention, lack of emotional effectiveness, inappropriate expressions, and disturbances in movement and behavior
-early onset, poor prognosis, delusions, hallucinations, stereotypy, negativism |
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Emil Kraepelin
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unifed distinct symptoms under the name dementia praecox
-distinguished differences between schizophrenia and bipolar |
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dementia praecox
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the orignial name for schizophrenia
-defined by an early onset, and deterioration of intellectual ability -include diagnostic subtypes: catatonia, hebephrenia, and paranoia |
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catatonic schizophrenia (SUBTYPE)
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-catatonia: constellation of schizophrenia symptoms including repetitive, peculiar, complex gestures, and, in some cases, an almost manic increase in overall activity level
-features: a subtype of manic-depressive -WITHIN SCHIZOPHRENIA: alternating between stuporous immobility and excited agitation |
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hebephrenia schizophrenia (SUBTYPE)
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disorganized schizophrenia
-some delusions and hallucinations but not completely categorized by them -disorganized speech, behavior, and perceptions |
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paranoia schizophrenia (SUBTYPE)
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a type of schizophrenia in which patient has numerous systematized delusions as well as hallucinations and ideas in reference. May also be angry, agitated, and argumentative
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Diagnosis of Schizophrenia
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Must have 2 or more symptoms for at least 1 month
-delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms -social and occupational functioning have declined since onset -signs of disturbance for at least 6 months; at least 1 month duration for delusions, hallucinations, disorganized speech, disorganized behavior or catatonic behavior; during the remaining time either negative symptoms or other symptoms in attenuated form |
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Positive Symptoms
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excesses and distortions
-delusions and hallucinations |
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Negative Symptoms
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behavioral deficits
-avolition-lack of motivation/interest -alogia-lack of speech -anhedonia-pleasure for activities -flat affect-lack of expression of emotion -asociabilty-severe impairments in relationships |
flat affect: 1/4 display this symptom
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Negative Symptom surprises
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-people with schizophrenia report a decreased anticipatory pleasure although when experiencing something pleasurable, they report the same consummatory pleasure as those without schizophrenia
-people with schizophrenia have a flat affect but still experience the emotions internally |
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Bleuler
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-created the name SCHIZOPHRENIA (split brain)
-did not believe there was always an early onset or a progressive pattern of dementia -associative splitting of the mind -connections of personality is inhibited in schizophrenia -difficulty in keeping one's train of thought |
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psychotic
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before: delusions and hallucinations
now: major disturbances in thought, emotion, behavior, and perception |
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Diagnosis of Schizophrenia
-Criterion A |
Criteria A: 2 or more symptoms present for a month
-delusions (if bizarre, satisfies criterion alone) -hallucinations (if 2 voices conversing in commentary or running commentary of person's behavior or thoughts, satisfies criterion alone) -disorganized speech (derailment) -grossly disorganized catatonic behavior -negative symptoms (anhedonia) |
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Diagnosis of Schizophrenia
-Criterion B |
Social/occupational dysfunction
-downward drift -refers to fact that individuals with Schizophrenia develop a lower economic level than their parents |
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Diagnosis of Schizophrenia
-Criterion C |
duration-symptoms persist for at least 6 months (include Criterion A); subthreshold symptoms rest of time
-subthreshold symptoms are usually negative symptoms if not displayed for 6 months |
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Diagnosis of Schizophrenia
-Criterion D |
Schizoaffective/Mood Disorder exclusion
-combo of schizo and mood disorder symptoms together |
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Diagnosis of Schizophrenia
-Criterion E |
Substance/general medical exclusion
-symptoms are not due to substance abuse ex: phencyclidine (shrooms) or ketamine |
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Diagnosis of Schizophrenia
-Criterion F |
Presence of Autistic or Pervasive Developmental Disorder
-if person have Austism, and does not fit the other criterion, they would not receive a seperate diagnosis |
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Disorganized Symptoms
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hebephrenic, odd emotionality, and catatonic behavior
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NOTE
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-Schizophrenia does not need a singular symptom for diagnosis like mania for Bipolar, it has heterogenetity across patients
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Theoris of Delusions (McKay)
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*these theories suggest why people with this disorder continue delusions even when contradictions are present
Motivational -attempts to deal with and relieve anxiety felt -creates stories around some issue -become preoccupied with the delusion Deficit -beliefs results from brain dysfunction which creates disordered thoughts |
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Delusions
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-delusions-false beliefs------persecutory:most common
-misinterpretation of perceptions or experiences -resistant to disconfirming evidence -may be bizarre -50-70% experience positive symptoms -Jaspers-basic characteristics of madness -Cotard's Syndrom-they think they are dead -Capgras Syndrome-rare, they think that their loved one has taken body parts out of them or they are aliens |
Types of Delusions:
Referential Grandiose Somatic Religious |
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Hallucinations
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Any sensory modality
-absence of sensory stimulation Auditory -audible thoughts -running commentary -vocies conversing satisfy Criterion A--->speaking in the third person Biological: increase levels of activity in Broca's area during auditory hallucinations |
Auditory is the most common
Must be completely conscious to be considered a hallucination |
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Broca's and Wernicke's
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Broca's area is involved in speech production whereas Wernicke's area is involved in language comprehension
-auditory hallucinations involve understanding the speech of others -consistent with metacognition theory |
more activation in Broca's than Wernicke's area
-suggests that they are hearing their own thinking, they just don't comprehend that it's their voice |
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Disorganized Symptoms
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erratic behaviors that affect speech, motor behavior and emotional reactions
*must impair effective communication -incoherence -speech severaly disorganized (like receptive aphasia), illogical speech -Loose associations -rambles, difficulty sticking to one topic, Tangentiality-not answering specific questions -grossly disorganized behavior -inappropriate affect, dress, sexual behavior, or hoarding |
25% of Schizophrenics experience these symptoms
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Prodromal Symptoms
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identify symptoms (emotional expression) that can predict the development of the disorder
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Schiffman
-videotaped children at lunch -negative affect: more likely to develop |
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DSM subtypes
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depends on presentation of symptoms
-follows algorithm -three types -catatonic type -disorganized type -paranoid type |
people DO change subtypes
based on prominent symptoms during evaluation |
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Schizophrenia subtypes
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paranoid: delusions, hallucinations related to persecution, or grandiosity, ideas of reference
undifferentiated: meet criteria for schizophrenia but not for a subtype residual: no longer meet criteria for schizophrenia but still exhibits signs of disorder for at least 1 episode |
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Evaluation of Subtypes
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diagnosis of subtypes is difficult
-reliability low poor predictive validity overlap of symptoms among subtypes |
there is an overlap of subtypes, therefore the subtypes will most likely be taken out of DSM diagnostic criteria
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Other Associated Descriptive Features
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-sleep disturbances
-abnormalities of psychomotor activity EX: pacing, rocking, grunting,catatonia and disorganzied behavior -poor insight regarding illness -anosognosia |
they do not feel that they are ill or have anything wrong with them
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Features of Schizophrenia
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-disorder impacts families and friends
-social skills deficits -substance abuse= 80-90% smoke -commorbidity with other disorders too -suicide rates high (10% succeed, 20-40% parasuicide) |
10% suicide rate
80% smoke |
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Features of Schizophrenia continued
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-lifetime prevalence= 1%
-slightly more often in men -onset typically late teens or early adult men: 18-25 women: 25-35, after 40 -diagnosed more frequently in African Americans -may reflect clinician bias or cultural insensitivity |
lifetime prevalence=1%
more men African Americans |
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Other Psychotic Disorders
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Schizoaffective Disorder: symptoms of both mood and schizophrenia, prognosis similar to Schizophrenia
-Brief Psychotic Disorder: symptom duration of 1 day to 1 month, often triggered by extreme stress -Schizophreniform Disorder: symptom duration greater than 1 month but less than 6 months -Schizophrenia |
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Other Psychotic Disorder continued
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Shared Psychotic Disorder
-rare -develops delusions as a result of a close relationship with a delusional person |
on test
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Other Psychotic Disorder continued
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Delusional Disorder: feeling that one is being treated malevolently
-non-bizarre delusions -subtypes: jealous, erotomania, somatic -persecutory and grandiose -no other symptoms of schizophrenia |
NO hallucinations or disorganized speech
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Biological theories of Schizophrenia
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-genetic transmission: can develop with or without genetic link
-brain structure/functional abnormalities -neurodevelopmental factors: at birth -neurotransmitter theories |
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Genetic
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-family, twin and adoption studies
-neurodevelopmental: one twin could get less oxygen causing development -different genes may be responsible for different symptoms: a general diathesis may be inherited |
traits are inherited
they have found at least 11 chromosomes linked to schizophrenia not just one gene for schizophrena |
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Family Studies
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-the greater the genetic similarity, the greater the risk
-87% with schizo parents DO NOT develop schizo -63% do not have family with schizo but DO develop schizo |
-87% with schizo parents DO NOT develop schizo
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Twin Studies
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-MZ 48%
-DZ 17% -heritability in Finnish twin study-83% -symptoms, onset, course, and prognosis may vary |
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Epigenetic
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discordant twins showed numerous differences in molecular DNA structure than concordant
-in areas of dopamine -one has it, one doesn't |
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Adoption Studies
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-adopted children are 10x more likely to develop if biological parent has it
-Finnish adoption studies: if mother has schizophrenia, child is more likely to develop it along with other disorders |
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Offspring of Twins
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-nonschizophrenia parents: child=1.7%
-if a parent or twin has schizophrenia, child=17% |
one twin may not have the gentic link to schizo but may have children that develop it if the other twin does have the genetic link
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Endophenotyping= behaviors linked to the development of schizophrenia
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-biomarker linking phenotypical behaviors to genetics
-eye-tracking -cognitive deficits in emotion identification -inability to filter out unnecessary information (prepulse inhibition deficits) |
These behaviors are indications that a child will develop the disorder
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Enlarged Ventricles
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not all, but many do
-implies atrophy of brain tissues or adjacent brain areas have not fully developed, observed more in males -if they have an enlarged ventricle=more severe symptoms and less responsive to meds -suggests that schizophrenia may increase the progression of aging |
Enlarged ventricles correlate with:
-poor performance and cognitive tests -poor premorbid adjustment -poor response to treatment |
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Prefrontal Cortex
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-shows deficits in cognitive things related to this area
-dysfunction seems to occur before the onset -impairment on neuropsychological tests (memory) -smaller, less activity (hypofrontality) even in those who have not developed the disorder -individuals show low metabolic rates in Dorsal Lateral Prefrontal Cortex: failure to show frontal activated related to negative symptoms |
memory and negative symptoms related to Prefrontal Cortex
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Continued Brain Structure
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-abnormal connection between the prefrontal and the amygdala and the hippocampus=poor memory consolidation
-deteriorated brain areas may contribute to the different manifestations of disorder -neuroimaging studies show structural changes across the cortex from 13-18 |
suggests that brain maturation is linked to the onset or the appearance of it
-peak in dopamine during this time -from imaging-able to predict onset |
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Animal Model
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-neuronatal Ventral Hippocampal Lesion
-experimental model of schizophrenia -projection to PFC -aberrant development of PFC |
surgical connection of the hippocampus and the PFC
-difficult to accomplish |
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Neurodevelopmental
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Congenital Factors
-damage during gestation or birth -obstetrical complications rates high in patients with schizophrenia -prenatal hypoxia=delivary may result in loss of coritcal matter (30% of individuals) viral damage to fetal brain -flu during 2nd trimester=schizophrenia rates are higher -maternal exposure to parasite/herpes simplex/rubella |
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Developmental Factors
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-PFC matures in adolescence or early adulthood
-dopamine activity also peaks in adolescence -stress activates HPA system which triggers cortical secretion= cortical increases dopamine |
dopamine is highly indicated in schizophrenia
-PFC not developed until teens |
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Neurotransmitters
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Dopamine theory
-disorder due to excess levels of dopamine -drugs that alleviate symptoms reduce dopamine -neuroleptics (dopamine antagonists) produce negative side effects similar to Parkenson's disease -Amphetamines, which increase dopamine levels, increase the positive symptoms -L-Dopa produces schizophrenic like symptoms -Neuroimaging studies show more dopamine receptors and higher levels of dopamine in people with schizophrenia |
L-dopa (treatment for Parkenson's) creates symptoms of Schizo
-Amphetamines increase dopamines and increase schizo symptoms -Antagonists alleviate symptoms |
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Evaluation of Dopamine Theory
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Dopamine theory doesn't completely explain disorder
-antipsychotics blocik dopamine rapidly but symptom relief takes several weeks -to be effective, antipsychotics must reduce dopamine activity to below normal levels -many do not respond to phenothiazines or other dopamine antagonists |
-Zyprexa is used for those who do not find relief from traditional antipsychotics
-it is a very weak antagonist |
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Dopamine Theory Revised
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mesolimbic pathways
-excess numbers of dopamine receptors or oversensitive dopamine receptors in the striatum -excessive stimulation of D2 receptors -antipsychotics bind to D2 receptor in this area blocking dopamine's action -related to positive symptoms |
Dopamine's D2 receptors are excessively stimulated which produce positive symptoms
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Dopamine Theory Revised Continued
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-unusally low dopamine in PFC- Mesocortical
-deficiency in stimulation of D1 receptors |
D1 receptor deficiencies are related to:
-cognitive deficits -negative symptoms -antipsychotics such as phenothiazine are ineffective |
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Other Neurotransmitters
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-serotonine neurons regulate dopamine neurons in mesolimbic pathway
-deficiencies in GABA and Glutamate |
GABA and Glutamate are suggested to be a link to Schizophrenia because drugs like PCP and ketamine create positive symptoms
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Psychosocial Factors
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1. reaction to stress=more reactive to stress
2. socioeconomic status -sociogenic hypothesis= stress cause poverty -social selection theory= downward drift |
enhanced reaction to stress
downward drift |
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Family Factors
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1. schizophrenogenic mother
-overprotective and rejecting simultaniously 2. expressed emotion high=hostility by family 3. Communication deviance -hostility and poor communicaton -not specific to families of schizo but did predict onset in one study |
Evidence does not support the conflicting mother theory
-high expressed emotion does cause relapse but does NOT cause development |
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Medical Treatment
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-first generation antipsychotic meds= phenothiazines, butyrophenones (little effect on negative symptoms)
-Etrapyramidal side effects= tardive dyskinesia (neurological disorder), Akinesia (slowed motor, monotone, expressionless), maintenance dose |
difficulty for compliance
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Medical Treatment Continued
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-second generation antipsychotics= clozapine, binds to D4 receptor, and impacts Seritonine
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Side effects:
-can impair immune symptom functioning, seizures, dizziness, fatigue, drooling, weight gain, ARGANULOCYTOSIS (deficiency in genulocytes May improve cognitive functioning |
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Other Biological Treatments
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-insulin coma therapy (1930s)
-psychosurgery (prefrontal lobotomies) -ECT -TMS-for hallucinations, magnetic fields interrupt normal brain communication |
TMS is the only one used anymore
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Psychological Treatments
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1. family therapy to reduce expressed emotion
-educate family about causes, symptoms, and signs of relapse -stress importance of medication -help family avoid blaming patient -improving communication and problem-solving 2. Social Skills training and role playing |
Family therapy is effective when combined with meds (long-term)
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Psychological Treatments Continued
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3. CBT
-recognized and challenge delusional beliefs -token economy based on operant conditioning -recognize and challenging expectations associated with negative symptoms 4. Cognitve enhancement therapy (CET) -improve attention, memory, problem solving and other cognitive based symptoms |
Cognitive Therapies challenge delusions and lack of hope
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Outcomes
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-40-60% recieve little to no care in a given year (because of deinstitutionalization that has occurred)
-Of those who do, hospitalized when symptoms are worse, discharged with little or no follow-up -many end up in nursing homes, single room occupancy hotels in run-down areas, homeless or in prison |
the thirds rule:
1/3 recover 1/3 receive treatment 1/3 chronic |
