• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/32

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

32 Cards in this Set

  • Front
  • Back
Schizophrenia
Having an array of diverse symptoms: extreme oddities in perception, thinking, action, sense of self, and manner of relating to others.

The onset usually begins late adolescence or early adulthood.
Origins of Schizophrenia Construct
The first clinical description was offered in 1810 by John Haslam. He claimed his patient suffered from delusions.

50 years later Morel described a case of a 13 year boy who was intelligent and good at student, but suddenly stopped doing anything and forgot almost everything he learnt. Morel coined the term Demence Precoce as mental deterioration at a early age.

Emil Kraepelin used the latin version of Morel’s term as dementia praecox- someone becoming suspicious of those around him, sees poison in his food, is pursued by the police, feels his body is being influenced, or thinks that he is going to be shot or that the neighbors are jeering him.

Eugen Bleuler was the one who introduced the term schizophrenia- as characterized by disorganization of thought processes, a lack of coherance between thought and emotion, and a split off from reality.
Epidemiology
The risk of developing schizophrenia is a lifetime prevalence of 0.7%.
People who come from a family of schizophrenia have a higher risk of developing the disorder than others who don’t.
People whose fathers were 45-50 years old at the time birth have a higher chance as well.
Parents who work as a dry cleaner is also a risk factor.
People of afro carribean descent living in the UK have a high risk.
Onset age is 18-30 years old being the peak of time for the illness.
Slightly more men than women (1.4/1 ratio).
In men there a peak in new cases between 20-24 years old, Males tend to have a more severe form and peak of new cases between 20-24 years old. After the age of 35 it drops.
In women this is not seen, and there mean rises after 40 due to estrogen levels being low during menopause. This can mean that estrogen served as a protective factor for women.
Clinical Picture
The main hallmark features are hallucinations, delusions, and disorganized speech/thought.

Two of more of these have to be present for a large portion of time during a 1 month period.

Negative symptoms and disorganized catatonic behavior has to persist for at least 6 months while including the one month hallmark frame.
Hallmark Feature~ Delusions
An erroneous belief that is fixed despite evidence of it not there. Tricks are played in the mind. Disturbance in the content of thought.

Not all people who suffer delusions are schizophrenic. However, it is common in schizophrenics being 90%.

There are certain types:

Persecutory Delusions-feels that one is being followed, under survelliance, or being tricked and made of by others.

Delusions of Reference- media/newspaper/books or songs are made purposely for them or targeting them.

Grandiose Delusions- belief that they have exceptional power, talent, or is someone famous.

Erotomanic Delusions- someone of higher status/ importance is romantically involved with them or in love with them.

Thought insertion, withdrawal, control and broadcasting- someone is implanting stuff in their brain, removing or controlling their thoughts, or broadcasting them so others can hear them.

Bizarre vs. Non bizarre delusions- alien brain or FBI watching you.
Hallmark Feature~ Hallucinations
A sensory experience that seems real to the person having it, but is not.
It can occur in auditory, visual, olfactory, tactile, or gustatory.
Auditory hallucination is the most common. Some reported hearing more than one voice and how it got worse when they were alone.
The voices mostly say negative stuff, but rarely positive things.

Hallcuinating patients showed increased activity in Broca’s area- involved in speech production.
The voices are their own misinterpretation as coming from another.
Transcranial magnectic stimulation is used to reduce activity in speech production areas which caused hallucinating patients to have a reduction in auditory hallucinations.
Hallmark Feature~ Hallucinations Types
There are different types of hallcuinations:

Auditory Hallucinations- commanding and voice talking.

Visual Hallucinations- frightening, vague, distorted, or clear.

Olfactory Hallucinations- sense of smell, sometimes thinking it is coming from their own body.

Tactile Hallucinations- sense of touch, bugs crawling, or an invisible hand.

Gustatory Hallucinations- sense of taste, strange taste when eating or drinking.
Hallmark Feature~ Disorganized Speech/ Thought
Fails to make sense, and hard to understand.
It is not due to low intelligence, poor education, or cultural deprivation.
The process if referred as cognitive slippage, derailment, loosening of associations, or incoherence.
New made up words called neologisms are to be found.
They also take words too seriously, they have a hard time understanding cliché or proverbs.
Disorganized Catatonic Behavior
Goal directed activity is severely disrupted.
The impairment occurs even in daily functioning routines such as hygiene, going to work, and social relations.
Silliness and unusually dressed- impairment in the functioning of the prefrontal region of the cerebral cortex.
Catatonia- absence of movement and speech to what is called a catatonic stupor, sometimes they hold a unusual posture for a period of time.
Video
Many people describing their life with these disorders.
Suicidal Ideation, racing thoughts, 40-50% of patients attempted suicide. 10-15% succeed. Delusional and paranoia felt that someone was going to shoot him.
Guy 2: Loose hallucinations, intoxications.
Female: bad attention, used to bad connotations. Male: Loose Associations, Tangeliaty.
Positive Symptoms
An excess of distortion in a normal behavior and experience, such as hallucinations & delusions.
Negative Symptoms
Absence or deficit of normally present behaviors.

Important negative symptoms in schizophrenia are Flat Affect (blunted emotional expressiveness), Alogia (very little speech),
Asocial (without friends without social relationships),
and Avolition (lack of goal directed activities).

Most patients exhibit both positive and negative symptoms, but a large amount of negative symptoms is not a good indicator for the patient’s future.
Disorganized Symptoms
Disorganized behavior and disorganized speech that was previously thought to reflect positive symptoms might be better separated, thus disorganized symptoms is now recognized.
Other Psychotic Disorders Part 1
Other Psychotic Disorders:

Schizoaffective Disorder- features of both schizophrenia and severe mood disorder (unipolar or bipolar). Mood symptoms have to meet criteria for a full major mood episode and also be present for more than 50% of the total duration of the illness. 10 year outcome is better for people with Schizoaffective disorder than schizophrenia.

Schizophreniform Disorder- schizophrenia like psychosis but have only been there for a month does not last for the full 6 months. The prognosis is better.

Delusional Disorder- holding onto false beliefs. Otherwise, they do behave normally. They don’t have disorganized speech/behavior, and no hallucinations. A subtype is Erotomania- having great love for a person of a higher status.
Other Psychotic Disorders Part 2
Brief Psychotic Disorder- involving disorganized speech/behavior. Great emotional turmoil usually due by a stressful event. Generally last for only a day, sometimes a few days. Afterwards, the person functions normal again, and may never go back to that episode. Rarely seen in clinical settings because they remit so quickly. triggered by a stressful event, last a day and within a month they are back to normal functioning.
Genetic Factor Part 1
Disorders of the schizophrenia type tend to run in families.
There is a strong association between the closeness of the blood relationship and the risk for developing the disorder.
However, it is not always the genes.

Twin Studies- having higher concordance rates for schizophrenia among MZ twins than DZ twins. Although environment can play an important role in the development, it not always genes.

Adoption Studies- Any genetic liability conveyed by the mothers is not specific to schizophrenia, but also includes a liability for other forms of psychopathology. The child still has the gene for schizophrenic, but if the environment changes in a more healthier way the child may not be venerable to that disorder. Children with the schizophrenic gene and having to live with poor communication & a lot of stressors have a higher risk. If the children with the genetic predisposition live in a healthier environment appear to do very well. Genetic makeup controls our sensitivity
Genetic Factors Part 2
Molecular genetics- specific regions on certain chromosomes that may contribute to schizophrenia. These genes are known as candidate genes. An example of one is COMT gene located on the 22 chromosome. A deletion of this gene can make a high risk for schizophrenia. It is involved in dopamine metabolism. Other genes are 1 gene on chromosome 8, the dysbindin gene on chromosome 6, and the DISC1 on chromosome 1. It’s not just 1 gene, it is a multiplicity of genes. Numerous or hundreds of genes.
What is Transmitted?
Genes are controlling the abnormalities in the structure of the brain and in neurotransmitter systems.
Other Biological Factors
Having a loss of brain volume because of having enlarged ventricles (mostly fluid). The enlarged ventricles takes up more space which makes less space for important brain tissue. It gets worse over time.
The volume of gray matter declined over time. There is a reduction in the volume of regions in the frontal and temporal lobes, these areas play a role in memory, decision making, and in the processing of auditory information. Reduction in the amygdala which is involved in emotion. Reduction in hippocampus which is involved with memory. Reduction in the thalamus which is involved with sensory input.
White matter disruptions, which affect the connectivity of the brain, and how well the cells of the nervous system can function. This abnormality is correlated with cognitive impairments.

Patients having abnormally low hypofrontality decision making, and cognitive-attentional deficits. Hypofrontality is mostly involved with the negative symptoms of schizophrenia.
The Brain
Basal Ganglia- contribute to paranoia and hallucinations.

Auditory system- overactivity of the speech area.

Frontal Lobe- difficulty in planning and organizing thoughts.

Occipital Lobe- difficulties in interpreting complex images, recognizing motion, and reading emotion on faces.

Limbic system- involved with emotion and disturbances are thought to contribute to agitation.

Hippocampus- learning and memory is impaired.
Disrupted Cytoarchitecture
Disruptions of the migration of neurons in the brain.
Cells failing to arrive at their destinations, and the overall organization of cells in the brain will be compromised .
Missing certain neurons that are called inhibitory interneurons that are responsible for regulating the excited neurons.
Patients then have a hard time handling stress.
Dopamine Hypothesis
Dates back to the 1960s when they figured out the drug Chlorpromazine (Thorazine) helped schoziphrenic patients by blocking dopamine receptors.

Amphetamines are drugs that produce an excess of dopamine, an abuse of it led to a form of psychosis that involved paranoia and auditory hallucinations.

L- DOPA drug that increased dopamine in the brain for Parkinson’s disease caused psychotic symptoms.

Dopamine made us pay attention to more unimportant and random stuff it gives more salience to stimuli that are irrelevant. Dopamine is not the only neurotransmitters that is involved.

Glutamate may be another one, and it makes sense because one action for dopamine receptors is to inhibit the release of glutamate. When one inhibit the release of glutamate it causes psychosis.
Prenatal Exposures
Prenatal infection- infections in the year of development might have a causal significance for schizophrenia. If the mother contracts the flu during the last trimester(4-7 months) it can increase the risk for schizophrenia. Other infections can be Rubella and Toxoplasmosis.

Rhesus incompatibility- occurs when a RH- mother carries a RH+ fetus. This leads to a incompatibility between the mother and the fetus. The result can be blood diseases, brain abnormalities, or schizophrenia. The reason for this is oxygen deprivation, or hypoxia.

Early Nutritional Deficiencies- being deprived of nurtients can lead to schizophrenia. It can be general malnutrition or lack of Folate and iron.

Perinatal Birth Complications-Birth complications can lead to schizophrenia. Many delivery problems such as reech delivery, prolonged labor, or the umbilical cord around the baby’s neck affecting oxygen. This can point to a damage to the brain.
Psychological and Social Factors
Family communication problems could be the result of trying to communicate with someone who is severely ill and disorganized.
Some families having communication deviance. Ineffective communication is vague, confusing, and unclear.

Patients returning home to family have a higher relapse due to EE(Expressed Emotion). It can be hostile, critical, and emotional over involving (EOI). Patients have a higher relapse because all these family emotions contribute to stress, and schizophrenic patients have a hard time dealing with stress.
Too much stress are likely to release of cortisol.

Urban living seems to increase the risk for schizophrenia.

Immigrants also have a high risk for schizophrenia due to the stress of moving, cultural misunderstanding, and discrimination.
A Diathesis Stress Model of Schizophrenia
Genetic factors & Prenatal factors(birth complications, or prenatal events) combine to result in

-→ brain vulnerability-→

stress factors(urban living, family, immigration) & maturation processes may push the vulnerable person across the threshold and into-→

psychosis/schizophrenia.
Early Indications of Vulnerability: Prodromal (early signs)
The pre-schizophrenia children showed more motor abnormalities including hand movements than their healthy siblings, showing less positive facial emotion and more negative facial emotion. These differences were apparent by the age of 2.

They also had delayed speech and delayed motor development at age 2.

Adolescents at high risk for schizophrenia showed more movement abnormalities (facial tics, blinking, and tongue thrusts).

One can see the way on how a child moves because movement abnormalities and psychotic symptoms share some of the same neural circuitry in the brain.

Problems in the neural circuitry first show as movement abnormalities then as the child matures it manifests into psychotic symptoms.
Treatments & Outcomes
Prognosis before the 1950’s was very bleak. Straitjackets, electroconvulsive shock therapy, living on remote institutions being kept away from normal citizens.

Dramatic improvements came in the 1950’s when antipsychotics drugs were introduced. 15-25 years after developing schizophrenia almost 40% can be thought of as being recovered- with the help of drugs and therapy they could function.

For a miniority of patients -12%, long term institutionalization was necessary.

A third of patients show continued signs of illness, usually with prominent negative symptoms.

A cure for schizophrenia has not been discovered.

Patients who lived in industrialized countries tend to do better than who live in more industrialized nations because levels of EE are lower in countries that are less industrialized. This helps explain why clinical outcomes in patients is different in many parts of the world.
Pharmacological Approaches Part 1
The common property that they all share is their abilitity to block dopamine D2 receptors in the brain.
First generation anti-psychotics are medications like chlorpromazine (Thorazine) and haloperidol (Haldol).
They work best for the positive symptoms in schizophrenia.
Common side effects are drowsiness, dry mouth, and weight gain.
Minorities are at a high side effect risk for extrapyramidal side effects (EPS)- involuntary movement abnormalities. Such side effects are controlled by taking another medication such as neuroleptics.
If taken for a long period of time one might develop tardive dyskinesia- involuntary movements of the lips and tongue.
In rare cases there can be a toxic reaction the medication like neuroleptic malignant syndrome- high fever, muscle rigidity, and can be fatal.
Pharmacological Approaches Part 2
Second generation antipsychotics created in the 1980’s the first being Clozaril.

Other examples are Risperidone, Olanzapine, and Seroquel.

They cause fewer EPS effects, but they still have side effects such as drowsiness, weight gain, diabetes, and drop in white blood cells.
Psychosocial Approaches Part 1
Sometimes these approaches are conjunction with medications.

Behavioral Family Therapy- decreasing EE and giving the family better coping, problem solving, and communication skills.

Social and living skills training- Helping the functional outcome. Acquire the skills they need to function better on a day to day basis. These skills include employment, relationship, self care, and managing medications. For conversational skills, these components might be learning to make eye contact, speak at a normal and moderate volume, taking one’s turn in a conversation, and so on. This does not resemble talk therapy. Helps patient be more assertive, acquire new skills, and social functioning. Less likely to relapse and need hospital treatment.
Psychosocial Approaches Part 2
Cognitive Remediation- helping patients improve some of their neurocognitive deficits (problems with verbal memory, vigilance, and performance on card sorting tasks). These improvements might help with overall functioning. Helps with memory, attention, and executive functioning skills. Improvements in social functioning. Even if patients have been ill for many years they can still benefit from this approach.

Coginitive Behavioral therapy- goal is to decrease the intensity of positive symptoms, reduce relapse, and decrease social disability. Therapist and patient works together to explore subjective nature of the patient’s delusions and hallucinations, examine the evidence for and validate reality testing. This is not helpful for negative symptoms.


Case Management- They act as a broker. They help to manage all their services, locational training, living skills, resources for food, and taking educational classes. They help the patient not get lost in the system.
Video
What it is like to have a hallucination or delusion from a schizophrenic.
Now there is a way to get into a mind of a schizophrenic.
A device that stimulates and walking in the footsteps of a schizophrenic.
Ken is free of voices and hallunictaions by a drug. Drugs are the only avaible treatment for visual hallucinations, but now there is a auditory treatment for hallucinations (TMS) by placing it on the temporal left side of the brain.