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19 Cards in this Set
- Front
- Back
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Psychosis |
State defined by loss of contact with reality - Ability to perceive and respond to the environment is significantly disturbed; functioning impaired - Symptoms: hallucinations (false sensory perceptions) and delusions (false beliefs)
*May be substance induced or cause by brain injury but most psychoses appear in the form of schizophrenia |
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Schizophrenia Facts |
- Serious mental disorder that affects approximately 1% of population worldwide (over 20 million people) - As many as 10% of all disabled persons in US have schizophrenia - Disorder accounts for 75% of all mental health expenditures and approx. 40% of all Medicaid reimbursements - Only 10-30% of people with disorder are employed - Quality of life is significantly poorer - Found in all socioeconomic groups but more frequent in lower levels (downward drift theory) - Equal number of men & women diagnosed; for men symptoms begin earlier, more severe - Rates differ by ethnicity and race (2% of African American, 1.4% of Caucasians) - Usually diagnosed in late adolescence/early adulthood - 50-70% of cases have chronic, relapsing course with high morbidity & permanent disability - 1/3 of patients recover completely |
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Schizophrenia Definition |
Disorder characterized by disturbances in thought, emotion, and behavior
Core Features: - Faulty perceptions - Poor attention - Inappropriate affect - Disturbances in motor functioning |
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Schizophrenia: 3 Main Categories of Symptoms |
Positive Negative Disorganized |
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Schizophrenia: Positive Symptoms |
Refers to those that represent abnormal experiences added onto what is normal
Hallucinations: distortions of perception - Most common = hearing voices that are not there - Theorists suggest a misattribution of their thoughts as being someone else's voice - Heightened perceptions: May feel senses being flooded by sights and sounds
Delusions: Beliefs that are held contrary to reality or unusual - Some have many delusions, others hold onto one that takes control of their lives
*Delusions of persecution = most common in schizophrenia - Feeling that others are plotting against them, spied on, threatened, attacked *Delusions of reference = attaching special meaning to objects, events, or the actions of others *Delusions of grandeur = belief that one is great, super human, etc. *Delusions of control = believing that one's thoughts, feelings, and actions are being controlled by other people |
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Schizophrenia: Negative Symptoms |
Refer to those that represent an absence of a normal experience - Thought that people with negative emotions experience lack of feelings; NOT the case
Example: Flat Affect - Avoidance of eye contact - Immobile, expressionless face - Lack of emotion - Apathetic, uninterested - Monotonous voice
Loss of Volition - No motivation or directedness - Drained of energy, loss of interest in normal goals
Social Withdrawal - Seems to lead to a breakdown of social skills, including ability to accurately recognize other people's needs and emotions
Subdivided into: Primary = those that directly reflect a disease process Secondary = those that are due to side effects of medication (ex: sedation) |
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Schizophrenia: Disorganized Symptoms |
Refers to a fragmentation of experience or behavior - Seem to lose the ability to organize behavior and make it conform to community standards - May speak incoherently - Show emotional responses out of context
Loose Associations: linking random facts together that don't actually go together Neologisms: making up works Clang: Rhyming random words together |
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Course of Schizophrenia: Three Phases |
Prodomal: beginning of deterioration; mild symptoms Active: Symptoms become increasingly apparent Residual: Return to prodromal levels
Each phase may last for days or years Fuller recovery more likely in people: - With high premorbid functioning - Whose disorder was triggered by stress - With rapid onset - With later onset - Greater positive symptoms |
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How Theorists Explain Schizophrenia |
A diathesis-stress relationship is at work - People with a biological predisposition will develop it only if certain kinds of stressors are present |
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How Theorists Explain Schizophrenia: Biological View |
Genetic Factors: Believed some people inherit a biological predisposition to schizophrenia - Triggered later by exposure to stress
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How Theorists Explain Schizophrenia: Etiology: Genetics |
- Parent with schizophrenia raises child's risk 1-10% - Identical twin with schizophrenia raises risk to 50% - Suggests that it's likely to be caused by multiple genes; when inherited, less severe forms of illness are seen - Identified 8 chromosomal sites associated with increased rate
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How Theorists Explain Schizophrenia: Etiology: Viral or Immunopathology |
- Viral & immune system-related theories remain popular; evidence inconsistent - Strongest evidence involves maternal exposure to viral infection during pregnancy *Increased rates of illness among offspring of mothers exposed to/treated for influenza infections during their second trimester *CRUCIAL time for cortical development - Virus invades brain tissue during fetal development
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How Theorists Explain Schizophrenia: Etiology: Birth Complications |
Three types of difficulties related to increased rate of developing disorder: 1 Pregnancy complications - Bleeding, Rh incompatibility 2 Delivery complications - Hypoxia, etc. 3 Abnormal fetal development - Low birth weight, reduced head size, etc. |
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How Theorists Explain Schizophrenia: Etiology: Neuroanatomy |
Focus on interactions between regions Regions most implicated: frontal lobes, temporal lobes, basal ganglia Recent work adds in: cerebellum, thalamus, hippocampus
- Decreased prefrontal inhibition of limbic system circuitry can account for the emergence of hallucinations, etc. - Hypofrontality can also account for negative symptoms
Theories - Increased stress initiates a set of reactions leading to an increase in cortisol which can damage the hippocampus - Hippocampus damage has been implicated in a variety of psychotic phenomena including decontextualizing of memories and alterations of self-experience (both common in schizophrenia) |
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How Theorists Explain Schizophrenia: Etiology: Neurophysiology - I |
Most influential of these theories is the dopamine hypothesis Theory grew out of several lines of evidence: 1 Emergence of psychotic symptoms in people who abused amphetamines, cocaine, etc. which are known to increase brain dopamine 2 Emergence of psychotic symptoms in Parkinson's disease patients who receive excessive doses of L-dopa (dopamine precursor) 3 Positive effects of anti-psychotic medication in controlling positive symptoms (known ability of these medications was to block dopamine receptors) |
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How Theorists Explain Schizophrenia: Etiology: Neurophysiology - II |
Theories suggest an excess in number of dopamine receptors & over-sensitivity in DA receptors (particularly D2) - Excess of dopamine activity in mesolimbic pathway - Antipsychotic meds work on these pathways by blocking dopamine receptors in this neural system (decreases positive symptoms) |
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How Theorists Explain Schizophrenia: Etiology: Neurophysiology - III |
Mesocortical pathway is also implicated - Begins in same region as mesolimbic pathway and projects to prefrontal areas which project back to limbic areas that are innervated by DA - Dopamine neurons in the prefrontal cortex may be underactive (hypofrontality) and fail to modulate (exert inhibitory control over) the dopamine neurons in the limbic area |
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How Theorists Explain Schizophrenia: Etiology: Neurodevelopment |
View schizophrenia as involving abnormalities throughout the lifespan with varying expressions of neuropathology during different phases of development
Fish (1987) & Walker (1994) - Walker examined home movies of preschizophrenic children & non-affected siblings - Found preschizophrenic children demonstrate poorer motor skills and abnormal affective responses (crying & upset when situation didn't warrant it) |
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How Theorists Explain Schizophrenia: Etiology: Environmental Factors - I |
- Childhood abuse associated with increased rates - High rates of neglect, physical abuse, and sexual abuse found in histories of people with the illness - Suggested that stress cause by abuse can lead to hippocampal damage, which can lead to decontextualization of memories of abuse experiences, resulting in experience of hallucinations *Other CNS changes can constitute an environmentally-medicated biological diathesis for the disorder |
