Schizophrenia

Front 1

How many suffer from schiz. and what increased risks are they at? what classes? gender ratio and onset?

Back 1

1/100 persons, 24 mil worldwide. increased risk of suicide and physical illness. 15% of schiz. attempt suicide. found more freq. in lower social classes, equal male to female ratio and earlier onset for men than women -> 21 yrs vs. 27 yrs

Front 2

why do some think schiz. may be a group of separate disorders that happen to have some features in common?

Back 2

the sxs, course, responsiveness to tx and triggers vary greatly in schizophrenia.

Front 3

what three categories are the sxs grouped into?

Back 3

positive sxs: excesses of thought, emotion and behavior. negative sxs: deficits of thought emotion and bh. psychomotor sxs: unusual movements or gestures. both types of sxs are usually present, half ppl with schiz. display significant difficulties with memories and other kinds of cogn. f-ning.

Front 4

What do positive symptoms consist of?

Back 4

delusions (of persecution most common), disorganized thinking and speech, heightened perceptions and hallucinations and inapp. affect. neologisms-make up words that have meaning only to them. perseveration - repeat words/statements again and again. clang-rhyme to think or express self. most common halluc. is auditory, assoc. with higher blood flow in broca's area during halluc. (area helps produce speech)

Front 5

what do negative sxs consist of?

Back 5

poverty of speech/alogia (speak very little or convey little meaning) loss of volition/apathy (more common in those whove had it longer), blunted and flattened affect/anhedonia (still experience the emotions, just dont show them), social withdrawal

Front 6

What is the usual course of schizophrenia?

Back 6

usually go through 3 phases: predromal-sxs not yet obvious, individual is beginning to deteriorate. active-sxs become more apparent, sometimes triggered by stress. many then enter residual phase in which return to predromal-like level of f-ning, the striking sxs of active phase lessen but some negative sxs may remain. each phase lasts days to years. a full recovery is more likely in those who f-ned quite well before disorder. 1/4 pts recover completely from schizophrenia. relapses are more likely during times of life stress.

Front 7

What are the five types of schizophrenia that DSM-IV distinguishges?

Back 7

1. disorganized characterized by confusion, incoherence, flat/inapp affect, attn and perception problems, extreme social withdrawal and mannerisms. 2. catatonic - central feature is psychomotor disturbance of some sort. 3. paranoia have organized system of delusions and auditory halluc. that may guide their lives. 4. vague category for those that dont fall ointo others. 5. residual type when sxs lessen in strength and number but remain in residual form

Front 8

what kind of a relationship of causes does schiz. have?

Back 8

diathesis-stress: need for a biological predisposition and certain kinds of events or stressors present.

Front 9

schizophrenia, like a number of other disorders is a polygenic disorder, caused by a combo of gene defects, what are two kinds of genetic factors assoc. with etiology?

Back 9

1. biochemical abnormalities - dopamine hypothesis, phenothiazines bind most strongly to D-2 receptor. some ppl with parkinsons develop schiz-like sxs if take to much L-dopa which raises dopamine levels
2. Abnormal brain structure: particularly cases of negative sxs. have enlarged ventricles, abnormalities in hippocampus, amygdala and thalamus.

Front 10

what is the psychodynamic view of etiology of schizophrenia?

Back 10

caused by regression to pre-ego stage and efforts to reestablish ego control. state of primary narcissim, Fromm-Reichmann: cold unnurturing parents may set it in motion, schizophrenogenic mothers. or bio. abnormalities have certain persons extremely prone to extreme regression

Front 11

Cognitive view?

Back 11

in short, people take a "rational path to madness" halluc. are in accord with biological view, but furtther features emerge when individuals attempt to understand their unusual experiences.

Front 12

Sociocultural view?

Back 12

1. multicultural factors: higher rate in blacks than whites and the economically disadvantaged (hispanics also more likely than whites). better recovery rates in pts of developing countries than western.
2. social labeling: self-fulfilling prophecy leads to development of sxs.
3. family dysfunction: parents of ppl with disorder often display more conflict, have greater diff. communicating with each other and are more critical and overinvolved in kids. schiz 4x more likely to relapse in a home with high expressed emotion than low e.e.

Front 13

a step up from the restraining public mental hospitals, the pinel-era hospitals were meant to protect pts from stresses of daily life in a healthful env. but what occurred in face of overcrowding?

Back 13

emphasis shifted from giving humanitarian care to keeping order. pts were transferred to back wards if they failed to improve quickly, most of these pts were schiz.

Front 14

in 1953 what two approaches brought hope to schizophrenics?

Back 14

1. milieu therapy - institutions can help individuals by creating a social climate or milieu, that builds productivity, self respect and a sense of responsibility.
2. token economy based on operant conditioning, in a study after 4 1/2 yrs of token economy, 98% had been released, mostly to sheltered care facilities compared to 71% pts in a milieu program and 45% of pts who received custodial care only.

Front 15

How well do antipsychotic drugs work?

Back 15

in most cases drug produce the maximum level of improvement within first 6 months of tx. antipsychotic drugs reduced sxs in at least 65% of pts with schiz. (reduce pos. sxs more completely and more quickly than neg sxs) more effective than any tx/approach alone.

Front 16

what is tardive dyskinesia?

Back 16

does not unfold until after a person has taken conventional drugs for over a year. includes involuntary writhing or ticlike movements. more than 10% of conv. antipsychotic drug users experience this at some pt, longer its taken more likely to get it, pts over 50 more likely to get it.

Front 17

what are more effective atypical or conventional antipsychotics?

Back 17

atypical help 85% of pts, conventional help 65%.

Front 18

rehospitalizations decrease by 50% among clients treated with cogn-bh therapy

Back 18

over 50% of schiz. live with family, if feel more positively about family in general will do better in tx

Front 19

what are the key features of community care programs

Back 19

coordination of pt services, short-term hospitalization, partial hospitalization (ppl recovering from severe mental disorders in day centers often to better than those in extended periods in hospital or outpatient therapy), supervised residencies, occupational training. fewer than half of all ppl who need them receive appropriate community mental health services. in a given yr 40-60% of schiz. receive no tx at all, usually due to poor coordination and shortage of services.

Front 20

what are mentally ill chemical abusers? (MICAs)

Back 20

pts with psychotic disorders as well as substense-related disorders. 1/3 homeless ppl in US have a severe mental disorder.