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85 Cards in this Set

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Tendency for people with disorder to differ from each other in symptoms, family and personal background , response to treatment and ability to live outside of hospital.
- difficult to predict how person will be affected by schizophrenia and prospects for future and whether condition will improve, stabilize or worsen.
Total number of cases with the disorder at given point in time, changes depending on how diagnosis is made. Men and women equal risk, Strike men earlier and more severe later and more emotional for women
Negative Symptoms
Absence or loss of typical behaviours and experiences
Apathy and loss of motivation
Inability to feel pleasure and lack of emotional responsiveness
Misinterpretations of sensory perceptions while awake and conscious and absence or corresponding external stimuli.
Implausible beliefs that persist despite reliable contradictory evidence. They reflect disorder of thought content.
Persecutory Delusions
"Paranoid", believe being pursued or targeted. Most common.
Referential Delusions
Common meaningless occurrence have significant and personal relevance.
Somatic Delusions
Beliefs related to patient's body.
Religious Delusion
Belief that biblical or other religious passages offer way to destroy or save the world.
Delusions of Grandeur
Belief in divine or special powers that can change course of history or provide communication channel to god.
3 Expectations of Persecutory Delusions
1. Develop in people who make interpretations of experience too quickly and jump to conclusions.
2. Bias in reasoning so that negative events are always perceived as coming from environment or form other people
3. Persecutory delusions reflect inability to imagine feeling, perspectives and experiences of other people
Loosening of Associations
Logical connections between ideas, shifts from one topic to another quickly. Answers to questions are hardly related.
Deficit or decrease in communication. No elaboration.
Affective Flattening
Lack of emotional expressiveness. Grossly disorganized; trouble with goal-directed behaviours.
Catatonic Behavior
Decreased responsiveness to environment, assume unusual and rigid postures, resistant to change.
Waxy Flexibility
Allowing others to make their body and maintaining position.
6 Criteria
A. Characteristic symptoms
B. Social or occupational dysfunction
C. Persistence of disturbance for at least 6 months
D. Exclusion of concurrent schizoaffective or mood disorders
E. Exclusion of substance use or medical conditions
F. Consider history of autistic disorder or another pervasive developmental disorder.
Mood congruent
Consistent with a person's emotional state and reflect a mood disorder rather than schizophrenia.
Paranoid type
Prominent delusions or auditory hallucinations and the absence of markedly impaired cognitive functioning or affect.
- Absence of symptoms including disorganized speech and behaviour, catatonia and flat or inappropriate emotions.
-Least disabling
- Most common
Disorganized Type
Most disabling
- Disorganized speech and behaviour as well as flat or inappropriate affect.
- Absence of goal orientation and may present impaired functioning
Catatonic Type
Acute psychomotor disturbance
- Immobility
- Extreme negativism and rigidity
- Peculiarities of voluntary movement
Undifferentiated Type
Meeting Criterion A but without sufficient characteristics to satisfy criteria for the paranoid, disorganized or catatonic subtypes.
Residual Type
Patient with at least one prior episode of schizophrenia and with negative symptoms as well as attenuated positive symptoms.
- Not currently experiencing prominent positive psychotic symptoms.
Disease Markers
Objective diagnosis is possible if measurable disease markers can be identified.
- MArkers that occur in virtually all people with the illness
- Any physical, psychological or biological characteristics or trait.
A true marker must be very common among patients with diagnosis for the disorder.
Marker occurs very infrequently among healthy people or people with other disorders.
Vulnerability Marker
Vulnerability marker is a stable and enduring sign or trait of the disorder that occurs before a person actually succumbs to the disorder and experiences symptoms.
- Reflects inherent predisposition
Intermediate between the microscopic world of genes and nerve cells and the experiential and psychological world or symptoms.
Cognitive Marker
Impairment on Continuous Performance Test.
Eye Tracking
Irregular eye movements
- Neurological impairments
- Better suited as potential marker for a specific variant of schizophrenia or for broader classification of impairment that includes other psychiatric disorders.
Cognitive Subtypes
Patients with schizophrenia could be separated into cognitively impaired, cognitively normal and verbal memory-impaired subtypes.
Severely rejecting mother
Collective Unconscious
Carl Jung, Universal symbols existed in the unconscious mind an erupted into waking life in the course of dreams and mental illnesses like schizophrenia.
Social Drift
People from lower socio-economic classes could not rise economically if they had a predisposition for schizophrenia.
Meehl, occurs throughout the brain, making nerve cells abnormally reactive to incoming stimulation. A single gene inherited from either parent.
Cognitive Slippage
Information is disorganized, incoherent and "scrambled"
Aversive Drift
Related to negative symptoms like social withdrawal and disinterest. Unselective neural firing that causes cognitive slippage, gives rise to a gradual increase in punitive, unpleasant social experience.
Experiencing cognitive slippage and aversive drift.
- Person may be spared full-blown psychotic disorder.
Compensated Schizotype
Able to function in everyday life, although usually at a cost to him or herself or to other people. Meehl mentioned Adolf Hitler as an example.
Neurodevelopmental Diathesis-Stress Theories
Subtle brain injuries during fetal development or birth could become diathesis.
-Stress of maturational demands on weakened brain that precipitates psychotic disorder
Genetic Contribution
Schizophrenia is observed to recur in some families with a risk of about 13 % to the children of a parent with schizophrenia.
Incomplete Penetrance
Proportion of people with a dominant gene will fail to show the effect of that gene. Lack of expression may be due to the environment or to other factors.
- Penetrance of schizophrenic gene is less than 100%, may be closer to 50%.
Birth-related Complications
Medical and delivery related problems at birth may be key environmental and biological events that interact with genetic diathesis and further predispose a person to schizophrenia.
High Risk Children
A child of a parent with schizophrenia has at least 10 times the normal risk of developing the disorder.
- "follow back" approach, begins with patients known to have schizophrenia in adulthood.
- Look back in time and find evidence of disturbed mental life and behaviour during infancy and childhood.
Expressed Emotion
Negative itnerpersonal communications directed at family members with the disorder.
- Also occurs in families with mood and eating disorders.
- Neg family attitudes may make adjusting to psychological problems difficult in general rather that only in relation to schizophrenia.
Cumulative Liability
Shows itself early in behaviour and increases with adverse environmental events and stresses over the course of childhood and adolescence.
Neuropsychological Tests
Frontal or prefrontal lobe of the brain.
- Believed that psychological capacities ascribed to the frontal brain were impaired in schizophrenia.
Wisconsin Card Sorting Test
Object of this test is to discover the new principle each time it changes and to respond with correct matches.
- Easy for healthy people
- Prefrontal damage abnormally few successfully correct matches.
Structural Magnetic Resonance Imaging
Clear detailed images of many brain structures, volume and shape of different brain regions in patients and healthy people.
Finding from CT and MRI studies
Complex patterns of structural abnormalities in patients with schizophrenia.
- CT suggests structural alterations in brains of patients, ventricle are larger. Compression or loss of nerve tissue.
- MRI shows reduced grey matter volumes
Positron Emission Topography
Displays or readout changes in blood flow, metabolism or rate at which energy is used, or the location and density of nerve cells containing specific kinds of chemical receptors.
Functional Magnetic Resonance Imaging
Detecting the changes in blood oxygenation and flow that occur in response to neural activity.
Findings in PET and fMRI sutdies
Functional activation changes
- Different patterns of frontal brain activation and deactivation in schizophrenia rather than just overall reduction.
- Left temporal lobe involved in attention, understanding of speech and written language, and interpretation of visual world.
- Amygdala and hippocampus, colour these interpretations with emotion and store them in memory.
Dopamine Hypothesis
- Antipsychotics block effects of dopamine
- Especially dopamine D2 receptor site
- Cocaine and amphetamine increase DA
- Neurotransmitters byproducts found in cerebral spinal fluid
Chemical receptors that bind selectively with specific receptor sites
- Could find out density and distribution of various receptors.
Early Treatment
Insulin coma
- Frontal lobotomies
- Leukotomies
Henry Laborit
Interested in syndrome of circulatory shock that occurred during and after surgery.
First genuine antipsychotic medication.
- Mood influencing effects
- Antipsychotic effects took several weeks to develop fully
Risperidone and Olanzapine
Symptom control with fewer side effects than the older chlorpromazine family of drugs.
- Return of symptoms if drugs discontinued
Cognitive Behavioural Therapy
At least one form of psychotherapy may indeed be helpful. Focus on four principle problems:
1. Emotional Disturbances
2. Psychotic Symptoms
3. Social Disabilities
Form of psycho-education, understand symptoms by comparing their experiences to those of mentally healthy adults.
Stages of CBT
1. Generate trusting and collaborative relationship
2. Record and monitor thoughts
3. Focus in individual's unique clinical presentation, test validity of symptoms, consider influence on daily life, develop alternative explanations for delusions and hallucination. Do not confront
4. With negative symptoms id sources of inactivity or withdrawal.
5. Try to direct cognitive skill development toward preventing symptom relapses and sever illness episodes.
Social Skills Training
Learning based intervention
- Rehab to develop practical social and living skills.
- Promotes independence and reduces stressors
- More effective in other patients
Cognitive Remediation Programs
Target specific thinking skills, teach compensatory strategies, providing practice exercises and holding group discussions.
Family Therapy
Conceptualizes the patient as a member of a family system.
- Aims for active involvement of each member of the family in the treatment process.
- Focus in deinstitutionalization
- Psycho-education
Early Intervention
People considered at high risk for developing schizophrenia as well as those in the prodromal and first episode phases of the disorder.
Period before the appearance of psychotic symptoms when the vulnerable adolescents often become withdrawn and suspicious.
"First Episode" Patients
Experience their first episode of intense unmistakable symptoms.
Made up words
Stuck on topic
Thought Insertions
Make them believe things
Thought Withdrawal
Thoughts being stolen form their head
Repeat back what others say
Imitate actions of other people
3 Phases
1. Prodromal: Start symptoms at low levels, unusual behaviour, no full delusions and hallucinations
2. Active: Psychotic symptoms, episodic
3. Residual: Not full psychotic symptoms anymore
Positive symptoms, too much DA
Negative symptoms, too little DA
Frontal Lobe
Avolition, flexibility, motivation
Left Temporal Lobe
Disorganized speech, thought disorder
Right Temporal Lobe
Process emotion, lack of affect
Recall meaning from tone of voice
Basal Ganglia
Motor, could explain catatonia