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103 terms

schizophrenia

schizophrenia and psychosis
STUDY
PLAY
onset of schizophrenia
typical onset between 18 and 30
(schizophrenia)
incidence of schizophrenia
1 in 100 (1%) In the general population, in over 2.5 million Americans(schizophrenia)
Positive symptoms of schizophrenia
Behaviors in excess of those displayed by healthy people (hallucinations, delusions)(schizophrenia)
Negative symptoms of schizophrenia
Behaviors less than those displayed by healthy people (affective flattening, alogia, abolition, asociality, anergia(schizophrenia)
affective flattening
negative symptom of schizophrenia that consists of a severe reduction or the complete absence of affective responses to the environment(schizophrenia)
alogia
absence of thought:
Inferred from observing speech:
-Poverty of speech: Brief responses
-thought blocking: loses train of thought
-poverty of content: Circumstantial speech, typically with extraneous detail
avolition
lack of motivation, big difference prior to illness. Once they had the onset of schizophrenia it was an extreme difference.
Lack of social, work, and/or Academic Motivation. Unable to initiate and persia in Goal Directed Activities, persistent and pervasive
asociality
socially withdrawn
Hallucinations
perception in absence of sensation.
ie: seeing Hillary Clinton when in fact no one is actually present
Auditory Hallucinations
Hearing voices or noises when no sounds are present, most commonly experienced hallucination of schizophrenics
Visual Hallucinations
seeing objects that are not present
Tactile hallucinations
perceptions that something is happening to the outside of one's body - for example, that bugs are crawling up one's back
olfactory Hallucinations
false perception of smell. IE: smelling feces or roses without actually having presence of those smells
Illusions
misperceptions. A real stimulus is misperceived for example Seeing your friend Liz as Hillary Clinton.
* Not diagnostic of schizophrenia
hypnogogic Hallucinations
dreamlike auditory or visual ecperiences while dozing or falling asleep
Hypnopompic Hallucinations
Hallucinations that occur when awakening from sleep
Delusion
A false personal belief, with 100% conviction despite all evidence to the contrary. The belief is not shared by society or subculture
Delusions of reference
Excessive meaning, special messages via TV, radio, newspaper. Seems like Everyone with their arms crossed assuming that they are all pointing to him assuming that they want to kill him.
Delusions of persecutions
paranoid delusions that people are out to get to you, to hurt you physically, or emotionally (i.e.: government or FBI)
Grandiose delusions
Believes to have special knowledge or power, intellect (IE: Barak Obama doesn't tell anyone, but I am his secret advisor)
Erotomatic Delusions
believing that they have a secret love relationship with someone (movie star, singer, or head cheerleader in high school) IE: I am secretly married to Jennifer Lopez
paranormal delusions
delusions involving ghosts, aliens, voodoo, black magic etc.
delusions of physical processes
delusions of technology: stealing brainwaves, affecting my thinking IE: people are recording me
delusions of control
a force other than themselves is moving their body against their will. IE: someone is moving them around like a puppet
delusions of thought broadcasting
their thoughts can be heard by everyone in the room/ world, no privacy (fairly common delusion)
Disorganized speech
Thought disorder, conceptual disorganization. Types: Tangentiality, derailment (loose associations), incoherence (word salad)
Tangentiality
person responds to a question with oblique or irrelevant reply. IE:
Doctor: what city are you from?
Patient: That's a hard question to answer because my parents... I was born in Iowa, but I know that I am white instead of Black, so Apparently I came from the North Somewhere, and I don't know where, you know I don't know whether I'm Irish or Scandinavian
derailment
Changes subject mid sentence. Person is jumping the tracks- derailing, every sentence or every two sentences they are changing the subject.
Doctor: Did you enjoy college
Patient: I really enjoyed some communities, I tried it, and the, and the next day when I'd be going out, I took control, I put bleach in my hair in California
disorganized behavior or appearance
unusual or unproductive behavior, unusual appearance, catatonic behaviors
catatonia
might be frozen (stuck) hospitalized waxy flexibility; able to move around like gumby, and rigid posture, statue like
unusual appearance
(IE: has metal container on his hair, or lining underwear with tin foil so the government wouldn't steal his sexual energy, or over dressing)
unusual behavior
bizarre behavior- licking doorknobs, picking up lids and putting them in their pocket, shoving thumbtacks up their nose
anergia
Lack of energy, lack of mental or physical exertion. 25 year old Naps three hours daily and sleeps ten hours nightly
circumstantial speech
Doctor: I heard you were late for your morning group.
Patient: I'm having a rough day. I woke up late, my alarm clock has been working poorly. Then it took forever for me to brush my teeth because I couldn't find my toothpaste. I started talking to my roommate and I lost track of time. I got to the bus stop just in time to see the bus pulling away. I caught the next bus and talked to a man from india....(goes on and on)
Diagnosis of Schizophrenia
Severe Dysfunction
Essential To Diagnosing Schizophrenia
The Severe Dysfunction InSocial Fxning, Work/School Fxning, And Self-Care Must Last at least 6 months
Phases Of Schizophrenia (Minimum of 6 Months)
Prodromal Phase
Progressive Deterioation In Social Fxning, Work/School Fxning, And Self-Care
Active phase Not Fully Developed
Active Phase (Minimum Of 1 Month)
At Least Two Of The Following Five Symptoms Are Displayed
Delusions
Hallucinations
Disorganized Speech
Disorganized Or Catatonic behavior
Negative Symptoms
Residual Phase
Active phases symptoms significantly reduced
Continued reduction In Social Fxning, Occupational Fxning, And Self-Care
Phases of schizophrenia
(minimum of 6 months) Prodromal phase, Active phase, Residual phase
Subtypes of Schizophrenia
Catatonic type, Disorganized type, Paranoid type, Undifferentiated type, residual type
Schizophrenia catatonic type
catatonic symptoms are prominent
Schizophrenia Disorganized type
Disorganized behavior and/or speech are prominent
Schizophrenia paranoid type
bizarre delusions involving persecution or hallucinations
Schizophrenia undifferentiated type
criteria for symptoms are met, but no one set of symptoms predominate
Schizophrenia residual type
active phase symptoms are present but substantially reduced, dysfunction continuing
other psychotic disorders
brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, delusional disorder
Brief psychotic disorder
Sudden onset of psychotic (delusions, hallucinations). Person Returns to normal functioning within one month. Sometimes brief psychotic disorder is precipitated by a stressor (IE: fired at work, sexual assault) and sometimes no precipitating event can be identified
scizophreniform disorder
positive and negative symptoms similar to schizophrenia. Duration of dysfunction: 1 month< X< 6months
schizoaffective disorder
Person Meets The symptom and dysfunction Duration Criteria For schizophrenia
Person Also experiences mood episodes (e.g., Manic, Major Depressive, mixed episodes)
delusions and hallucinations Have Been Experienced Without mood symptoms For At Least two weeks
Mood Episode Time (MET) Is Significant relative to psychotic dysfunction Time (PDT)
MET/ PDT < 20-25% then schizophrenia
MET/ PDT > 20-25% then schizoaffective disorder
Delusional Disorder
non-bizarre delusions
hallucinations Are Absent Or Very Infrequent
negative symptoms Are Absent Or Very mild
Normal Functioning (work, social, self-care)
Types
Erotomanic Type
Grandiose Type (secret Millionare)
Jealous Type
Persecutory Type (FBI is following him)
Somatic Type (believes he has a heart illness-NO ANXIETY)
Ventricular enlargement
A stable trait in people diagnosed with Schizophrenia-enlarges this portion of the brain
reduced asymmetry
the left side of the brain and the right side of the brain are aligned or reversed that of a regular brain.
Dopamine Hypothesis
Symptoms of Schizophrenia are caused by overactive dopamine. Evidence For The Dopamine Hypothesis
typical antipsychotics (Thorazine, Haldol) Reduce Dopamine Transmission And Reduce positive symptoms
Stimulant drugs, Such As Amphetamines, That Are Biochemically Similar To Dopamine, Induce psychotic Sxs In Normals And Worsen Sxs Of Sz Patients
Evidence Against The Dopamine Hypothesis
_atypical antipsychotics (Clozaril, Zyprexa, Risperidol), That Have Their Greatest Effects On the serotonin system And Little Or No Effect On The Dopamine System, Reduce The positive symptoms of schizophrenia
Neurocognitive impairments (e.g., Inattention, Impaired Planning And Organization) Suggest That The Frontal Lobes Are underactive
Imaging Studies Indicate That The frontal lobes Are Underactive
Conclusions
dopamine transmission Plays A Role
Other Transmitters Involved
Neurotransmitters Are underactive In Some Brain Areas
Neuro Cognitive Impairments in Schizophrenia
Impaired verbal memory, impaired attention/ vigilance, Impaired executive Functioning (organization and planning, set/rule maintenance)
Neurocognitive as a genetic marker
Neurocognitive impairments are present prior to the onset of the disorder, neurocognitive impairments are not due to positive symptoms, neurocognitive impairments are observed in the siblings and children of persons with schizophrenia
Relations between Neurocognition and Functioning in Sz
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Treatment of schizophrenia
Antipsychotic medications(Typical Antipsychotics, Atypical Antipsychotics),
Token economy, Skills training, Family education
Typical Antipsychotics
(e.g.,Thorazine, Haldol, Prolixin)
Reduce Dopamine Transmission
Therapeutic Effects
Suppress Positive Symptoms
No Effect On Negative symptoms
Side Effects
Muscle Stiffness/ Tardive Dyskinesia
Sedation / Mental Slowing
Atypical Antipsychotics
(e.g., Abilify, Zyprexa, Risperidol, Cloziril)
Reduce Transmission Of Multiple NTs, Little Effect On Dopamine
Therapeutic Effects
Suppress Positive Symptoms
Little Effect On On Negative Symptoms
Side Effects
Weight Gain
Diabetes
Liver Damage
Token Economy
Differential Reinforcement of Desirable and undesirable behaviors
Desired Behaviors Made Known To Patients
Group Attendance
Self-Care/ Hygiene
Prosocial Behaviors On The Ward
Patients Accumulate Tokens/Points
Patients Purchase Desirable Items With Their Tokens/ Points
Skills training
Psychoeducation With Intensive Role plays
Modules
Symptom Management
Warning signs
Persistent Symptoms
Txing(training) In Reporting Symptoms And Side Effects To Doctor
Medication Management
Person learns to appreciate their need for Medication ("Medication Insight")
Txing In Reporting Symptoms And Side Effect To Case Manager Or Psychiatrist
Training In Social Skills
Learning to elicit Rewarding Social Experiences
Training In Vocational Skills
Money Management/ Conservatorship
Family Education
Emphasize Biological Origins Of The Disorder To Reduce Feelings Of Blame and Shame
Management Of Expressed Emotion In Family By Increasing Communication skills
Expressed Emotion = Anger, Criticism, Negativity About The Patient
Educate Family And Pt About
Symptoms
Course
Meds
"Disorganized" Symptom Cluster
includes severe and excessive speech, behaviors, and emotions
-cognitive slippage
-loose associations
-tangentiality
-catatonia
Subtypes of Schizophrenia
paranoid, disorganized, catatonic, undifferentiated, residual
paranoid type
most common subtype of schizophrenia, characterized by the appearance of delusional thinking accompanied by frequent auditory hallucinations
disorganized type
subtype of schizophrenia characterized by confused behavior and disorganized delusions, among other features
Catatonic type
subtype of schizophrenia characterized by bizarre movements, postures, or grimaces
Undifferentiated type
a subtype of schizophrenia diagnosed if a patient does not meet criteria for paranoid, disorganized, or catatonic subtypes of schizophrenia
residual type
patients who no longer meet criteria for active phase symptoms but demonstrate continued signs of negative symptoms or attenuated forms of delusions, hallucinations or disorganized speech- in "partial remission"
Schizophreniform disorder
disorder in which individuals meet the primary criteria for schizophrenia but show symptoms lasting only 1 to 6 months.
Schizoaffective disorder
Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder.
Delusional disorder
A psychosis marked by severe delusions of grandeur, jealousy, persecution, or similar preoccupations
Brief psychotic disorder
Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor.
Shared psychotic disorder
a delusion develops in an individual in the context of a close relationship with another person who has an already established delusion - their delusion is similar in content
Schizotypal personality disorder
a personality disorder characterized by detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors
schizophrenia stats
Onset and prevalence of schizophrenia worldwide
About 0.2% to 1.5% (or about 1% population)
Often develops in early adulthood
Can emerge at any time
Schizophrenia life expectancy
generally chronic
Most suffer with moderate-to-severe lifetime impairment
Life expectancy is slightly less than average
Female with schizophrenia
tend to have a better long-term prognosis
family studies -schizophrenia
Inherit a tendency for schizophrenia, not forms of schizophrenia
Risk increases with genetic relatedness
Endophenotypes
Genetic mechanisms that contribute to the underlying problems causing the symptoms and difficulties experienced by people with psychological disorders.
Genetic and Behavioral Markers of Schizophrenia
Genetic markers: Linkage and association studies
Endophenotypes
Schizophrenia is likely to involve multiple genes
Behavioral markers: Smooth-pursuit eye movement
The procedure - eye-tracking a moving object
Tracking deficits - schizophrenics and their relatives
Causes of Schizophrenia: Neurobiological Influences
The dopamine hypothesis
Drugs that increase dopamine (agonists)
Result in schizophrenic-like behavior
Drugs that decrease dopamine (antagonists)
Reduce schizophrenic-like behavior
Examples - neuroleptics, L-Dopa for Parkinson's disease
Dopamine hypothesis is problematic and overly simplistic
Current theories - emphasize many neurotransmitters
Causes of Schizophrenia: Other Neurobiological Influences
Structural and functional abnormalities in the brain
Enlarged ventricles and reduced tissue volume
Hypofrontality - less active frontal lobes
A major dopamine pathway
Viral infections during early prenatal development
Findings are inconclusive
Medical Treatment of Schizophrenia
Development of antipsychotic (neuroleptic) medications
Often the first line treatment for schizophrenia
Began in the 1950s
Most reduce or eliminate positive symptoms
Acute and permanent side effects are common
Extrapyramidal and Parkinson's-like side effects
Tardive dyskinesia
Compliance with medication is often a problem
Noncompliance with medication
Psychosocial Treatment of Schizophrenia
Psychosocial approaches: Overview and goals
Behavioral (i.e., token economies) on inpatient units
Community care programs
Social and living skills training
Behavioral family therapy
Vocational rehabilitation
Cultural considerations
Research on symptoms of schizophrenia in deaf patients
16 empirical investigations of deaf persons with schizophrenia between 1929 and 2005 (Mompremier, 2009)
executive functioning
a set of mental processes that control and regulate other behaviors
treatment for ADHD
Reinforcement programs
To increase appropriate behaviors
Decrease inappropriate behaviors
May also involve parent training
Amnestic Disorder
Inability to learn new information despite normal attention. Can't recall previously learned info. Disoriented to place & time. Confabulation: imaginary events to fill memory gaps. Denial of problem, lack of concern, apathy. Acute or insidious. Variable duration and course.
DSM 5 (PPD)
Autism Spectrum Disorder
No subtypes
causes of amnestic disorder
Resulting from stroke or chronic heavy alcohol use
Causes of Dementia: Alzheimer's Disease
Neurofibrillary tangles
Amyloid plaques
The role of deterministic genes
Beta-amyloid precursor gene
Presenilin-1 and Presenilin-2 genes
The role of susceptibility genes - ApoE4 gene
Brains of Alzheimer's patients tend to atrophy
Neurofibrillary tangles
a structural change in the cerebral cortex associated with Alzheimer's disease in which bundles of twisted threads appear that are the product of collapsed neural structures
Substance-Induced Dementia
exposure/use of drugs causing dementia, but has worse deficits & permanent
Creutzfeldt-Jakob Disease
A neurological disease transmitted from animals to humans that leads to dementia and death resulting from abnormal protein accumulations in the brain. Linked to mad cow disease ( bovine spongiform encephalitis)
Pick's disease
a rare disorder that affects the frontal and temporal lobes and is clinically similar to Alzheimer's disease
Huntington's disease
progressive and fatal type of dementia caused by dominant alleles
Parkinson's disease
a progressive disease that destroys brain cells and is identified by muscular tremors, slowing of movement, and partial facial paralysis
Other Causes of Dementia
Head trauma - accidents are leading cause
Memory loss is the most common symptom
HIV-1
Causes neurological impairments and dementia
Cognitive slowness, impaired attention, and forgetfulness
Apathy and social withdrawal
Vascular Dementia
Progressive brain disorder involving loss of cognitive functioning, caused by blockage of blood flow to the brain that appears concurrently with other neurological signs and symptoms.
Dementia of the Alzheimer's Type: Extent of Deficits
Range of cognitive deficits
Aphasia - difficulty with language
Apraxia - impaired motor functioning
Agnosia - failure to recognize objects
Difficulties with
Planning
Organizing
Sequencing
Abstracting information
Sundowner syndrome
When the sun goes down the elderly become confused and often combative.
Alzheimer DSM IV TR
Multiple cognitive deficits
Develop gradually and steadily
Memory, orientation, judgment, and reasoning deficits
Additional symptoms may include
Agitation, confusion, or combativeness
Depression and/or anxiety
"Sundowner syndrome"
Dementia
Gradual deterioration of brain functioning
Deterioration in judgment and memory
Deterioration in language / advanced cognitive processes
Has many causes and may be irreversible
Dementia initial stage
Memory and visuospatial skills impairments
Agnosia - inability to recognize and name objects
Facial agnosia - inability to recognize familiar faces
Other symptoms
Delusions, apathy, depression, agitation, aggression
Dementia later stage
Cognitive functioning continues to deteriorate
Total support is needed to carry out day-to-day activities
Death due to inactivity and onset of other illnesses