PSYCH 340: Chapter 11
Meaning of "schizein" in Greek:
To split
Meaning of "phren" in Greek:
Mind
What was Haslam's contribution to diagnosing schizophrenia?
He outlined a description of the symptoms of schizophrenia.
What was Pinel's contribution to diagnosing schizophrenia?
He described cases of schizophrenia.
What was Morel's contribution to diagnosing schizophrenia?
He coined the term "dementia precox" which means premature loss of the mind.
What was Kraepelin's contribution to diagnosing schizophrenia?
He unified the distinct categories of schizophrenia under the name dementia praecox.
What was Bleuler's contribution to diagnosing schizophrenia?
He coined the term schizophrenia ("split of the mind").
Define psychosis.
Major disturbances in thought, emotion, and behavior.
Give some examples of psychosis.
- Flat or inappropriate affect
- Disordered thinking in which ideas are not logically/semantically related
- Faulty perception and attention
- Bizzare disturbances in motor activity
Describe the Prodromal phase.
- lasts 1-2 years before the official diagnosis of schizophrenia
- 85% of patients with schizophrenia experience it
- Unusual ideas of reference, magical thinking, increased anxiety, attention problems...
What does ideas of reference mean?
The idea of self-reference in neutral events. Ex.: believing that everyone in the city is talking about them; believing that a television news segment has to do with them...
Why is schizophrenia considered one of the worst mental disorders?
Due to its high rate of completed suicide.
When (time wise) is schizophrenia diagnosed?
After the onset of symptoms for 1-2 years (aka Prodromal phase)
Why is there a poor overall prognosis?
Because we are generally ill-equipped to deal with this disorder and it's highly stigmatized.
What factors contribute to the high mortality rate among patients with this illness?
The use of illicit drugs, comorbidity, and poor family/social support.
Name some comorbid conditions:
Depression
Social anxiety
Substance abuse
Specifiers:
- First episode of multiple
- Continuous
- Unspecified
- With catatonia
What is the difference between positive and negative symptoms of schizophrenia?
Positive: presence of too much of a behavior that isn't present in most people
Negative: the absence of a behavior that should be evident in most people
Name 3 positive symptoms.
Delusions
Hallucinations
Disorganized speech
What is the scale of severity?
It's a five point scale (0-4) with 0 being not severe and 4 being very severe symptoms
Define formal though disorder.
Disorganized thoughts will lead to disorganized speech and neologisms (new words that client makes up)
Describe a bit about disorganized speech.
Cognititve slippage, incoherence, derailment, not making any sense, sentences are not properly syntaxed and follow no semantic order.
Define delusions.
Erroneous belief that is fixed and firmly held despite any clear contradictory evidence.
What is "ludere?"
Its the Latin word for "to play" and refers to delusions as playing tricks on the mind
What other diagnoses are delusions found in?
Mania and delusional depression
Name and describe three types of delusions.
- Delusions of body changes: organs don't work or were removed
- Delusion of reference: neutral environment is believed to have some personal and special meaning
- Thought insertion: thoughts are being inserted into one's mind by some external agency
What is the difference between delusions and hallucinations?
Hallucinations are sensory while delusions are mainly maladaptive thoughts.
Which parts of the brain are hallucinations associated with?
Broca's area (speech production) and the visual center
Name the two broad domains of negative symptoms:
- Reduced expressive behavior
- Reductions in motivation or in the experience of pleasure.
Name the 5 A's of negative symptoms/
- Affect
- Alogia
- Avolition
- Anhedonia
- Asociality
Describe a flat affect
No emotional response and no stimulus can elicit a response; lifeless expression; still experiencing plenty of internal emotions but doesn't show it; present in most people with illness
Describe alogia.
Poverty of speech (amount is greatly reduced) and poverty of content of speech (amount of speech is reasonable bit it tends to be vague and repetitive).
Describe avolition.
Lack of interest and motivation; inability to intiate or persist in goal-directed activity; apathy; bad hygiene; poor life functioning.
Describe anhedonia.
Diminished ability to experience pleasure; lack of interest in activities and sex; clients are aware of this and normally report it.
Describe asociality.
Childhood social troubles; poor social skills; severely impaired social relationships; greater shyness
What is catatonia?
It's a specifier that can be present in diagnosis but doesn't need to be. Catatonia is the characterized by severe motor abnormalities and is similar to mania. Bizarre gestures, repeated movements, increase of level of activity.
Catatonic immoblity:
adopting unusual postures and holding them for long periods of time. In waxy flexibility, another person can position them, and they will hold that posture the same.
What are the 5 schizophrenic disorders included in the DSM-4?
- Disorganized
- Catatonic
- Paranoid
- Undifferentiated
- Residual
Define ecolalia.
Repeating other people's words over again.
Define echopraxia
Repeating other people's gestures.
In paranoid schizophrenia, what are the types of prominent delusions?
- Delusions of persecution
- Grandiose delusions
- Grandiose jealousy
- Ideas of reference
In which schizophrenic diagnosis are the delusions and hallucinations not surrounded by a specific theme?
Disorganized
Discuss some genetic factors of the etiology of schizophrenia
- Higher concordance in monozygotic twins
- Negative symtpoms (5A's) have a genetic component
- 10% prevalence in first-degree relatives of a proband with schizophrenia
Discuss the theory of the schizophrenogenic mother.
Thoery that the mother was to blame for her child's psychiatric problem due to her dominant and conflict-inducing parenting behavior.
What was the finding in the adoptive family study from Finland?
After 21 years, the index adoptees developed more schizophrenia and schizophrenia-like symtpoms than did the controls
What is one of the most important causal factors that relates to diagnosis?
Gene-environment interaction.
Evidence for dopamine hypothesis:
Drugs are successful in treating schizophrenia by decreasing dopamine levels; amphetamines induce symtpoms of psychosis that closely resembles paranoid schizophrenia
Evidence against dopamine hypothesis:
It might not be excess in dopamine, but rather oversensitive dopamine receptors; HVA is not found in greater amoutns in people with schizo
What is the result of under-active dopamine neurons in the prefrontal cortex?
Negative symptoms (5A's)
What is the result of release of mesolimbic dopamine neurons from inhibitory control?
Positive symptoms (delusions, hallucinations, disorganized speech)
List some congenital and developmental considerations of the cause of schizophrenia.
R\Pregnancy complications and birth defects; Malnutrition; Gene-environment interaction
Discuss the effects of psychological stress on schizophrenia.
increased stress leads to increased likelihood of relapse. Low socio-economic status leads to increased stress
What is the diathesis stress model?
A genetic/environmental predisposition to stress and a related diagnosis
What's going on in the prefrontal cortex?
- Less dopamine neurons
- reduction in grey matter
- less activation
Sociogenic hypothesis:
Stressors associated with low SES may contribute to development of schizo
Social-selection theory:
It's a huge domino effect. They're social deficits will increase with the development of their psychosis, which may drift them toward poverty-ridden areas of the city. Their cognitive and motivational problems will impair their ability to work and make a living. They will end up isolating themselves and escaping from relationships.
What is the most common treatment?
Antipsychotic medication (first generation neuroleptics) (Dopamine antagonists (D2))
Why might patients with schizophrenia stop taking their antipsychotic meds?
Because the side effects are unpleasant (like uncontrolled motor movement). Psychoeducation may help as well as social encouragement
What are the differences between first and second generation neuroleptics?
- First: effect on positive symptoms vs. Second: effect on both negative and positive
- less side effects
- Blocks more receptors, not just D
Two forms of psychological treatments:
Psycho-social and cognitive-behavioral
2 psychosocial treatments:
- Social skills training: helps with employment, fostering relationships, breaking down tasks to make them easier
- Family therapy and Reducing expressed emotion: high amount of perceived criticism and low warmth leads to low medication adherence and stigmatization.
How does CBT help?
Works on dysfunctional attitudes and internalizing stigma. Works on interpreting thoughts and feelings.
What is command hallucinations in CBT?
The person believes they are being commanded to do something.
Think about how schizophrenia can be destigmatized in the contemporary world.
Psychoeducation to family members as well as psychiatric professional; increase education in younger people to devleop a greater understandng and acceptance earlier on.