Psychopathology Schizophrenia
Terms
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- Schizophrenia statistics
- 1% population, 3-4 million in US, develops early adulthood about 18, can emerge at any time, generally chronic, lower life expectancy, affects both sexes equal, females have better long term prognosis, onset differs in sexes, strong genetic component
- Residual Type
- No disabling signs, one past episode of schizophrenia, display less extreme residual signs
- Negative symptoms
- Absence or insufficiency of normal behavior, can include lack of goal directed behavior, daily self maintenance or violent actions
- Akithesia
- Uncontrollable urge to move,
- Prenatal Causes
- Viral infections during Pregnancy of influenza, infections in the second trimester result in no finger prints like schizophrenics, findings inconclusive
- Process Distinction
- Insidious onset, biologically based, negative symptoms, poor prognosis
- Disorganized type
- Disorganized symptoms prevalent, not a good prognosis, chronic and episodic, marked disruptions in speech and behavior, flat or inappropriate affect, hallucinations and delusions fragmented, lacks remission
- Capgrass syndrome
- Believe yourself or someone close to you has been replaced by a double
- Catatonia Spectrum
- Immobility, Waxy flexibility (put someone in position and stay there) and Wild agitation (can have inhuman strength and become wild and violent)
- Atypical Antipsychotics
- Work on negetive and positive symptoms of schizophrenia
- Echopraxia
- Copy all movement you see
- Types of Delusions
- Erotomanic (love exists btw you and someone else), Grandiose, Jealous (sex partner unfaithful), Persecutory, Somatic (people following you around)
- Undifferentiated type
- Wastebasket category, combination of other types, have symptoms of schizophrenia but fail to meet specific criteria
- Phenothiazines
- First medications for schizophrenics, worked on positive symptoms
- Brief Psychotic Disorder
- One or mor positive symptoms of schizophrenia, precipitated by extreme stress or trauma, remits on its own, one month or less
- Paranoid type
- Not many negative or disorganized symptoms, best prognosis, no intellectual impairment, hallucinations and delusions prevalent
- Psychosis
- Broad term for hallucinations, delusions and break with reality, heterogenous,
- Behavioral markers
- Smooth Pursuit eye movement is the ability to move eyes in sequential pattern, measure with pendulum, tracking deficits appear in schizophrenics and their relatives
- The dopamine hypothesis
- Sites dopamine imbalance as the cause, drugs that increase dopamine can cause psychotic symptoms, drugs that reduce dopamine reduce psychotic symptoms, said to be too simple of a theory cause effect of drugs vary on how quick they work, current theories involve multiple neurotransmitters
- Positive symptoms
- Active manifestations of abnormal behavior, Delusions are common to all schizos and are misrepresentations of reality (capgrass and cotard), hallucinations experience sensory events without input
- Schizophreniform Disorder
- Schizophrenic symptoms for less than six months, some time limited, good premorbid functioning, most resume normal life
- Schizoaffective Disorder
- Schizophrenic and mood disorder symptoms independent of one another, prognosis similar to schizophrenics, don't get better on their own, more psychotic symptoms worsens prognosis
- Disorganized symptoms
- Include severe and excess disruptions in speech, behavior and emotion
- Echolalia
- Repeat everything you hear
- Delusional Disorder
- More rare than schizophrenia, lack other symptoms, have beliefs contrary to reality
- Genetic research
- Search for genetic markers inconclusive, likely to involve multiple genes, risk in transmitted independently of diagnosis
- Psychosis history
- Over 200 years ago, benedict morel introuced dementia praecox (early loss of mind), Emil Draepelin focused on subtypes and made modern names, eugen bleuler introduced term schizophrenia
- Schizophreniginic Theory
- Mother put kid into double bind, sent them into situations with mixed messages that kid can't figure out and creates schizophrenia
- First Neuroleptic/Antipsychotic treatments for Schizophrenia
- Often first line treatment for schizophrenia, began in 50's, reduce or eliminate positive side effects, acute and permanent side effects are common,
- Type two distinction
- More reliable distinction, negative symptoms, poor response to medication, pessimistic prognosis and intellectual impairments, missing brain matter, ventricles enlarged which explains IQ drop
- Expressed Emotion
- Communication style in family, criticism, overprotetion, chaos, high stress
- Hebephrenic Reactions
- Unexpected reactions or emotions towards events
- Twin studies
- Monozygotic risk is 48%, Fraternal risk is 17%, risk for schizophrenia remains high even if raised in a home without it
- Psychosocial treatment for schizophrenia
- Behavioral inpatient units build motivation to do everyday tasks and prepares people for real world, Community care programs, social and living skills training, behavioral family therapy destresses family life, vocational rehabilitation
- Family studies
- Inherit a tendency for schizophrenia but not specific forms, risk increases with genetic relatedness
- Tardive dyskinesia
- EPS symptoms
- Tangentiality
- Going off on a tangent, persons mind can't focus
- Extrapyramidal side effects
- Permanent, uncontrolled muscle movements
- Transcranial Magnetic Stimulation
- Untested procedure for hallucinations
- Schizotypal Personality Disorder
- May reflect less severe form of schizophrenia, no delusions just strange beliefs
- Shared Psychotic disorder
- Delusions of one person manifest in another, also called Folie a Deux, when around psychotic too long start to believe their delusions
- Historical Treatments of Schizophrenia
- Insulin shock therapy, Electroconvulsive therapy, prefrontal labotamy
- Agranulocytosis
- Kills off white blood cells in system, sex side effects and heart problems
- Akinesia
- Poverty of speech and mood
- Type one distinction
- More reliable distinciton, positive symptoms, good response to medication, optimistic prognosis and absence of intellectual impairment
- Cognitive slippage
- Illogical and incoherent speech
- Avolition
- Lack of initiation and persistance
- Schizophrenia general
- Type of psychosis, disturbed thought, emotion and behavior, lose either thoughts, feelings, affect or behavior, starts at 18 because of life changes
- Catatonic Type
- Disorganized motor behavior prevails, severe and rare, includes Echolalia and Echophraxia
- Affective flattening
- Little expressed emotion, still feel emotions just don't show it
- Neuroleptic Malignant syndrome
- High fever and muscle rigidity
- Reactive Distinction
- Acute onset (extreme stress), notable behavioral activity, best prognosis
- Abnormalities of the brain
- Brain matter is missing in enlarged ventricles and reduced tissue volume causing cognitive deficits, Hypofrontality is less active frontal lobes witch are major dopamine pathways
- Cotard Syndrome
- Someones body changed in a serious way like the brain melting
- Alogia
- Relative absense of speech, or what comes out is unintelligable
- Causes of Schizophrenia
- Stress may activate underlying vulnerability or increase relapse risk, families show ineffective communication patterns and high expressed emotion, psychological factors exert minimal effect on producing schizophrenia
- Alan Bellack
- Came up with social skills training
- Good versus Poor premorbid functioning
- Focus on functioning prior to disorder, no longer widly used
- Auditory hallucination
- Makes Broca's area light up not Wernickes, don't recognize self speaking as self
- Anhedonia
- Lack of pleasure or indifference, no depression associated with it
- Loose associations
- Conversation in unrelated directions, never on subject
- Side effects of medication
- Extrapyramidal and parkinson-like side effects, tardive dyskinesia, photosensitivity, akinesia, Akithesia, Agaranulocytosis, Neuroleptic Malignant syndrome, psychomotor retardation
- Acute versus Insidious onset
- Determines the kind of schizophrenia you have and prognosis