What does it mean to say that schizophrenia is a heterogenous condition?
- Means it presents in many different ways
- Often comorbid with many other disorders
T/F: Social drift is common in those with schizophrenia.
- TRUE
- Can lose their jobs very quickly, end up without shelter
What are the common positive symptoms (i.e., exaggerated, distorted behaviour)?
- Hallucinations - usually auditory (voices), associated with other symptoms (delusions)
- Delusional belief - irrational and rigidly held beliefs by the patient against all evidence
- Disorganized symptoms - speech, loose associations, tangentiality
- Bizarre behaviour - catatonia, unpredictable movements, incongruity of affect and behaviour
What’s catatonia?
- The ability to remain in odd positions for a long time
- Very rigid positions
What are the negative symptoms (losses/deficits in normal functioning) found in those with schizophrenia?
(5 A’s)
- Avolition/apathy - lack of motivation and interest
- Anhedonia - diminished capacity to anticipate and experience pleasurable emotions
- Asociality - lack of interest in social interactions
- Alogia - poverty of speech, blocking (may want to talk, but nothing comes out)
- Affective flattening - lack of emotional expressivity, diminished facial expression
What are the diagnostic criteria for schizophrenia?
- Must have 2 out of the five major symptom groups which include delusions, hallucinations, disorganized speech, grossly disorganized behaviour (ex. catatonia) and negative symptoms. One of them must be one of the first three listed
- A decline in social or occupational behaviour for at least 3 months
- Continuous signs of disturbance persist for at least 6 months
- Mood disorders have been ruled out
- Not due to drugs or medications, or medical condition
- If there is autism, or another pervasive developmental disorder, then prominent hallucinations or delusions, in addition to the other symptoms of schizophrenia, must be present for at least a month
What are some common facts regarding the epidemiology of schizophrenia?
- Lifetime prevalence is between 0.5% and 1%
- Incidence is 1 per 10 000 per year
- Mean age of onset is between 20 and 45 years old (don’t know why people shift)
- 71% of patients experience their first symptoms by age 25. Treatment often starts at that time
- Schizophrenia is associated with a 12-15 years decrease in life expectancy
What are the common phases associated with the course of schizophrenia?
- Premorbid phase - can start in childhood/adolescence. Mild impairments in cognitive/social functioning
- Prodromal phase - early adolescence, sub-threshold positive symptoms, comorbid mood and anxiety symptoms, functional problems
- Psychotic phase - first-episode psychosis, meets criteria for diagnosis, late adolescence/early adult years
- Stable phase - May start to decline slowly, others can remain stable with symptoms that persist for years
What % of individuals develop a severe, unremitting form of schizophrenia?
- 10-15% of those diagnosed
- Treatment resistance may develop in 1/3 of the patients
T/F: The course of schizophrenia over the first two years following diagnosis often predicts long-term outcomes. Some patients go into remission in the first 5 years post-diagnosis
- TRUE
- Professionals don’t know why
What’s the difference between functional recovery and personal recovery?
- Personal recovery - Individual has a reduction in symptoms such as hallucinations and delusions
- Functional recovery - individual returns to work and is able to socialize (much less common)
What are some differences between men and women concerning the epidemiology of schizophrenia?
- Men and women experience the disorder equally
- Men experience symptoms 4-5 years earlier than women, are more likely to exhibit negative symptoms and to have a chronic, deteriorating course
What are some of the better predictors of having a better prognosis for schizophrenia?
- Being female
- Rapid (vs. slow over time) onset
- Predominance of positive symptoms (fewer negative)
- Good pre-disorder functioning
- Personal characterisics and resources (resilience)
T/F: There is strong support for a genetic influence in schizophrenia.
- TRUE
What were some important genetic findings discovered by the Schizophrenia working group of the psychiatric genomics consortium?
- Many of the genes involved govern the functioning of neurotransmitters such as dopamine and glutamate
- The strongest findings concern chromosome 6, which is heavily involved in immune functioning
- Many alleles that indicate high risk for schizophrenia also indicate high risk for bipolar disorder
How can schizophrenia be viewed as a neurodevelopmental disorder?
- Research has shown that allele mutations, deletions, and duplications might play a role in schizophrenia, similar to autism, ADHD, and intellectual disabilities
What has brain imaging revealed about the neuropathology concerning schizophrenia?
- Abnormally reduced in overall gray matter, including reduced frontal brain volumes and frontal brain blood flow
- Abnormalities in the left temporal lobe, which is strongly connected to the frontal lobes, the amygdalae, and the hippocampus
- Enlargement of the ventricles, indicating a general loss of surrounding neural tissue.
*These are not signs of the disorder
T/F: Neuropsychological testing indicates that most people with schizophrenia are cognitively impaired, and many have low IQ.
- TRUE
- IQ may decline over time
What’s the dopamine hypothesis?
- Many drugs that stimulate dopamine (ex. LSD, cocaine) cause hallucinations
- Recent research has emphasized dopamine dysregulation as a contributor to schizophrenic symptoms
- Particularly, increased sub-cortical dopamine may result in the development of aberrant salience (i.e., attach importance to things that have no significance)
How may glutamate levels be affected in those with schizophrenia?
- May have lower levels of glutamate in the prefrontal cortex and the hippocampus
- May help explain more of the negative symptoms
T/F: Most people who are diagnosed with schizophrenia appear typical during childhood.
- FALSE
- Most show problems in childhood
What developmental factors may contribute to schizophrenia?
- Pregnancy and birth complications such as exposure to viruses, prolonged labor, preterm delivery, low birth weight, and fetal distress
- Early signs of motor impairment, cognitive limitations, social withdrawal, and aggression
- ACEs
What are the cognitive problems associated with schizophrenia?
- Impaired problem solving
- Memory deficits
- Impaired learning and word recall
What are the different subtypes of schizophrenia?
- Impaired problem solving
- Memory deficits-memory impaired
- Cognitively impaired
- Cognitively normal (will have better rehabilitation)
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Chapter 1 - Introduction to Psychopathology29
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Chapter 3 - Classification and Assessment of Mental Disorders26
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Chapter 4 - Mood Disorders and Suicide56
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Chapter 5 - Anxiety Disorders and OCD43
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Chapter 6 - Dissociative and Somatic Symptom and related disorders28
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Chapter 7 - Psychological Factors Affecting Medical Conditions22
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Chapter 13 - Sex disorders73
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Chapter 9 - Schizophrenia39
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Chapter 17/18 - Prevention and treatment43
