1
Q
Psychotic Symptoms
A
hallucinations, delusions (strange fixed believes that are not amendable even with evidence to the contrary), and some other stuff
2
Q
Dementia Praecox
A
-Emile Kraeplin
-A disorder with progressive deterioration; unlike other dementias, begins at an early age
3
Q
Eugen Bleuler
A
-1911 used term “schizophrenia”
-“Schizo” (to split, or crack) “phren” (mind)
-Disorder characterized primarily by disorganization of thought processes
Split from reality
-Distinction from “multiple personality disorder” or dissociative identity disorder
-Considered schizophrenia a group of disorders, not a single disease state
-Led to very broad definition, more subjective
4
Q
Symptoms of Schizophrenia
A
- perception
- content of thought
- form of thought
- affect
- psychomotor
6.disorder of relating
5
Q
Perception
A
-Hallucinations
-Can occur in all sensory modalities
-negative hallucinations
-Can occur while and have qualities of real sensory/perceptual experiences
6
Q
Negative Hallucinations
A
stimulus is present, but person with schizophrenia does not see stimulus
7
Q
Johns & McGuire Study Setup
A
-People with schizophrenia - healthy controls, no psychotic symptoms
-Two groups of people with schizophrenia - one of whom were hearing voices, one who were not
-Had them put on headphones and read out words that came on a screen - words could be complimentary, derogatory, or neutral adjective - person would speak into mic connected to amplifier which had some sort of acoustic distortion fed directly back into ear (hearing words in headphones - sometimes slightly distorted by computer) - introduces disparity between what person is saying and feedback they are getting - had to indicate if it was the person or someone else -
8
Q
Johns & McGuire Study FIndings
A
- people w/hallucinations were more likely to misattribute their own voice to someone else and particularly if it was a derogatory word - bc sound is a little different they couldn’t connect it with their own voice
-Ppl argued that it reflects bias on part of those w/schizophrenia to misattribute negative thoughts they have (especially of themselves) to somebody else
9
Q
Content of Thought
A
-Delusions
-Controlled by outside force
-False belief based on an incorrect inference
-Firmly believed despite contradictory evidence
-false belief, but willing to entertain the idea that it’s false
-Common in schizotypal PD and prodromal schizophrenia
10
Q
A
11
Q
Types of Delusions
A
-Grandiose Delusions
-Delusions of Jealousy
-Nihlistic Delusions
-persecutory delusions
-delusions of reference
-somatic delusions
12
Q
Delusions of Reference
A
belief that some event or object or person is signaling something to you specifically
13
Q
Thought Withdrawal
A
an individual believes their thoughts are being removed or stolen from their mind by an external force or entity
14
Q
Thought Insertion
A
individual believes their thoughts are not their own, but rather foreign thoughts inserted into their mind by an external agent, person, or force
15
Q
Thought Broadcasting
A
don’t necessarily hear your own thoughts as a foreign entity but you think they are being broadcast to everyone around
16
Q
Made Impulses
A
some sort of external force causing you to do things/act on thing you don’t want to do
17
Q
Made Feelings
A
your feelings are being caused by some sort of external entity
18
Q
Form of Thought
A
-Formal thought disorder/speech disorder - classified as speech/thought disorder
a) Derailment
b) Word Salad
c)Alogia
d)Neologisms
e)Blocking
f) Illogical Thinking
19
Q
Derailment
A
loose associations, with a manic episode you can often follow thought logic w/pressured speech, in schizophrenia move from one thing to another but can’t follow it
20
Q
Word Salad
A
extreme end, people producing real words that may have grammatical structure but jumbled up words where the content doesn’t seem to go anywhere
21
Q
Alogia
A
poverty of speech or content of speech, saying words but communicating very little
22
Q
Neologisms
A
words get mashed together or someone comes up with a new word altogether or gives an existing word new meaning
23
Q
Affect
A
-blunted/flat
-inappropriate
-Problems perceiving others’ emotions
23
Q
Blocking
A
patient is talking and they just stop very abruptly, often accompanied with thought withdrawal
24
Catatonia
-Catalepsy/waxy flexibility
-stupor
-posturing
-mutism
-catanoic excitement
-catatonic negativism
-echolalia
-echopraxia
25
Catalepsy
immobile but blinking and breathing, healthcare provider could actually put them into odd physical positions, and they would just stay there until moved again
26
Stupor
immobile, appear to possess no awareness of their environment
27
Posturing
would move around but strike random odd positions / facial expressions
28
Catatonic Excitement
psychomotor agitation but purposeless - people moving around very frantically but without any obvious motivation
29
Catatonic negativism
marked, purposeless resistance to instructions or attempts to move or interact with person
30
Echolalia
repetition of word or phrase over and over again
31
Disorder of Relating
-Very withdrawn
-Preoccupied with a fantasy world
-Disordered volition
-Anhedonia
32
Positive Symptoms
-the presence of symptoms that shouldn’t be there
-Hallucinations, delusions, inappropriate affect
33
Negative Symptoms
-absence of something that should be there
-Blunted affect, alogia, avolition
34
Positive vs. Negative Symptoms
-Positive tend to respond better to medications
-Negative symptoms often very hard to treat
-But very few people have only negative
35
DSM5 Symptoms
-Delusions
-Hallucinations
-Disorganized speech and behavior
-Grossly disorganized or catatonic behavior
-Negative symptoms
-Level of functioning markedly lower than prior to onset
-Unipolar, bipolar depression, schizoaffective disorder ruled out
-Not attributable to substance
36
Symptom Duration
-Symptoms present for six months and include at least one month of active symptoms
37
Symptom Requirements
Need at least TWO of the symptoms
-at least one of these two required symptoms has to be one of delusions, hallucinations, or disorganized speech and behaviour
38
Schizoaffective Disorder
-People with schizophrenia features and severe mood disorder
-Mood disorders can be unipolar or bipolar; must currently meet criteria for depressed mood
-Delusions or hallucinations for 2 or more weeks in the absence of mood episode during lifetime duration of illness
-Sx of major mood episode present for the majority of illness
-Not attributable to effects of a substance
-Prognosis is somewhere between schizophrenia and mood disorders
-Long-term prognosis for schizoaffective > schizophrenia
39
Prevelance
0.7% to 1%
40
Gender Breakdown
-M:F ratio ~1.4:1
-women tend to present with more symptoms of depression, which may explain the imbalance in diagnoses
-female sex hormones (estrogen) may also be protective
-postmenopausal, estrogen decreases
-late-onset schizophrenia is more common in women
41
Childhood Schizophrenia
-extremely rare, more common in boys
42
Onset
-onset always insidious, very gradual hard to tell where it began
-not an abrupt break in reality, a string of problems leading to the onset
-almost always characterised by early speech and language problems
-adult onset also had early speech and language problems
-delayed motor development, poor coordination
-long-term follow up: continue to show signs and symptoms
-very small % remit, some remain continuously psychotic
43
Level of Impairment
-only 20%-30% of individuals with schizophrenia able to live independently and or maintain jobs
-another 20-30% have persistent moderate symptoms and impairment
-remaining 50% experience severe impairment for the remainder of their lives
44
15yr Study
-only 20%-30% of individuals with schizophrenia able to live independently and or maintain jobs
-another 20-30% have persistent moderate symptoms and impairment
-remaining 50% experience severe impairment for the remainder of their lives
45
Life Expectancy
-avg expentancy is 20yrs shorter than the general population
-the disparity is increasing
46
Risk Factors
-risky lifestyle, antipsychotics can have higher rates of physiological side effects, more likely to die in sucicde, esp early on in the disorder
-smoking can improve cognitive behaviour in schiz, so ppl tend to smoke more, increased health risk
47
Prognostic Indicators
-80% of patients w/5 good predictors good outcome, 40% of patients with other group
48
Good Prognostic Indicators
-good premorbid adjustment
-acute onset (less than one month)
-manic and depressive symptoms confusion or disorientation during psychosis
-family history of mood disorder
49
Bad Prognostic Indicators
-poor premorbid adjustment
-Insidious, gradual onset
* Negative symptoms (esp. blunted affect)
* Family history of schizophrenia
* In some studies a lower IQ
50
SUD Comrbidity
-Substance abuse very common
* Especially alcohol and nicotine
* Nicotine incredibly common
* Substances may also play a role in triggering
51
Suicide Comorbidity
* Abt. 20% will attempt on one or more occasions
* 5% die by suicide
* Especially for schizophrenic young men, w/their first psychotic episode
* Some evidence that those with best premorbid functioning more at risk
52
Schizophrenia & Violence
-very slight increase in risk population wide
-aggression most common in younger male patients w/history of violence
-tendency to stop taking meds, impulsivity, sub abuse
-drug use/abuse alone increases risk more
-majority of people with schizophrenia more likely to be victims of violence or suicide (aggression against self)
53
Twin Studies
-higher concordance for Mz twins than Dz twins
-in meta analysis
-concordance in Mz: 28%
-concordance in Dz: 6%
-genetic risk seems stronger in those who have also experienced perinatal complications
54
Fischer Study
-assume that the Mz dont experience a more similar environment to each other than Dz, but this is not necessarily true
-even from conception the environment of Mz twins is more similar than Dz, Mz are share placenta (monochorionic), blood supply, nutrients all the same
-Mz twins who were monochorionic are more likely to be concordant for schizophrenia than Mz who were dichorionic
55
Endophenotype
intermediate step between microscopic genes and nerve cells and the experiential and psychological phenotype
56
Endophenotype Requirements
-must segregate with illness in the population
-must be heretible
-must not be state dependent
-must co-segregate with illness w/i families
-must be present at a higher rate w/i affected families than in the population
-must be amenable to reliable measurement, and be specific to the illness of interest
57
O'Driscoll Study
-eye tracking abnormalities
-schizo have abnormal tracking of sinusoidal wave, many brief saccades away from the wave
-present in ppl who are ill and family members of ppl who are ill, stable over time even in recory and never medicated populations
-sometimes seen in bipolar, but usually a function of the medication
58
SES Influence
-social class and ethnic minorities
-ppl with schizophrenia tend to have lower SES
-social causation vs social selection
-more common in urban environments, living in a dense urban environment is stressful
59
Social Selection
SES is a an effect of schiz, family of origin
60
Social Causation
-SES causes schiz, immigrants to UK and Netherlands from caribbean and africa
-stress of immigrating and being a minority
61
Advanced Paternal Age & Schiz
-advanced paternal age at conception associated with increased risk
-bc of denovo mutations more common in older men?
-or bc of personality? And fathers own genetic risk for schiz
62
Birth Complications
-schizophrenic patients more liekly to have experienced birth complications
-breech delivery, prolonged labor, umbilical cord around neck
-resulting in hypoxia/anoxia
-anoxia at birth can also result in DA supersensitivity
63
Prenatal Exposure
-viral infections
-did the antibodies predict schiz?
-tested herpes simplex II, rubella, influenza
-direct evidence particularly during 2nd trimester
64
Season of Birth
-small significant increase for ppl born in late winter early spring
-5-15% increase
-northern and souther hemisphere
-stronger further from the equator
-# of viruses can cause fetal damage, freely circulating
-more common in fall and early winter
-do most damage in second trimester
65
Malnutrition in Pregnancy
-Dutch Huger Winter
-rates about 2x normal in individuals conceived during the famine
-general lack of nutrition? Or specific lack of folate or iron?
-replicated following famine in China
66
Neurodevelopment in 2nd Trimester
-neural migration is an important task of 2nd trimester
-Disruptions can affect neural connectivity, particularly cortical connectivity
-could result in decreased gray matter
-could result in cell death whoch also results in decreased grey matter
67
Brain Volume
-lots of evidence for decreased whole brain volume in schizophrenia
-even in recent-onsent, suggesting that its not a result of treatment
-prgressive loss of gray matter over time
-progressive deterioration also continues for many years into the illness
-young ppl show a lot of progressive loss of grey matter
68
Loss of Grey Matter Course
-seems to start int he parietal cortex and spread to regions implicated in the symptoms of schiz liek langiage deficits and cognitive control
69
Loss of Grey Matter Explanations
-also evident in Mz twins of ppl w/schizophrenia
-not explained by antipsychotic medications or other treatments
-not explained by damage from the illness itself
-may be under genetic control
70
Working Memory
a process where info is held in memory for a short time for the purpose of doing other things
71
Dopamine Hypothesis
-antipsychotic drugs work on DA system, blocking D2 receptors
-cocaine, amphetamines boost DA activity
-can result in psychosis, paranoia, distorted sense of reality
72
CSF Studies for Dopamine
tap spinal column to see levels of metabolites, dont see any differences in ppl with schiz in the spinal fluid
73
DA Receptor Testing
-challenging b/c most ppl w/schizophrenia are on antipsychotics
-best evidence: excess DA transmission in striatum, reduced DA transmission in frontal lobes
-region-specific functioning that drives schiz
74
Aberrant Salience
-increased DA may cause patients to attend more irrelevant stimuli, finding meaning in things where there is no meaning
-Patients may struggle to make sense of everyday experiences
75
Reward Cues
Failure to respond to meaningful reward cues bc of:
-anhedonia
-negative symptoms
76
Abnormal Movements
-caused by irregular dopamine levels
-oral-facial (tics, grimacing)
-upper limb dykinesias (tremors to uncontrollable discoordination)
-movement abnormalities also present throughout premorbid period
77
DLPFC (dorsolateral prefrontal cortex)
-activity heavily regulated by DA
-cognitive deficits consistent in schizophrenia, including working memory
-also evident prior to the development of schiz
-may be implicated in schizophrenia
78
Park & Holzman Study Setup
-tested WM deficits in schiz, healthy controls, bipolar
-task was to have a subject sitting in front of a screen in front
-Touch target
-Touch screen while doing a distractor task for a delay period
-Ask to put finger back on target (memory guided)
79
Park & Holzman Study Findings
-deficits unique to schiz, ppl w/schiz were much worse at remembering where the target had been
-in later studies
-evident when ill and when healthy
-in college students w/schizotypal symptoms
-evident in 1st degree relative
80
Cannabis & Schizophrenia
-cannabis is one of the most used drugs among adolescents and YA globally
-highest prevalence among young people
-ppl w/schizophrenia 2x more likely to smoke marijuana
-evidence suggests a dose-response relationship, more frequent use of higher-potency cannabis products associated with a greater risk of schizophrenia
-odds of developing psychotic symptoms were 3-9x higher in heavy users compares to nonusers
81
Cannibis & Correlation
-this is a correlational study, causality cant be ethically studied
-does cannabis cause schiz or do ppl vulnerable to schiz tend to self medicate more?
-use of cannabis is strongly assc w/ the onset of psychosis disorders at an earlier age
-evidence that it predicts onset of schiz
-significant even when controlling for childhood symptoms of psychosis
-reduction in brain volume over time is much more pronounced in users
-but also could be that ppl in the deteriorating course could be drawn to use
82
Natural Cannabis Experiment
-from pre legalization to post legalization, 0.7% developed schizophrenia in the general population w/o CUD vs 8.9% of those w/CUD
-the PARF for CUD associated w/schiz almost tripled from 3.7% during prekegalization period to 10.3% during the legalization period
-the PARF in the postlegalization period ranged from 18.9% among males aged 19-24 yrs to 1.8% among females aged 45-65 yrs
-the proportion of incident cases of schizophrenia associated with CUD almost tripled during a period of substantial liberalization of cannabis policy
83
Expressed Emotion
a style of communication very high in:
-critisism
-hostility
-emotional overinvolvement
84
High EE Family
-family members were hypercritical of the patients, dismissive of symptoms and repeated outbursts
-having a high EE family that you frequently interact with repeatedly shown to predict relapse
-regardless of characteristics of the patient
-when EE is lowered, relapse rates decrease
-EE may play a causal role
-stress of living with high EE family
-attributions (high criticism)
85
Rosenfarb Study
-not really difference in negative mood symptoms
-difference in odd or disruptive behaviour, where it is higher in high EE family
-paitent says something strange
-family membe critisizes
-increases the probability of another strange remark, doubling down bc it is their reality
-increases probability of more criticism
86
EE & other Psychopathologies
-EE non-specific, being in a high EE family is a predictor of lots of types of psychopathology
-also predicts worse outcomes in depression and bipolar
-seems to be protective for BPD
PSYC 337
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