N165 Final: Unit 7b

  1. Schizophrenia
    • a disorder characterized by positive symptoms: hallucinations, delusions, disorganized speech and thought; negative symptoms: absence of normal cognition or affect, flat affect, poverty of speech, and lack of motivation; and cognitive
    • symptoms: problems with working memory and attention
    • Prevalence of symptoms is similar across cultures (1-2%)
    • The incidence is the same for men and women
  2. Positive symptoms:
  3. Hallucination
    • a perception in the absence of a stimulus.
    • In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space. (think sensory disorder).
    • Command hallucinations can occur and involve voices giving orders
  4. Delusion
    an idiosyncratic, irrational belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument, typically a symptom of mental disorder (think thought disorder)
  5. Disorganized speech/thought
  6. Over-inclusion
    jumping from idea to idea without the benefit of logical association
  7. Paralogic thought
    • on the surface the thinking may appear logical, but is actually seriously flawed.
    • ‘Para’ means ‘almost’ or ‘next to,’ so this term means ‘almost logical.’ e.g., Jesus was a man with a beard, I am a man with a beard, therefore I am Jesus!
  8. Negative symptoms
  9. Flat affect
    • affect is a medical term for mood.
    • A patient with a flat affect has very little reaction to events around them
    • they display little-to-no emotion physically, and may not feel emotions very much either.
  10. Inappropriate affect
    • In this case, the mood (affect) the patient displays does not match the circumstances.
    • Examples: laughing at very serious things, crying at funny things
  11. Catatonic behavior (catatonia)
    unresponsiveness to environment, usually marked by immobility for extended periods and echolalia
  12. Echolalia
    parrot-like repetition of speech
  13. Waxy flexibility
    a psychomotor symptom of catatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture
  14. SUBTYPES OF SCHIZOPHRENIA (useful to think about differences, but not used as much in diagnosis now)
  15. Paranoid type
    • well-formed hallucinations and delusions (e.g., of persecution, grandeur)
    • Mostly positive symptoms / fewer negative symptoms.
    • Most common and best prognosis
  16. Disorganized type
    • Disorganized speech, silly behavior, and flat affect / disturbed emotional expression
    • Delusions and hallucinations are less pronounced than in the paranoid type and have little meaning or logic.
    • Patients tend to be incoherent/unintelligible and have issues with daily self care.
    • Also known as hebephrenic (‘childish behavior’)
  17. Residual type
    Primarily displays negative symptoms like flat affect, reduced speech, lack of motivation
  18. Catatonic type
    • Unresponsive to surroundings with echolalia, waxy flexibility
    • rare
  19. Undifferentiated type
    • Combination of hallucinations, specific delusions, and general disorganization No single symptom type is most prominent
    • As with undifferentiated versions of other neuropsych disorders, these patients don’t fit well into other categories
  20. POSSIBLE CAUSES OF SCHIZOPHRENIA:
  21. Congenital risks –
    • difficult birth (e.g., oxygen deprivation)
    • prenatal viral infection (e.g., flu)
  22. Brain structure changes
    enlarged ventricles, decreased hippocampus and amygdala, loss of temporal and frontal cortex
  23. Hypofrontality hypothesis
    • theory that problems in the frontal lobe are associated with schizophrenia
    • For example, in identical twins, the one with schizophrenia has decreased blood flow to the frontal lobes.
    • Also, schizophrenics have problems with executive function tasks like the Wisconsin card sorting task.
    • This evidence suggests that genetic and environmental changes to the frontal lobes may cause schizophrenia.
  24. Neurochemical changes:
  25. Dopamine
    • a neurotransmitter that affects mood, energy, sexual desire and motor coordination
    • May play a role in schizophrenia, especially with hallucinations.
    • Antipsychotic meds decrease dopamine
  26. Glutamate
    • a key excitatory neurotransmitter.
    • Some evidence suggests that glutamate decreases may be correlated with schizophrenia.
    • Meds that increase glutamate, however, do not help symptoms (but do increase the risk of seizures).
  27. TREATMENTS FOR SCHIZOPHRENIA:
  28. Anti-psychotic medications
    • typical antipsychotic (older, more side effects), decreases dopamine brain-wide; primary effect is on positive symptoms.
    • Atypical antipsychotics (fewer side effects) – affect dopamine pathways in more complex form and may also interact with serotonin pathways
    • primary effect is on positive symptoms, also some negative ones
  29. Tardive dyskinesia
    • a possibly permanent disorder of involuntary, repetitive, purposeless movements as a side effect of long-term or high-dose use of dopamine antagonists like antipsychotics.
    • Compare to L-Dopa meds for Parkinson’s disease, which cause psychosis (abnormal cognition like delusions and hallucinations) in patients with PD by increasing dopamine too much.
    • Here the antipsychotics decrease dopamine so much that patients may develop movement disorders - tardive dyskinesia specifically.
  30. Electroconvulsive shock therapy (ECT)
    used mainly in catatonic schizophrenia
  31. Occupational therapy
    self-care, work options
  32. SCHIZOPHRENIC SPECTRUM DISORDERS:
  33. Schizophreniform disorder
    a disorder in the schizophrenic spectrum characterized by symptoms of schizophrenia for less than 6 months, less social dysfunction than schizophrenia, and a more likely recovery. May simply be early diagnosis of schizophrenia.
  34. Schizoaffective disorder
    a disorder in the schizophrenic spectrum characterized by mood changes and psychosis (think schizophrenia plus bipolar disorder)
  35. Schizotypal personality disorder
    a personality disorder in the schizophrenic spectrum characterized by symptoms of paranoia, social anxiety, inappropriate and reduced affect, lack of close relationships, magical thinking, and vague metaphorical speech. These symptoms resemble the positive symptoms of schizophrenia, which is why it is included in the spectrum.
  36. Magical thinking
    • a thought pattern commonly seen in schizotypal personality disorder in which the patient experiences fear of performing certain acts or having certain thoughts because of an assumed correlation between doing so and threatening calamities.
    • Magical thinking may lead people to believe that their thoughts by themselves can bring about effects in the world or that thinking something corresponds with doing it.
  37. Schizoid personality disorder
    • a personality disorder in the schizophrenic spectrum characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, and emotional coldness.
    • These symptoms resemble the negative symptoms of schizophrenia, which is why it is included in the spectrum.
    • Such patients often act like hermits, happily withdrawing from society.
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N165 Final: Unit 7b
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