Task 8 Schizophrenia

Question 1

Psychotic

Answer 1

experiences and beliefs that are not in touch with reality

Question 2

Psychosis

Answer 2

If you are unable to tell the difference what is real and what not (most prominent is schizophrenia)

Question 3

Delusions

Answer 3

ideas that an individual beliefs are true but are highly unlikely and often simply impossible (preoccupied)
o Different types of delusions can cooccur
o Persecutory delusion: False belief that oneself or one’s loved ones are being persecuted, watched, or conspired against by others
o Delusions of reference: Belief that everyday events, objects, or other people have an unusual personal significance
o Grandiose delusion: False belief that one has great power, knowledge, or talent or that one is a famous and powerful person
o Delusions of being controlled: Belief that one’s thoughts, feelings, or behaviours are being imposed or controlled by an external force
o Thought broadcasting: Belief that one’s thoughts are being broadcast from one’s mind for others to hear
o Thought insertion: Belief that another person or object is inserting thoughts into one’s mind
o Thought withdrawal: Belief that thoughts are being removed from one’s mind by another person or by an object
o Delusions of guilt or sin: False that one has committed a terrible act or is responsible for a terrible event
o Somatic delusion: False belief that one’s appearance or part of one’s body is diseased or altered

Question 4

Hallucinations

Answer 4

o Healthy people do sometimes experience hallucinations, but they do not impair their daily function
o In schizophrenia they are more frequent, persistent, complex, bizarre and often entwined with delusions

Question 5

Auditory hallucinations

Answer 5

most common, e.g. speaking about the individual in third person or giving commands and instructions
 Often negative quality
o Can occur in depression and bipolar too
o Cultural background can influence the content, same as with delusions

Question 6

Visual hallucinations

Answer 6

seeing not existing things

Question 7

Tactile hallucinations

Answer 7

involve the perception that something is happening to the outside of the persons body, e.g. bugs crawling up her back

Question 8

Somatic hallucinations

Answer 8

perception that something is happening inside the persons body, e.g. worms eating the intestines

Question 9

Disorganized thought and speech

Answer 9

o Formal thought disorder: disorganized thinking of people with schizophrenia
o Loose associations: the tendency to switch to seemingly unrelated topics
o Neologism: making up words that only make sense for them
o Clangs: making up associations because of same sounds of words rather than content
o More common in men because language centrum is only in one site of brain in women its more bilateral

Question 10

Disorganized behaviour

Answer 10

o May display unpredictable and apparently untriggered agitation , e.g. suddenly shouting
 Might be a response to delusions or hallucinations
o Often show problems with task as getting dressed because of impairments in memory and attention ´

Question 11

Catatonia

Answer 11

unresponsiveness to the environment
 Negativism: lack of response to instructions
 Mutism: rigid, inappropriate, or bizarre posture, to a complete lack of verbal or motor responses
 Catatonic excitement: purposeless and excessive motor activity for no apparent reason

Question 12

Negative symptoms

Answer 12

o Labelled this way because it involves the loss of certain qualities
o Tend to be persistent and more difficult to treat compared to positive symptoms

Question 13

Restricted affect (negative symptom)

Answer 13

 Refers to a severe reduction in or absence of emotional expression in persons with schizophrenia
 People report anhedonia, the loss of the ability to experience pleasure (might be falsified by self-report)
 Might still experience emotions just can’t show them

Question 14

Avolition (negative symptom)

Answer 14

inability to initiate or persist at common, goal directed activities
• Slowed down in movements and seems unmotivated
• May be expressed as asociality, the lack of desire to interact with other people
o Can only be diagnosed of indviduals have access to welcoming family and friends but show no interest in socializing with them (often they are dropped by family and friends)

Question 15

Cognitive deficits (negative symptom)

Answer 15

• Deficits in attention, memory, working memory and processing speed
• Might be the underlying cause for the other symptoms (e.g. distinguish real from unreal)
• Cognitive deficits can be used as indication for later development of schizophrenia

Question 16

Prognosis of schizophrenia

Answer 16

o Between 50 and 80% will be rehospitalized after the first hospitalization
o 10 years shorter life expectancy
o Suffer more form infectious and circulatory disease
o 10 to 15% commit suicide
o 15 year study found 41% had at least one or more periods of complete recovery lasting at least one year

Question 17

Gender and age factors

Answer 17

o Women tend to have better prognosis than men
 Also show milder negative symptoms
 Also later onset late 20s early 30s (so often already more settled and educated)
 Estrogen may affect dopamine which might protect women
o Males show greater abnormalities in brain
o General decrease with age due to lower dopamine levels

Question 18

Sociocultural factors

Answer 18

o Less severe in developing countries

 Might be due to social environment, closer and broader family networks

Question 19

Other psychotic disorders

Answer 19

fall along a continuum of severity. Schizophrenia is worst, followed by schizoaffective disorder, schizophreniform disorder and other psychotic disorders

Question 20

Schizoaffective disorder

Answer 20

mix of schizophrenia and mood disorder
 Simultaneously experience psychotic symptoms and prominent mood symptoms meeting the criteria for major depressive or manic episodes
 Mood symptoms must be present for the majority of the period of illness and 2 weeks with hallucinations or delusion without mood symptoms

Question 21

Schizophreniform disorder

Answer 21

: requires that individual meet criteria A,D an E but show symptoms that only last for 1-6 months
 Functional impairment can be present but is not necessary
 2/3 will receive schizophrenia or schizoaffective diagnose

Question 22

Brief psychotic disorder

Answer 22

 Show sudden onset of delusions, hallucinations, disorganizes speech and/or disorganized behaviour
 Only last between 1 day and 1 month
 Sometimes triggered by major stressor e.g. accident
 Most people show excellent outcome

Question 23

Delusional disorder

Answer 23

 Have delusions lasting at least 1 month

 No psychotic symptoms and other than reactions to delusions don’t act odd or have difficulties in functioning

Question 24

Schizotypal PD

Answer 24

 Life long pattern of significant oddities in self-concept, their ways of relating to others and their thinking and behaviour
 Lack of sense of self and trouble setting goals
 Restricted emotionality
 Do not understand other humans behaviour
 Maintain grasp on reality
 Think that random events are related to them
 Cognitive deficits are present but less severe than in schizophrenia

Question 25

Genetic contributors

Answer 25

different genes are thought to be responsible for different symptoms
 50% percent of shared genes have 10% chance of developing

Question 26

Structural and functional abnormalities

Answer 26

o Neurodevelopmental disorder, in which a variety of factors lead to abnormal development of the brain in the uterus and early life
o Gross reduction of gray matter in cortex
o Hippocampus differs from the norm (functional and structural)
o Reductions and abnormalities in white matter (present before onset)
 Reduces the interaction between brain regions
o Enlargement of ventricles (also present before onset)
o Abnormal connections

Question 27

Birth complications

Answer 27

 Perinatal hypoxia: deprivation of oxygen in the few weeks before or after birth
• Might interact with genetic factors and triggers Schizophrenia
 Prenatal Viral Exposure: high rates of desease when mother had a virus while pregnant

Question 28

Revised theory (davis)

Answer 28

different types of dopamine receptors and different levels of dopamine in various areas of the brain can account for symptoms
 Mesolimbic pathway: excess dopamine activity, Impairs reward and salience
• Might lead to processing salience where non should be, contributing to hallucinations and delusions and deficits in motivation
 Unusual low dopamine activity in PFC, attention, motivation and organization of behaviour
• Might lead to negative symptoms

Question 29

Serotonin

Answer 29

serotonin neurons regulate dopamine neurons in the mesolimbic system

Question 30

Social drift

Answer 30

Because schizophrenia symptoms interfere with a person’s ability to complete an education and hold a job, people with schizophrenia tend to drift downward in social class compared to the class of their family of origin

Question 31

Schizophrenia and the family

Answer 31

 Schizophrenia results when mothers are at the same time overprotective and rejecting of their children
• Leads to poor self-perception and world perception →develop distorted views which enhance Schizophrenia
 Expressed emotions:
• Being overprotective on the one side but on the other belief that the patient can control the system which is expressed as e.g. hostility
o Leads to relapse
• High criticism and low warmth increases risk of full blown schizophrenia

Question 32

Cognitive perspective

Answer 32

o Difficulties in attention, inhibition and social difficulties leads to conversation of limited resources
 By using biases or thinking styles
 Delusions arise when person tries to explain strange perceptual experiences
o Hallucinations arise from hypersensitivity to perceptual input, coupled with attribution of experiences to external sources

Question 33

Typical Antipsychotic drugs/neuroleptics

Answer 33

 Blocking dopamine receptors, thereby reducing its action in the brain
 Used to treat positive symptoms but not negative ones
 25% percent do not respond
 If medication is stopped relapse rate is nearly 100%
cannot treat negative symptoms
strong side effects

Question 34

Atypical Antipsychotics

Answer 34

 Clozapine: binds to D4 receptor but influences several other neurotransmitters including serotonin
• Reduces negative and positive symptoms
• Side effects: dizziness, nausea, sedation, seizures, hypersalivation, weight gain, and tachycardia
o Agranulocytosis: deficiency of granulocytes, ­substances produced by bone marrow that fight infection

Question 35

Significant main effects between normal and schizophrenic hallucinations

Answer 35

frequency, duration, emotional valence of content, controllability, voices speaking in third person, total distress and age at onset (were older)

Question 36

Attribution to external agency

Answer 36

healthy individuals fostered an external explanation more often than patients
 No predictor

Question 37

Best predictors for no psychotic disorder

Answer 37

having control over AVHs for most of the time, hearing voices less than once a day, age at onset before 16, hearing voices with a predominantly positive content

Question 38

Emotional valence

Answer 38

Strongest predictor for psychotic disorder

Question 39

Difference in onset

Answer 39

o Large difference in onset age may suggest a different pathophysiology

Question 40

Meta cognitive training

Answer 40

targets these specific biases
o Including elements of psychoeducation, cognitive remediation, CBT and social cognitive aspects
o Subdivided into modules
o Treatment: delivered in a group of 3-10 patients
o Main objective:
 Raise patients awareness of these cognitive distortions (critical reflection)
 Altering their current repertoire of problem solving skills

Question 41

Jumping to conclusions

Answer 41

 Gather very little information before arriving at strong conclusions
 Aggravated under stress and in an emotional context
 Select also less reliable cues

Question 42

Attributional style and self-esteem in schizoprehia

Answer 42

o Often cast blame for negative events onto other people and/or institutions rather than distribute over multiple sources
o Attribution of positive and negative events to external sources
 Fosters subjective powerlessness
 Could give rise to feelings of aliens control
o Converge onto single explanations more often

Question 43

Metamemory

Answer 43

o Reduced memory vividness
o Overconfidence esp. for false memories
o A large part of patients holds are false

Question 44

Bias against disconformatory evidence

Answer 44

o Far more easy to be trapped on wooden path

Question 45

theory of mind

Answer 45

o Related to cognitive dysfunction

o Makes other biases and dysfunctions more severe when combined

Question 46

Feasibility and subjective and objective effectiveness

Answer 46

o Patients rated MCT superior
 Subjective effectiveness is important for success even if it does not correspond to objective effectiveness
o Also objective effective

Question 47

Recent studies for frontal model

Answer 47

 Have provided evidence for hypo- and hyperactive DLPFC during WM tasks in schizophrenia
 Also found abnormalities in AC and other frontal regions
 ACC (anterior cingulate gyrus) also a key region of disrupted frontal lobe function
• Less activation in conflict (accounts for performance monitoring) and error related activity

Question 48

Disrupted connectivity or loss of prefrontal conrol

Answer 48

o Fronto-temporal network dysfunction in schizophrenia
o Disorder is better understood as a disruption in the integration of brain networks
o Results: the degree of left STG overactivation and abnormally positive STG-prefrontal interactions, correlating with the severity of active illness

Question 49

Temporal lobe dysfunction

Answer 49

o Verbal spatial and memory impairments

Question 50

DSM-5 Schizophrenia

Answer 50

o A Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2, or 3:
 Delusions (fixed beliefs that are not amenable to change in light of conflict evidence) Has to be extreme and can’t be only a cultural belief
 Hallucinations
 Disorganized speech (i.e., frequent derailment or incoherence)
 Grossly disorganized or catatonic behaviour
 Negative symptoms (i.e., diminished emotional expression or avolition)
o B For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
o C Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences)
o D Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the active and residual periods of the illness
o E The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
o F If there is a history of autism spectrum disorder or communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia are also present for at least 1 month (or less if successfully treated)
• Prevalence: 0,3-7% global