Ch 13/14 AB Psych

Vocabulary flashcards for reviewing schizophrenia and personality disorders lecture notes.

Schizophrenia

A disorder of psychosis, in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor irregularities.

Positive Symptoms

Bizarre additions to a person’s behavior in schizophrenia, such as delusions, disordered thinking and speech, heightened perceptions, hallucinations, and inappropriate affect.

Delusions

Positive symptom; Faulty interpretations of reality; can include delusions of persecution, reference, grandeur, and control.

Heightened perceptions

Positive symptom; senses may feel flooded

Hallucinations

Positive symptom; Sensory perceptions that occur in the absence of external stimuli; auditory hallucinations are most common.

Inappropriate effect

Positive symptom; emotions unsuited to the situation

Disordered thinking

Positive symptom; thought disturbances (loose associations—derailment, clang associations— rhymes, neologisms—made-up words, preservation— repetition of words/statements)

Negative Symptoms

Pathological deficits that are lacking in an individual, such as poverty of speech, blunted or flat affect, loss of volition, and social withdrawal.

Poverty of speech/ Alogia

Negative symptom; Poverty of speech; restricted quantity of speech or speech content

Blunted/Flat Affect

Negative symptom; Show less emotion than most people; face is expressionless, avoidance of eye contact.

Loss of Volition

Negative symptom; Apathy, lack of motivation or directedness.

Psychomotor Symptoms

Awkward movements, repeated grimaces, odd gestures; may take extreme forms, extreme forms called catatonia.

Catatonia

Extreme psychomotor symptoms, including stupor, rigidity, posturing, and excitement.

Premorbid functioning

Functioning before the onset of the disorder

Prodromal Phase

Beginning of deterioration; mild symptoms.

Active Phase

Symptoms become increasingly apparent and prominent.

Residual Phase

A return to prodromal-like level of symptoms.

Diagnosing schizohprenia

Diagnosis only after symptoms of the disorder continue for 6 months or more

• Must include a period of a month or more of active symptoms: delusions, hallucinations, and/or thought disorder

• Must show a deterioration in their work, social relations, and ability to care for themselves

Type I Schizophrenia

Dominated by positive symptoms; better adjustment before the disorder, later onset of symptoms, and greater likelihood of improvement.

Type II Schizophrenia

Dominated by negative symptoms; may be tied largely to structural abnormalities in the brain.

Biological factors dominate explanations of schizophrenia

Genetic and biological studies reveal the key roles of inheritance and brain activity and help inform treatments:

-Family pedigree studies show that schizophrenia is more prevalent among relatives with the disorder (1% prevalence in the general population versus 10% in first-degree relatives)

-Twin study findings: if an identical twin develops the disorder, there’s a 48% chance that the other twin will develop it. If the twins are fraternal, the second twin has a 17% chance of developing the disorder

Dopamine Hypothesis

Certain neurons using dopamine fire too often, producing symptoms of schizophrenia.

Evidence for Dopamine Hypothesis

Recognizing the effects of phenothiazines, dopamine antagonists, effects in reducing psychotic symptoms

-Patients with Parkinson’s disease have abnormally low levels of

dopamine. When given too much Parkinsonian medication, L-dopa, a drug that raises dopamine levels, some patients will develop schizophrenia-type symptoms

-First-generation antipsychotic drugs can produce Parkinsonian symptoms by raising dopamine levels

-High doses of amphetamines, which increase dopamine activity in the

brain, may develop amphetamine psychosis—can produce symptoms

similar to schizophrenia

• Investigators have located dopamine receptors to which first-generation antipsychotic drugs bind—particularly D2 receptors

Challenges to the Dopamine Hypothesis

Discovery of new antipsychotic drugs (2nd generation antipsychotic

drugs) which are as effective or more effective than first-generation drugs.

2nd generation antipsychotic drugs bind to additional receptors (D1 and

D4) and neurotransmitters (e.g., serotonin, glutamate, and GABA) receptors, suggesting that abnormalities in the interactions or activity of these NTs might be involved as well as dopamine in schizophrenia

Dysfunctional brain structures and circuitry

Recent investigations to identify the brain circuit involved in schizophrenia. Brain structures in this circuit include the prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra. Some structures may be overactive and some are underactive

Psychodynamic theories of schizophrenia

Psychodynamic theory in the 1940s by Frieda Fromm-Reichman that

schizophrenia is caused by the schizophrenogenic mother = cold, domineering, uninterested in child’s needs despite appearing overprotective. The confusion caused by a parent being both overprotective and rejecting could lead to schizophrenia in the child. This well-known theory has not received empirical support and has been primarily rejected.

▪ Later theories look at biological factors setting the stage for (i.e., predisposing) individuals to develop various behavioral and psychological risks

Cognitive-behavioral views of schizophrenia

certain schizophrenia-related behaviors are learned/reinforced through operant conditioning. Interventions would need to reinforce appropriate interpretations of verbal and social cues and unusual sensory experiences such as hallucinations

Sociocultural views of schizophrenia

examine the roles of cultural, social, and familial factors’ contributions to schizophrenia

When did improvements to institutional care start?

The 1950s with milieu therapy; token economy

Milieu Therapy

Institutions can help patients make progress by creating a social climate that promotes productive activity, self-respect, and individual responsibility.

Token Economies

Based on operant conditioning principles used in hospital wards to change behaviors; patients are rewarded when they behave in socially acceptable ways.

First-generation antipsychotic drugs

The group of antipsychotic drugs developed throughout the 1960s, 1970s, and 1980s, that comprised the first wave of antipsychotic drugs and are still in use today. Also called neuroleptic drugs.

Extrapyramidal Effects

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by antipsychotic drugs.

Parkinsonian symptoms

at least 50% may develop muscle tremors and rigidity, shuffle their feet, show little facial expression, experience dystonia (bizarre movements of the face, neck, tongue, and back), akathisia (great restlessness, agitation, and discomfort in the limbs). May treat with anti-Parkinsonian drugs, medication reduction, or change medication.

Neuroleptic Malignant Syndrome

approx. 1% (especially the elderly) may develop a potentially fatal reaction that can include muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system. Must immediately stop medication and treat symptoms

Tardive Dyskinesia

later onset reaction 6 months to 1 year after starting medication that can include involves writhing or tic-like involuntary movements, usually of the mouth, lips, tongue, legs, or body. Usually difficult to treat or eliminate

Second-generation antipsychotic drugs

Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, and Abilify; drugs developed in recent decades, whose biological actions are different from that of the first-generation antipsychotic drugs. Also called atypical antipsychotic drugs.

Benefits of 2nd gen antipsychotic meds

may cause fewer extrapyramidal side effects and less tardive dyskinesia)

Challenges to 2nd generation antipsychotic meds

similar to older antipsychotic medications, newer antipsychotic medications can have side-effects such as dry mouth, constipation, weight gain, dizziness, sexual dysfunction, etc.). Newer ones may have some risky side effects such as some producing elevations in blood sugar (e.g., clozapine/Clozaril and olanzapine/Zyprexa) and some (e.g., clozapine/Clozaril) may require blood draws due to serious risk such as agranulocytosis—dangerous drop in white blood cells).

Cognitive Remediation

Provides increasingly more complex computer tasks that focus on difficulties in attention, planning and memory, and social awareness

Hallucination reinterpretation and acceptance

Change how clients view and react to their hallucinatory experiences through education, identification of triggers, challenge inaccurate ideas, and teach coping strategies

Family Therapy

psychoeducation and support

Coordinated Specialty Care (CSC)

(formerly called “Social Therapy”)—Addresses social and personal difficulties in clients’ lives through practical advice, problem solving, decision making, social skills training, medication management,

employment counseling, financial assistance, and housing

Features of effective community care

Attending to the recovery needs of people who are severely mentally ill:

▪ Medication

▪ Psychotherapy

▪ Help in handling daily pressures and responsibilities

▪ Guidance in making decisions

▪ Training in social skills

▪ Residential supervision, and vocational counseling

Additional broad services:

▪ Coordinated services

▪ Short-term hospitalization

▪ Partial hospitalization

▪ Supervised residences

▪ Occupational training and support

Threats to Community Treatment

Poor coordination of services

-Shortage of services

-Shortage of funding—need to elevate value given to mental health as

integral to a person’s health and heighten value for people/communities

most vulnerable

Schizophrenogenic Mother

A type of mother — supposedly cold, domineering, and uninterested in the needs of her children — who was once thought to cause schizophrenia in her child (theory has received little support).

Expressed Emotion

The general level of criticism, disapproval, and hostility expressed in a family. People recovering from schizophrenia are considered more likely to relapse if their families rate high in expressed emotion.

Deinstitutionalization

The practice of releasing patients from public mental hospitals.