PSYCH270 Exam 4 (UMich, Chang)

Schizophrenia

Psychotic disorder that invlves disturbances in thinking (delusions), perception (hallucinations), speech, emotions, behavior; needs 2+ pos/neg/disorganized symptoms for at least one month, must include delusions/hallucinations/disorganized speech; 1-2% will have an episode; 10-13% rate among homeless; ~$19bil cost

Catatonia

Alternating immobility and excited agitation

Hebephrenia

Silly and immature emotionality

Paranoia

Delusions of grandeur or prosecution

Kraepelin's contributions to schizophrenia

Combined catatonia, hebephrenia, paranoia to create dementia praecox; also distinguished dementia praecox from manic-depressive illness

Bleuler's contributions to schizophrenia

Introduced term "schizophrenia" (signaled departure from Kraepelin); Bleuler thought all symptoms had underlying associative splitting (highlighted unuiversal underlying problem); schizophrenia was incorrectly used to mean multiple personalities; four As of schizophrenia

Dementia praecox

Latin term "premature loss of mind"; Kraepelin's early name for schizophrenia; began in adolescence; reflected cognitive/perceptual impairments; mental breakdown appeared irreversible

Associative splitting

Separation among basic functions of human personality (cognition, emotion, perception)

Psychotic behavior

Psychological disorder category; hallucinations, loss of contact w/ reality

Positive symptoms of schizophrenia

Symptoms that add to individual's experience (e.g. hallucinations, delusions)

Negative symptoms of schizophrenia

Symptoms that are deficits in functioning (e.g. lack of expressiveness, emotional withdrawal)

Disorganized symptoms of schizophrenia

Rambling speech, erratic behavior, inappropriate affect

Delusions

"Basic characteristic of madness"; psychotic symptom w/ disorder of thoughts and presence of strong beliefs that are not rooted in reality; may be used to explain mental chaos

Delusions of persecution

Delusion that others are out to get you

Capgras syndrome

Delusional belief where an individual believes someone they know has been replaced by an imposter/double; 1/2 of those w/ Capgras have schizophrenia

Cotard's syndrome

Delusional belief where an individual believes they are dead

Motivational view of delusions

Views delusions as attempts to deal w/ and relieve anxiety/stress

Deficit view of delusion

Views delusions as resulting from brain dysfunction

Hallucination

Psychotic symptom of perceptual disturbance where something is seen/heard/sensed even though it is not actually present; auditory hallucinations are most common

Avolition/apathy

Negative symptom; inability to initiate/persist in activities; cannot perform day-to-day functions

Alogia

Negative symptom; absence of speech (brief replies, uninterested in conversation)

Anhedonia

Negative symptom; lack of pleasure

Asociality

Negative symptom; lack of interest in social interactions

Affective flattening

Negative symptom; apparently emotionless demeanor (toneless speech, vacant gaze) when a reaction would be expected

Insight

Those w/ schizophrenia usually lack this; awareness that they have a problem

Disorganized speech

Disorganized symptom; style of talking involving incoherence and lack of typical speech patterns

Tangentiality

Going off on a tangent instead of answering a specific question

Loose association/derailment

Abruptly changing the topic of conversation to unrelated areas

Inappropriate affect

Disorganized symptom; emotional display that is improper for a situation

Catatonic immobility

Disturbance of motor behavior where someone remains motionless for extended periods; possible symptom of schizophrenia

Waxy flexibility

Tendency to keep their bodies and limbs in the position they are put in by someone else

Schizophrenia subtypes

Historically: paranoid, disorganized, catatonicc (dropped in DSM-IV-TR)

Schizophreniform disorder

Psychotic disorder w/ symptoms of schizophrenia that last less than 6 months (can resume normal lives)

Schizoaffective disorder

Psychotic disorder w/ symptoms of both schizohrenia and major mood disorder (e.g. depressive disorder, bipolar disorder)

Delusional disorder

Psychotic disorder w/ persistent belief(s) contrary to reality (in the absence of other characteristics of schizophrenia)

Subtypes of delusional disorder

Erotomanic, grandiose, jealous, persecutory, somatic

Erotomanic type of delusion

Delusion that one is loved by another person (usually of higher status)

Jealous type of delusion

Delusion that one's sexual partner is unfaithful

Persecutory type of delusion

Delusion that oneself is being maleveolently treated in some way

Somatic type of delusion

Delusion where one feels afflicted by a physical defect/medical condition

Shared psychotic disorder (folie a deux)

Psychotic disturbance where people develop a delusion similar to that of someone they share a close relationship w/

Substance-induced psychotic disorder

Psychosis caused by ingestion of medications, drugs, or toxins

Psychotic disorder associated w/ another medical condition

Condition characterized by hallucinations/delusions that are the direct result of another physiological disorder (e.g stroke, tumor)

Brief psychotic disorder

Psychotic disturbance w/ delusions, hallucinations, or disorganized speech/behavior that lasts less than 1 month; often occurs in reaction to a stressor (regain ability to function)

Attentuated psychosis syndrome

Disorder w/ onset of psychotic symptoms which puts someone at a higher risk for schizophrenia; designated for more study by DSM-5

Prodromal stage

1-2 year period before serious symptoms occur but when less severe but unusual behaviors begin to emerge; up to 85% of those who develop schizophrenia have a prodromal stage

Genetic influences

Genes are responsible for making some individuals vulnerable to schizophrenia

Family studies

Severity of parent's schizophrenia influenced likelihood of child having schizophrenia; all forms of schizophrenia were seen in families (no genetic predisposition for different subtypes, it just manifests differently); how many genes you share with someone w/ schizophrenia affects risk

Twin studies

Identical quadruplets differed in onset/sx/dx of schizophrenia; children are not all brought up the same way (unshared environments)

Adoptive studies

Even when raised away from biological parents, children of parents w/ schizophrenia had a higher risk to develop the disorder; however, healthy homes can be a protective factor

Genes of schizophrenia

Those w/out schizophrenia may be able to still pass it on ("carrier")

Endophenotyping

When researchers try to find basic processes that contribute to behaviors/symptoms of a disorder and then find the gene(s) that cause(s) these difficulties

Smooth-pursuit eye movement/eye-tracking

Ability to track movements slowly is deficient in many people w/ schizophrenia; possible endophenotype for the disorder

Dopamine theory and evidence

Theory that schizophrenia is linked w/ an overactive dopamine system; evidence: drugs that block dopamine (e.g. phenothiazines) are effective, (these same drugs can create Parksinson's-like symptoms as a negative side effect), L-dopa/drugs that increase dopamine (e.g. amphetamines) worsen symptoms; new drugs (dozapine) are effective, but target serotonin receptors

Evidence against dopamine theory

Evidence: a significant # of people w/ schizophrenia are not helped by dopamine blockers, symptoms only reside slowly after dopamine blockers, dopamine blockers are only partly helpful in treating negative symptoms of schizophrenia

Olanzapine and evidence against dopamine theory

Drug helpful for those who aren't treated w/ traditional neuroleptic medications; but it's a weak dopamine antagonist... so why is it helpful if DT is true? (double-edged sword)

Current thinking about schizophrenia

3 specific neurochemical abnormalities (dopamine D2 rece[tprs, lack of prefrontal dopamine D1 receptors, alterations in glutamate transmission)

Influence of brain structure on schizophrenia

Enlarged ventricles (not seen in everyone, though); less activity in frontal lobes (hypofrontality); too much activity in frontatl lobes (hyperfrontality)

Prenatal influence on schizophrenia

Prenatal exposure to influenza/viruses/infections

Perinatal influence on schizophrenia

Pregnancy/delivery complications

Stress's influence on schizophrenia

Stressful life events; stressful environments; gene-environment model; retrospective nature of research may cause problems

Schizophrenogenic mother

According to an obsolete, unsupported theory, a cold, dominating, and rejecting parent who was thought to cause schizophrenia in her offspring

Double bind communication

According to an obsolete, unsupported theory, a communication style of conflicting messages that was thought to cause schizophrenia

Expressed emotion (EE)

Hostility, criticism, and over-involvement demonstrated by some families toward a family member with a disorder; often contributes to relapse; high EE -> relapse of chronic schizophrenia

Kraepelin's treatment for dementeia praecox

Good patience, kindly disposition, self-control

Old treatments for schizophrenia

Injecting insulin, lobotomies, ECT

Neuroleptics

Drugs (dopamine antagonists) that treat psychotic symptoms and schizophrenia; means "taking hold of the nerves"

Reasons for patient non-compliance w/ medication

Not taking medication routinely; negative doc-patient relationship; unwanted side effects

Extrapyramidal symptoms

Serious side effects of antipsychotics; includes motor difficulties, akinesia (lack/slowness of movement), tardive dyskinesia (involuntary facial movements)

Token economy

Social learning behavior modification system where individuals earn items they can exchange for desired rewards by displaying appropriate behaviors; possible treatment for schizophrenia

Psychosocial interventions for schizophrenia

Reteaching social skills, role-playing, adaptation to their disorder, improving cognitive processes, behavioral family therapy

Treatment across cultures

Xhosa of South Africa: traditional healers/oral treatments; Latinos: family support; Native Chinese: alternative medicine and more religious beliefs about schizophrenia (past lives, ancestor worship); British: biological, psychological, community treatments

Instability of early family rearing environment

Suggests that environmental influences may trigger onset of schizophrenia (e.g. poor parenting)

Delirium

Rapid-onset reduced clarity of consciousness/cognition, confusion, disorientation, and deficits in memory/language

Causes of delirium

Improper use of medications (common in elderly), dementia, age

Treatment for delirium

Addressing underlying cause, psychosocial intervention (first line of treatment)

Prevention of delirium

Monitoring drug/medicine usage, interventions during hospital stays for the ederly

Major neurocognitive disorder

Gradual deterioration of brain functioning that affects memory, judgment, language, and other advanced cognitive processes

Mild neurocognitive disorder

Modest impairment in cognitive abilities that can be overcome with accommodations such as extensive lists or elaborate schedules; focuses more on early stages of cognitive decline

Agnosia

Inability to recognize/name objects; common symptom of neurocognitive disorder

Facial agnosia

Type of agnosia; inability to recognize even familiar faces; symptom of neurocognitive disorder

Neurocognitive disorder prevalence

Rate is increasing because life expectancy is getting longer (more risk of developing)

Classes of neurocognitive disorder based on etiology

Alzheimer's disease (most common); vascular injury; frontotemporal degeneration; traumatic brain injury; Lewy body disease; Parkinson's disease; HIV infection; substance use; Huntington's disease; prion disease; another medical condition

Alzheimer's disease

Disease of the celebral cortex that causes an atypical form of senile dementia, discovered in 1906 by Alois Alzheimer

Neurocognitive disorder due to Alzheimer's disease

Condition resulting from a disease that develops most often in people 50 and older, characterized by multiple cognitive defects that develop gradually and steadily

Symptoms of Alzheimer's

Forgetting important events, losing objects, less interest in non-routine activities, less interest in others, social isolation, confusion, depression, anxiety, agitation

Sundowner syndrome

When the elderly become more confused/combative later in the day

Education's influence on Alzheimer's

Intellectual achievment prevents/delayys onset of symptoms; people w/ higher level of education experience a more rapid decline when symptoms become severe (therefore, education just holds the symptoms back temporarily)

Cognitive reserve hypothesis

Theory that suggests that the more synpases a person develops throughout life, the more neuronal death must place before the signs of dementia are obvious; mental activity that occurs during education serves as asn initial protective factor against disorders

Estrogen's influence on Alzheimer's

Estrogen/progestin may contribute to risk for Alzheimer's

Cultural/racial prevalence of Alzheimer's

Japanese/Nigerian/Native Americans/Amish/low-med income countries = less likely to be affected by Alzheimer's; however, this may be because less people seek help/education difference

Vascular neurocognitive disorder

Progressibe brain disorder w/ loss of cognitive functioning caused by blockage of blood flow to the brain that appears w/ other neurological signs/symptoms

Chronic traumatic encephalopathy (CTE)

Neurocognitive disorder resulting from repetitive head trauma

Dementia pugilistica

Past name for CTE; often experienced by athletes

Frontotemporal neurocognitive disorder

Condition that damages frontal/temporal regions of the brain and affects personality/language/behavior; two types (decline in appropriate behavior/decline in language)

Pick's disease

Rare neurological disorder that results in presenile dementia (early in life)

Traumatic brain injury (TBI)

Brain injury caused by a blow to the head/other impact; injures brain and results in diminished neurocognitive capacity

Neurocognitive disorder due to traumatic brain injury

Condition resulting from jarring of the brain from a blow to the head/other impact; symptoms last for at least a week after initial trauma

Neurocognitive disorder due to Lewy body disease

Neurological impairmeent affecting people w/ Lewy body disease (when protein deposits damage brain cells and cause motor impairments and loss of alertness)

Neurocognitive disorder due to Parkinson's disease

Disorder w/ progressive decline in motor movement; results from damage to dopamine pathways