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141 Cards in this Set
- Front
- Back
How many times more likely are people with schizophrenia likely to die from suicide compared to the general population?
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12 times
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Prevalence of schizophrenia
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1%
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Are the symptoms of schizophrenia heterogenous or homogenous?
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heterogeneous
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Is schizophrenia more prevalent in men or woman?
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men
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Onset of schizophrenia
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Typically late adolescence/early adulthood, sometimes in childhood
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Schizophrenia is a syndrome characterised by what?
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a collection of signs and symptoms of unknown aetiology, predominately defined by observed signs of psychosis
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What are the three categories of symptoms in schizophrenia?
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positive, negative, disorganised
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Split brain in schizophrenia refers to what?
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split from reality
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Describe the course of schizophrenia?
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typically a number of acute episodes of symptoms, and less severe but still debilitating symptoms between episodes
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The life expectancy of people with schizophrenia is reduced by how many years?
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25
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What are the two positive symptoms of schizophrenia?
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hallucinations and delusions
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What are the five negative symptoms of schizophrenia?
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avolition, alogia, anhedonia, blunted effect, and asociality
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What are the 2 disorganised symptoms of schizophrenia?
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disorganised behaviour and disorganised speech
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Acute episodes of schizophrenia are characterised by what?
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positive symptoms
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What type of schizophrenia symptoms are characterised by?
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excesses and distortions
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Beliefs contrary to reality and firmly held in spite of disconfirming evidence describe what symptoms of schizophrenia?
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delusions
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To diagnose schizophrenia in the DSM-IV-TR 2 or more of what 5 symptoms must be present a significant proportion of the time during a one month period?
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1. delusions; 2. hallucinations; 3. disorganised speech; 4. grossly disorganised or catatonic behaviour; 5. negative symptoms
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In the DSM-IV-TR only criterion A is required is delusions are what?
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bizairre or hallucinations consist of voice keeping a running ocmmentary on the persons behaviour or thoughts, or two or more voices conversing with each other
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How many criterion for schizophrenia are in the DSM-IV-TR?
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6
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What are criterion B to F in the DSM-IV-TR criteria for schizphrenia?
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B) symptomas must cause clinically isignificant distress or impairment in social, occupational, or other important areas of functioning, C) continuous signs of the disturbance persist for at least 6 months. May include periods of prodromal or residual symptoms, D) symptoms can not be due to either schizoaffective disorder or mood disorder with psychotic features, E) symptoms can not be due to substance abuse or general medical condition, F) if there is a history of PDD then the additional diagnosis od SCZ can only be made in prominent delusions or hallucinations are also present for at least a month (or less if treated successfully)
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What are the four likely changes to the criteria for schizophrenia in the DSM-5?
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1. removal of the subtypes; 2. negative symptoms will be described in more detial; 3. addition of criterion that one of the symptoms must be hallucinations, delusions ro disorganised speech; 4. removal of requirement that only one symptom be present if delusion is bizarre
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What new syndrom is being added to the DSM-5 that is argued to be prodromal psychosis?
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attenuated psychosis syndrome
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What are five types of delusions?
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typically a number of acute episodes of symptoms, and less severe but still debilitating symptoms between episodes
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Sensory experiences in the absence of any relevent stimulation form the environment describes what symptoms of schizophrenia?
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hallucinations
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What are the 5 subtypes of schizophrenia in the DSM-IV-TR that are being removed in DSM-5?
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paranoid, disorganised, catatonic, undifferentiated, and residual type
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What are the subtype for shcizophrenia being removed in the DSM-5?
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little predictive validity
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What is being proposed in the DSM-5 instead of the subtypes?
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a dimensional aspect which will alow more individualised descriptions of symptoms and their severity within the diagnosis of schizophrenia
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Whati cognitive symptoms are associated with schizophrenia?
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impairments in attention, working memory, and executive function
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What are the three main reasons why cognitive symptoms associated with schizophrenia have recived considereable attention in the research in the last decade?
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1. they are present in the prodrome of the illness, 2. they are persistent and resistent to treatment; and 3. they are most associated with functional impairment than other symptoms of schizophrenia
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What are two cons for the categorical methods or diagnosis utilised in the DSM?
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medical model implies causation which is not the case and thereis stigma attached to the diagnosis
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What are five pros for the categorical methods or diagnosis utilised in the DSM?
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1. categorial approach simplifies complex data; 2. diagnosis guides treatment; 3. diagnosis allows for better prognositic judgement; 4. essential for clinical research; 5. some patients can feel relief at being given a diagnosis
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There is a strong belief that shcizophrenia may actually be what rather than a single diagnosis?
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a collection of syndromes
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What are the six main types of delusions?
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thought insertion, thought broadcasting, controlled by external force, persecutory, grandiose, and ideas of reference
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Delusions where a person believes that thoughts are not his or her own but have been placed in his or her mind by an external source is known as what?
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though insertion
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Delusions where a person believes that his or her thoughts are broadcast or transmitted so that others know what they are thinking are known as what?
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thought broadcasting
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Delusions where a person has an exaggerated sense of his or her own self importance, power, knowledge, or identity are known as what?
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grandiose delusions
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Delusions where a person incorporates unimportant events within a delusional framework and reading personal significance into the trivial activities of others is known as what?
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ideas of reference
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An example of persetcutory delusion?
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there are people plotting against me
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What proportion of people with schizophrenia have delusions?
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more than half
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What percentage of people with schizophrenia report auditory hallucinations?
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74%
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Many people with schizophrenia experience their hallucinations as what?
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frightening or annoying
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What area of the brain has been found on an fMRI when people with schizophrenia report hearing voices?
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broca's area
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What are four types of auditory hallucinations?
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spoken by another person, two voices arguing, voices commenting on their behaviour, and voices telling then to do things
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Auditory hallucination characterised by voices telling them to do things are known as what?
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comman hallucinations
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Auditory hallucination are mostly what?
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derogatory
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Negative symptoms tend to endure beyond what?
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an acute epsiode
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The presence of many negative symptoms is a strong predictor of what?
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poor quality of life
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A lack of motivation and a seeming absence of interest in, or an inability to persist in what are usually routine activities, including work or school, hobbies or social acitivties describes which negative symptom?
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Avolition or apathy
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Severe impairments in social relationships characterises which negative symptom of schizophrenia?
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asociality
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A loss of interest in or a reported lessening of the experience of pleasure is called what?
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anhedonia
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What are the two types of pleasure experiences in the anhedonia construct?
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anticipatory pleasure and consummatory pleasure
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Which type of pleasure to people with schizphrenia have a deficit in, and which do they not have a deficit in when they experience the negative symptom of anhedonia?
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deficit in anticpatory pleasure but no consummatory pleasure
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The lack of outward expression of emotion characterises which negative symptom of schizophrenia?
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blunted or flat affect
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Does blunted affect mean that the perosna inner experience of emotion in impoverished?
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no
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A significant reduction in the amount of speech describes which negative symptoms of schizophrenia?
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alogia
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Problems with organising ideas and in speaking so that a listener can understand indicates which symptom of schizophrenia?
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disorganised speech
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How many patterns of disorganised speech can be found in people with schizophrenia?
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21
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In disorganised speech replying a question in an irrelevent manner is known as what?
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tangentiality
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In disorganised speech replying a question in a highly detailed roundabout way that is not always relevent but the question is always answered in the end is known as what?
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circumstantiality
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In disorganised speech new word formation that may involve combinations of words that are similar in meaning or sound are known as what?
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neologisms
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Disorganised speech is assocaited with problems in what cogntive function?
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executive function - problem solving, planning, and making assocations between thinking and feeling
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What is the symtoms characterised by the persons inability to organise their behaviour and make it fit with social norms?
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disorganised behaviour
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What are some examples of disorganised behaviour?
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inexplicable bouts of agitation, deressing in unusual clothing, acting in a childlike or silly manner, hoarding food or collecting garbage
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Which cogntiive symptoms has been shown to be more highly related to functional diasability than positive symptoms?
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working memory
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Does twin study research shows a stronger genetic component for positive or negative symptoms?
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negative symptoms
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There may be a shared genetic vulnerability between schizophrenia and which other disorder?
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bipolar
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Relatives of people with schizophrenia are at what?
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increased risk of developing schizophrenia and this risk increases the closer the relative
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What is the inherent confoudn in twin studies of schizophrenia?
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environment
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What type of study removes the inherent confound of environment in the genetic vulnerability of schizophrenia?
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adoption studies
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Adoption studies have revealed that people are at risk more than the general population of developing schizophrenia if what?
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if a biological parent has schizophrenia
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Do you inherit schizophrenia or a predisposition for schizophrenia?
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a predisposition
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What constitutes the genetic predisposition for schizophrenia?
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still not clear as it appears to be transmitted by more than one gene
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The study of family pedigrees to try and determine the chromosome(s) the schizophrenia henes are located on is known as what?
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Linkage studies
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What has been found in linkage studies of schizophrenia?
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highly inconsistent findings with as many as 11 chromonsomes being implicated
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The study of of how often a specific gene and a particular phenotype co-occur is known as what?
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association studies
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What has been found in association studies of schizophrenia?
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many non replicated findings however 4 canditate genes appear to be implicated
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What are the two of the four canditate genes implicated in assocation studies of schizophrenia?
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COMT - linked with executive functioning; NGRI - associated with glutamates, and NMDA receptor involved in myleination of the brain which is essential for connectivity shown to be disrupted in schizophrenia
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GWAS stands for what?
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Genome Wide Association Studies
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What do GWAS studies involve?
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rapid scanning of a person's entire genome to allow researcher to conduct a more broad serch for rare mutations in genes
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What was found in one GWAS study linked to schizophrenia?
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more than 50 mutations that were 3 times more common in people with schizophrenia than people without, however these mutations were only actually identified in around 20% of people with schizophrenia
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Linkage, assocaition and GWAS studies hightlight what about schizophrenia?
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it is highly heterogeneity
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Chemicals that allow neurons to send a signal across a synapse to another neuron are call what?
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neurotransmitters
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What is the Dopamine Theory of Schizophrenia?
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the theory posits that schizophrenia is related to excess dopamine
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What is the Dopamine theory os schizophrenia based on?
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the fact that drugs which act to reduce dopamine acitivty can be effective in treating schizophrenia and vice versa
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What are three refinements of the dopamine theory that indicate that dopamine is not the only neurotransmitter involved in schizophrenia?
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1. dopmaine receptors are more likely the area of disorder rather than dopamine; 2. Excess doapmine receptoes are mainly related to the positive symptoms of schizophrenia and not the negative, 3. There are differences in the neural pathways which use dopamine as a neurotransmitter
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Is dopamine in excess or reduced in the mesolimbic pathway? What about the mesocortical pathway?
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in excess in the mesolimbic pathways and reduced in the mesocortical pathways
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Do antipsychotics tend to treat positive or negative symptoms?
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positive symptoms
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Antipsychotic medications decrease the levels of which neurotransmitter?
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dopamine
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Which neurotransmitter has a role in regulating dopamine neurons in the mesolimbic pathways?
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serotonin
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Why has serotonin received focus in schizophrenia?
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due to the efficacy of some atypical antipsychotics which also target serotonin
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Which is the brain main excitatory neurotransmitter in which activity has been found to be reduced in people with schizophrenia?
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glutamate
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How was glutamate first implicated in schizophrenia research?
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through the effects of drugs like ketamine and PCP which block the glutatmate receptor NMDA and produce schizophrenia like psychosis
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Which primary inhibitory neurotransmitter of the brain that has received considerable attention in schizophrenia research over the last 5 to 10 years?
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GABA
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Deficits in which neurotransmitter have been repeatedly implicated in the pathophysiology of schizophrenia?
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GABA
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In which part of the brain is GABA transmission mostly disrupted in people with schizophrenia?
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prefrontal cortex
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Which four neurotransmitter systems are not mutually exclusive in their influence of schizophrenia but appear to exert their changes via complex interactions with each other?
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dopamine, serotonin, glutamate and GABA
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Early on in the illness which brain regions show reductions in volume?
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hippocampus, thalamus, amygdala, insulla and anterior anterior cingulate
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In the chronic stage of the illness there are more extensive reduction in corticol volume particualrly in which areas of the brain?
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medial and left dorsolateral prefrontal cortex and the left superior temporal gyrus
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in schizophrenia is ventrical volume incresed or decreased?
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increased
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Overal in schizphrenia there is a rediction in what?
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grey matter and whole brain volume
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Brain abnormalities in schiziphrenia are not restricted to dinstinct brain regions they also involve what?
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connections between these regions
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DTI stands for what?
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Diffusion Tensor Imaging
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There is cosiderable research implicating which area of the brain in schizophrenia?
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the prefrontal cortex
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EXplain the neurodevelopmental theory of schizophrenia?
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that schizophrenia is a neurodevelopmental disorder of brain function that unfolds as the individual grows older
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There is a recognied overlap between the early signs of schizophrenia and the hallmarks of what?
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adolescence
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Which theory asserts that schizophrenia develops from disruptions and errors in processes such as synaptic pruning, organisation of cortical circuits, and neuronal migrations that occur during adolescence?
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Neurodevelopmental theory of schizophrenia
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What are the four main environmental risk factors to psychosis?
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developmental trauma, minority group position, urbanised area, and cannibas use
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The more trauma experienced the more likely you are to develop what?
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schizophrenia
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The minority group position risk factor for psychosis depends of what?
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the ethinic density of the area the person is living in and not the ethnic group per se
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The main psychotropic comopnent of cannanis causes what in healthy controls?
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psychotic symptoms and cogntive deficits similair to those found in schizophrenia
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What must exist for the risk factors of schizophrenia to impact on the development of schizophrenia?
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a genetic predisposition
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Tratment of schizophrenia includes a combination of what three things?
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medication, hosptial admission, and psychosocial treatment
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The appropriateness fo a given treatment depends on what?
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the stage of the illness
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What were the main two treatments for schizophrenai prior to the development of antipsychotic medication in the 1950's?
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ECT or lobotomy
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What three factors form the concept of expressed emotion (EE)?
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critical comments, hostility, and emotional overinvolvement
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Does low or high EE predict a relapse?
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high EE
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Why were first generation antipsychotic drugs known as neuroleptics?
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because they produced side effects similar to the symptoms of neurological disorders
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First Gen antipsychotics had what effects on the different types of schizophrenic symptoms?
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they reduced positive and disorganised symptoms but had little effects on negative symptoms
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The primary action of firt gen antipsychotics was to clock what?
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dopamine receptors
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What percentage of people did not response to first gen antipsychotics?
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30%
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Why did 75% of people quit first gen antipsychotic within 2 years?
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unpleasant side effects
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What were the side effects of first gen meds?
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sedation, blurred vision, dizziness, restlessness, sexual dysfunction, extrapyramidal, tardive dyskinesia and neuroleptic malignant syndrome
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Involuntary movements of the mouth are caused by what disorder?
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tardive dyskinesia
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What is the name of the side effects of first gen meds that resembled the motor symptoms of parkinsons disease?
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extrapyramidal
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What is neuroleptic malignant syndrome?>
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severe muscles rigidity, fever, racing heart, increased blood pressure, coma and even death
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What was the first second gen drug?
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clozapine
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Why was clozapine initially used?
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for people who didn’t respond to first gen drugs
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What is the main serious side effects assocaited with taking clozapine?
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impairment of the immune system
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atypical antipsychotics are what?
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sec gen antipsychotics
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What did the clincial trial called CATie reveal about second gen drugs?
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found that the sec gen were barely different from the old
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What effect did CATie have on the antipsychotic supplies?
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some drug companies pulled out of making them
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New med research is targeted at what?
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underlying pathophysiology of schizophrenia
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What is NEWMEDS?
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Novel Methods Leading to New Medications in Depresion and Schiziphrenia
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What are the three main psychological treatments fro people with schizophrenia?
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social skills training, family therapy, and CBT
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Which type of psychological treatment is characterised by teaching people with schizophrenia how to successfully manage a wide variety of interpersonal situations?
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social skills training
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Which type of psychological therapy used to treat schizophrenia is characterised providing education to family about schizophrenia and about medication treatments, communications skills andproblem solving, social network expansion and hope?
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family therapy
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Which type of psychological therapy used to treat schizophrenia is characterised by encouraging the person to test out their delusional beliefs?
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CBT
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What are the 6 steps of family therapy used to treat schizophrenia?
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1. Educate about schizophrenia; 2. Educate about antipsychotic medication; 3. Blame and Avoidance reduction; 4. Comunication and problem solving skills in the family; 5. Social network expansion; and 6. Hope
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Which non-invasive brain stimulation technique involves pulses of magnetic energy, generated by an electrical current passing through a coil placed on the head?
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Transcranial Magnetic Stimulation (TMS)
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Which non-invasive brain stimulation technique uses a very gentle electrical current to change activity levels of cells in particular areas of the brain?
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Transcranial Direct Current Stimulation (TDCS)
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What is the only treatment for cognitive symptoms of schizophrenia?
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cogntive remediation
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