STUDY GUIDE FINAL EXAM New material 50 Chapter 13 Schizophrenia and Other Psychotic Disorders What are the DSM criteria for Schizophrenia How is it differentiated from Schizoaffective Disorder Schizophreniform Disorder Delusional Disorder Brief Psychotic Disorder Shared Psychotic Disorder Schizophrenia o Psychosis or loss of contact with reality two or more of these need to be present for at least a month and need to meet both criterion A and B for 6 months Criterion A Delusion hallucinations disorganized speech behavior negative symptoms Criterion B diminished level of care What are risk factors for schizophrenia Higher in people born to older fathers 45 50 Begins in later adolescence 18 30 Signs in early adolescence prodromal Heritable and similar across all cultures More severe in men maybe estrogen is a protective factor Over diagnosed in black people maybe because of the way they express it What are delusions and some examples of them Delusions rigidly held abnormal erroneous irrational thoughts they are firmly fixed and held despite contradictory evidence disturbance in content of thought Examples o Thought broadcasting belief that others can hear or are aware of an individuals thoughts o Thought insertion belief that someone can insert thoughts into the individuals brain o Delusion of reference that a song on the radio is directed towards oneself o Other strange beliefs that organs are removed delusions of grandeur that one is jesus aliens controlling the body people out to get you What are hallucinations and what are the most common kinds What is the relationship between hallucinations and subvocal speech Hallucinations actual sensory experiences they seem real and occur in absence of any external perceptual stimulus occur in any sensory modality but usually auditory people talking to you PET scans show possible misperceived speech misperceive self talk think self thoughts are coming from the outside What is disorganized speech Disorganized behavior Disorganized speech can t make sense despite conforming to semantic syntactic rules of speech disturbance in Disorganized behavior affects work social functioning and self care impairment of goal directed activity daily form not content of thought functioning o Lack of movement and speech What are the positive and negative symptoms of schizophrenia Positive excess distortion in normal repertoire or behavior experiences Negative absence deficit of normally present speech o Alogia lack of speech one word response don t elaborate o Avolition inability to initiate goal directed activity stare off o Annedonia lack of pleasure lack of social life o The more severe the more negative symptoms What are the genetic biological and psychosocial causal factors for schizophrenia Genetic o Twin studies 28 48 concordance 6 dizygotic o Might have genes but if grow up in normal household maybe wont get it o Excessive dopamine in brain maybe gene responsible for dopamine metabolism reactors o Rhesus incompatibility problems with antibodies o Breach delivery prolonged labor Biological Psychosocial o Lack of inhibitory neurons get overly excited stressed out o Heightened sensory awareness o Low glutamate levels o Older beliefs uncaring mother o Cortisol stress releases dopamine o Urban living increases likelihood by 2 7 times o Darker skin maybe more stress o Level of social adversity What are some of the functional and structural brain abnormalities found in schizophrenia o Enlarged ventricles decreased brain volume o Decreased brain matter o Temporal lobe dysfunction o Reduction in myelin What are the roles of dopamine and glutamate in schizophrenia Low glutamate levels glutamate excitatory so when blocked positive and negative symptoms only in a mature brain More receptors for dopamine in brain react more to it need to block those What are the treatments employed for schizophrenia How do the antipsychotic medications work and what are some of their side effects Treatments o In 1950 s were just institutionalized lobotomies o Then anti psychotic drugs improved prognosis but still had symptoms o 38 of people diagnosed functioned well 15 20 years later o long term institutionalization needed for 12 o other factors mess with life expectancy o anti psychotic block dopamine receptors inhibit brain uptake of dopamine 60 have improved symptoms o 1st generation medications neuroleptic increased involuntary movement movement abnormality in tongue and jaw in 56 long term users o 2nd generation medications atypical weight gain not more effective used as first line less disturbing side effects o estrogen antipsychotic side effects VIDEO Larry There are all kinds of voices talks to self and invented fake baseball friends He could only hear the voices so it went unnoticed Went to hospital senior year of high school Friends were either from history or invented Key Terms thought broadcasting is the belief that others can hear or are aware of an individual s thoughts thought insertion The delusion that thoughts are being placed into one s mind by an outsider thought withdrawal The delusion that someone or something is removing thoughts from one s mind delusions of reference refers to the strongly held belief that random events objects behaviors of others etc have a particular and unusual significance to oneself Example A man might have the delusion that each time he hears a cat meow it takes one day off his life loose associations A thought disorder in which series of ideas are presented with loosely apparent or completely unapparent logical connections Example He went to the ballpark and bought Frank s beer belly home in a bag of grass seed neologisms make up words that could sound real but aren t Schizophrenia disorganized speech catatonia Catatonia is a state of apparent unresponsiveness to external stimuli in a person who is apparently awake Schizophrenia catatonic type type of schizophrenia in which the central feature is pronounced motor symptoms of either an excited or stuporous type Catatonic stupor lack of movement speech can be excessive repetitive stereotyped movement that is repeated Avolition refers to a psychological state that is characterized by general lack of drive or motivation to pursue meaningful goals tardive dyskinesia neurological disorder resulting from excessive use of antipsychotic drugs side effects can occur months to years after treatment had been initiated or stopped symptoms involve involuntary movements of the tongue lips jaw