Please enable JavaScript.

Coggle requires JavaScript to display documents.

Schizophrenia (Schaefer (Schizophrenia is a 'global' condition in…

- - - - Potential triggers: family stress, emotional disorder, experience of trauma
    - - Low socioeconomic status, living in urban arena, increased level of stressful lige events, high stress family environment (prone to relapse)
      - Mediating symptoms: HPA axis, stress sensitivity = heighetened levels of cortiosol relase in schizophrenic people
      - Potential neurological markers of a diagnosis of schizophrenia (alteret HPA axis, smaller hippocampus) may be product of prolonged stessful or traumatisk events during development
      - Prevalence: 15 times more likely to experience sexual abuse
        
        25-40% comorbid PTSD: symptoms associated with stressful life events
        
        Instrusive trauma-related memory (flashbacks, postpsychotic PTSD); level of a match between specific emotional experienced suffered during a trauma and emotional content of hallucinations
        
        Content of stressful experiences not important: general stressor that induce biological reaction that produce vulnerability to random anomalous experiences (idiosyncratic)
    - - Sedatice effect of antihistamines = antipsychotic, chlorpromazine
      - Dopaminergic activity associated with drug = dopaminergic dysregulation underlying positive symptoms (D2 receptor) + amphetamines (agonists) onset of psychosis
      - Side effects: muscle tremors (low levels of dopamine)
      - Serotonin
      - Kapur (2003): excess of dopamine = salience attached to random stimuli that produce delusions of reference
    - - MZ = 44%/DZ = 12%
      - Offspring (one diagnosed parent) = 9%
      - Genetic markers
        
        Gene(s) responsible for poor cognitive functioning
        
        Starte reflex
  - - - Positive and Negative Symptom Scale (PANSS)
      - Family history of severe mental problems
      - Stigma
    - - Homework + build on content from previous sessions: cognitive functioning deficits interfere?
      - Short-term; include other professionals in long-term care, especially end of treamtent
      - engagement + goal = experiences are interpreted and result in emotionel distress
      - Assesment
        
        (1) any patterns within the interpretation of a wide range of events
        
        (2) when this pattern of interpretation started
        
        (3) any significant life events associated with the onset of pattern of interpretation
        
        Therapist hopes to maneuver patient into understanding that own verden of events is one possibility, but not the only
      - Effect size: moderate and broadly similar (treatment-resistant psychosis)
    - - Double-bind theory
        
        contradictory information from parents (usually mothers) produced unavoidable conflict which the child mentally withdrew
        
        Schizophrenogenic mother: cold and alienating to children
      - Expressed emotion (EE)
        
        Emotional atmosphere of family and how this appears to be associated with relapse of psychotic symptoms
        
        Hostile, critical or overinvolved
        
        Inflexible styles of coping
    - - Wider social isses associated with the diagnosis: social stigma, self-labeling, psychoeducation, side effects of medication, negativ self-view,
    - - Initial assessment; physical health, social and occupational functioning, suicidality
      - Collaborative development of treatment goals
      - Possibility of patient trying to get them to offer help they cannot provide
      - Nonexpert, empathic, flexible approach should enable the clinician to engage with most people who have received a diagnoses
  - - - Sensory perceptions of stimuli that are not really there; any sensory modality (auditory most common)
        
        Types: voices commenting; command hallucinations
        
        3% will experience voice hearing
        
        Association with activation of left primært auditory cortex and the right middel temporal gyrus = production of inner speech
        
        Auditory productt of misattribution of internally stimuli to efternavn source
        
        Idiosyncratic belief about origin of voice
    - - Present in around 75% of patients receiving hospital care
      - A fixed false belief that is held in the face of evidence to the contrary; not belief held within culture/subculture; cannot be made sende of with reference to normal thought process
      - Can often be understood within context of hallucinations; important to consider of symptoms are found in non-clinical sample
        
        Delusions of persecution
        
        Delusions of grandeur
        
        Delusions of control
        
        Delusions of reference
      - Reasoning: ‘jump to conclusions’, abandon original conclusions; increased reliance om occuring info; failure to integration this into plast situations; self-serving bias
      - Three dimensions; conviction, preoccupation, awareness of others reactions to one’s beliefs
  - - - Global intellectuel functioning poor: WM/LM memory, executive functioning, attention, processing speed, social cognitive (1 STD below)
      - Treatment: computerized treatment, cognitive remediation therapies = errorless learning, selv-monitoring, scaffolding
  - - - Role of a genetic vulnerability in some of experiences
    - - "Normal": interpretations critical
    - - Psychotic presentation: evolved out of the presence of unusual experiences (how experiences are interpreted)
      - Psychosis: experiences being interpreted as negative, threatening, external and with hypervigilance and safety behaviours
      - Distinctions: core unusual experiences "normal" or anomalous biologically based phenomena
- - - - Clinical interviews
        
        Rating scales
        
        SANS
        
        PANS
        
        Limited insight or awareness of illness and cannot reliably report on own experiences
        
        Next generation rating scales include assessment of observable behaviour and reported experience of emotion, motivation and desire for close relationship
        
        Do not necessarily capture emotion, motivation and close relationship; ratings made at a single point in time + not provide an opportunity for people to express or experience emotions
        
        Aid diagnosis by assessing severity of specific symptoms
      - Self-report measures
        
        Advantage over clinical interview rating scales: not affected by social skills deficits or interpersonal factors
        
        They can reliably and accurately complete such measures
        
        They do not approach measures with different underlying conceptualisations or knowledge structures of the constructs
        
        Anhedonia are most used self-report measure: TEPS
        
        Consideration of particular symptoms guides treatment decisions more effectively and efficiently than lumping alle the negative symptoms together
    - - First-generation: phenothiazines (chlorpromazine), thioxanthenes, butyrophenones - most effective with positive and disorganisation symptoms (30% do not respond favorably) = side effects (dystonia, akathisia, tardive dyskinia
      - Second-generation: modestly more effect than first-generation in reducing negative symptoms and improving cognitive deficits = side effects (pancreatitis)
    - - Maladaptive beliefs benefit
      - Challenging belief structures tied to low expectation for success (avolition) and low expectations for pleasure (antipathy pleasure deficit in anhedonia)
      - Small to moderate effect sizes for CBT in treating positive symptoms, negative symptoms and general life functioning
    - - Interventions are designed to improve or enhance basic cognitive functioning such as problem solving, verbal learning, perceptual learning, memory
      - Small effect in symptom reduction
    - - Teach how to manage successfully a wide variety of interpersonal situation
      - Largest impact on social skills, but also significant impact on negative symptoms
    - - Loving-kindness (LKM)
        
        Quiet contemplation and attention to the here and now
      - Two groups of nine participations attended 1-hour weekly sessions for 6 weeks
      - Three major elements: discussion, skills teaching, practice
      - Treatment associated with a decrease in anhedonia and asociality: increase in positive emotions at posttreatment and at 3-month follow-up assessments
  - - - Asociality
        
        Decreased interest in forming close relationships with others and/or reduced social activity: may interact only superficially and briefly, and appear aloof or indifferent to social interactions
        
        Do not feel lonely
      - Avoliation
        
        Diminished motivation and difficulty in initiating and persisting in what are usually routine activity: experience component and a behavioural component
      - Anhedonia
        
        Reduction in the experience of pleasure; diminished pleasure in different domains
        
        People with schizophrenia appear to have a deficit in anticipatory but not consummatory pleasure; anticipate less pleasure form expected future activities
      - Blunted affect
        
        Lack of outward expression of emotion: refers not to reported experience of emotions
      - Alogia
        
        Significant reduction in amount of speech: about half of people with schizophrenia exhibits this
    - - Negative symptom factor is not strongly correlated with other factors that emerge
      - Symptoms factors: expression (blunted affect/alogia), experience (abolition, sociality, anhedonia)
    - - Negative symptoms tend to endure beyond acute episodes and have profound effect
      - Presence of many negative symptoms is a strong predictor of poor clinical outcome; major impact on family members; functional outcomes
  - - - Age onset is between 18-15, usually somewhat earlier in men (associated with more negative symptoms and poorer prognosis)
      - Women tend to have overall better prognosis than men (better functioning prior, better treatment-response, fewer negative symptoms)
      - More severe acute episodes with less severe but still debilitating symptoms between these episodes
    - - Substance abuse: 50%
      - Anxiety disorders (panic, OCD, social anxiety), depression
      - People with schizophrenia are also more likely to die from any cause
    - - Consideration of gender
      - Person evidencing negative symptoms with positive symptoms would not qualify for a diagnosis
      - Lack of insight
  - - - People with schizophrenia report feeling emotions as strongly as people without
      - Are expressing emotions but at an undetectable intensity level
    - - Emotional experiences in people with and without are largely the same
      - Diminished experience of positive emotion
      - People with schizophrenia appear less likely to anticipate that future events will be pleasureable and to experience pleasure in anticipation of things to come, they may be less likely to seek out experiences they might find equally pleasure
    - - Difficulty translating reward information into goal-directed or motivated reward-seeking behaviour
    - - Mistaking a lack of expression for a lack of distress needs to be avoided
      - Training of expressive behaviour may be effective
- - - - Symptoms may be present without significant suffering
- - - - Schizophrenia associated with more negative symptoms, few affective symptoms, longer duration
      - Discussion: Is schizoprenia a valid scientific category?