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by mtoom


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Describe genetic inheritance pattern of psychosis (2)
  • Is there a single major genetic locus? 
  • Familiality (tends to occur more in families than by chance alone) but is multifactorial
  • Not a single major genetic locus
Give some acquired (biological risk factors) for psychosis? (5)
  • Influenza
  • Starvation (middle trimester)
  • Perinatal and birth complications
  • Advanced paternal age
  • Daily marijuana
In addition to genetics and acquired risk factors, what else can contribute to risk for schizophrenia? (1)
  • Brain structure
  • Genetics
  • Acquired risk factors
If your identical twin has schizophrenia, or both parents have schizophrenia, what is your risk?
At least 50%
What is the stress-vulnerability model?
Idea of some baseline pre-existing vulnerability that can be worsened by stressors or improved by mitigating factors
Name 5 effective psychosocial treatments that work for all patients
  • Medication
  • Case manager
  • Psycho-education
  • Stress management skills
  • Family interventions
Name 3 effective psychosocial treatments that work for some patients
  • Cognitive-behavioural therapy
  • Vocational interventions
  • Cognitive remediation
Medications are more effective for which type of symptoms (positive or negative)?
Meds more effective against positive symptoms
  • Less effective against negative symptoms and thought disorganizational symptoms
Which is a major difference between medications?
Major difference between meds in time it takes to discontinue
Compare effectiveness of anti-psych drugs?

Important considerations for prescribing? (2)
All drugs are same effectiveness (execpt clozapine which is more effective than all others)
  • Make sure side effects are considered in prescriptions
  • Good rapport with doctor helps 
With regard to case management what sort of role is effective and what is ineffective?
  • Prime therapist role: Effective
  • Case manager "broker": Not effective 
What are elements of psycho-education? (4)
  • Causes and treatments of schizophrenia
  • Normalizing schizophrenia as an illness (reduces stigma)
  • Set expectations about course and outcomes in disease
  • Focus on knowledge
Describe strategies taught in stress management (5)
  • Illness only slows progress
  • Change behaviour, thoughts, physiology for better
  • Don't try too hard, but do try enough
  • Change situations and behaviour (goal-setting, problem solving, coping, etc.)
  • Change physiology (relaxation, yoga, etc.)
Discuss strategies in stress management? (4)
  • Lower expectations at beginning (fun, socializing)
  • Forward-looking, constructive
  • Start with one task (with repetition)
  • Progress to additional tasks (with repetition)
Describe a major risk factor in family history for schizophrenia?
Expressed emotion (EE): Hostile, critical or emotionally overinvolved 
  • More often consequence of symptoms than a cause
  • 2/3 of family members: burden, stress
  • Can be improved: Reducing EE reduces risk of relapse
What effect does family involvement have on relapse?
Family involvement reduces risk of relapse
  • Researchers believe that family involvement in treatment overrides loss of confidentiality
  • Can be sessions combined with patient or separate

Components of intervention:
  • Involves assessing relationships in the family
  • Involves joint sessions
  • Goal-setting for parents/sibs
  • At least 9 months of involvement 
Does cognitive behavioural therapy work for schizophrenia?
  • What are its advantages? 
It works
  • Time-limited therapy, so economical
  • Thoughts and behaviours influence emotion and psychosis 
What schizophrenic patients are ideal for CBT?
  • What is the goal? 
Stable outpatients with partial insight
  • Goal to reduce refractory positive symptoms 
How can CBT be used as prevention in schizophrenic patients?
  • Prodrome: Delay/prevent 1st episode
  • Later illness: Reduce chances of relapse
Should CBT used with medications in treatment approach?
Yes, always
For stable outpatients with partial insight but medication-resistant symptoms, what is the evidence for CBT?
Strong evidence
  • ↓ Delusions and hallucinations
  • ↓ Negative symptoms
Effects maintained for 6-12 months

Evidence exists that CBT:
  • Prevents/delays 1st episode
  • Reduces hospital readmission rates
  • Reduces duration of stay if admitted
  • Saves money
For schizophrenia how does CBT compare to other supportive non-medication therapies?
  • Adding any psychotherapy is better than drugs alone
  • CBT seems to have some but not consistent advantages over other supportive therapy 
Work promotes health (income, structure, interests, talents, recognition, identy).

Regarding vocational interventions, do training and placement programs work well?
No they don't
  • However, "place then train" does seem to work
  • Usually part-time, entry-level jobs
What is meant by cognitive remediation in schizophrenia?
Trying to improve cognitive skills in schizophrenia patients
  • Pts have highly variable skills
  • Cog skills are robust predictor of outcomes
  • Meds have limited effects on cognition
What are treatments for cognitive dysfunction in schizophrenia? (3)
  • Remediative: Target specific areas (e.g. problem-solving)
  • Compensatory: Alternate strategies for deficit areas (e.g. plans, lists)
  • Adaptive: Change enviornment (e.g. using a timer)
Describe evidence that cognitive remediation treatments are effective?
  • ↑ general cognition
  • ↑ psychosocial functioning
  • ↓ symptoms
Effects maintained after 8 months
In conclusion, what can be said about medications for schizophrenia? (2)
  • What symptoms are meds effective for?
  • Necessary, but far from sufficient
  • Effective for positive symptoms 
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