1: Schizophrenia Flashcards
incidence of schizophrenia
1% worldwide
onset of schizophrenia
typically early in life: 15-25 y/o
- during critical years of school, academic, and vocational development
- Sx can hinder a person’s ability to meet their own goals
which parts of the mental status exam are grossly abnormal in schizophrenia?
- thought process/form
- thought content
psychotic or positive Sx
- hallucinations (disturbed perceptions)
- delusions (disturbed thought content)
- disorganization (disturbed thought formation)
negative Sx
- restricted or inappropriate affect
- avolition (lack of motivation)
- alogia (paucity of speech)
- inability to start and follow through with activities
- lack of pleasure or interest in life
cognitive impairement Sx
- difficulty prioritizing tasks or organizing thoughts
- lack of insight (anosognosia)
- problems with information processing and verbal memory
schizophrenia diagnosis criteria
- two or more of the following for a significant portion of one month:
- delusions (fixed false beliefs)
- hallucinations (usually auditory)
- disorganized speech (tangential, incoherent, derailment)
- grossly disorganized or catatonic behavior (agitation, posturing)
- negative Sx (affective flattening, avolition, alogia) - interpersonal or psychosocial dysfunction present
- continues signs of illness for at least 6 months with at least 1 month of active criterion A sx
- not due to another mental illness
- not due to substances or general medical condition
mental status abnormalities in attitude
- suspicious
- resistive
- negativistic
- guarded
- hostile
mental status abnormalities in appearance
- disheveled
- unkempt
- unshaven
- no makeup
- malodorous
- mismatched and/or dirty clothing
- impaired temp response
- clothes inappropriate for weather
mental status abnormalities in behavior
- awkward
- decreased arm swing while walking
- stereotypical movements
- poor eye contact
- decreased rate of speech
- Parkinsonian gait and/or tremors (often med side effect)
mental status abnormalities in mood and affect
- subjective: depressed, poorly described
- objective: FLAT, irritable, angry, hostile
mental status abnormalities in thought processes **
- loose associations
- disorganized
- tangential
- non-sequential
- decreased spontaneity
- unable to reach conversational goals
- poverty of thought
- thought blocking
- alogia (paucity of speech)
- neologisms
- word salad
- clang associations (putting together words based on alliteration or rhyming rather than meaning)
mental status abnormalities in thought content **
- distortions of reality
- psychotic
- grandiose
- paranoid delusions
- delusions of thought broadcasting
- thought insertion or thought control
- ideas of reference from the TV or radio
- bizarre delusions
- auditory hallucinations (often complex)
mental status abnormalities in insight
-diminished capacity to understand that they are experiencing Sx of an illness and therefore need ongoing Tx
mental status abnormalities in judgment
-often poor as evidenced by lack of relationships, employment, inability to provide for basic needs of food and/or shelter
mental status abnormalities in intellect
-decreased working memory, future recall, decreased complex reasoning
describe morbidity: the longer Sx are untreated or inadequately treated, the…
- longer the time to remission
- more residual Sx
- worse long-term prognosis
what physical changes occur in the brain in schizophrenia
accelerated brain gray matter loss
timeline of schizophrenia
- premorbid period: 0-18 y/o
- prodromal period: 18-23y/o
- onset/deterioration: 23-35 y/o
- residual/stable: rest of life
7 burdens of psychosis
- early mortality
- medical co-morbidities (huge amount of smoking)
- suicide
- substance abuse disorders
- unemployment
- homelessness
- incarceration
downward drift hypothesis
-individuals with schizophrenia enter into (or fail to rise out of) a lower socioeconomic group as a direct result of the illness –> there are a disproportionate number of schizophrenics in low socioeconomic groups
two treatment models for schizophrenia
- medical model: to relieve Sx to cure disease
2. recovery model: to relieve Sx to improve fxn
Tx (general)
- medications
- sometimes cognitive psychotherapies
- case management
- counseling/therapy
- psychosocial rehabilitation
goals of psychosocial rehabilitation
- minimize stigma and integrate individuals into society
- impact either the env’t or the individual’s ability to deal with the env’t to facilitate improvement in Sx or distress
7 first generation antipsychotics
- thorazine (chlorpromazine)
- mellaril (thioridazine)
- prolixin (fluphenazine)
- trilafon (perphenazine)
- haldol (haloperidol)
- moban (molindone)
- loxitane (loxapine)
9 second generation antipsychotics
- clozaril (clozapine)
- risperdal (risperidone)
- zyprexa (olanzapine)
- seroquel (quetiapine)
- geodon (ziprasidone)
- abilify (aripiprazole)
- fanapt (iloperidone)
- saphris (asenapine)
- latuda (lurasidone)
pros/cons of first gen vs. second gen antipsychotics
first gen:
- dopamine antagonists
- very effective
- sedative properties
- bad side effects w/ long term tx (parkinsonian Sx)
second gen:
- more insulin resistance, development of DM, and obesity
- alleviates the extrapyramidal effects found in first gen (due to serotonin effects)
