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Psych 2 > 1.3 - Schizophrenia > Flashcards

1.3 - Schizophrenia Flashcards

1
Q

In the United States, the lifetime prevalence of schizophrenia is

A

about 1 percent

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2
Q

Schizophrenia is (EQUALLY/UNEQUALLY) prevalent in men and women

A

Schizophrenia is equally prevalent in men and women

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3
Q

Schizophrenia onset is earlier in

a. men than in women
b. women than in men

A

Schizophrenia onset is earlier in men than in women

More than half of all male schizophrenia patients, but only one third of all female schizophrenia patients, are first admitted to a psychiatric hospital before age 25 years.

The peak ages of onset are 10 to 25 years for men and 25 to 35 years for women.

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4
Q

What are the peak ages of onset for

men
women

A

The peak ages of onset are 10 to 25 years for men

25 to 35 years for women

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5
Q

About 90 percent of patients in treatment for schizophrenia are between (xx to yy) years old

A

15 and 55

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6
Q

disorder is characterized as late-onset schizophrenia when

A

when onset occurs after age 45 years

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7
Q

First­ degree biological relatives ofpersons with schizophrenia have a (greater/lesser) risk for developing the disease than the general population.

A

ten times greater risk

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8
Q

The simplest formulation of the dopamine hypothesis of schizophrenia posits that schizophrenia results from (NOT ENOUGH/TOO MUCH) dopaminergic activity.

A

The simplest formulation of the dopamine hypothesis of schizophrenia posits that schizophrenia results from TOO MUCH dopaminergic activity.

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9
Q

Which biochemical factors are important in schizophrenia are:

A
  • Dopamine
  • Serotonin

Norepinephrine

GABA

Neuropeptides

Glutamate

Acetylcholine and Nicotine

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10
Q

What are the symptoms of schizophrenia?

Criterion A

A
  1. Delusions
  2. Hallucinations
  3. Disorganized speech (e.g., frequent derailment or incoherence)
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms (i.e., diminished emotional expression or avolition).
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11
Q

What are the 3 most important symptoms of schizophrenia?

How many are required for diagnoses? (1/2/3)

A

At least one of these must be (1), (2), or (3)

  1. Delusions
  2. Hallucinations
  3. Disorganized speech (e.g., frequent derailment or incoherence)
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12
Q

Diagnostic criteria A for the symptoms of schizophrenia

A

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):

  1. Delusions
  2. Hallucinations
  3. Disorganized speech (e.g., frequent derailment or incoherence)
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13
Q

Criterion B-F of Schizophrenia

A

B. Level of functioning in one or more major areas of functioning, such as work, interpersonal relations, or self-care, is markedly below the level achieved before the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of functioning).

C. Continuous signs of the disturbance persist for at least 6 months.

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out. Either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

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14
Q

Subtypes of schizophrenia

A

Paranoid Type

Disorganized Type

Catatonic Type

Undifferentiated Type

Residual Type

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15
Q

Subtypes of schizophrenia

Paranoid Type

A

paranoid type of schizophrenia is characterized mainly by the presence of delusions of persecution or grandeur

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16
Q

Subtypes of schizophrenia

Disorganized Type

A

characterized by a marked regression to primitive, disinhibited, and unorganized behavior and by the absence of symptoms at meet the criteria for the catatonic type

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17
Q

Subtypes of schizophrenia

Catatonic Type

A

marked disturbance in motor function; this disturbance may involve stupor, negativism, rigidity, excitement, or postur­ing

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18
Q

Subtypes of schizophrenia

Undifferentiated Type

A

patients who clearly have schizophrenia cannot be easily fit into one type or another.

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19
Q

Subtypes of schizophrenia

Residual Type

A

charac­terized by continuing evidence ofthe schizophrenic disturbance in the absence of a complete set of active symptoms or of sufficient symptoms to meet the diagnosis of another type of schizophrenia

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20
Q

Differential Diagnosis of Schizophrenia-Like
Symptoms:

Medical and Neurological

A
  • Substance induced
  • Epilepsy-
  • Neoplasm, cerebrovascular disease, or trauma-especially frontal or limbic
  • Acute intermittent porphyria
  • AIDS
  • Vitamin B12 deficiency
  • Carbon monoxide poisoning
  • Cerebral lipoidosis
  • Creutzfeldt-Jakob disease
  • Fabry’s disease
  • Fahr’s disease
  • Hallervorden-Spatz disease
  • Heavy metal poisoning
  • Herpes encephalitis
  • Homocystinuria
  • Huntington’s disease
  • Metachromatic leukodystrophy
  • Neurosyphilis
  • Normal pressure hydrocephalus
  • Pellagra
  • Systemic lupus erythematosus
  • Wernicke-Korsakoff syndrome
  • Wilson’s disease
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21
Q

Differential Diagnosis of Schizophrenia-Like
Symptoms:

Psychiatric

A
  • Atypical psychosis
  • Autistic disorder
  • Brief psychotic disorder
  • Delusional disorder
  • Factitious disorder with predominantly psychological signs and symptoms
  • Malingering
  • Mood disorders
  • Normal adolescence
  • Obsessive-compulsive disorder
  • Personality disorders-
  • Schizoaffective disorder
  • Schizophrenia
  • Schizophreniform disorder
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22
Q

Course of Schizophrenia

A
  • The classic course of schizophrenia is one of exacerbations and remissions.
  • Patients usually relapse, however, and the pat­tern of illness during the first 5 years after the diagnosis gen­erally indicates the patient’s course.
  • Further deterioration in the patient’s baseline functioning follows each relapse of the psychosis. This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders.
23
Q

What is the major distinction between schizophrenia and the mood disorders?

A
  • Further deterioration in the patient’s baseline functioning follows each relapse of the psychosis.

This failure to return to baseline functioning after each relapse is the major distinction between schizophrenia and the mood disorders.

24
Q

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, what percent is described as having a GOOD outcome?

A

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, only about 10 to 20 percent of patients can be described as having a good outcome

25
Q

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, what percent is described as having a POOR outcome?

A

over the 5- to 10-year period after the first psychiatric hospitalization for schizophrenia, more than 50 percent of patients can be described as having a poor outcome, with repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts

26
Q

What is a poor outcome of schizophrenia?

A

repeated hospitalizations, exacerbations of symptoms, episodes of major mood disorders, and suicide attempts

27
Q

Features Weighting Toward to Good Prognosis in Schizophrenia

A
  • Late onset
  • Obvious precipitating factors
  • Acute onset
  • Good premorbid social, sexual, and work histories
  • Mood disorder symptoms
    (especially depressive
    disorders)
  • Married
  • Family history of mood disorders
  • Good support systems
  • Positive symptoms
28
Q

Features Weighting Toward to Poor Prognosis in Schizophrenia

A
  • Young onset
  • No precipitating factors
  • Insidious onset
  • Poor premorbid social, sexual,
    and work histories
  • Withdrawn, autistic behavior
  • Single, divorced, or widowed
  • Family history of
    schizophrenia
  • Poor support systems
  • Negative symptoms
  • Neurological signs and symptoms
  • History of perinatal trauma
  • No remissions in 3 years
  • Many relapses
  • History of assaultiveness
29
Q

Treatment of schizophrenia

A
  • antipsychotic drugs
  • psychosocial treatment
  • hospitalization
  • ECT
30
Q

first­ generation antipsychotics

aka

A

dopamine receptor antagonists

clozapine (Thorazine)

31
Q

second-generation
antipsychotics

aka

A

serotonin dopamine antagonists (SDAs)

32
Q

EMIL KRAEPLIN-

A

dementia precox

Emphasized the distinct cognitive process (dementia)

early onset (precox)

33
Q

4 A’s EUGEN BLEULER

A

Associations
Affect
Autism
Ambivalence

34
Q

Prevalence

Phil and US

A

Region 6 (Phil) 1996 - 4.3%

US Lifetime prevalence of Schizophrenia - 1 - 1.5%

NIMH-ECA Study - 1.3%

35
Q

What percentage of patients with schizophrenia attempt suicide at least once?

A

50% of patients with schizophrenia attempt suicide at least once

36
Q

What percentage of patients with schizophrenia die by suicide during a 20 year follow up period?

A

10 -15% of patients with schizophrenia die by suicide during a 20 year follow up period

37
Q

Premorbid Signs and Symptoms of schizophrenia

A

SCHIZOID

SCHIZOTYPAL

38
Q

5 symptoms dimensions of schizophrenia

A
  1. positive symptoms
  2. negative symptoms
  3. cognitive symptoms
  4. aggressive symptoms
  5. anxiety/depression
39
Q

Positive symptoms of schizophrenia

A

excess of normal function

  • catatonic behavior
  • delusions
  • hallucinations
  • distortions or exaggerations in language and communication
40
Q

Positive symptoms are associated not just with schizophrenia, but also with

A
  • bipolar disorder
  • schizoaffective disorder
  • childhood psychotic illnesses
  • psychotic depression
  • Alzheimer’s
41
Q

cognitive symptoms of schizophrenia

A
  • thought disorder
  • impaired attention
  • impaired verbal fluency
  • problems with serial learning
  • impairment in vigilance for executive functioning
42
Q

negative symptoms of schizophrenia

A
  • blunted affect
  • emotional withdrawal
  • poor rapport
43
Q

aggressive symptoms of schizophrenia

A
  • hostility
  • verbal abusiveness
  • physical abusiveness
44
Q

depressive / anxious symptoms of schizophrenia

A
  • depressed mood
  • anxious mood
  • guilt
45
Q

NEURODEVELOPMENTAL HYPOTHESIS of schizophrenia

A

proposes that a proportion of schizophrenia is the result of an early brain insult, either pre or perinatal which affects brain development leading to abnormalities which are expressed in the adult brain

46
Q

5 symptoms of psychosis

A
  • Hallucinations
  • delusions
  • disorganized speech
  • disorganized behavior
  • gross distortions of reality testing
47
Q

Cognitive deficits found in schizophrenia show ( DETERIORATION / NO DETERIORATION) over the course of the illness

A

Cognitive deficits found in schizophrenia show NO DETERIORATION over the course of the illness

non-progressive

48
Q

Risk factors for schizophrenia

A
  • Nutrition
  • Seasonality
  • Infection or infectious agents
  • Obstetric complications
49
Q

Hyperdopaminergic state in (cortex / subcortical) area may underlie the (negative / positive) symptoms of schizophrenia

A

Hyperdopaminergic state
in SUBCORTICAL area may underlie
the POSITIVE symptoms of schizophrenia

50
Q

Hypodopaminergic state in (cortex / subcortical) area may underlie the (negative / positive) symptoms of schizophrenia

A

Hypodopaminergic state in CORTEX may underlie

the NEGATIVE symptoms of schizophrenia

51
Q

Nigrostiatal tract function

a. emotional expression
b. inhibit prolactin release
c. initiation and coordination of motor movements

A

c. initiation and coordination of motor movements

52
Q

Mesolimbic/Mesocortical Tracts function

a. emotional expression
b. inhibit prolactin release
c. initiation and coordination of motor movements

A

a. emotional expression

53
Q

Tuberoinfundibular tract function

a. emotional expression
b. inhibit prolactin release
c. initiation and coordination of motor movements

A

b. inhibit prolactin release

Psych 2 (5 decks)

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