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NMSK Exam 1 > 16. Schizophrenia > Flashcards

16. Schizophrenia Flashcards

1
Q

Schizophrenia

  • MC occurs in?
A
  • MC in:
    • M
    • Adolescence of young adulthood; occurs earlier in Males (18 - 25 YO)
      *
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2
Q

What precipitating events can trigger Schizophrenia?

A
  1. Psychosocial stressor
  2. Trauma
  3. Drug and alcohol use
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3
Q

RF for schizophrenia

A
  1. Cannabis use (6x more)
  2. Urban areas
  3. Immigrants
  4. Obstetric complications
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4
Q

Poorer prognosis of Schizophrenia is associated with what factors?

A
  1. Negative symptoms
  2. Poor cognitive performance on testing
  3. Less support
  4. Younger onset
  5. Insidious onset
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5
Q

Which is associated with worse prognosis in schizophrenia: negative or positive symptoms?

A

Negative symptoms

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6
Q

What are prodromal signs and symptoms of schizophrenia?

A

1. Early symptoms may exist before full disease

2. Schizoid or schizotypal personality

3. Few close friends as adolescents

4. Minimal social activities

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7
Q

Schizophrenia Etiology?

A
  1. Genetics (concordance rate in monozygotic twins = 40-50%; 10-15% in dizygotic)
  2. Early life complications: AE that occured in pregnancy, labor/delivery and early in neonatal life (hemorrhage, preterm labor, maternal infection, blood group mismatch).
  3. Flu virus in 1st trimerster (7x)
  4. URI in mom at ANYTIME in pregnancy (3x)
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8
Q
  • Etiology of schizophrenia (genetics + early life complications) is mainly driven by ____ genome and independent of what?
  • Genes expressed in ______ drive interactions
A
  • Driven by FETAL genome and independent of parents gene-environmental interaction.
  • Placenta
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9
Q

Pathology of Schizophrenia

A
  1. Enlarged lateral ventricles
  2. ↓ in dendritic branching
  3. ↑ DA
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10
Q

What is the “revised dopamine hypothesis” that leads to schizophrenia?

A

Schizophrenia => DA imbalance and periods of high/low secretion of cortisol

  1. ↑ DA in the mesolimbic area and hippocampus => positive symptoms
  2. ↓ DA in prefrontal CTX and amygdala => negative symptoms
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11
Q

Positive symptoms

A
  1. Hallucinations (mainly auditory)
  2. Delusions (fixed, false beliefs)
  3. Disorganized thinking (speech)
  4. Disorganized/ bizzare motor behavior (including catatonia)
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12
Q

Negative Symptoms

A
  1. ↓ emotional expression ***
  2. Avolition ***
  3. Alogia
  4. Anhedonia
  5. Asociality
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13
Q

What types of symptoms account for most morbidity seen in schizophrenia?

A

Negative symptoms

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14
Q

Describe what each of the following are:

  1. Avolition
  2. Alogia
  3. Anhedonia
  4. Asociality
A
  1. Avolition = lack of motivation to complete tasks
  2. Alogia = no speech
  3. Anhedonia = no pleasure
  4. Asociality = no interest in social interactions
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15
Q

Fixed, false beliefs that do not make sense

A
  • Delusions
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16
Q

Types of

Delusions

A
  1. Paranoid = “govt is coming after me”
  2. Grandiose = “I am the richest one here”
  3. Referential =
  4. Erotomanic = “Beyoncé is in love with me”
  5. Nihilistic =
  6. Somatic =
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17
Q

What type of hallucinations are the most common in schizophrenia?

A

Auditory hallucinations (usually familiar/unfamiliar voices that are distinct from ones own thoughts)

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18
Q
  1. Hallucinations that occur while falling asleep are called ______.
  2. Hallucinations that occur when waking up are called _______.
  3. What are they indicative of?
A
  • Hallucinations when falling asleep = hypnAgogic (Asleep)
  • Hallucinations when waking up = hypnoPOMPic (get pumped up in the morning)
  • Indicative of narcolepsy, NOT psychosis.
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19
Q

Types of Disorganized Thinking (speech)

A
  1. Tangentiality = change topic frequently and doesnt answer Q
  2. Derailment or loose associations
  3. Incoherence or “word salad”
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20
Q

Types of

Grossly Disorganized Motor Behavior (Positive symptom)

A
  1. Catatonic behavior = ↓ reactivity to environment
  2. Catatonic excitement = purposeless, excessive motor activity
  3. Negativism = resists instructions
  4. Inappropriate or bizarre behaviors = waxy flexability
  5. Mutism and stupor = no verbal/motor response
  6. Repeated stereotypes movments = staring, grimacing, echolalia
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21
Q

What 2 negative symptoms are most prominent in schizophrenia?

A
  • 1. ↓ emotional expression: ↓ eye contact, ↓ speech intonation, ↓ hand/head/face movements
  • 2. Avolition: ↓ in motivation to complete activities
22
Q

Schizophrenia Diagnostic Criteria

A
  • A. At least 1 month of 2 or more of the following symptoms
    • At least 1 of 3:
        1. Delusions,
        1. Hallucinations,
        1. Disorganized speech
      1. Grossly disorganized or catatonic behavior
      1. Negative symptoms
  • B. At least 1 sx from Criteria A lasts at least 6 months: can include periods of prodromal/residual sx
    • During prodroma/residual periods = may only be negative symptoms or at least 2 group A sx that present in an attentuated form (such as having odd beliefs or unusual perceptual experiences)
  • C. Adults (after sx begin = level of functioning is below than what is was before onset); Children (do not acheive expected level of fx)
  • D. Schizoaffective disorder/mood disorder with psychotic features are R/O
  • E. Not due to substance use/meds/medical condition
  • F. If hx of Autism or communication disorder of childhood onset, dx of schizophrenia is made ONLY if prominent delusions or hallucinations (+ other required sx) are also present for at least 1 month.
23
Q

If hx of Autism or communication disorder of childhood onset, dx of schizophrenia is made ONLY if what?

A

Prominent delusions or hallucinations (+ other required sx) are also present for at least 1 month.

24
Q

Schizophrenia - Catatonic Type

Dx Criteria

A

Clinical picture is dominated by at least 2 of the following:

    1. Motor immobility (catalepsy and stupor)
    1. Excessive motor activity (purposless and not influenced by external stimuli)
    1. Extreme negativism or mutism
    1. Pecularities of voluntary movement such as posturing, stereotypes movements, prominent mannerism or grimacing
    1. Echolalia or echopraxia
25
Q

Schizophrenics have a high risk of _______.

What increases the risk?

A
  • HIGH risk of suicide
  • Risk ↑ with:
    1. substance use
    2. major depression
    3. previous high functioning.
26
Q
  • Diagnosis of schizophrenia is based on _________.
  • Before diagnosing, what do we need to screen for?
A
  • Clinical symptoms
  • Screen to rule out:
    1. Seizure disorder
    2. Metabolic disorder
    3. Thyroid dysfunction
    4. Brain Tumor
    5. Neurosyphillus
    6. Use of street drugs
27
Q

Before diagnosing schizophrenia, what work up must be done?

A
  1. CBC w diff, CMP, TSH, UA, lipids, HgbA1C, prolactin
  2. Urine drug screen
  3. CT/MRI of the brain
  4. Neuro exam
  5. EEG
28
Q

DDx for Schizophrenia

A
  1. Neurocognitive Disorders
    1. Delirium
    2. Dementia
  2. Neuropsychiatric Manifestation of AI Disorder
  3. Mood disorders
29
Q

Why is dementia a DDx for Schizophrenia?

A

Mimics negative symptoms you see in Schizophrenia

30
Q

How do you treat a Schizophrenia patient with acute psychosis?

A
  • Hospitilize: make sure pt is safe and stabilized.
    • IM injections if in inpatient: Haloperidol, fluphenazine, lorazepam
31
Q

How do you treat a Schizophrenia patient once they are stabilized?

A
  1. Convert newer, atypical antipsychotics
32
Q

How do you treat a Schizophrenic patient for maintenance?

A

Keep patients symptom-free, while avoiding incapacitating side effects

33
Q

Which 2nd generation antipsychotic used to treat Schizophrenia causes agranulocytosis?

A

Clozapine

34
Q

Which 2nd generation antipsychotic used to treat Schizophrenia causes

↑ in prolactin?

A

Risperidone

35
Q

Which 2nd generation antipsychotic used to treat Schizophrenia causes

WG, metabolic side effects (DB)?

A

Olanzapine

36
Q

Which 2nd generation antipsychotic used to treat Schizophrenia causes

WG, excessive sedation, less risk of Tardive Dyskinesia?

A

Quetiapine

37
Q

Which 2nd generation antipsychotic used to treat Schizophrenia causes

QTC prolongation?

A

Ziprasidone

38
Q

Which 2nd generation antipsychotic used to treat Schizophrenia causes

QTC prolongation and ↑ prolactin?

A

Iloperidone

39
Q

What Schizophrenia treatments make symptoms worse?

A
  1. Insight-oriented groups
  2. Individual psychotherapy
40
Q

Schizophrenia treatments

A
  1. Community treatment: Integrated Behavioral Medicine Clinics, Residential Living facilities, Care managers
  2. Self-help programs
  3. ECT
  4. Benzos for catatonic disordre
41
Q

Schizophreniform Disorder

A
  • 1. Meets criteria for schizophrenia, but symptoms last LESS than 6 months.
    1. Schizoaffective disorder/mood disorder with psychotic features have been ruled out.
    1. Not attributable to substance or another medical condition
  • (Milder form of schizophrenia)
42
Q

Brief Psychotic Disorder

Diagnostic Criteria

A
  1. 1 or more sx from Criteria A for schizophrenia, with at least one of the first 3.
  2. Sudden onset of psychotic symptoms; last at least 1 day but fully remit in less than 1 month.
  3. Not better explained by: MDD or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia; not due to a substance or other medical condition.
43
Q

Schizoaffective Disorder

Diagnostic Criteria

A
  1. Chronic psychotic symptoms (meet criterion A schizphrenia) with brief periods of mania or major depression.
  2. Must have 2 or more weeks of delusions/hallucinations (psychotic symptoms) alone (w/o mania or depression)
  3. Sx that meet criteria for major mood episode are present for the majority of the active and residual portion of illness.
  4. Not due to effects of a substance or drug of abuse.
44
Q

Delusional Disorder

Diagnostic Criteria

A

On test: if pt ONLY has delusions (“I’m being followed by the FBI”)

  1. 1 or more delusions that last longer than 1 month
  2. No other abnl behavior/ impairment in functioning
  3. Never meet criterion A for schizophrenia
  4. If manic/MDD episode occur, they are brief compared to episodes of delusions
  5. Not caused by another substance/ general medical condition.
45
Q

DDx for Delusional Disorder

A
  1. Alzheimers
  2. Huntingtons Dz
  3. Brain tumors
  4. Complex Partial Seizures
  5. Stroke
46
Q

TIMELINE:

  1. Schizophrenia =
  2. Schizophreniform =
  3. Brief Psychotic Disorder =
A
  1. > 6 months
  2. 1 - 6 months
  3. Less than 1 month
47
Q

Substance/Medication-Induced Psychotic Disorder

A
  1. 1 or both of following sx:
    1. Delusions
    2. Hallucinations
  2. Evidence (from Hx, PE, labs) of both
    1. [Delusions/hallucinations] above developed during or soon after substance intoxication/withdrawal or exposure to meds
    2. Substance is capable of causing [delusions/hallucination].
  3. Not a independent psychotic disorder. Evidence that would support such is
    1. [Delusions/hallucinations] occured BEFORE substance/meds
    2. [Delusions/hallucinations] persist 1 month after cessation of withdrawal/intoxication
    3. Evidence of not being caused by meds/substance
  4. Disorder does not occur ONLY in delusions
  5. Causes distress/impairment in functioning.
48
Q

Catatonia Associated with Another Mental Disorder

&

Catatonia Associated with Another Medical Condition

Diagnostic Criteria

A
  • 3 or more of the following symptoms
    • 1. Stupor (no psychomotor activity; not actively relating to env)
    • 2. Catalepsy (passive induction of posture held against gravity)
    • 3. Waxy flexbility
    • 4. Mutism
    • 5. Negativism
    • 6. Posturing
    • 7. Mannerism (odd way of NL actions)
    • 8. Stereotypy (repetitive, frequent, non-goal directed movements)
    • 9. Agitation
    • 10. Grimacing
    • 11. Echolalia
    • 12. Echopraxia (mimicking others movements)

If medical condition

    1. Evidence of another medical condition
    1. Not better explained by another mental disorder
    1. Does not occur only during delerium
    1. Distress in functioning
49
Q

Schizoid personality

A

Very introverted; voluntarily withdraws from social interactions

50
Q

Schizotypal

A

Schizoid sx (introverted, voluntary withdraws from social interacts) + magical thinking and odd behavior

NMSK Exam 1 (22 decks)

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