32: Schizophrenia Spectrum - Sieleni Flashcards
schizophrenia spectrum
schizotypal (personality) disorders –> psychotic disorders –> schizophrenia
definition schizophrenia
abnormalities in 1 or more of 5 domains
- delusions
- hallucinations
- disorganized thinking and/or speech
- grossly disorganized or abnormal motor behavior including catatonia
- negative symptoms
fixed beliefs that are not amenable to change in light of conflicting evidence
delusions
can be persecutory, referential, grandiose, erotomanic, nihilistic, or somatic)
perception-like experiences that occur without an external stimuli
hallucinations
includes auditory voices
inferred from the individual’s speech and it must impair communication
disorganized thinking
a less severe impairment occurs in prodromal and residual phase of schizophrenia
define these domains:
- derailment or loose associations
- tangentiality
- incoherence or word salad
- switching from topic to topic
- answers to questions obliquely related or unrelated
- severely disorganized resembling receptive aphasia
resistance to instructions =
negativism (catatonia)
rigid, inappropriate or bizarre posture to a complete lack of verbal or motor responses =
mutism (catatonia)
purposeless and excessive motor activity without obvious cause =
catatonic excitement (catatonia)
diminished emotional expression: reductions in the expression of emotions in face ,eye contact, and intonation of speech
negative symptoms
account for morbidity of schizophrenia (less prominent in other psychotic disorders)
decrease in motivated self initiated purposeful activities
avolution
diminished speech output
alogia
decrease ability to experience pleasure from positive stimuli or degradation in teh recollection of pleasure previously experienced
anhedonia
lack of interest in social interactions
asociality
a pervasive pattern of social and interpersonal deficits marked by discomfort or inability to have close relationships as well as cognitive and perceptual distortions and eccentricities of behaviors, beginning in early adulthood and present in a variety of contexts
schizotypal disorder
must have 5 of the below
- ideas of reference
- odd beliefs or magical thinking
- unusual perceptual experiences including body illusions
- odd thinking or speech
- suspicious or paranoid ideation
- inappropriate or constricted affect
- behavior or appearance that appears odd eccentric or peculiar
- lacks close friends or confidents other than first degree relatives
- extensive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about oneself
schizotypal disorder is more prevalent in …
males
only a small percentage of schizotypals go on to schizophrenia
presence of one or more delusions with a duration of 1 mo or longer but no significant hallucinations and no markedly impaired or bizarre behavior
delusional disorders
delusion disorders = erotomanic grandiose jealous * more com. in men persecutory * most freq somatic mixed unspecified
another person is in love with individual
conviction of having some great talent or insight or having made some important unrecognized discovery
spouse or lover is unfaithful
belief that one is being conspired against, cheated, spied on, followed, poisoned, drugged, maligned, harassed, or long term goals are obstructed
involved bodily functions or sensations
no one theme is prominent
dominant delusional belief cannot be determined
duration at least 1 day but not more than 1 mo with eventual return to premorbid functioning
presence of one or more of following: delusion, hallucination, disorganized speech, grossly disorganized or catatonic behavior
brief psychotic disorder
disturbance is brief but level of impairment is severe
those with time frames of 1-6 mo as opposed to 1 mo are found more in developing countries
more common in females
2 or more of the following present for a significant time during a 1 MONTH period. at least one of these must be one of the first 3 choices
- delusions
- hallucinations
- disorganized speech
- disorganized/catatonic behavior
- negative symptoms
schizophreniform disorder
lasts at least 1 mo but less than 6 mo
1/3 recover in 6 mo and the other 2/3 go on to have schizophrenia or schizoaffective disorder
2 or more of the following present for a significant time during a 1 MONTH period. at least one of these must be one of the first 3 choices
- delusions
- hallucinations
- disorganized speech
- disorganized/catatonic behavior
- negative symptoms
AND
for a significant protion of time since onset the level of function is decreased in one or more major areas
schizophrenia
continuous signs of disturbance persist for at least 6 months with 1 month of active symptoms
lifetime prevalence 0.3-0.7%
anosognosia =
lack of insight into one’s own clinical illness
hallmark of schizophrenia
symptom, not coping strategy
with schizophrenia, _____ symptoms are more closely related to prognosis and are more persistent
negative
psychotic symptoms tend to diminish over life course
risk factor for schizophrenia
late winter early spring or summer are increased risk
higher risk in urban areas
males v. females with schizophrenia
male: early to mid 20s poorer adjustment lower education more brain sturcture abnormalities more negative s/s more cognitive impairment limited social contact
female: late 20s
lower incidicence
less brain structure abnormalities, less cognitive impairment
better outcomes with 35% develop before age 30
more psychotic symptoms
schizophrenia rates of comorbidity with substance disorders is __________
high
over 50% use tobacco (dampens hallucinations)
delusions or hallucination for 2 or more weeks in absence of major mood episode during the lifetime duration of the illness
schizoaffective disorders
1/3 as common as schizophrenia with lifetime prevalence of 0.3%
higher in female and depressed
prevalence of substance/medication induced psychotic disorder
7-25%
of individual with first episode psychosis
psychotic disorders can be due to another medical disorder. which have an increased suicide rate associated with illness greater than with psychosis?
Ms
epilepsy
if psychotic and older than 80…
medical condition is major neurocognitive disorder (dementia) (comorbidity)
lifetime prevalence of psychotic disorder due to another medical disorder is 0.21 -0.54 when stratified by age. in those older than 65 it is as high as 0.74%
describe catatonia
stupor catalepsy waxy flexibility mutism negativism posturing mannerism stereotypy (repetitive, abnormal, frequent non-goal directed movement) agitation grimacing echolalia (minic speech) echopraxia (mimic movement)
35% of inpatients with schizophrenia get this specifier
catatonia
monozygotic twin rates
40-50%
16% chance if partents schizophrenic
risk correlates with age of father
histopathological changes
- decreased volume of hippocampus, thalamus, temporal and prefrontal cortex
- decreased total gray matter volume
- cyto-architerctural abnormalities
- decreased synaptic connectivity
- caudate volume decreased in neuroleptic naive; increased with neuroleptic exposure
- evidence of abnormal cell migration in hippocampus and frontal cortex
- absence of gliosis suggests developmental abnormality
neuroimaging changes
- lateral and third ventricle enlarged
- bilateral (L greater than R) approximately 10% volume reduction
- if present at time of diagnosis this may progress to poor outcome pt
- larger ventricles in affected discordant monozygotic twins
functional brain imaging
- hypofrontality at rest in chronic pts may correlate with negative symptoms
- consistent failure to activate prefrontal cortex during performance of cognitive task (deficit syndrome)
- temporal lobe activity increased at baseline - impaired activation in response to memory task
long term psychosocial tx
evidence based practices SMAHSA
- assertive community tx
- integrated treatment for co-occurring disorders
- supported employment
- illness management and recovery
- family psycho-education
- permanent supportive housing
- Med TEAM
- consumer-operated services
- interventions for disruptive behavior disorders
- tx of depression in older adults
- supported education
homicide rate may be ____________ but still ______ of the pop
increased by 10 fold
less than 1%
as a group they are more frequently victimized than other individuals
suicide risk is _______ ( ____ with schizophrenia) with the highest risk in the _______ of illness
10-15%
20%
first 5 yrs
5-6% of those with schizophrenia/schizoaffective disorder die by suicide
