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CS3: Exam 3 > 32: Schizophrenia Spectrum - Sieleni > Flashcards

32: Schizophrenia Spectrum - Sieleni Flashcards

1
Q

schizophrenia spectrum

A

schizotypal (personality) disorders –> psychotic disorders –> schizophrenia

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2
Q

definition schizophrenia

A

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
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3
Q

fixed beliefs that are not amenable to change in light of conflicting evidence

A

delusions

can be persecutory, referential, grandiose, erotomanic, nihilistic, or somatic)

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4
Q

perception-like experiences that occur without an external stimuli

A

hallucinations

includes auditory voices

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5
Q

inferred from the individual’s speech and it must impair communication

A

disorganized thinking

a less severe impairment occurs in prodromal and residual phase of schizophrenia

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6
Q

define these domains:

  • derailment or loose associations
  • tangentiality
  • incoherence or word salad
A
  • switching from topic to topic
  • answers to questions obliquely related or unrelated
  • severely disorganized resembling receptive aphasia
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7
Q

resistance to instructions =

A

negativism (catatonia)

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8
Q

rigid, inappropriate or bizarre posture to a complete lack of verbal or motor responses =

A

mutism (catatonia)

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9
Q

purposeless and excessive motor activity without obvious cause =

A

catatonic excitement (catatonia)

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10
Q

diminished emotional expression: reductions in the expression of emotions in face ,eye contact, and intonation of speech

A

negative symptoms

account for morbidity of schizophrenia (less prominent in other psychotic disorders)

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11
Q

decrease in motivated self initiated purposeful activities

A

avolution

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12
Q

diminished speech output

A

alogia

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13
Q

decrease ability to experience pleasure from positive stimuli or degradation in teh recollection of pleasure previously experienced

A

anhedonia

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14
Q

lack of interest in social interactions

A

asociality

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15
Q

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

A

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
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16
Q

schizotypal disorder is more prevalent in …

A

males

only a small percentage of schizotypals go on to schizophrenia

17
Q

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

A

delusional disorders

18
Q 
delusion disorders =
erotomanic
grandiose
jealous * more com. in men
persecutory * most freq
somatic
mixed
unspecified
A

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

19
Q

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

A

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

20
Q

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
A

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

21
Q

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

A

schizophrenia

continuous signs of disturbance persist for at least 6 months with 1 month of active symptoms

lifetime prevalence 0.3-0.7%

22
Q

anosognosia =

A

lack of insight into one’s own clinical illness

hallmark of schizophrenia

symptom, not coping strategy

23
Q

with schizophrenia, _____ symptoms are more closely related to prognosis and are more persistent

A

negative

psychotic symptoms tend to diminish over life course

24
Q

risk factor for schizophrenia

A

late winter early spring or summer are increased risk

higher risk in urban areas

25
Q

males v. females with schizophrenia

A 
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

26
Q

schizophrenia rates of comorbidity with substance disorders is __________

A

high

over 50% use tobacco (dampens hallucinations)

27
Q

delusions or hallucination for 2 or more weeks in absence of major mood episode during the lifetime duration of the illness

A

schizoaffective disorders

1/3 as common as schizophrenia with lifetime prevalence of 0.3%

higher in female and depressed

28
Q

prevalence of substance/medication induced psychotic disorder

A

7-25%

of individual with first episode psychosis

29
Q

psychotic disorders can be due to another medical disorder. which have an increased suicide rate associated with illness greater than with psychosis?

A

Ms

epilepsy

30
Q

if psychotic and older than 80…

A

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%

31
Q

describe catatonia

A 
stupor
catalepsy
waxy flexibility
mutism
negativism
posturing
mannerism
stereotypy (repetitive, abnormal, frequent non-goal directed movement) 
agitation
grimacing
echolalia (minic speech) 
echopraxia (mimic movement)
32
Q

35% of inpatients with schizophrenia get this specifier

A

catatonia

33
Q

monozygotic twin rates

A

40-50%

16% chance if partents schizophrenic

risk correlates with age of father

34
Q

histopathological changes

A
  • 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
35
Q

neuroimaging changes

A
  • 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
36
Q

functional brain imaging

A
  • 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
37
Q

long term psychosocial tx

A

evidence based practices SMAHSA

  1. assertive community tx
  2. integrated treatment for co-occurring disorders
  3. supported employment
  4. illness management and recovery
  5. family psycho-education
  6. permanent supportive housing
  7. Med TEAM
  8. consumer-operated services
  9. interventions for disruptive behavior disorders
  10. tx of depression in older adults
  11. supported education
38
Q

homicide rate may be ____________ but still ______ of the pop

A

increased by 10 fold

less than 1%

as a group they are more frequently victimized than other individuals

39
Q

suicide risk is _______ ( ____ with schizophrenia) with the highest risk in the _______ of illness

A

10-15%
20%
first 5 yrs

5-6% of those with schizophrenia/schizoaffective disorder die by suicide

CS3: Exam 3 (15 decks)

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