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
