Alterations in Cognition Flashcards
Schizophrenia Overview
1 in 100 people, 1% in Canada
any race, culture or SE group
substance abuse disorder occurs in nearly 50% of persons diagnosed
gradually prodromal phase, often mistaken for difficult behaviour
phenomenological picture varies
Epidemiology of Schizophrenia
age of onset
- late teens, early twenties (5-45yo)
gender difference
- men early 20s, women late 20s
comorbid conditions
- depression, substance abuse, anxiety, OCD
Etiology of Schizophrenia
Biological/biochemical
- overactive neuronal activity r/t excessive dopamine transmission
- genetics
Psychosocial
- coping
- sensitivity and vulnerability to personal, family and environmental stress
- risk and protective factors
- social support
Risk Factors for Schizophrenia
perinatal complications
- traumatic delivery
- maternal malnutrition
- exposure to toxins
- hypoxia
- in utero exposure to influenza viruses
- late winter or early spring births
Prodromal phase of early psychosis
from onset of unusual behaviour to onset of psychotic symptoms
Schizophrenia Diagnosis
a. impaired functioning
- social or occupational below previously achieved level
b. signs of illness persist at least 6 months, 1 month of active symptoms
c. Two out of five symptoms:
Positive - delusions, hallucinations, disorganized speech, abnormal behaviour (excessive dopamine, hyperstimulation of D2 receptors)
Negative - such as impairments, anhedonia, blunted affect
Schizophrenia Subtypes
paranoid, disorganized, catatonic, undifferentiated, residual
subtypes are eliminated because they are not stable conditions, no significant clinical utility or scientific validity and reliability
Delusions
false belief based on incorrect inference about external reality
firmly held despite objective and contradictory proof
Overvalued idea
belief or idea sustained beyond the bounds of reason
held with less intensity or duration than delusions
Preoccupation
thought content centred on a particular idea with strong affective tone
- suicidal, homicidal, paranoid trend
Delusions of Reference
behaviour of others refers to self
Delusions of Control
false belief that one’s will, thoughts or feelings are being controlled by external forces
- thought insertion
- thought withdrawal
- thought broadcasting
Bizarre Delusion
false belief that is absurd or fantastic beyond the range of possibility
Alogia
poverty of thinking and speech
Affective flattening or blunting
lack of emotional expression
Avolition
unable to start tasks, lack of motivation
Anhedonia
unable to experience enjoyment
Attentional Impairment
social inattentiveness
hypostimulation of D1 receptors
Treatment for Schizophrenia
a. psychopharmacological
b. training in illness self-management
c. case management (ACT)
d. family psychoeducation
e. supported employment
f. integrated substance abuse treatment
g. ECT
h. brain exercise
Interaction Strategies for those with altered realities or disordered thoughts
- accept and make effort to understand
- decrease stimuli, redirect to quieter areas
- use focused questions deliberately
- listen for themes, seek clarification
- focus on how they feel and not the content
- avoid arguing or explain
- be aware of non-verbal communication
- reorient calmly
Dos and Don’ts (with disordered thoughts)
Do
- open, empathic, describe their experience
- observe for triggers and help reduce
- ask about feelings
- focus on reality based thoughts
Don’t
- react
- negate their experience
- underestimate feelings
- don’t dwell
Antipsychotic Medications
- Conventional
- typical, first generation
- more side effects, i.e. EPS
- dopamine antagonist - Novel
- atypical, second generation
- serotonin-dopamine antagonist
efficacy requires:
- assessment
- appropriate dosing and duration
- management of side effects
First Generation or Typical Antipsychotics
*treats positive symptoms but can cause EPS
Loxapine (loxitane)
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Extrapyramidal Side Effects (EPS)
- tardive dyskinesia
- pseudoparkinsonian symptoms
ridigity, mask-like facial expression, stiff gait - restlessness, akathisia
- weakness
- muscle fatigue
- slowed movements
- oculogyric crisis
prolonged involuntary upward deviation of the eyes
Ancillary Medications
a. antidepressants
b. benzodiazepines (anxiety or sleep disturbance)
c. antidyskinetics
benztropine (Cogentin)
d. anticonvulsant (mood stabilizer?)
Carbamazapine (Tegratol)
Divolproex (Epival)
Second Generation or Atypical Antipsychotics
*Relieves both positive and negative symptoms with fewer EPS
Risperidone (Risperdal) Olanzapine (Zyprexa) Clozapine (Clozaril) Aripiprazole (Abilify) Quetiapine (Seroquel)
Neuroleptic Malignant Syndrome (NMS)
an extremely serious reaction to neuroleptic drugs and dopamine blockage, at high doses of neuroleptic
onset:
- elevated temperature
- labile blood pressured
- elevated CPK
- altered LOC
- rigidity
- diaphoresis
- tachycardia
treatment:
- discontinue medication
- keep cool
- hydrate well
Schizophreniform Disorder
identical to schizophrenia except symptoms lasts at least 1 month but no longer than 6 months, return to baseline functioning after exacerbation
Schizoaffective Disorder
features of both schizophrenia and mood disorder
- manic or depressive episode while exhibiting positive symptoms of schizophrenia
- delusions or hallucination present for 2 weeks without prominent mood symptoms
- symptoms of mood episode last for substantial portion of the total illness
Delusional Disorder
delusions are non-bizarre for at least 1 month
never had characteristic symptoms of schizophrenia
disturbances does not markedly impair functioning
- persecutory
- grandiose
- somatic (investigate medical condition)
- religious (unusual religious experiences)
- guilt
- jealous
- erotomanic
- mixed
Brief Psychotic Disorder
duration of 1 day but less than a month with full return to normal functioning
Substance Induced Psychotic Disorder
Prominent hallucination or delusions
Psychotic Disorder NOS (not otherwise specified)
when there is not enough information for more specific diagnosis
