Bipolar & Schizophrenia Flashcards
Key Features that Define the Psychotic Disorders
Delusions, hallucinations, Disorganized Thinking (Speech), Grossly Disorganized or Abnormal Motor Behavior (including Catatonia), Negative Symptoms
Only subcategory of Symptomatology Presence
Catatonia
With schizophrenia, OT focus is on
Distress and dysfunction
substantial portion of the morbidity associated with schizophrenia but are less prominent in other psychotic disorder
Negative symptoms
fixed beliefs that are not amenable to change in light of conflicting evidence
Delusions
perception-like experiences that occur without an external stimulus
Hallucinations
ranges from childlike “silliness” to unpredictable agitation
Grossly Disorganized or Abnormal Motor Behavior (including Catatonia)
decrease in reactivity to the environment
Catatonia
Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech.
Avolition, Alogia, Anhedonia, Asociality
Negative symptoms
decrease in motivated self-initiated purposeful activities
Avolition
manifested by diminished speech output. Lack of speech
Alogia
the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced
Anhedonia
refers to the apparent lack of interest in social interactions and may be associated with abolition, but it can also be a manifestation of limited opportunities for social interactions
Asociality
symptoms are primarily hallucinations, delusions, and bizarre behavior; often referred to as a thought disorder; also referred to as a psychotic disorder
Schizophrenia
delusions, perceptual distortions, hallucinations
No cognitive deficits, physch tic episodes, responds well to meds
Positive symptoms (Type 1)
affective flattening or blunting, alogia, avolition, anhedonia, inattention
Onset not all at once, chronic course (lifelong), poor response to meds
Negative symptoms (Type 2)
disconnection from reality
Hallucinations
Delusions — persecutory, referential, somatic, religious, grandiose
Psychotic symptoms
Negative symptoms cluster
Alogia — LACK OF SPEECH
Avolition — LACK OF MOTIVATION
Anhedonia — LACK OF PLEASURE
Attentional impairment — LACK OF FOCUS
Disorganized symptoms
Disorganized
Disorganized and bizarre behavior
Inappropriate affect
Gender differences in schizophrenia
Higher incidence in males
POORER RESPONSE TO MEDS
MORE NEGATIVE SYMPTOMS
RESPONSE TO MEDS
MORE POSITIVE SYMPTOMS
Psychosocial interventions for schizophrenia
Illness management
Assertive community treatment
Family psychoeducation
Supported employment
Medications in schizophrenia
Antipsychotic
many harmful side effects (sedation, sun sensitivity, anticholinergic effects — dry mouth, constipation, blurred vision; movement d/o - tardive dyskinesia)
Typical (1st generation or conventional)
Typical (1st generation or conventional)
Thorazine
Haldo
Prolixin
Atypical (2nd generation)
Clozaril (wt. gain and diabetes)
Risperdal
Zyprexa (wt. gain and diabetes)
Seroquel
Geodon
Bipolar and related disorders are placed between the chapters on schizophrenia spectrum and other psychotic disorders to recognize their place as a bridge between 2 diagnostic classes in terms of
•Symptomatology
•Family
•History, and
•Genetics
BIPOLAR & RELATED CONDITIONS
•Bipolar I disorder
•Bipolar II disorder
•Cyclothymic disorder
•Substance/medication induced bipolar and related disorder
•Bipolar and related disorder due to another medical condition
•Other specified
•Unspecified
Bipolar 1
Represents the classic manic-depressive disorder (affective psychosis)
Bipolar 2
Requires at least one episode of major depression and at least one hypomanic episode
CYCLOTHYMIC DISORDER
Diagnosis given to adults who experience at least 2 years of hypomanic and depressive periods without ever fulfilling the criteria for an episode of mania, hypomania, or major depression
a mood state characterized by period of at least one week where an elevated, expansive or unusually irritable mood exists
Mania
Can be associated with a number of substances of abuse, some prescribed medications, and some medical conditions
MANIC-LIKE PHENOMENA
1.Inflated self-esteem or grandiosity
2.Decreased need for sleep
3.More talkative than usual or pressure to keep talking
4.Flight of ideas
5.Distractibility
6.Increase in goal-oriented activity
7.Excessive involvement in activities that have high potential for painful outcome
Manic episodes
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
Hypomanic episode
Hypomanic episode requirements needs at least 3 symptoms. What are they?
1.Grandiosity
2.Decreased need for sleep
3.More talkative than usual or pressure to keep talking
4.Flight of ideas or subjective experience that thoughts are racing
5.Distractibility
6.Increase in goal-directed activity
_________ _________ is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
Disturbance in mood and the change in functioning are observable by others
Episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
Episode in not attributable to the physiological effects of substance
Hypomanic episode
1.Feelings of worthlessness or excessive or inappropriate guilt (which can be delusional) nearly every day
2.Diminished ability to think or concentrate, or indecisiveness, nearly every day
3.Recurrent thoughts of death (not just fear of dying), suicidal ideations without a plan, or a suicide attempt or plan for suicide
major depressive episode
Mean onset age of BP 1
18 years
BP 2 age of onset
Mid-20s
Essential feature is chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other.
CYCLOTHYMIA
