Ch. 15 Schizophrenia/Psychotic Disorders Flashcards
________ is a significant concern among patients with schizophrenia
Risk for Suicide
Psychosis is…
A severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with or distortion of reality. There may be evidence of hallucinations (false sensory perceptions not associated with real external stimuli) and delusions (fixed, false beliefs). Psychosis can occur with or without the presence of organic impairment.
Phase I of Schizophrenia
Premorbid Phase
- Occur before there is clear evidence of illness and may include distinctive personality traits or behaviors.
- Shy and withdrawn
- Poor peer relationships
- Doing poorly in school
- Antisocial behavior
Phase II of Schizophrenia
Prodromal Phase
- More clearly manifest as signs of the developing illness of schizophrenia
- Begins with a change from premorbid functioning and extends until the onset of frank psychotic symptoms.
- Anywhere from a few weeks to 2-5 years
- Deterioration in role functioning and social withdrawal
- Substantial functional impairment
- Depressed mood, poor concentration, fatigue
- Sudden onset of obsessive-compulsive behavior
Phase III of Schizophrenia
Active Psychotic Phase (Acute Schizophrenic Episode)
- In the active phase of the disorder, psychotic symptoms are prominent.
- Delusions
- Hallucinations
- Impairment in work, social relations, and self-care
Phase IV of Schizophrenia
Residual Phase
- Symptoms of the acute stage are either absent or no longer prominent.
- Negative symptoms may remain
- Flat affect and impairment in role functioning are common
- Residual impairment often increases with additional episodes of active psychosis.
Factors associated with a positive prognosis of schizophrenia
Good premorbid functioning
Later age at onset
Female gender
Abrupt onset precipitated by a stressful event
Associated mood disturbance
Brief duration of active-phase symptoms
Minimal residual symptoms
Absence of structural brain abnormalities
Normal neurological functioning
No family history of schizophrenia
DSM-V Criteria for Schizophrenia
A). Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition)
B). For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset
C). Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A
Delusional Disorder is…..
- Characterized by the presence of delusions that have been experienced by the individual for at least 1 month.
- If present at all, hallucinations are not prominent, and behavior is not bizarre.
- Subtypes of delusional disorders include erotomanic, grandiose, jealous, persecutory, somatic, and mixed
Brief Psychotic Disorder is…
- The sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor.
- These symptoms last at least 1 day but less than 1 month, and there is an eventual full return to the premorbid level of functioning
- Evidence of impaired reality testing may include incoherent speech, delusions, hallucinations, bizarre behavior, and disorientation.
- Catatonic features also may be associated with this disorder.
Substance- and Medication-Induced Psychotic Disorder is…
- The prominent hallucinations and delusions are found to be directly attributable to substance intoxication or withdrawal or after exposure to a medication or toxin
- The medical history, physical examination, and laboratory findings provide evidence that the appearance of the symptoms occurred in association with a substance intoxication or withdrawal or exposure to a medication or toxin.
Psychotic disorder due to another medical condition is…
Prominent hallucinations and delusions are directly attributable to a general medical condition.
Catatonic disorder due to another medical condition is…
- This diagnosis is made when catatonic features are evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of another medical condition
- Catatonia refers to a significant motor disturbance that may range from stupor (no motor activity) to excessive motor activity and agitation.
Schizophreniform disorder is…
The essential features of schizophreniform disorder are identical to those of schizophrenia with the exception that the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months
Schizoaffective disorder is…
- This disorder is manifested by signs and symptoms of schizophrenia, along with a strong element of symptomatology associated with the mood disorders (depression or mania).
- The decisive factor in the diagnosis of schizoaffective disorder is the presence of hallucinations and/or delusions that occur for at least 2 weeks in the absence of a major mood episode
Positive symptoms of Schizophrenia include…
Delusions (Fixed, False Beliefs)
* Persecutory—belief that one is going to be harmed by other(s)
* Referential—belief that cues in the environment are specifically referring to them
* Grandiose—belief that they have exceptional greatness
* Somatic—beliefs that center on one’s body functioning
Hallucinations (Sensory Perceptions Without External Stimuli)
* Auditory (most common in schizophrenia)
* Visual
* Tactile
* Olfactory
* Gustatory
Disorganized Thinking (Manifested in Speech)
* Loose association
* Tangentiality
* Circumstantiality
* Incoherence (includes word salad)
* Neologisms
* Clang associations
* Echolalia
Grossly Disorganized or Abnormal Motor Behavior
* Hyperactivity
* Hypervigilance
* Hostility
* Agitation
* Childlike silliness
* Catatonia (ranging from rigid or bizarre posture and decreased responsivity to complete lack of verbal or behavioral response to the environment)
* Catatonic excitement (excessive and purposeless motor activity)
* Stereotyped, repetitive movements
* Unusual mannerisms or postures
Negative Symptoms of Schizophrenia include…
Lack of Emotional Expression
* Blunted affect
* Lack of movement in head and hands that adds expression in communication
* Lack of intonation in speech
Decreased or Lack of Motivation to Complete Purposeful Activities (Avolition)
* Neglect of activities of daily living
Decreased Verbal Communication (Alogia)
Decreased Interest in Social Interaction and Relationship (Asociality)
* Withdrawal
* Poor rapport
Diminished Ability for Abstract Thinking
* Concrete interpretation of events and communication from others
Describe Persecutory delusions
- These are the most common type of delusion in which individuals believe they are being persecuted or malevolently treated in some way.
- Frequent themes include being plotted against, cheated or defrauded, followed and spied on, poisoned, or drugged.
- The individual may obsess about and exaggerate a slight rebuff (either real or imagined) until it becomes the focus of a delusional system.
- Repeated complaints may be directed at legal authorities
- May also be referred to as paranoid delusions, which describes the extreme suspiciousness of others and of their actions or perceived intentions
- Aggression or violence may occur because the individual believes that he or she must defend him/herself against someone or something perceived to be a threat.
- e.g., “The FBI has ‘bugged’ my room and intends to kill me”; “The government put a chip in my brain to erase my memories”
Describe Grandiose delusions
- The individual has an exaggerated feeling of importance, power, knowledge, or identity.
- The individual may believe that he or she has a special relationship with a famous person or even assume the identity of a famous person
- Grandiose delusions of a religious nature may lead to assumption of the identity of a deity or religious leader
- e.g., “I am Jesus Christ”
Describe Delusions of Reference
- Events within the environment are referred by the psychotic person to himself or herself and these beliefs become fixed (as with other delusions) despite evidence to the contrary. I
- e.g., “Someone is trying to get a message to me through the articles in this magazine”
- Ideas of reference: when a person with ideas of reference is offered an alternative explanation, the person is more likely able to consider that he or she has misinterpreted the situation.
- For example, an individual with ideas of reference may think that other people in the room who are giggling must be laughing about him but with additional information can acknowledge that there could be other explanations for their laughter.
Describe Delusions of control or influence
- The individual believes that certain objects or persons have control over his or her behavior (e.g., “The dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do”) or the person believes that his or her thoughts or behaviors have control over specific situations or people (e.g., the mother who believed that if she scolded her son in any way, he would die).
- This is similar to magical thinking, which is common in children (e.g., “The sky is raining because I’m sad”).
Describe Somatic delusions
- The individual has a false idea about the functioning of his or her body.
- This may be a false belief that the he or she has some type of general medical condition or that there has been an alteration in a body organ or its function
- (e.g., “The doctor says I’m not pregnant, but I know I am”; “There is an alien force that is eating my brain”).
Describe Nihilistic delusions
The individual has a false idea that the self, a part of the self, others, or the world is nonexistent (e.g., “The world no longer exists”; “I have no heart”).
Describe Erotomanic delusions
Individuals with erotomanic delusions falsely believe that someone, usually of a higher status, is in love with him or her.
Famous persons are often the subjects of erotomanic delusions.
Sometimes the delusion is kept secret, but some individuals may follow, contact, or otherwise try to pursue the object of their delusion.
Describe Jealous delusions
- The content of jealous delusions centers on the idea that the person’s sexual partner is unfaithful.
- The idea is irrational and without cause, but the individual with the delusion searches for evidence to justify the belief.
- The sexual partner is confronted (and sometimes physically attacked) regarding the imagined infidelity.
- The imagined “lover” of the sexual partner also may be the object of the attack.
- Attempts to restrict the autonomy of the sexual partner in an effort to stop the imagined infidelity are common.
What are loose associations?
- Thinking is characterized by speech in which ideas shift from one unrelated subject to another.
- Typically, the individual with loose associations is unaware that the topics are not connected.
- When the condition is severe, speech may be incoherent
- (e.g., “We wanted to take the bus, but my lunch was cold. The FBI is watching me. No one needs to pay to get to heaven. We have it all in our pockets”).
What are neologisms?
The person invents new words, or neologisms, that are meaningless to others but have symbolic meaning to the individual (e.g., “She wanted to give me a ride in her new uniphorum”).
What are Clang Associations?
Choice of words is governed by sounds. Clang associations often take the form of rhyming. For instance, “It is very cold. I am cold and bold. The gold has been sold.”
What is Word Salads?
A word salad is a group of words that are put together randomly, without any logical connection (e.g., “Most forward action grows life double plays circle uniform”).
What is circumstantiality?
The individual delays in reaching the point of a communication because of unnecessary and tedious details.
The point or goal is usually met but only with numerous interruptions by the interviewer to keep the person on track of the topic being discussed.
What is Tangentiality?
Tangentiality refers to a veering away from the topic of discussion and difficulty maintaining focus and attention.
What is Perseveration?
The individual who exhibits perseveration persistently repeats the same word or idea in response to different questions.
It is a manifestation of a thought processing disturbance in which the person gets stuck on a particular thought.
What is Echolalia?
Echolalia refers to repeating words or phrases spoken by another.
- In toddlers this is a normal phase in development, but in children with autism, echolalia may persist beyond the toddler years.
- In adulthood, echolalia is a significant neurological symptom of thought disturbance that occurs in schizophrenia, strokes, and other neurological disorders.
Describe auditory hallucinations
- Auditory hallucinations are false perceptions of sound.
- Most commonly they are of voices, but the individual may report clicks, rushing noises, music, and other noises.
- Command hallucinations are “voices” that issue commands to the individual. - They are potentially dangerous when the commands are directing violence toward self or others.
- Auditory hallucinations are the most common type in schizophrenia.
