Chapter 12: Schizophrenia Spectrum Disorders Flashcards
How long does someone have to experience delusions to have delusional disorder?
1 month or longer
How long does someone experiencing a brief psychotic disorder experience symptoms?
longer than a day but less than 1 month
What kind of substances can induce delusions and/or hallucinations?
illicit drugs, alcohol, medications, or toxins
When does schizophrenia typically begin?
between 15 and 25
People may experience diminished school performance and cognitive ability. They may become less socially engaged or adept. They may also demonstrate attenuated (mild) psychotic symptoms, such as suspiciousness and/or eccentric or disorganized speech or thought in which phase of schizophrenia
prodromal phase
Does Schizophrenia affect a specific culture/race?
no
When are suicide attempts most common when someone is diagnosed with Schizophrenia?
within the first 3 years
What are some comorbidities associated with schizophrenia?
substance abuse disorders, anxiety, depression, suicide, polydipsia, and physical illness
What symptoms must a person experience and for how long to be considered for a schizophrenia diagnosis?
At least one of these three must be present:
delusions, hallucinations, disorganized speech
These could be present:
grossly disorganized or catatonic behavior, and negative symptoms (diminished emotional expression or abolition)
At least 2 of these symptoms for a significant portion of a one month period
What must happen to someone’s level of functioning to be considered for a diagnosis of schizophrenia?
it must be markedly below the level achieved before the onset
(in areas such as: work, interpersonal relationships, or self-care)
How long does a person need to have continuous signs of disturbances for consideration of a schizophrenia diagnosis?
at least 6 month with at least 1 month of symptoms
What must be ruled out before someone can receive a diagnosis for schizophrenia?
schizoaffective disorder and depressive or bipolar disorder
How can schizoaffective and depressive or bipolar disorder be ruled out when attempting to make a schizophrenia diagnosis?
the patient must have either had (1) no depressive or manic episodes occurring concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness
What can the disturbances not be attributed to if someone is being considered for a schizophrenia diagnosis?
physiological effects of a substance or another medical condition
If the history of autism spectrum disorder or a communication disorder of childhood onset, how can the additional diagnosis of schizophrenia be diagnosed?
only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia are also present for at least a month
If there is a sudden increase in psychotic activity, what electrolyte should be looked at?
sodium (specifically hyponatremia)
What percentage of the risk of schizophrenia is genetic?
about 80%
Which neurotransmitter plays a role in schizophrenia development?
dopamine, serotonin, glutamate, GABA, and acetylcholine
What are the differences in brain structure for a patient who has schizophrenia?
reduced volume in the right anterior insula, reduced volume and changes in shape of the hippocampus, accelerated age-related decline in cortical thickness, gray matter deficits, reduced connectivity amount various brain regions, neuronal overgrowth, widespread white matter abnormalities
What do PET scans show in a schizophrenic patient?
a lowered rate of blood flow and glucose metabolism in the prefrontal cortex
What are prenatal stressors that can increase the risk of schizophrenia?
infection, a father above the age of 35 when conception occurs, and being born during late winter or early spring
What are some environmental factors that increase the risk of schizophrenia?
increased cortisol levels, developmental and family stress, toxins such as tetrachloroethylene (found in old water pipes and used in dry cleaning), childhood sexual abuse, exposure to social adversity, migration, and psychological trauma
What are factors that are associated with a less positive prognosis for schizophrenia?
a slow onset (more than 2 Years), younger age at onset, longer duration between Symptoms onset and first treatment, longer periods of untreated illness, and more negative symptoms
What are factors that improve the prognosis of schizophrenia?
reducing the frequency, intensity, and duration of relapse
Symptoms such as hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, and impaired judgment and cognition result in functional impairment. The person can have difficulty coping, and symptoms become apparent to others. This phase can last several months.
Acute phase
In this phase, symptoms are stabilizing and diminishing, and there is movement toward a previous level of functioning. This phase can last for months. Care in an outpatient mental health center or a partial hospitalization program may be needed
stabilization
In this phase, the condition has stabilized and a new baseline may be established. Positive symptoms (described later) are usually significantly diminished or absent, but negative and cognitive symptoms continue to be a concern
maintenance or residual phase
What are factors that can reduce the risk of developing schizophrenia?
enhanced coping and social skills
What is done in an initial assessment of a schizophrenic patient?
Mental state exam along with a review of spiritual, cultural, biological, psychological, social, and environmental factors that might be affecting the presentation
What are the positive symptoms of schizophrenia?
The presence of symptoms that should not be present. Positive symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behavior, or speech
What are the negative symptoms of schizophrenia?
The absence of qualities that should be present. Negative symptoms include the inability to enjoy activities (anhedonia), social discomfort, or lack of goal-directed behavior
What are cognitive symptoms associated with schizophrenia?
Subtle or obvious impairment in memory, attention, thinking (e.g., disorganized or irrational thoughts); impaired executive functioning (e.g., impaired judgment, impulse control, prioritization, and problem solving)
What are affective symptoms associated with schizophrenia?
Symptoms involving emotions and their expression
What is reality testing?
the automatic and unconscious process by which we determine what is and is not real
How do the symptoms of schizophrenia alter a person’s life?
the symptoms alter the individual’s ability to work, build/maintain interpersonal relationships, self-care abilities, social functioning, and the quality of life that the patient can have
What are delusions?
false beliefs that are held despite a lack of evidence to support them
What are the most common delusions?
persecutory, grandiose, or religious ideas
Results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected
associative looseness
the most extreme form of associative looseness, is a jumble of words that is meaningless to the listener
word salad