Chapter 16 Schizophrenia Flashcards
Schizophrenia
Cannot be defined as a single illness
- Thought of as a syndrome or as a disease process with many varieties and symptoms
Characterized by psychosis:
- Altered cognition, perception, and reality testing
- Affects thinking, language, emotions, social behavior
75%: Develop gradually, presenting at 15 to 25 years of age
Child-onset and late-onset are more rare
- Peak Incidence of Onset: 15-25 years of age for men & 25-35 yrs of age
What are the 3 main categories that schizophrenia affects?
Thoughts, behavior, & emotions
Positive/Hard Symptoms
Ambivalence
Associative looseness
Bizarre behavior
Delusions
Echopraxia
Flight of ideas
Hallucination
Ideas of reference
Preservation
Ambivalence
Holding seemingly contradictory beliefs or feelings about the same person, event, or situation
Associative Looseness
Fragmented or poorly related thoughts and ideas
Bizzare Behavior
Outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior
Delusions
Fixed false beliefs that have no basis in reality
Echopraxia
Imitation of the movements and gestures of another person whom the client is observing
Flight of Ideas
Continuous flow of verbalization in which the person jumps rapidly from one topic to another
Hallucination
False sensory perceptions or perceptual experiences that do not exist in reality
Ideas of Reference
False impressions that external events have special meaning for the person
Preservation
Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic
Negative/Soft Symptoms
Impedes one’s ability to:
- Initiate and maintain conversations and relationships
- Obtain and maintain employment
- Make decisions and follow through on plans
- Maintain adequate grooming
- Function socially
List of Negative Symptoms:
Alogia
Anhedonia
Apathy
Asociality
Avolition
Blunted Affect
Alogia
Tendency to speak little or to convey little substance of meaning (poverty of content)
Anhedonia
Feeling no joy or pleasure from life or any activities or relationships
Apathy
Feelings of indifference toward people, activities, and events
Asociality
Social withdrawal, few or no relationships, lack of closeness
Avolition
Absence of will, ambition, or drive to take action or accomplish tasks
Blunted Affect
Restricted range of emotional feeling, tone, or mood
Anergia
Lack of energy
Schizoaffective Disorder
Diagnosed when the client is severely ill & has a mixture of psychotic and mood symptoms
Signs & symptoms include those of both schizophrenia and a mood disorder such as depression or BPD
- May occur simultaneously or may alternate between psychotic and mood disorder symptoms.
Typical 1st line Treatment: Atypical antipsychotics
Onset of Schizophrenia
Can be abrupt/insidious
Most clients slowly and gradually develop signs and symptoms such as:
- Social withdrawal
- Unusual behavior
- Loss of interest in school or at work,
- Neglected hygiene
Patients w/ earlier onset show worse outcomes
- Younger clients display a poorer premorbid adjustment, more prominent negative signs, and greater cognitive impairment than do older clients.
Those who experience a gradual onset of the disease (about 50%) tend to have a poorer immediate- and long-term course than those who experience an acute and sudden onset
DSM V Criteria for Schizophrenia Highlights
Two or more of the following for a significant portion of time in 1 month:
- Delusions: False fixed belief
- Hallucinations: Involves 5 senses
- Unusual taste or smell that no one else can sense-> migraine or seizure
- Disorganized speech
- Gross disorganization of behavior or catatonia
- Negative symptoms (diminished emotional expression or avolition)
- Functional impairment of some kind
Continuous disturbance for at least 6 months
Immediate Term Course of Schizophrenia
Follows either pattern:
- Client experiences ongoing psychosis and never fully recovers, although symptoms may shift in severity over time
or
- Client experiences episodes of psychotic symptoms that alternate with episodes of relatively complete recovery from the psychosis
Long-Term Course of Schizophrenia
Intensity of psychosis tends to diminish over time
Many clients with long-term impairment regain some degree of social and occupational functioning.
- Over time, the disease becomes less disruptive to the person’s life and easier to manage, but rarely can the client overcome the effects of many years of dysfunction.
Schizophreniform Disorder
The client exhibits an acute, reactive psychosis for less than 6 months necessary to meet the diagnostic criteria for schizophrenia.
If symptoms persist over 6 months, the diagnosis is changed to schizophrenia
- Social or occupational functioning may or may not be impaired
Catatonia
Characterized by marked psychomotor disturbance and either excessive motor activity or virtual immobility and motionlessness.
Motor immobility may include catalepsy (waxy flexibility) or stupor
Excessive motor activity is apparently purposeless and not influenced by external stimuli.
Other behaviors include extreme negativism, mutism, peculiar movements, echolalia, or echopraxia.
Can occur with schizophrenia, mood disorders, or other psychotic disorders
Delusional Disorder
The client has one or more nonbizarre delusions
- Focus of the delusion is believable
Delusion may be persecutory, erotomanic, grandiose, jealous, or somatic in content
Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre
Brief-Psychotic Disorder
The client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month.
The episode may or may not have an identifiable stressor or may follow childbirth
Shared Psychotic Disorder
2 people share a similar delusion
The person w/ this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions, most commonly siblings, parent, and child or partners/spouses
The more submissive or suggestible person may rapidly improve if separated from the dominant person
Clinical Picture of Schizophrenia in Children/Adolescents
Children/Adolescents have atypical/prodromal signs for years before diagnosis
Children Prodromal Signs:
- Do less well in school as compared to siblings
- Less socially engaged
- Less positive
- Unusual motor development
Carries worse prognosis than adult-onset
Diagnosed before age 12
Occurring in 1 out of 40,000 children
Adolescent Prodromal Signs
Gradual process lasting a few months or few years
Social withdrawal
Irritability
Depression
Antagonistic
Conduct problems
Academic decline
**Suspicious and low level of distorted thinking
Prodromal Signs
Early symptoms that indicate a problem may be developing
Etiology of Schizophrenia: Genetic Factors
Schizophrenia is the most inheritable out of all mental health disorders
- Largest genetic component
Recent studies indicate that the genetic risk of schizophrenia is polygenic, meaning several genes contribute to the development
Etiology of Schizophrenia: Neuroanatomic & Neurochemical Factors
Findings have demonstrated that people with schizophrenia have relatively less brain tissue and cerebrospinal fluid than those who do not have schizophrenia
CT Scan: Enlarged ventricles in the brain & cortical atrophy
Glucose metabolism & oxygen are diminished in the frontal cortical structures of the brain
Dopamine Theory: Excess dopamine activity
- Drugs that increase activity in the dopaminergic system sometimes induce a paranoid psychotic reaction similar to schizophrenia
- The greater the ability of the drug to block dopamine receptors, the more effective it is in decreasing symptoms of schizophrenia
Cultural Considerations for Patients w/ Schizophrenia
Ideas that are considered delusional in one culture, such as beliefs in sorcery or witchcraft, may be commonly accepted by other cultures.
Also, auditory or visual hallucinations, such as seeing the Virgin Mary or hearing God’s voice, may be a normal part of religious experiences in some cultures.
Cultural Concepts of Distress
The ways in which people experience distress in the context of their lives and surroundings
Schizophrenia Prognosis: Better Prognosis
NOTE: Prognosis worsens each acute episode!!
- Severity of course r/t Tx adherence & other factors
Late or sudden diagnosis onset
Good pre-illness functioning
Family hx of mood disorders vs. schizophrenia
Paranoid schizophrenia subtype or many positive symptoms
Female
Minimal cognitive impairment
Schizophrenia Prognosis: Negative Prognosis
Onset: Early age at onset
Pre-Illness Level of Functioning: Poor pre-illness functioning
Family hx of schizophrenia
Disorganized schizophrenia subtype with many negative symptoms
Male
Significant cognitive impairment
Phases of Schizophrenia
Prodromal: Onset, mild changes
- Onset of symptoms begin one month to a year before first psychotic break or full-blown illness
Acute: Crisis Stabilization Unit
- Exacerbation of symptoms
Stabilization: Outpatient
- Symptoms diminishing
- Movement toward previous level of functioning
Maintenance or Residual: New baseline is established
- Relapses may occur at any time
Treatment for Schizophrenia: Psychopharmacology
Maintenance Therapy for Schizophrenia Treatment
