Class 2 Flashcards
epidemiology schizophrenia
1% of the population, M=W, age of onset earlier in M who tend to have worst prognosis
DSM-5 criteria schizophrenia
A. 2/more of the following symptoms, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one must be 1,2 or 3.
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized/ catatonic behavior
5. Negative symptoms
B. For a significant portion of time, level of functioning in one or more major areas (work, interpersonal relationships or self-care) is markedly below the level achieved prior to onset (if child/adolescent, failure to achieve expected level of interpersonal, academic or occupational functioning)
C. Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least one month of symptoms that meet A and may include periods of prodromal/ residual symptoms. During these periods, the signs of the disturbance may be manifested by only negative symptoms or by 2 or more symptoms A in an attenuated form.
D. Not schizoaffective, depression, BAD because either
1. No major manic/depressed episode have occurred concurrently with active phase symptoms
2. If manic/ depressed episode have occurred, they have been present for a minority of the total duration of the active and residual periods of the illness.
E. No subs, GMC
F. If autism/ communication disorder at childhood, schizophrenia if only prominent delusions/ hallucinations + other symptoms of A for at least 1 month.
Schizoaffective disorder DSM-5
A. An uninterrupted duration of illness during which there is a major mood episode (manic or depressive)in additionto criterion A for schizophrenia; the major depressive episode must include depressed mood.
Criterion A for schizophrenia is as follows:
Two or more of the following presentations, each present for a significant amount of time during a 1-month period (or less if successfully treated). At least one of these must be from the first three below.
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. Hallucinations and delusions for two or more weeks in the absence of a major mood episode (manic or depressive) during the entire lifetime duration of the illness.
C. Symptoms that meet the criteria for a major mood episode are present for the majority of the total duration of the active as well as residual portions of the illness.
D. The disturbance is not the result of the effects of a substance (e.g., a drug of misuse or a medication) or another underlying medical condition.
The following are specifiers based on the primary mood episode as part of the presentation.
Bipolar type:includes episodes of mania and sometimes major depression.
Depressive type: includes only major depressive episodes.
Oculogyric crisis
uncontrolled rolling back of eyes (eyes looking up, blinking rapidly, head pulled to the left, pain, fixed regard)
Dystonia
involuntary movements of face, arms, legs, neck. + M less than 25y (head pulled to the left)
Akathisia
continuous restlessness and fidgeting. + W, 50-60 days after start of treatment. Give propanolol 30-90 mg/day
Better prognosis
good premorbid functioning, later age of onset, F, abrupt onset of sx w/ obvious precipitating factor, associated with mood disturbance, rapid resolution, minimal residual symptoms, absence of structural bran abnormalities, normal neurological functioning, no family history, family history of mood disorder, married, good social support, positives symptoms
% that have a good outcome, % that live a normal life
10% have a good outcome, 20-30% live normal lives
Delusions
false personal belief that is inconsistent with the person’s intelligence/ culture. Despite obvious proof that the beliefs are false/ irrational.
Hallucination
disturbances of perceptions
types of delusions:
Erotomanic: someone, usually of higher status, is in love with them
Grandiose: irrational ideas regarding their own worth, talent, knowledge/ power, may believe that they have a special relationship with a famous person/ assume their identity (they think that the actual person is an impersonator). Religious: think they’re a deity/ religious leader.
Jealous: partner is unfaithful. Search for evidence, confront partner/l lover. May try to restrict autonomy of partner.
Persecutory: someone is after them, there’s a conspiracy against them
Somatic: they have an illness
Mixed
Nihilistic: false idea that the self, a part of the self, others/ the world is nonexistent
Reference: all events with in the environment are referred by the psychotic person to themselves.
Delusional disorder criteria
A. The presence of one (or more) delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusion theme (e.g., the sensation of being infested with insects associated with delusions of infestation.
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.
D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Diagnosis of schizotypal personality disorder
For a diagnosis of schizotypal personality disorder, patients must have
• A persistent pattern of intense discomfort with and decreased capacity for close relationships
• Cognitive or perceptual distortions and eccentricities of behavior
This pattern is shown by the presence of ≥ 5 of the following:
• Ideas of reference (notions that everyday occurrences have special meaning or significance personally intended for or directed to themselves) but notdelusionsof reference (which are similar but held with greater conviction)
• Odd beliefs or magical thinking (eg, believing in clairvoyance, telepathy, or a sixth sense; being preoccupied with paranormal phenomena)
• Unusual perceptional experiences (eg, hearing a voice whispering their name)
• Odd thought and speech (eg, that is vague, metaphorical, excessively elaborate, or stereotyped)
• Suspicions or paranoid thoughts
• Incongruous or limited affect
• Odd, eccentric, or peculiar behavior and/or appearance
• Lack of close friends or confidants, except for 1st-degree relatives
• Excessive social anxiety that does not lessen with familiarity and is related mainly to paranoid fears
Also, symptoms must have begun by early adulthood.
