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Behavioral Health > Clin Med - Schizophrenia > Flashcards

Clin Med - Schizophrenia Flashcards

1
Q

List the 5 domains of abnormality that define schizophrenia spectrum and other psychotic disorders

A
  • Delusions
  • Hallucinations
  • Disorganized thinking (speech)
  • Grossly disorganized or abnormal motor behavior (including catatonia)
  • Negative symptoms
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2
Q

Define catatonic behavior

A

a marked decrease in reactivity to the environment, ranging from:
o Negativism
o Maintaining a rigid, inappropriate or bizarre posture
o Mutism and stupor

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3
Q

negativism

A

resistance to instructions

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4
Q

mutism and stupor

A

complete lack of verbal and motor responses

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5
Q

define catatonic excitement

A

Purposeless and excessive motor activity without obvious cause

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6
Q

list the features of catatonia

A
  • Repeated stereotyped movement
  • Staring
  • Grimacing
  • Echoing speech (echolalia)
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7
Q

what symptoms of schizophrenia account for much of the diseases morbidity

A

negative symptoms

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8
Q

what are the two most prominent negative symptoms associated w/ schizophrenia?

A
  • diminished emotional expression

- avolition

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9
Q

diminished emotional expression

A

reductions in:

  • expression of emotions in the face
  • eye contact
  • intonation of speech (prosody)
  • movements of the hands, head, and face that normally give and emotional empasis of speech
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10
Q

avolition

A
  • a decrease in motivated self-initiated purposeful activities
  • the individual may sit for long periods of time and show little interest in participating in work or social activities
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11
Q

other negative symptoms associated with schizophrenia

A
  • alogia
  • anhedonia
  • asociality
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12
Q

alogia

A

diminished speech output

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13
Q

anhedonia

A

decreased ability to experience pleasure from positive stimuli or degradation in the recollection of pleasure previously experienced

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14
Q

asociality

A
  • apparent lack of interst in social interactions
  • may be associated w/ avolition
  • can also be a manifestation of limited opportunities for social interactions
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15
Q

DSM-5 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. Hallucination
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (especially diminished emotional expression or avolition)
• 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
• 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 the active-phase symptoms (seen above) 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 sx or by 2 or more sx listed in the above criteria present in an attenuated form (ex: odd beliefs, unusual perceptual experiences)
• Schizoaffective disorder and depressive or bipolar disorder w/ psychotic features have been ruled out because either:
o No major depressive or manic episodes have occurred concurrently w/ the active-phase sx, or
o If mood episodes have occurred during the active-phase sx, they have been present for a minority of the total duration of the active and residual periods of the illness
• The disturbance is not attributable to the physiological effects of a substance or another medical condition
• If there is a hx of autism specftrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required sx of schizophrenia, are also present for at least 1 month (or less if successfully treated)

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16
Q

DSM-5 Criteria for Brief psychotic disorder

A

• Presence of one (or more) of the following sx. At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
• Duration of an episode of the disturbance is at least 1 day but less than 1month, with eventual full return to premorbid level of functioning
• The disturbance is not better explained by major depressive or biplar disorder w/ psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (drugs of abuse, a medication) or another medical condition

17
Q

DSM-5 criteria for schizophreniform disorder

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 the 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 sx (i.e diminished emotional expression or avolition)
• An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for revoery, it should be qualified as “provisional.” (If it lasts over 6 months, the diagnosis is changed to schizophrenia)
• Schizoaffective disorder and depressive or bipolar disorder w/ psychotic features have been ruled out b/c either:
o No major depressive or manic episodes have occurred concurrently w/ the active-phase sx, or
o If mood episodes have occurred during active-phase sx, they have been present for a minority of the total duration of the active and residual periods of the illness
• The disturbance is no attributable to the physiological effect of a substance (e.g, a drug of abuse, a medication) or another medical condition

18
Q

DSM-5 criteria for schizoaffective disorder

A
  • An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent w/ criterion A of schizophrenia (the major depressive episode must include depressed mood)
  • Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness
  • Sx that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
  • The disturbance is not attributable to the effects of a substance (drug of abuse or medication) or another medical condition.
19
Q

DSM-5 Criteria for substance/medication-induced psychotic disorder

A

• Presence of one or both of the following sx:
o Delusions
o Hallucinations
• There is evidence from the history, physical exam, or lab findings of both (1) and (2):
o The sx in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
o The involved substance/medication is capable of producing the sx in Criterion A
• The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following:
o The sx preceded the onset of the substance/medication use
o The sx persist for substantial period of time (about 1 month) after the cessation of acute withdrawal of severe intoxication; or
o There is other evidence of an independent non-substance or medication-induced psychotic disorder (e.g. a hs of recurrent non-substance/medication related episode)
• The disturbance does not occur exclusively during the course of a delirium
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

20
Q

structural abnormalities observed in pts with schizophrenia

A
  • differences in cellular architecture, white matter connectivity and gray matter volume
  • in a variety of regions: prefrontal and temporal cortices
  • reduced overall brain volume
21
Q

functional nuerologic abnormalities observed in pts with schizophrenia

A
  • impairments in motor coordination
  • impairments in sensory integrations
  • impairments in motor sequencing of complex movements
  • left-right confusion
  • disinhibition of associated movements
22
Q

state the findings of genetic research that may be associated w/ the development of schizophrenia

A
  • possible malfunction in genes responsible for making dopamine and regulating its interactions w/ receptors
  • possible imbalance in the interplay b/w dopamine and glutamate
  • strong genetic factors
  • currently identified alleles are also associated w/ bipolar, depression and autism
23
Q

lifetime prevalence of schizophrenia in the general population

A

0.3-0.7%

24
Q

lifetime prevalence of schizophrenia in monozygotic and dizygotic twins

A

mono: 40-50%
di: 10%

25
Q

lifetime prevalence of schizophrenia in those whose parents have hx of schizophrenia

A
  • child of 1 schizophrenic parent: 10-15%

- child of 2 schizophrenic parents: 30-40%

26
Q

describe the course of schizophrenia

A
  • pscyhotic features emerge b/w late teens and early 30s
  • impaired cognition usually precedes psychosis
  • 20% have a favorable course
  • most require daily living support
  • some have a course of progressive deterioration
  • psychotic sx tend to diminish over the life course
27
Q

what are the functional consequences of schizophrenia?

A
  • significant social and occupational dysfunction
  • often fail to make educational progress or keep employment d/t avolition
  • most don’t marry
  • most have limited social contact outside of family
28
Q

common comorbitities of schizophrenia

A
  • tobacco use disorder
  • anxiety disorder
  • OCD
  • panic disorder
  • personality disorder
  • weight gain
  • DM
  • metabolic syndrome
  • cardio and pulmonary dz
29
Q

when is a psychotic disorder d/t a general medical condition (organic cause) suspected over schizophrenia?

A
  • pt presents w/ significant memory loss, confusion, disorientation or clouding of consciousness
  • no personal or family hx of serious psychiatric illness
  • pt has serious medical illness or chronic medical condition w/ periodic relapses
  • psychosis developmed rapidly (a few days) in a pt who previously functioned well
30
Q

what are the predictors of an improved prognosis for schizophrenia

A
  • rapid onset of psychotic sx
  • onset after age 30 (particularly in women)
  • good premorbid social and occupational functioning
  • marked confusion and emotional features during acute episode
  • probable precipitating stress to the acute psychosis and no evidence of CNS abnormalities
  • no family hx
31
Q

what are the predictors of a poor prognosis for schizophrenia

A
  • early age onset
  • no precipitators w/ insidious onset
  • poor premorbid social, occupational or social functioning
  • negative sx
  • family hx
  • no remission in 3 years
  • poor support system
  • drug abuse
  • dysfunctional family setting
32
Q

what is the usual course of a brief psychotic disorder?

A
  • sudden onset (nonpsychotic to psychotic state w/i two weeks)
  • typically have emotional turmoil or overwhelming confusion
  • may have severe impairment and need protective supervision
  • overall outcome is good
  • high rates of relapse
33
Q

what is the usual course of schizophreniform disorder?

A
  • similar development to schizophrenia
  • 1/3 recover w/i 6 months
  • remaining 2/3 eventually receive a diagnosis of schizophrenia or schizoaffective disorder
34
Q

duration of a brief psychotic disorder

A

1 day to less than 1 month

35
Q

duration of schizophreniform disorder

A

at least 1 month but less than 6 months

36
Q

duration of schizophrenia

A

greater than 6 months

37
Q

describe the usual course of schizoaffective disorder

A
  • possible auditory hallucinations and delusions for 2 months before onset of a major depressive episode
  • psychotic sx and full MDE are then present together for 3 months
  • then, the pt recovers completely from the DME, but the psychotic sx persist for another month before disappearing
  • typical age of onset is early adulthood
38
Q

how do you distinguish the diagnosis of substance/medication-induced psychotic disorder from substance intoxication or substance withdrawal?

A

when the sx in criterion A predominate in the clinical picture and when they are sufficiently sever to warrant clinical attention

Behavioral Health (11 decks)

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