Clinical Approach to Schizophrenia and Other Psychotic Disorders Flashcards
When is the onset of schizophrenia?
- Peak time of onset at late adolescence and early adulthood
What are some precipitating events of schizophrenia?
- Psychosocial stressor
- Traumatic events
- Drug and alcohol abuse (cannabis use increases risk 6x)
What are some prognostic variables in schizophrenia?
- Positive symptoms: better prognosis
- Negative symptoms: poor prognosis
What is seen in the better prognosis of schizophrenia?
- Patients with mood disorders = schizoaffective disorder, major depression with psychotic features or bipolar disorder
What is seen in the poorer prognosis of schizophrenia?
- Negative symptoms
- Poor cognitive performance on testing
- Poor supports
- Younger onset
What are some prodromal signs and symptoms of schizophrenia?
- May exist before symptoms of disease
- Possible schizoid or schizotypal personalities
- Few close friends as adolescents
- Minimal social activities
What are the positive symptoms of schizophrenia?
- Symptoms added to the presentation and typically present in the active phase
- Delusions
- Hallucinations
- Catatonia
- Agitation
How is the form of thought affected in schizophrenia?
- Loosening of associations: connections among patient’s ideas are absent or obscure
- Poverty of content and speech
- Thought blocking: internal interruption in patient’s speech/thoughts
How is the content of thought affected in schizophrenia?
- Delusions of persecution/reference/influence
- Thought broadcasting
- Grandiose delusions
- Somatic delusions
How are perceptual disorders affects in schizophrenia?
- Hallucinations
- Illusions: distortions of real images
What are the negative symptoms of schizophrenia?
- Symptoms that appear missing from the presentation and typically present in the residual phase
- Affective flattening
- Apathy
- Social withdrawal
- Anhedonia
- Poverty of thought
- Content of speech
How long must the symptoms be present for the diagnosis of schizophrenia?
- 6 months
How is the diagnosis of schizophrenia made?
- Psychiatrist usually comes to diagnosis based on clinical symptoms
What needs to be ruled out in the medical screening for schizophrenia?
- Seizure disorders
- Metabolic disorders
- Thyroid disorders
- Brain tumor
- Neurosyphilis
- Street drug use
What is associated with higher rates of schizophrenia?
- In patients born in the winter and early spring months (may have possible association of prenatal exposure to influenza virus)
What is the current hypothesis of schizophrenia?
- Increased dopamine in neuronal tracts
- Increased serotonin and norepinephrine
- Decreased GABA and glutamate receptors
What are some current ways that are being look at to diagnose schizophrenia?
- Blood test: measures the activity of genes
- Eye tracking: delayed saccadic eye movements
- Brain imaging: structural volume reduction in cortical structures
What is need for more than a month for the diagnosis of schizophrenia?
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
What else is needed in the diagnosis of schizophrenia?
- Marked social or occupation dysfunction
- Duration of at least 6 month of persistent symptoms such as attenuated forms of group A symptoms or negative symptoms
- Symptoms of schizoaffective and mood disorder ruled out
- Substance abuse and medical conditions ruled out as etiologic
What are some subtypes of schizophrenia?
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferentiated type
- Residual type
What are some risk factors for schizophrenia and violence?
- Personality traits: antisocial and borderline
- History of violent acts
- Paranoid beliefs
- Content of auditory hallucinations
- Substance abuse
- Impulsivity
- Talking about violence
What is the leading cause of death in schizophrenics?
- Suicide
- Substance use
- Comorbid major depression’
- Previous high functioning
- Clozapine may reduce this
What is the catatonic type of schizophrenia?
- Clinical picture is dominated by at least two of the following:
1. Motoric immobility as evidenced by catalepsy or stupor
2. Excessive motor activity
3. Extreme negativism or mutism
4. Peculiarities of voluntary movement such as posturing, stereotyped movements, prominent mannerisms or prominent grimacing
5. Echolalia or echopraxia
What are some treatment options for schizophrenia?
- Hospitalization
- Group therapy
- Individual psychotherapy
- Community treatment
- Self-help programs
- Pharmacology
- ECT
What is schizoaffective disorder?
- Uninterrupted period of illness with either a major depressive episode or manic episode concurrent with symptoms that meet criterion A for schizophrenia
- Same period of illness, have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms
What is schizopreniform?
- Meets criteria A, D and E for schizophrenia
- An episode of the disorder lasts at least 1 month but less than 6 months
What are some good prognostic features of schizophreniform?
- Onset of psychiatric symptoms within 4 weeks of first noticeable change. Confusion or perplexity at height of episode
- Good premorbid social and occupational functioning
- Absence of blunted or flat affect
What is delusional disorder?
- Delusions of at least 1 month’s duration
- Have never met criterion A for schizophrenia
- Apart from the impact of the delusion, functioning is not impaired and behavior is not odd or bizarre
What are some other medical things that could be on the differential for delusional disorder?
- Alzheimer’s
- Huntington’s
- Brain tumors
- Complex partial seizures
- Strokes
What are some psychiatric things that could be on the differential for delusional disorder?
- Schizophrenia (delusions are usually bizarre and more impairment in function)
- Somatoform disorders
- Malingering
What is the timeline for schizophrenia?
- > 6 months
What is the timeline for schizophreniform?
- 1-6 months
What is schizoid (high yield)?
- Very introverted and voluntary withdraws from social interactions
What is schizotypal (high yield)?
- Schizoid symptoms + magical thinking and odd behavior
What is schizophrenia (high yield)?
- Schizotypal + psychosis
What is schizoaffective (high yield)?
- Schizophrenia + mood disorder
What is the side effects of clozapine?
- Agranulocytosis
- Weight gain
What is the side effects of ziprasidone?
- QTc prolongation
- Possibly less weight gain
