Lecture 58: Psychosis Disorders, Schizophrenia Flashcards
Who are the 3 fathers of schizophrenia?
- Emil Kraeplin
- Eugen Bleuler
- Kurt Schneider
What are the 4 A’s of schizophrenia?
- Autistic thinking/behavior
- Abnormal affect
- Abnormal Associations
- Ambivalence
What are the first rank symptoms of Schneider?
- Auditory hallucinations of voices
- reduces the number of required criteria from 2 to 1
- Thought insertion, withdrawal, broadcasting
- Made feelings/impulses/behaviors
- Delusional Perception
What is the epidemiology of schizophrenia?
Lifetime risk = .7%
Greater incidence with migration, northern latitude, urbanicity
Higher incidence in men but equal prevalence among genders
-because men die more frequently
.5% worldwide
7th in terms of global burden of disease by WHO
-lost employment (estimated cost is 60 billion)
What is “prodromal” psychosis?
Clinically people often have a period of attenuated psychotic symptoms before the onset of overt psychosis
-visual/auditory illusions
-mild paranoid ideas or ideas of reference (but able to reality test)
Functional decline and evidence of negative symptoms
Difficulty with cognition
What is the DSM-IV-TR diagnosis criteria for schizophrenia?
A. Characteristic POSITIVE symptoms
i. delusions
ii. hallucinations
iii. disorganized speech
iv. disorganized or catatonic behavior
v. negative symptoms
B. Social/Occupational Dysfunction (work, relationships, self care)
C. Duration: prodrome/acute/residual symptoms = >6months
D. Not due to a different psychiatric, medical or neurological disorder
What are the schizophrenia subtypes?
- Paranoid
- prominent delusions or hallucinations
- relative LACK of disorganization, catatonia, flat affect
- Disorganized
- disorganized behavior and speech
- flat or inappropriate affect
- Catatonic
- abnormal motoric/posturing or speech
- Undifferentiated
- does not meet criteria for other subtype
- Residual
- only attenuated symptoms
What are characteristics of hallucinations?
Any sensory perception that is not real
- auditory most common - visual, olfactory, gustatory, somatic/tactile (can hallucinate that you are having sex)
What are delusions?
Thinking that aliens are tracking you
Construct to explain what’s going on
Narrative making machine mechanisms…but the narrative makes no sense
What is a nihilistic delusion?
The delusion that you are not a real thing
Woman who thinks she is spoiled meat
What are the Negative symptoms of schizophrenia?
- Alogia
-reduced verbal communication - Flat affect
- Anhedonia: loss of the ANTICIPATION of pleasure
-less motivation as a result - Avolition
-reduced motivation - Asociality
-reduced social drive and interaction
At least one negative symptom present in great majority of patients
What is deficit syndrome?
When the persistent negative symptoms are the most prominent problem of schizophrenia
What are the comorbidities of schizophrenia?
Depression -up to 33% experience depression 5% complete suicide Anxiety -social phobia and OCD 2 std below IQ level -FAILURE TO MEET EXPECTATIONS/gains
What is schizoaffective disorder?
Schizophrenia WITH mood disorder…
A. An uninterrupted period of illness during which at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet criterion A for szhiophrenia
B. During the same period of illness, there have been delusiosn of hallucinations for at least 2 weeks in ABSENCE of prominent mood symptoms
C. Symptoms that meet criteria for a mood episode are present for a substantial portion of total duration of active and residual period of illness
Subtypes = bipolar and depressive
So biopolar schizoaffective
Depressiive schizoaffective
What are the cognitive deficits associated with schizophrenia?
Cognition is 1-2 standard deviations
-loss of attention, visual/verbal learning, speed of functioning
Child will have a failure to meet gains in terms of intellectual development
-if you look at standardized test at 6, schizophrenic person is behind peers
-same with graduating high school
