onset and initial presentation Flashcards
epidemiology:
causes of health outcomes and diseases in populations
prevalence:
proportion of persons who HAVE a condition at or during a particular time period
incidence
refers to the proportion or rate of persons who DEVELOP a condition during a particular time period
prevalence is important for:
understanding the burden of a disease on society at any given time
incidence is important for:
understanding changes in the expression of disease in individuals
precise prevalence estimates are difficult to obtain due to:
clinical and methodological factors such as the complexity of diagnosis, overlap with affective disorders, and variation in diagnostic methods
males tend to be diagnosed _____ than females so the ratio of males to females is _____ in younger age groups
earlier; higher
mortality rates in females is ____ over time and thus, the male to female ratio changes over time
lower
prevalence of schizophrenia disorders may be increasing due to:
increase in incidence, life expectancy is increasing, and mental health is becoming less taboo
for many years the belief was that the incidence of schizophrenia was constant both:
geographically and temporally
why is incidence increasing?
cannabis use and urban living
the population attributable risk fraction:
estimate of the proportion of cases of schizophrenia that would have been prevented if no individuals had been exposed to cannabis use
urban areas have higher:
population density and poverty which are both risk factors for schhizphreia
more ____ tend to live in urban environments which also increases risk for schizo
immigrants
urban living also includes these environmental factors that are associated with increased risk of schizo:
poor air quality, low levels of sun exposure, daily life stressors
incidence is higher in ____ early but higher in ____ later
men; women
the earlier age of onset in men has been attributed to:
male’s brain has greater susceptibility to neurodevelopment disorders
the bump in incidence in women could be secondary to:
loss of the antidopmaniergic action of estrogens
incidence _____ in age in both sexes
decreases
DALY’s stands for:
disability-adjusted life years
one DALY equals:
one lost year of healthy life
true or false: the onset of schizophrenia in children 12 years or younger is not rare
false
what does it mean if a child is diagnosed with childhood onset schizophrenia?
possibly reflects a more homogeneous disease, more severe, worse outcome, likely linked to genetics
more than half children with confirmed schizophrenia have:
comorbid mood or anxiety disorders
outcome and prognosis for Childhood Onset Schizo are positively correlated with the:
presence and severity of these developmental abnormalities
late onset schizophrenia age:
after age 45
is late onset schizo more common in males or females?
females (around time of menopause)
what is late onset schizophrenia associated with? (6)
- high levels of occupational functioning
- being married
- more severe paranoid delusions
- more visual, tactile and olfactory hallucinations
- less severe disorganization
- less severe negative symptoms
risk factors for late onset schizo include: (5)
- negative life events
- history of psychotic symptoms
- poor social networks
- cognitive impairment
- functional limitations
average age of schizophrenia:
between ages 15-25 for men and 25-35 for women
synaptic pruning:
the cleaning away of underutilized synapses; reflected in the thickening of cortex
myelination:
development and extension of axons; reflected in increases in white matter
child brains show more ___ and less _____ activation
diffused; focused
is there higher or lower connectivity in adjacent regions in earlier life?
higher
is there stronger or weaker long range connections in adulthood?
stronger
changes in connectivity in brain from adolescence to adulthood are strongly impacted by:
life experience
if you can identify the disease early enough you can:
prevent the disease from fully developing or at least provide some protection from the worst outcomes AKA, early intervention
psychosis prodrome is characterized by:
changes in behavior and cognition, not all ppl experience this stage of illness
most noticeable presentation of schizo is:
social withdrawal and impaired functioning
true or false: there is no typical presentation of schizophrenia
true
schizo onset may be:
progressive or acute
progressive:
over months or years
acute:
over days or weeks
onset of schizo may be preceded by:
other psychiatric symptoms such as anxiety, or no history of psychiatric symptoms
are people mostly diagnosed in the emergency department or general medical outpatient visits?
emergency department with that at 84 percent and the other at 19 percent
which studies find a delay in receipt of effective treatment?
longitudinal
duration of untreated psychosis: (DUP)
time from first psychotic symptom to first psychiatric hospitalization
what does the DUP reflect?
the delay to receive treatment after the onset of psychotic symptoms
long periods without treatment arise from 2 sources:
intrinsic factors and extrinsic factors
examples of intrinsic factors:
symptom severity, patient attitudes
extrinsic factors examples:
access to care, insurance, culture
longer DUP is associated with ____ severe illness and ____ treatment outcome
more; worse
Jonas et al argued that DUP actually reflects:
differences in illness stage and argued that it does not predict a worse illness trajectory but indicates an individuals is farther along in their illness
lead time bias results:
those with longer DUP experience greater losses of psychosocial function before heir first hospital admission than those with shorter DUP
those with shorter DUP experience:
greater psychosocial function after their first hospital admission than those with lower DUP
to conclude that an individual has made a transition from clinical high risk state to actual psychosis, the individual must at very least demonstrate:
the mergence of at least 1 positive psychotic symptom
