Psych 5,6 - Schizophrenia Flashcards
What are the 5 schizophrenia “A” criteria?
- Hallucinations
- Delusions
- Disorganized thinking
- Disorganized Behavior
- Negative Symptoms
What are the different groupings of criteria for diagnosing schizophrenia, A, B, C, & D?
- Criteria A: Active Phase signs and symptoms
- Criteria B: Social Occupational Dysfunction: How bad is it?
- Criteria C: Time Duration
- Criteria D: Another Diagnostic Explanation
Define psychosis.
Grossly impaired reality testing. Persons incorrectly evaluate the accuracy of their perceptions and thoughts and make incorrect inferences about external reality, even in the face of contrary evidence.
(commonly delusions and hallucinations)
What are delusions?
Unfounded, unrealistic belief that is held without supporting evidence and are not amenable to change when conflicting evidence is presented; the person is totally convinced that what they believe is true; will often lead to conflicts with others
(bizarre vs. non-bizarre, pretty intuitive)
What are the positive sx of schizophrenia? (2)
Delusions and hallucinations (psychosis usually refers to these)
What are ‘bizarre’ delusions?
Clearly implausible, not understandable, and do not derive from ordinary life experiences
Rank the top 3 most common hallucinations in schizophrenia.
- Auditory hallucinations
- Visual hallucinations
- Tactile hallucinations (also seen in withdrawal)
- olfactory and gustatory hallucinations- very rare
What is disorganized thinking? Give specific eg’s of different types.
Impairs effective communication
- Trouble thinking clearly
- Trouble understanding others
Tangential thought process
- Looseness of association or Derailment
- Incoherence or Word salad
What is meant by “disorganized behavior,” as seen in schizophrenia? (provide several categories/eg’s of how it could be expressed)
- Childlike silliness; unpredictable agitation
- Problems with goal directed behavior
- Inappropriate sexual behavior
- Shouting, swearing
Catatonic behavior
List the 4 name negative sx of schizophrenia, and what each means. (4x A’s)
How many negative sx need one have to qualify?
- Affective flattening: lack of emotion, interpersonal emotional cues (facial expression, eye contact, body language)
- Alogia: poverty of speech; brief, laconic, empty replies
- Avolition: lack of motivation; inability to initiate and persist in goal directed activities
- Anhedonia: lack of pleasure; unable to enjoy activities
1 required
According to DSM 5, how many A criteria need one have for schizophrenia dx?
Do they have to be any particular sx?
What about timing?
Need to have 2 of the 5 signs and symptoms to meet the A criteria.
*One of the symptoms must be a “positive” symptom: hallucination, delusion, or disorganized thinking
Continuous signs for 6 months w/ 1 month criteria A symptoms
In general, what does criteria “B” of schizophrenia refer to?
Social/Occupational Dysfunction: how bad is it?
What is the downward drift hypothesis?
A disproportionate number of people with schizophrenia are in the low socioeconomic group.
- Hypothesis suggests that this results from those who start out with resources available to them gradually losing them and drifting downward into the low socioeconomic group.
Recall, what is the time criteria for the A sx of schizophrenia dx?
What is the time criteria for psychotic disorder or psychosis n.o.s. (not otherwise
specified)?
What is the time criteria for schizophreniform disorder?
Continuous signs for 6 months w/ 1 month criteria A symptoms (less if treated)
Duration of symptoms < 1 month
Duration of symptoms > 1 month, < 6 months
What is schizoaffective disorder defined as, per DSM 5?
How is it distinguished from regular schizophrenia? (1 thing)
Major mood episode (MDD or BAD), also c/w criterion A of Schizophrenia; Major mood sx are present for majority of the total duration of the illness
*At least one 2-week period of hallucinations or delusions WITHOUT mood sx present
Not due to substances or medical illness
What is delusional disorder, per DSM 5? (time range + what distinguishes it from schizophrenia)
How is their social/occupational functioning?
Bizarre or non-bizarre delusion for 1 month; most common: persecutory, jealousy
- A criteria for schizophrenia not ever met
Social-occupational function-ok
Mood symptoms-if any very brief vs the delusion
Not due to substances or medical illness or better explained by another psych disorder
Do affective/mood disorders w/psychoses like bipolar and depression first need to be r/o’d before diagnosing schizophrenia?
Yes
What’s a common medicine that can induce psychosis?
STEROIDS
Also, anesthetics, anti-cholinergics, anti-convulsants, anti-histamines, anti-hypertensive, cardiovascular meds, anti-microbial meds, anti-parkinsonian meds, chemotherapeutic agents, GI meds, muscle relaxants, NSAIDS, OTC, anti-depressants, disulfiram
Can drug withdrawal w/psychoses be diagnosed schizophrenia?
No, sx should resolve in a couple days, up to a few weeks, once the agents are stopped.
Read thru some dz’s that are a/w psychosis.
- Neurological: neoplasms, dementia, CVA’s, epilepsy, CNS infection, Huntington’s disease
- Endocrine: hyperthyroid, hypothyroid, hyperparathyroid, hypoparathyroid, hypoglycemia
- Metabolic-delirium: hypoxia, hypercarbia, hepatic diseases, renal diseases, fluid or electrolyte imbalances
What are some developmental disorders a/w psychosis? (what sx?)
Autism, Rhett’s, Asperger’s disorder
- Poor communication skills
- Poor reciprocal social skills (eg flat affect)
(childhood schizophrenia does exist but very rare)
List 3 personality disorders that must be differentiated from schizophrenia.
- Paranoid
- Schizoid
- Schizotypal
What is paranoid personality disorder described as?
Pattern of distrust and suspiciousness of others (delusion?)
What is schizoid personality disorder described as?
Social detachment & restricted affect (negative symptoms?)
What is schizotypal personality disorder described as?
Odd beliefs/unusual perceptual experiences (psychosis?), odd speech (disorganized thinking?), odd/eccentric behavior (disorganized behavior?)
What is the lifetime prevalence of schizophrenia in the US?
M vs. F? (more severe for M or F?)
What % need supportive living?
1%
M = F (more severe for M)
2/3 (1/3 is independent)
Name the 3 “phases” of schizophrenia.
A. Prodromal phase
B. Active phase (relapse)
C. Residual phase (remission)
What sx are a/w the prodromal phase of schizophrenia?
Vague sx: social isolation/withdrawal, peculiar behavior, impaired personal hygiene, inappropriate affect, abnormal speech, odd beliefs; often the prodromal phase is not identified until after an the first active phase (psychotic break) takes place
What sx are a/w the active phase of schizophrenia?
Patient meets the “A” criteria for schizophrenia
What sx are a/w the residual phase of schizophrenia?
After active phase(s) have taken place; no longer clearly meets the “A” criteria; much overlap with the Prodromal phase
What is the average age of onset w/males vs females?
- Males: late teens/20s
- Females: avg is a little later, only because they have a second peak in their 40s
What % of schizophrenics attempt suicide? What % are successful?
(just read for an idea)
What are the r/f for suicide in these pts?
20%
8%
- Depressive sx, feelings of hopelessness, being unemployed;
- Higher risk: period after psychotic episode or hospital d/c
- Especially high for younger males with co-morbid substance abuse
Describe the cognitive impairment a/w schizophrenia.
How severe are the impairments?
When do the impairments start?
What test can be used to detect these impairments?
SMART:
- Speed
- Memory (working, visual, verbal)
- Attention
- Reasoning
- Tact (social cognition)
- Pts moderately to severely impaired compared with general population.
- Appears early in course of illness, persists, and is stable
Wisconsin card-sorting test
What is anosognosia?
Describe the scale of anosisgnosia seen in schizophrenics.
Lack of awareness/insight of illness
- Some patients have no awareness of their illness.
- Some patients have partial awareness of their illness
- Some patients have awareness of their illness. Often, as illness progresses their awareness decreases. For patients with illness awareness or partial awareness, there may be variability in their awareness as their illness goes into and out of the active phase.
How are drugs/alcohol implicated? (just read)
30-50% alcohol abuse/dependence
10-15% marijuana abuse/dependence
5-10% cocaine abuse/dependence
- About 50% of patients with schizophrenia have, or have had, a problem with alcohol or illicit drugs
Describe the different types of overall outcomes for schizophrenic pts. Do most recover favorably?
Course is favorable for ~20% of patients; small number of individuals recover completely
Course is unfavorable for the great majority of patients
- 75% can’t work, are unemployed; schizophrenia is among the top 10 causes of disability
- 60-70% do not marry, most have limited social contacts
- Only about 33% live independently
What are some indicators of a better prognosis for schizophrenia?…
- M vs F?
- Pos vs. neg sx?
- Fam hx or not?
- Sudden or gradual onset?
- What is the overall best predictor of a good outcome?
Female w/ no neg symptoms
- No fam hx
- Sudden onset
- Good initial tx response **
What are some indicators of a worse prognosis for schizophrenia?…
- M vs F?
- Pos vs. neg sx?
- Fam hx or not?
- Sudden or gradual onset?
Young male w/ neg symptoms + subst use
- Fam hx
- Gradual onset
- Poor initial tx response
What causes schizophrenia?
Unknown!
What % of schizophrenic pts are compliant w/their meds?
Only ~30%
What are some psychosocial tx needs of schizophrenics? (read)
Handling of \$\$ Food Housing Employment Social Skills training Medical/dental care
How genetic is schizophrenia, vs nurture?
Prob 50/50 ish (moderate)
What are some issues w/r/t treatment in schizophrenia? (read)
- Sexual (consent, contraception, parenting)
- Legal (autonomy, privacy, confidentiality)
- Assault (same risk as pop except small subset)
- Victimization
- Stigma
What is the life-expectancy for schizophrenics?
48-53 years
What medical conditions are schizophrenics at increased risk for?
Cardiovascular disease risk
Smoking, diabetes, HTN, ^ lipids
Difficulty treating for medical illnesses
(suicide)
These contribute to the lower life expectancy
How would you treat the following w/anti-psychotics? Depression Bipolar disorder Med illness (delirium) Dementia Substance induced Delusional disorder Brief reactive, psych nos; schizophreniform Schizoaffective Schizophrenia
- Depression: temporarily
- Bipolar disorder: temp or indefinitely
- Med illness (delirium): temp, tx med illness
- Dementia: temp (ideally)
- Substance induced: temp; ID and avoid substance
- Delusional disorder: compliance problem
- Brief reactive, psych nos; schizophreniform: temp, r/o schizophrenia
- Schizoaffective: Usually indefinitely
- Schizophrenia: Usually indefinitely
What is the risk of schizophrenia w/o any family hx?
Risk if parent/sibling has it?
Risk if both parents have it?
Risk if identical twin has it?
No fam hx: 1%
Parent/sibling: 10%
Both parents: 40%
Identical twin: 50%
