Schizo spectrum disorders Flashcards
Schizophrenia spectrum and other psychotic disorders involve what three things?
1) . severely impaired cognitive processes
2) . personality disintegration/deterioration
3) . social withdrawal
what are the two components of severely impaired cognitive process?
1) . unusual or distorted thought processes
2) perceptual disturbances
schizo spectrum and other psychotic DOs: onset and which gender has higher risk?
onset- late adolescence, early adulthood
men have slightly higher risk
what is catatonia?
Catatonia - extreme loss of motor ability or constant hyperactive motor activity
what is avolition?
inability to take goal oriented action
what is poverty of speech?
lack of meaningful speech/limited output of speech
what are positive symptoms? examples
symptoms that are “added” to normal behavior
- hallucinations: sensory perception without physical stimuli
- delusions: firm, fixed beliefs despite evidence to the contrary
- disorganized speech
- behavioral disturbances
what are negative symptoms? examples
symptoms that take away from normal behavior
- Affect flattening
- Alogia: poverty of speech
- avolition: lack of will
- Asociality: social withdrawal
- Absence of normal cognition
- anhedonia
schizo spectrum and other psychotic disorders have abnormalities in the following five domains:
1) . delusions
2) . hallucinations
3) . disorganized thinking (speech)
4) . grossly disorganized or abnormal motor behavior
5) . negative symptoms
what are the 5 disorders?
- schizophrenia
- schizophreniform disorder
- schizoaffective disorder
- brief psychotic disorder
- delusional disorder
4 criteria for schizophrenia
1) . 2 or more of the following symptoms: positive symptoms, negative symptoms, grossly disorganized or catatonic behavior FOR AT LEAST 6 MONTHS
- AT LEAST ONE must be a delusions, hallucination, or disorganized speech for ONE MONTH
2) . social/occupational dysfunction (below level prior to onset)
3) . schizoaffective and bipolar disorders with psychotic features have been ruled out
4) . not due to substance or medical condition
what are the three phases of schizophrenia course?
1) . prodromal- onset and buildup of symptoms (negative symptoms present)
2) . Active/progressive phase: psychotic symptoms, positive symptoms predominate “psychotic break”
3) . residual phase: active symptoms decline; prodromal symptoms remain
___ in 6 schizophrenics commits an act of serious violence during first psychotic break
1 in 6
which type of meds reduce occurrence of violence in schizophrenics?
antipsychotics
criteria of brief psychotic disorder (4)
1) . No longer than ONE MONTH
2) . returns to premorbid level of functioning (REMISSION)
3) . commonly encountered after catastrophic event
4) . one or more: delusions, hallucinations, disorganized speech, disorganized/catatonic behavior
what is schizophreniform disorder?
same symptoms as schizophrenia (2 or more symptoms, not better explained by schizoaffective or bipolar with psychotic features, and not due to mental condition or substance) but is diagnosed if symptoms last between 1-6 months long (before 1 month = brief psychotic episode; after 6 months = schizophrenia)
what is schizoaffective disorder?
person meets criterion A for schizophrenia (2 or more symptoms, including one positive symptom, for at least a month) AND MDE, manic episode, or mixed episode
**Schizophrenia + mood disorder
criteria for delusional disorder (4)
1) . presence of 1 or more delusions
2) . LASTS ONE MONTH OR MORE
3) . Criterion A for schizophrenia has NEVER been met (NO PSYCHOTIC SYMPTOMS- no bizarre behavior)
4) . NO impairment in functioning
what are two main differential diagnoses for schizophrenia? (bc similar but doesn’t meet criteria for schizophrenia)
1) . MDD with psychotic features
2) . bipolar disorder with delusions
what is alogia?
Alogia is the inability to speak because of mental defect, mental confusion, or aphasia
first degree relative of a person with schizophrenia has a ____x greater risk of getting it
10x
the identical twin of a person with schizophrenia has a ___-___ % chance of developing it
40-65%
what is the primary treatment for schizo spectrum DOs?
MEDS
2nd gen antipsychotic meds are first line (risperidone, clozapine, quetiapine- fewer ADRs, less risk of EPS)
what are extra-pyramidal side effects (EPS)?
rigidity, bradykinesia, and tremor resembling Parkinson’s disease; severe restlessness known as akathisia; and abnormal involuntary movements known as tardive dyskinesia
what types of therapy are for people with schizo spectrum DOs?
CBT- for coping methods, rational cognitive perspectives
Family psychoeducation
Personal therapy
Compliance therapy- during acute illness phase
schizophrenia is a disorder encompassing what three things?
abnormal thinking, behavior, and emotion
pathophys of schizophrenia in relation to positive vs negative symptoms
exact cause unknown
POSITIVE symptoms thought to be from excess dopamine in the mesolimbic pathway and NEGATIVE symptoms from dopamine decrease in the mesocortical pathway
what is seen on a CT scan for a patient with schizophrenia
ventricular enlargement as well as decreased cortical volume
meds for treating schizophrenia
FIRST LINE: 2nd gen antipsychotics (TX POSITIVE AND NEGATIVE SYMPTOMS)
-risperodone, olanzapine, quetiapine, ziprasidone, abilify, lurasidone
2nd line: 1st gen (BEST FOR POSITIVE SYMPTOMS)
-haldol, droperidol, fluphenazine, chlorpromazine (increased risk of EPS)
Acute treatment of schizophrenia
if extremely agitated psychotic pt: IM zyprexa, geodon or abilify may be used. Haldol too but more ADRs
- hospitalize patient
- urine toxicology to rule out drug use
how do you treat acute EPS symptoms from 1st gen antipsychotics?
add a antimuscarinic drug such as benztropine or diphenydramine to block the M1 receptor so less ACh is able to bind
tx for delusional disorder
2nd gen antipsychotics first line
psychotherapy might be additive in some pts (not group)
tx for brief psychotic disorder
2nd gen antipsychotics
