Schizophrenia 1 Flashcards
Psychiatric conditions associated with psychosis include bipolar, MDD, Schcizophrenia/schizoaffective disorder as well as _____ (4).
- Schizophreniform Disorder
- Delusional Disorder
- Brief Psychotic Disorder
- Shared Psychotic Disorder
Differential diagnosis for psychosis include Panic Disorder, Depersonalization Disorder, Obsessive-compulsive Disorder as well as _____ (3).
- Personality Disorders (eccentric cluster)
- Autistic Disorder
- Substance abuse or withdrawal
Medical conditions associated with psychosis include brain trauma, CVA, tumor, epilepsy as well as _____(4).
- Metabolic disorder
- Vitamin deficiency
- Infection
- Toxic illness
Drugs that are associated with psychosis (3):
- Recreational drugs (stimulants, hallucinogen)
- Meds (anticholinergic, L-dopa/DA agonists, Ioniazid: anti-fungal)
- Withdrawal (EtOH, barbituates)
- Toxicity (Digitalis)
Prevalence of schizophrenia
0.5 - 1%
Schizophrenia age of onset
- 18-25 years old in men
- 21-30 years old in women
What are some risk factors for schizophrenia and development?
- Maternal age, stress, drug use, medical conditions
- High childhood insulin levels
- Low socioeconomic status
(schiz accounts for about 3% of all healthcare cost)
Schizophrenia genetics
Describe the course of schizophrenia
Psychotic break → accruing morbidity (first 10 years)
(Patients do not return to previous level of functioning after each additional break)
Schizophrenia: physical changes to the brain (2)
- cortical gray matter loss
- enlargement of the third and lateral ventricles
Schizophrenia monthly relapse rate
- 3.5% per month on maintenance medication
- 12% per month for patients who have discontinued antipsychotic therapy
(74% are non-compliant w/tx)
Schizophrenia risk factor for cardiovascular disease (5)
- Sedentary lifestyle: 72%
- Smoking: 70%
- Obesity: 50%
- Hypertension: 20%
- Elevated cholesterol: >18%
What are the five core symptoms of schizophrenia (must have at least two for at least one month)?
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms (diminished affect & speech, avolition)
4 diagnostic criteria of social and occupational dysfunction in schizophrenia:
- Self-care
- Occupation functioning
- Interpersonal relations
- Academic achievement
(seen since the onset of disturbance)
Continuous signs of schizophrenia disturbance last for at least _______
6 months
Positive symptoms of schizophrenia (4)
- Delusions
- Hallucinations
- Disorganized speech
- Catatonia
(Likely related to mesolimbic dopamine tract in the brain (excessive stimulation))
Negative symptoms of schizophrenia
(hint: the 4 A’s of negative symptoms)
- Alogia
- Affect: Flat or blunted
- Avolition
- Anhedonia
Alogia:
- Diminished amount of spontaneous speech
Or
- Impoverished in content with adequate amount
Affective flattening or blunting:
reduced intensity of emotional expression and response
(unchanging facial expression, decreased spontaneous movements, poverty of expressive gestures, poor eye contact, lack of voice inflections, and slowed speech)
Avolition:
unable to initiate goal-directed behavior and complete it
(loss of will or drive)
Anhedonia:
inability to experience pleasure
Cognitive symptoms of schizophrenia
- Attention
- Memory
- Executive function
(part of how delusions are formed)
Schizophrenia: mood symptoms
- Dysphoria
- Suicidality (1/3 attemt, 1/10 complete)
- Hopelessness
List the typical stages of schizophrenia
- Prodromal phase
- Active phase
- Residual phase
Prodromal phase of schizophrenia: onset & symptoms
- Onset: over months to years
- Sx: Subtle behavior changes: social withdrawal, work impairment, blunting of emotions, avolition, odd ideas and behavior
In the active phase of schizophrenia, the patient develops ______ symptoms.
psychotic symptoms
During the residual phase of schizophrenia, the active symptoms may be abesnt or no longer as prominent, but they do have _______ (3) symptoms.
- Role impairment
- Negative symptoms
- Attenuated positive symptoms
Schizophrenia: factors predicting good outcome include normal health otherwise, female gender, late onset (30’s), shorter prodrome and _______ (4).
- Mood symptoms (indicate possibly bipolar, which can be stabilized)
- No obsessions/compulsion
- Married
- High intelligence
Guidelines for interviewing schizophrenic patients include being attentive and respectful, structuring the conversation, having brief interactions, and providing educational approach and context the delusions as a reaction to stress. It is best to avoid ________ (2).
- arguing about delusions (do not agree or encourage them)
- dangerous interactions (though rare, schizophrenics are more likely than other patients to be violent)
First line treatment when initiating therapy for acute psychosis include _____. Second-line?
- antipsychotics (first or second gen), +/- benzos
- Clozapine (risk of agranulocytosis)
(Benzos offset the side effects of antipsychotics)
Medications for schizophrenia usually take effect within _____
a few days of onset of treatment
(effects are cumulative, so an adequate trial is 4 -6 weeks)
Delusions are disturbances in _____ rather than perception.
thought
______ theme is the most common delusion.
Persecutory
(other themes include: somatic, grandiose, religious, nihilistic or sexual)
Delusions are firmly held beliefs that are untrue as well as contrary to _______.
a person’s education and cultural background
Examples of delusions are “being controlled”, “mind reading”, or “broadcasting” as well as ______ (4).
- “reference”
- “thought broadcasting”
- “thought insertion”
- “though withdraawal”
Which mental status exam components are seen with dimensions of psychosis (3)?
- speech
- thought association
- abnormal motor behavior
4.
Abnormal motor behaviors seen with psychosis include catatonic stupor or excitement as well as _____ (5)?
- Automatic obedience
- Echopraxia
- Negativism (lack of response or opposition to instruction)
- Odd mannerisms
- Stereotypy (rythmic, repetitive movements)
Which three abnormal thought processes are seen with psychosis?
- Derailment / loose associations
- Clanging (i.e. “Slagle”, “bagel”)
- Thought blocking
Which four abnormal elements of speech are seen with psychosis?
- Poverty of speech
- Poverty of content of speech
- Neologisms (made up words)
- Echolalia
In a catatonic stupor a patient is _______ (3), yet fully conscious
- immobile
- mute
- unresponsive
What is the abnormal motor behavior exhibited when a patient has uncontrolled and aimless motor activity? Sometimes bizarre and comfortable postures are maintained for long periods.
Catatonic excitement
Define automatic obedience (abnormal motor behavior seen in psychosis)
Carries out simple commands in a robot like fashion
Define negativism (an abnormal motor behavior seen in psychosis)
Refuses to cooperate with simple requests for no reason
Define echopraxia (an abnormal motor behavior of psychosis)
Initiates movements or gestures of another person
_______ & _____ are the rating scales for schizophrenia.
- PANSS
- BPRS (18 of the 30 PANSS items)
Negative symptoms of schizophrenia are likely related decreased stimulation of the _______ tract in the brain, while positive symptoms of schizophrenia are likely related to the excessive stimulation of the ______ tract in the brain.
- mesocortical dopamine
- mesolimbic dopamine
