Schizophrenia Flashcards by Wesley Rubbin

Psychosis Terminology:

Positive Sxs

Atypical excesses (not a part of normal experience) i.e. hallucinations, delusions, etc.

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Psychosis Terminology:

Negative Sxs

Absence of normally occurring behaviors, i.e. lack of speech (alogia, amotivation, asociality) etc.

Up to 60% of those with Schizophrenia have strong neg. Sxs.

Neg. Sxs are frequently first Sx of illness.

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Psychosis Terminology:

Hallucinations

Perception not based on external stimuli

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Psychosis Terminology:

Illusion

Misperception of an external stimuli

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Psychosis Terminology:

Delusion

False belief maintained despite strong evidence to the contrary

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Psychosis Terminology:
Delusions can either be:
______ or _______

Bizarre - can never possibly occur

Non-bizarre - could potentially occur (but aren’t occurring now)

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Psychosis Terminology:
Specific types of delusions:
Ideas of reference

Incorrectly believe external events are occurring for or with specific reference to oneself

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Psychosis Terminology:
Specific types of delusions:
Thought broadcasting

Delusion that one’s thoughts are being broadcast out loud for others to hear

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Psychosis Terminology:
Specific types of delusions:
Thought insertion

Delusion that some of one’s thoughts have been inserted in one’s mind by others

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Psychosis Terminology:

Loose associations/derailment

Person’s ideas slip from one topic to another - at best obliquely related to one another

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Psychosis Terminology:

Neologism

a made-up word used by the person

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Psychosis Terminology:

Clanging

words are strung together based on sound similarity (vs. meaning)

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Psychosis Terminology:

Word salad/Incoherence

a mixture of words and phrases that lack logical coherence

this disturbance occurs within clauses, whereas with loose associations is between clauses

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Psychosis Terminology:

Poverty of content

person speaks but conveys little content

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Alogia

impoverished speech and thought

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Avolition

inability to initiate and persist in goal-directed activities

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Affect

refers to emotions

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Blunted affect

affective expression is reduced in intensity

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Flat affect

an absence of affective expression

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Inappropriate affect

affective content does not match the situation or content of what is being said

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Psychosis Terminology:
Negative Sxs: Referred to as the A’s (Bleuler’s terminology)
Anhedonia

inability to experience pleasure from activities that usually produce pleasurable feelings

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Schizophrenia Course:

Prodromal phase

the period leading up to the full blown Dx characterized by increase in Sxs and increase in adjustment problems

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Schizophrenia Course:

Residual

phase of the illness after remission of the florid active Sxs

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Schizophrenia - DSM-5 Diagnostics:
A. More than 2 Sxs each present for a significant portion of time during a 1 month period (less if successfully treated). (Most crucial criteria)

5 Domains

At least 1 of which must be (1), (2), or (3).

Delusions
Hallucinations
Disorganized speech
(freq. derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative Sxs

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Schizophrenia - DSM-5 Diagnostics: B. For a significant portion of time since onset, level of functioning in more than 2 major areas (e.g., work, interpersonal, self-care) is markedly ________ prior to onset.

below level | if onset during childhood there is a failure to achieve expected levels of functioning

Schizophrenia - DSM-5 Diagnostics: | C. Continuous signs persist for _____

more than 6 months The 6 months MUST include at least 1 month of active Sxs (less if actively treated) (active = meets criteria A) AND Rest of time may be prodromal or residual Note: during prodromal or residual phase, disturbance may be manifested only as - 1. negative Sxs OR 2. more than 2 criteria A Sxs present in an attenuated form (odd beliefs vs. delusions)

Schizophrenia - DSM-5 Diagnostics: | D. Schizoaffective Dx and Depressed or Bipolar Dxs with psychotic features have been ruled out b/c...

No major depressive or manic episodes during acute phase OR If mood episodes occur during active phase, they represent only a minor to total duration of the active and residual periods of the Dx.

Schizophrenia - DSM-5 Diagnostics: | E. Disturbance not attributable to ______ or other ________

substance or other medical condition

Schizophrenia - DSM-5 Diagnostics: | F. If Hx of ASD or a Communication Dx with childhood onset, additional Dx of schizophrenia ONLY MADE IF....

Prominent hallucinations or delusions, in addition to other required Sxs of schizophrenia are also present for more than 1 month (or less if successfully treated)

Schizophrenia - DSM-5 Specifiers: Hx specifiers: Episodes Remissions

- first episode - multiple episodes - continuous - acute = Sx criteria fulfilled - full or partial remission

Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Reactivity to environment

-Marked decrease in reactivity to the environment | present in several Dxs - psychotic, mood, and ASD

``` Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Extreme reactions S/M A ```

stupor/mutism or agitation

``` Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Repetitive behaviors E E S S ```

- echolalia (repeating speech) - echopraxia (repeating actions) - staring - stereotypies (repeated motor behaviors with no goal)

Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Behaviors that don't mach the situation

- mannerisms | - grimaces

Schizophrenia - DSM-5 Specifiers: Catatonia specifier: Motoric

- posturing - catalepsy (maintains a posture against gravity then slowly sinks back into resting state - waxy flexibility (maintains posture against gravity and resists repositioning) - negativism (resistant to direction)

``` Schizophrenia - Associated Sxs: Often present 1. ________ 2. ________ 3. ________ ```

1. Before psychotic Sxs appear 2. During remission 3. Seen in 1st degree relatives

``` Schizophrenia - Associated Sxs: Cognitive Sxs: Overall mental task deficits in... 1._______ 2.______ 3. ______ 4.______ 5.______ ```

1. Attention 2. Decreased processing speed (verbal tasks, visual stimuli) 3. Decreased Verbal memory 4. Decreased EF skills 5. Decreased reasoning

``` Schizophrenia - Associated Sxs: Social Cognition Sxs: 1. ______ 2. ______ 3. ______ ```

1. Emotional recognition 2. Social problem solving 3. Theory of the mind (putting self in other's shoes - recognizing that others have a mind as well)

``` Schizophrenia - Associated Sxs: Motor Sxs: 1.______ 2.______ 3.______ 4.______ ```

1. Early motor milestones (e.g., walking) 2. Gesturing 3. Sensory integration 4. Motor planning and sequencing

Schizophrenia Onset: Late _____/early _____ for males (family of origin might pull child back) Mid ____ to early _____ for females (implications for later onset - might have two support systems - family of origin and family of marriage)

teens; 20s for males mid 20s; early 30s for females

``` Schizophrenia Other sex differences: Females MORE likely to... 1. ________ 2. _______ ```

1. Be married | 2. Have an affective component

Schizophrenia Other sex differences: Females are LESS likely to... 1. ______

1. Have a Sx profile noteworthy for strong negative Sxs | Negative Sxs are associated with poorer outcome than positive Sxs

Schizophrenia Prognosis: A poorer prognosis is associated with... 1. Early _____

onset

Schizophrenia Prognosis: A poorer prognosis is associated with... 2. Gradual _____

onset/poor premorbid functioning

Schizophrenia Prognosis: A poorer prognosis is associated with... 3. ______ sex

the male

Schizophrenia Prognosis: A poorer prognosis is associated with... 4. _____ Hx of Sz.

Family Hx

Schizophrenia Prognosis: A poorer prognosis is associated with... 5. High levels of ______ _____ in family members with whom the client resides - Increased _____ over-involvement - Increased ______

expressed emotion; increased emotional over-involvement; increased hostility

Schizophrenia Course: Incidence of Sz. is ________ in different countries

the same

Schizophrenia Course: The course was _____ in developing (vs. developed) countries

better

Schizophrenia Course Cultural Differences: Cultures _____ in how they deal with Dxs

vary

Schizophrenia Course Cultural Differences: Closer links between ____ and _____ (may normalize behaviors)

Sxs; cultural/religious practices

Schizophrenia Course Cultural Differences: Stigma levels _____

vary

Schizophrenia Course Cultural Differences: More likely to be cared for by ______

family

Schizophrenia Course Cultural Differences: _______ likely to be married

Schizophrenia Course Cultural Differences: Extended ___________ may allow for more _______ re: home and life

family involvement; more role differentiation

Schizophrenia Course Cultural Differences: Developed nations may foster a _______ patient mentality

professional

Schizophrenia Etiology: Genetics Genetic factors account for up to ____ to _____ of variance in Sz.

60-80%

Schizophrenia Etiology: Genetics Adopted children had ______ rates of Sz if their bio moms had Sz IF they grew up in adopted family that was rated as _______

higher; dysfunctional

Schizophrenia Etiology: Neurodevelopmental Hypothesis Diathesis + Stress = Sz Diathesis is...

underlying vulnerability

Schizophrenia Etiology: Neurodevelopmental Hypothesis: Diathesis + Stress Genetic Diathesis

- If genetic, likely involves multiple genes | - Likely to develop into psychosis generally (vs. Sz specifically)

Schizophrenia Etiology: Neurodevelopmental Hypothesis: Diathesis + Stress Environmental Diathesis

Maternal complications (rubella, diabetes, smoking)

Schizophrenia Etiology: Neurodevelopmental Hypothesis: Stress + Diathesis 1. Excessive _____ pruning during adolescence 2. Myelination 3. _______ use during adolescence increase risk of Sz. 4. Psycho_____ stress

1. synaptic 2. problems 3. Cannabis 4. Psychosocial

``` Schizophrenia Etiology: Brain Structural Issues: Associated but not uniquely so with.... 1. Enlarged _____ 2. Decreased ______ ```

1. ventricles | 2. gray matter

Schizophrenia Etiology: Dopamine Hypothesis: Meds/drugs that increase dopamine lead to increase in _________

positive Sxs

Schizophrenia Etiology: Dopamine Hypothesis: Sz involves dysfunction in the DA system but....

not as simple as too much DA in the system

``` Schizophrenia Etiology: Dopamine Hypothesis: Other NTs likely to have a role: 1. _______ 2. _______ ```

1. Glutamate | 2. GABA

Antipsychotic Tx administration methods: 1. 2. 3.

1. Pill 2. Liquid 3. Depot (long term shot) Affect DA and other neurotransmitters A few days to work for agitation and hallucination Several weeks to work for delusions

Antipsychotic Meds | Clozapine (Clozaril)

Most effective antipsychotic by far but serious side effects preclude widespread usage - regular blood drawing. Can cause agranulocytosis - loss of WBC

Antipsychotic Side Effects: | Cardiac

QT prolongation

Antipsychotic Side Effects: | Alertness levels:

Sedation

Antipsychotic Side Effects: | Metabolic

Weight gain Changes in metabolism Increase risk of diabetes Increase risk of high cholesterol

Antipsychotic Side Effects: | Motor (Extrapyramidal)

Rigidity Muscle Spasms Tremors, restlessness

Antipsychotic Side Effects: | Tardive Dyskinesia

- Sudden involuntary muscle movements, typically around the mouth, tongue, and face. - Only sometimes reversible with meds discontinued.

Antipsychotic Side Effects: Weight gain Which meds are worst?

Worst: Zotepine (Zoleptil) Olanzapine (Zyprexa)

Antipsychotic Side Effects: QTc Prolongation: Which drugs are worst?

Worst: Sertindole (Serdolect) Amisulpride (Solian)

Antipsychotic Side Effects: Sedation: Which meds are worst?

Worst: Zuclopethixol (Clopixol) Clozapine (Clozaril)

Sz Tx: Assertive Community Treatment: Med adherence is low for Sz, so ACT intervention developed. Key Elements:

- Multidisciplinary team - High patient contact - Reduced caseload - 24/7 availability

Sz Tx: Assertive Community Treatment: Med adherence is low for Sz, so ACT intervention developed. Efficacy

Compared to Tx as Usual (TAU) ACT has - Increased med adherence - Increased quality of life - increased likelihood to be employed and living independently - decreased time in hospital/re-hospitalization - More cost effective

Sz Tx: Family Psycho-education/Decrease expressed emotion Key elements: Typically lasts 6-9 months and involves...

- psychoeducation - communication skills - problem solving - decreased high expressed emotion - decreased hostility/criticism - decreased emotional over-involvement

Sz Tx: Family Psycho-education/Decrease expressed emotion Efficacy: Participants found to have...

- higher functioning - higher med compliance - decreased hospitalization - decreased sense of burden among family members

Cochrane Review of Interventions with Sz: | CBT

showed some efficacy for positive Sxs but not for negative However - effects only lasted as long as continued CBT - higher the quality of the study (methodologically), the lower the effect size

Cochrane Review of Interventions with Sz: | Social Skills training

- some decrease in negative Sxs and relapse | - unclear if reaches significance level

Cochrane Review of Interventions with Sz: | Supported employment

- Individualized employment - some positive results re: retaining employment - low-quality data