Schizophrenia Flashcards
What is the difference between hallucination, delusion, & illusion?
- Hallucination: seeing without external stimuli
- Delusion: false unshakeable idea (i am a prophet)
- Illusion: external stimuli shows something different
What is schizophrenia?
- split (schisms) between thought content, affect, & behavior (if patient is sad they will laugh & vice versa)
- illness of the mind -> childlike behavior
- affects perceptions, thought, emotions, & behavior
What is the epidemiology of schizophrenia?
- prevalence: 1 %
- males have 30-40% higher lifetime risk
- presents in early 20s in males & 3 to 4 years later in females
- not common to get it after 40 -> look for Parkinsons
What are the phases of schizophrenia?
1- PRODROMAL: before first psychotic episode
- insidious & gradual
- patient becomes socially withdrawn & irritable
- has new interest in religion or occult physical complaints
2- ACTIVE
- hallucinations, delusions, disordered thoughts
3- RESIDUAL
- between episodes of psychosis
- flat affect (mask face no expressions even if patient has feelings)
- social withdrawal
- odd thinking (negative symptoms)
What is the clinical classification of schizophrenia?
- from 0 - 7 days -> acute
- from 7 days to 1 month -> subclinical
- from 1 month to 6 months -> schizophreniform
- after 6 months -> diagnosis of schizophrenia
What is the diagnostic criteria for schizophrenia?
CRITERIA A: 2 or more for 1 month AT LEAST
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms
CRITERIA B: signs of disturbance continue for at least 6 months
- including the 1 months of criteria A (active symptoms)
- the 5 other months patient could just be disturbed
CRITERIA C
- significant impairment of function
CRITERIA D
- substance & general medical conditions excluded (no evidence of organic pathology)
all criterias must be present
What are the negative symptoms?
- apathy
- lack of drive & initiative
- social withdrawal
- deterioration of social behavior
- poverty of thoughts
- flat affect
What is the prognosis of schizophrenia?
- complete recovery 15% (no relapse)
- relapsing illness 70% (even with treatment)
- suicide 5% (in borderline more)
How severe is the risk of relapse after the first psychotic episode?
- 90% of patients will be normal within a year (if not schizo yet)
- 80% will have a further episode within 5 years
- patients that discontinue antipsychotics are 5 times more likely to relapse over this time
What are the good prognostic factors?
- acute onset
- precipitating factor
- affective symptoms
- good premorbid personality
- negative family history
What are the poor prognostic factors?
- insidious onset
- no precipitating factor
- earlier age of onset
- family history of schizophrenia
- hebephrenic -> silly & childlike behavior, prominent affective symptoms (no manners)
- un systematized delusions
- high expressed emotion
- non-compliance
- neuro-cognitive deficits
What are the indications for hospitalization?
- acute psychotic episode with significant impairment of function
- homicidal or suicidal
- catatonia & refusal of food
- refusal of treatment
- if the family requests it
What medications are used to treat schizophrenia?
Atypical antipsychotics - lower side effects
- risperidone
- olanzapine
- quetiapine
Typical antipsychotic
- Haldol
Supportive psychological treatment
What is schizoaffective disorder?
- both schizophrenic & affective symptoms (depressive)
- develop simultaneously
What is the delusional disorder?
- present for at least 3 months
- can function well except area of delusion
- tend not to have cognitive & social impairment
