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Psych Exam 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Do you see positive or negative symptoms of Schizophrenia first?

A

Negative

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2
Q

When does Schizophrenia typically onset?

A

mid to late 20s

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3
Q

Dx of schizophrenia is based on what

A

Positive and negative symptoms + social/life impairment for at least 6 mo in the absence of another diagnosis

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4
Q

What are the 5 symptoms for Dx criteria of schizophrenia?

A

Hallucinations
Delusions
Disorganized thinking
Disorganized behavior
Negative symptoms

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5
Q

Dx criteria for Active Psychosis

A

2/5 symptoms lasting for at least one month

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6
Q

Dx criteria for Schizophrenia

A

persistant 2/5 symptoms with signs of disturbance to life for >6mo

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7
Q

What is Brief Psychotic Disorder?

A

If symptoms last less than a month

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8
Q

What is Schizophreniform disorder?

A

if symptoms last 1-6 mo

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9
Q

What is Schizophrenia?

A

if it lasts > 6mo

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10
Q

Prevalence of schizophrenia worldwide

A

0.3-0.9%

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11
Q

What is schizoaffective disorder?

A

Multiple psychotic symptoms + recurrent episodes of major depression/mania

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12
Q

Prevalence of Schizoaffective disorder

A

0.3%

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13
Q

Differentiation between positive and negative symptoms

A

Positive: symptoms that people without the disorder wouldn’t have
Negative: decrease in affect, mood, and interest

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14
Q

Positive Symptoms

A

Hallucinations
Delusions
disorganized thoughts/behaviors

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15
Q

Most common types of hallucinations in Schizophrenia?

A

Auditory (most)
Visual

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16
Q

What is a hallucination

A

the perception of a sensory process in the absence of an external source

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17
Q

Example of hallucinations

A

Hear someone talking to them
See people that aren’t there

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18
Q

What medication is effective for treatment of auditory hallucinations and how do patients describe it?

A

antipsychotics
“turn down the volume”

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19
Q

Examples of visual hallucinations

A

typically orbs or flashes of color, but can be humans, added body parts etc.

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20
Q

If a patient experiences these you can’t rule out schizophrenia but it is less likely

A

Olfactory/gustatory hallucinations

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21
Q

What are Somatic Hallucinations

A

include feelings of being touched, of sexual intercourse, or of pain

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22
Q

What are delusions?

A

fixed (resistant to change in face of evidence) false belief

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23
Q

Prevalence of delusions in schizophrenia

A

80%

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24
Q

Delusions ________ their hallucinations

A

justify

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25
Q

Bizarre delusions

A

clearly implausible

PJ is a mermaid that came from a far away alien planet

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26
Q

Nonbizarre delusions

A

Not true, but Very small chance its possible

IRS/CIA/FBI is stalking them

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27
Q

How is delusional content categorized?

A

Ideas of reference
Grandiose
Paranoid
Nihilistic
Erotomanic

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28
Q

Ideas of reference

A

Randome neutral events are not random, but for the individual in some way

EX: coded message in a commercial, song, radio

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29
Q

Grandiose Delusions

A

Patient believes that have a special significance or super power

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30
Q

Paranoid delusions are the most common (PJ is most worried about these)

A

Increased likelihood of homelessness bc patient goes off grid
Can show signs of aggressiveness

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31
Q

Nihilistic Delusions (uncommon)

A

Belief their deas or ones body is breaking down, or that they do not exist

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32
Q

Erotomanic Delusion

A

Believes they have a special relationship with someone

Lead to legal problems

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33
Q

Positive Symptoms respond ___ to medications while primary negative symptoms ____

A

Well

Dont

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34
Q

Examples of primary negative symptoms

A

flat affect
impairment in cognition
attention deficits
alogia
abolition
anhedonia
social withdrawal

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35
Q

T/F negative symptoms are less persistent that positive ones

A

False

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36
Q

Two clusters of negative symptoms

A

Diminished Expression
Avolition-apathy

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37
Q

What does volition mean

A

inability to initiate and persist in goal-directed activities

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38
Q

Negative symptoms within Diminished expression cluster

A

Affective flattening (poor eye contact - no emotion)
Alogia (poverty of speech)

39
Q

Negative symptoms associated with Avolition- Apathy cluster

A

Apathy (poor hygiene - can’t perform their role)
Asociality/Anhedonia ( no social interaction, little interest/intamacy)

40
Q

What is most evident first before other symptoms

A

Cognitive deficits

major disruption in school

41
Q

Most patients onset is subtle and evolves into a prodromal stage. what is that?

A

Prodromal phase - the interval between initial symptoms and full symptoms

42
Q

During prodromal phase we see what

A

progressive social withdrawal
negative symptoms

about 50% complain of depression in this phase

43
Q

Schizophrenia is a thought disorder. Give examples of severe disorganization in thoughts/behaviors leading to disjointed speech

A

derailment
neologisms (new words for things)
word salad

44
Q

Tangential speech

A

gets further off topic without answering question

45
Q

Circumstantial speech

A

eventually answers but it is very round about

46
Q

Derailment

A

switches topics without logic

47
Q

Neologisms

A

creation of new, idiosyncratic words

48
Q

Word salad

A

Words thrown together without any meaning

49
Q

Does schizophrenia have a strong genetic link?

A

Yes

50
Q

How much higher is lifetime risk in males?

A

30-40%

51
Q

Interesting risk factors for schizophrenia

A

Late winter to early spring birth month
urban environment
older paternal age
pregnancy complication
cannabis
family hx
hx of head injury

52
Q

Lab testing for schizophrenia

A

serum and urine toxicology
electrolyte and metabolic abnormality evaluation
serum glucose
kidney, liver, thyroid dysfunction
neurosyphilis
pregnancy test

53
Q

When is it typically not schizophrenia

A

acute onset >50 y/o
no auditory hallucinations
has olfactory/gustatory hallucinations

54
Q

Which schizo drugs are most likely to cause EPS effects?

A

1st gen antipsychotics (typical)

55
Q

What is the downside to second gen antipsychotics?

A

increase metabolic adverse effects

56
Q

Response time on antipsychotics

A

initial - 1-2 weeks
significant 2-4 weeks
full -10 weeks

57
Q

ER treatment of Schizophrenia

A

Risperdol or Seroquel (2nd gen)
+ Benadryl/benzotropine
+ call psych

58
Q

Before treatment what should you consider?

A

Movement disorder? dont give 1st gen
Fasting glucose, A1C, lipid panel? dont give 2nd gen
EKG with QT >500ms? dont give thioridazine, pimozide, mesoridazine

59
Q

Most common first line treatment for schizophrenia

A

olanzapine
risperidone
quetiapine

60
Q

Which drug is not used for initial treatment? and when is it considered? why?

A

Clozapine
failure of 2 drugs given in adequate does for 6 wks with evidence of adherence
CBC–> agranulocytosis (low WBC)

61
Q

Akathisia

A

restless, can’t sit still

62
Q

Dystonia

A

muscles contract involuntarily, stiff head movements

63
Q

Parkinsonism

A

tremor, stiff facial muscles, feet shuffle

64
Q

Tardive Dyskinesia

A

Facial movements happen involuntarily (sucking motion)

65
Q

Treatment of dystonia

A

IV anticholinergic or antihistaminic (diphenhydramine) + antipsych prophylaxis

66
Q

Parkinsonism treatment

A

1st reduce/switch drug
2nd benzotropine or amantidine in older patients

67
Q

Akathisia treatment

A
  1. reduce/switch
  2. propanolol
68
Q

Tardive Dyskinesia treatment

A

Ginko or valbenazine

69
Q

Most likely to cause QT prolongation

A

Ziprasidone
thioridazine
pimozide

70
Q

Least likely to cause QT prolongation

A

Lurasidone
aripiprazole

71
Q

Which drugs have the highest likelihood of weight gain? Treatment?

A

clozapine
olanzapine

Metformin 1500-2000mg daily

72
Q

Who should not be prescribed a high potency FGA or risperidone

A

Women with breast cancer

73
Q

Which drugs are most common to cause prolactin elevation?

A

FGA and risperidone

74
Q

Life threatening complication of antipsychotics

A

Neuroleptic Malignant syndrome

75
Q

When does NMS present

A

hours to days after admin of antipsychotics with mortality of 5%

76
Q

Manifestation of NMS

A

fever
muscle rigidity
altered mental status
leukocytosis
elevated alkaline phosphatase

77
Q

Management of NMS

A

stop drug
cool patient
hydration
skeletal muscle relaxant (dantrolen/bromocriptine)
benzodiazepine for agitation

78
Q

Fold increase of sudden cardiac death

A

1.5-4 fold increase with antipsychotic drug therapy

79
Q

Personality disorder

A

enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture,
is pervasive and inflexible
onsets in adolescence
causes impairments

80
Q

Cluster A (odd or eccentric)

A

paranoid, schizotypal,schizoid

81
Q

Cluster B (dramatic, emotional, erratic)

A

Antisocial
borderline
histrionic
narcissistic

82
Q

Cluster C (anxious/fearful)

A

avoidant
dependent
obessessive-compulsive

83
Q

paranoid personality disorder

A

a long standing pattern of distrust or suspiciousness
interferes with relationships due to false beliefs of motives

No long-term psychotic symptoms

rigid guarded position

84
Q

Schizoid personality disorder

A

detached from social relationships and exhibit a restricted range of emotional expression in their interactions with others, often appearing cold or indifferent

May experience intense emotions internally but dont display them

Completely not interested in any form of pleasure

enjoy mathematical games

85
Q

Schizotypal Personality disorder

A

Behave in an odd and eccentric manner, socially isolate, and cognitive distortions

magical thinking, odd beliefs, ideas of reference, bodily illusions, telepathic

suspicious and paranoid

ex: wear capes, dresses funny

86
Q

Schizotypal vs schizoid

A

schizoid does not have any paranoid ideations or suspicions (not worried about others thoughts)

87
Q

antisocial personality disorder

A

Demonstrate a disregard for others and behavior that violates others rights

diagnosis can be made only in persons over the age of 18 years and requires a hx of conduct disorder prior to that age

lie manipulate for personal gain and not remorseful

88
Q

Borderline Personality disorder

A

instability in their self-image, their affect, and their relationships with others

they can be quite impulsive and may engage in self-destructive behaviors, such as substance abuse, self mutilation, and suicide attempts

fearful of closeness

rapid shifts in mood “the sabatoger” no matter what you do you will not make them happy

89
Q

Histrionic personality disorder

A

Think females

attention seeking and emotionalism

dress and behave sexually to draw attention

90
Q

Narcissistic Personality Disorder

A

Long standing pattern of grandiosity, with a need for praise and admiration that stands out in contrast to a lack of sensitivity to others feelings

exaggerated sense of self-importance and social status require excessive admiration

beneath the grandiosity and devaluation exist an underlying view of self as inferior or inadequate

“Wears you out and doesn’t care about your feelings”

91
Q

Avoidant Personality disorder

A

Longstanding pattern of excessive anxiety in social situations and relationships, extreme hypersensitivity about what others think

Blame discomfort on themselves
dont feel deserving of attention

92
Q

Dependent Personality disorder

A

pervasive and excessive need to be taken care of
separation anxiety and submissive and clingy

93
Q

Obsessive-Compulsive Personality Disorder

A

Preoccupied with orderliness and perfectionism 24/7

laser focus on details and rules
insist others follow their plan
inflexible due to fear of losing control
distressed when faced with the need to make decisions

94
Q

Treatment of Personality Disorders

A

Longterm behavior therapy
refer

Psych Exam 2 (2 decks)

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