Schizophrenia Flashcards
1
Q
Do you see positive or negative symptoms of Schizophrenia first?
A
Negative
2
Q
When does Schizophrenia typically onset?
A
mid to late 20s
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
4
Q
What are the 5 symptoms for Dx criteria of schizophrenia?
A
Hallucinations
Delusions
Disorganized thinking
Disorganized behavior
Negative symptoms
5
Q
Dx criteria for Active Psychosis
A
2/5 symptoms lasting for at least one month
6
Q
Dx criteria for Schizophrenia
A
persistant 2/5 symptoms with signs of disturbance to life for >6mo
7
Q
What is Brief Psychotic Disorder?
A
If symptoms last less than a month
8
Q
What is Schizophreniform disorder?
A
if symptoms last 1-6 mo
9
Q
What is Schizophrenia?
A
if it lasts > 6mo
10
Q
Prevalence of schizophrenia worldwide
A
0.3-0.9%
11
Q
What is schizoaffective disorder?
A
Multiple psychotic symptoms + recurrent episodes of major depression/mania
12
Q
Prevalence of Schizoaffective disorder
A
0.3%
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
14
Q
Positive Symptoms
A
Hallucinations
Delusions
disorganized thoughts/behaviors
15
Q
Most common types of hallucinations in Schizophrenia?
A
Auditory (most)
Visual
16
Q
What is a hallucination
A
the perception of a sensory process in the absence of an external source
17
Q
Example of hallucinations
A
Hear someone talking to them
See people that aren’t there
18
Q
What medication is effective for treatment of auditory hallucinations and how do patients describe it?
A
antipsychotics
“turn down the volume”
19
Q
Examples of visual hallucinations
A
typically orbs or flashes of color, but can be humans, added body parts etc.
20
Q
If a patient experiences these you can’t rule out schizophrenia but it is less likely
A
Olfactory/gustatory hallucinations
21
Q
What are Somatic Hallucinations
A
include feelings of being touched, of sexual intercourse, or of pain
22
Q
What are delusions?
A
fixed (resistant to change in face of evidence) false belief
23
Q
Prevalence of delusions in schizophrenia
A
80%
24
Q
Delusions ________ their hallucinations
A
justify
25
Bizarre delusions
clearly implausible
PJ is a mermaid that came from a far away alien planet
26
Nonbizarre delusions
Not true, but Very small chance its possible
IRS/CIA/FBI is stalking them
27
How is delusional content categorized?
Ideas of reference
Grandiose
Paranoid
Nihilistic
Erotomanic
28
Ideas of reference
Randome neutral events are not random, but for the individual in some way
EX: coded message in a commercial, song, radio
29
Grandiose Delusions
Patient believes that have a special significance or super power
30
Paranoid delusions are the most common (PJ is most worried about these)
Increased likelihood of homelessness bc patient goes off grid
Can show signs of aggressiveness
31
Nihilistic Delusions (uncommon)
Belief their deas or ones body is breaking down, or that they do not exist
32
Erotomanic Delusion
Believes they have a special relationship with someone
Lead to legal problems
33
Positive Symptoms respond ___ to medications while primary negative symptoms ____
Well
Dont
34
Examples of primary negative symptoms
flat affect
impairment in cognition
attention deficits
alogia
abolition
anhedonia
social withdrawal
35
T/F negative symptoms are less persistent that positive ones
False
36
Two clusters of negative symptoms
Diminished Expression
Avolition-apathy
37
What does volition mean
inability to initiate and persist in goal-directed activities
38
Negative symptoms within Diminished expression cluster
Affective flattening (poor eye contact - no emotion)
Alogia (poverty of speech)
39
Negative symptoms associated with Avolition- Apathy cluster
Apathy (poor hygiene - can't perform their role)
Asociality/Anhedonia ( no social interaction, little interest/intamacy)
40
What is most evident first before other symptoms
Cognitive deficits
major disruption in school
41
Most patients onset is subtle and evolves into a prodromal stage. what is that?
Prodromal phase - the interval between initial symptoms and full symptoms
42
During prodromal phase we see what
progressive social withdrawal
negative symptoms
about 50% complain of depression in this phase
43
Schizophrenia is a thought disorder. Give examples of severe disorganization in thoughts/behaviors leading to disjointed speech
derailment
neologisms (new words for things)
word salad
44
Tangential speech
gets further off topic without answering question
45
Circumstantial speech
eventually answers but it is very round about
46
Derailment
switches topics without logic
47
Neologisms
creation of new, idiosyncratic words
48
Word salad
Words thrown together without any meaning
49
Does schizophrenia have a strong genetic link?
Yes
50
How much higher is lifetime risk in males?
30-40%
51
Interesting risk factors for schizophrenia
Late winter to early spring birth month
urban environment
older paternal age
pregnancy complication
cannabis
family hx
hx of head injury
52
Lab testing for schizophrenia
serum and urine toxicology
electrolyte and metabolic abnormality evaluation
serum glucose
kidney, liver, thyroid dysfunction
neurosyphilis
pregnancy test
53
When is it typically not schizophrenia
acute onset >50 y/o
no auditory hallucinations
has olfactory/gustatory hallucinations
54
Which schizo drugs are most likely to cause EPS effects?
1st gen antipsychotics (typical)
55
What is the downside to second gen antipsychotics?
increase metabolic adverse effects
56
Response time on antipsychotics
initial - 1-2 weeks
significant 2-4 weeks
full -10 weeks
57
ER treatment of Schizophrenia
Risperdol or Seroquel (2nd gen)
+ Benadryl/benzotropine
+ call psych
58
Before treatment what should you consider?
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
Most common first line treatment for schizophrenia
olanzapine
risperidone
quetiapine
60
Which drug is not used for initial treatment? and when is it considered? why?
Clozapine
failure of 2 drugs given in adequate does for 6 wks with evidence of adherence
CBC--> agranulocytosis (low WBC)
61
Akathisia
restless, can't sit still
62
Dystonia
muscles contract involuntarily, stiff head movements
63
Parkinsonism
tremor, stiff facial muscles, feet shuffle
64
Tardive Dyskinesia
Facial movements happen involuntarily (sucking motion)
65
Treatment of dystonia
IV anticholinergic or antihistaminic (diphenhydramine) + antipsych prophylaxis
66
Parkinsonism treatment
1st reduce/switch drug
2nd benzotropine or amantidine in older patients
67
Akathisia treatment
1. reduce/switch
2. propanolol
68
Tardive Dyskinesia treatment
Ginko or valbenazine
69
Most likely to cause QT prolongation
Ziprasidone
thioridazine
pimozide
70
Least likely to cause QT prolongation
Lurasidone
aripiprazole
71
Which drugs have the highest likelihood of weight gain? Treatment?
clozapine
olanzapine
Metformin 1500-2000mg daily
72
Who should not be prescribed a high potency FGA or risperidone
Women with breast cancer
73
Which drugs are most common to cause prolactin elevation?
FGA and risperidone
74
Life threatening complication of antipsychotics
Neuroleptic Malignant syndrome
75
When does NMS present
hours to days after admin of antipsychotics with mortality of 5%
76
Manifestation of NMS
fever
muscle rigidity
altered mental status
leukocytosis
elevated alkaline phosphatase
77
Management of NMS
stop drug
cool patient
hydration
skeletal muscle relaxant (dantrolen/bromocriptine)
benzodiazepine for agitation
78
Fold increase of sudden cardiac death
1.5-4 fold increase with antipsychotic drug therapy
79
Personality disorder
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
Cluster A (odd or eccentric)
paranoid, schizotypal,schizoid
81
Cluster B (dramatic, emotional, erratic)
Antisocial
borderline
histrionic
narcissistic
82
Cluster C (anxious/fearful)
avoidant
dependent
obessessive-compulsive
83
paranoid personality disorder
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
Schizoid personality disorder
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
Schizotypal Personality disorder
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
Schizotypal vs schizoid
schizoid does not have any paranoid ideations or suspicions (not worried about others thoughts)
87
antisocial personality disorder
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
Borderline Personality disorder
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
Histrionic personality disorder
Think females
attention seeking and emotionalism
dress and behave sexually to draw attention
90
Narcissistic Personality Disorder
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
Avoidant Personality disorder
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
Dependent Personality disorder
pervasive and excessive need to be taken care of
separation anxiety and submissive and clingy
93
Obsessive-Compulsive Personality Disorder
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
Treatment of Personality Disorders
Longterm behavior therapy
refer
