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Behavioral Dynamics > Schizophrenia* > Flashcards

Schizophrenia* Flashcards

1
Q

Disturbance in the perception of reality

A

psychosis

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2
Q

What is psychosis characterized by?

A

1+ of the following: hallucinations, delusions, disorganized or incoherent speech, disorganized or catatonic behavior, abnormal emotions, cognitive difficulties

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3
Q

Are psychosis and schizophrenia the same?

A

No, you can be psychotic and not have schizophrenia. Psychosis is a hallmark of schizophrenia

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4
Q

Sensory perceptions in the absence of any external stimuli

A

hallucinations (can be visual, auditory, olfactory, tactile, gustatory)

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5
Q

Sensory misperceptions of actual external stimuli

A

Illusions (Ex: we see sunlight but believe it is an alien coming down)

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6
Q

Fixed false beliefs that persist even with evidence to the contrary that are not shared by a defined religion, family, or subculture

A

Delusions

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7
Q

What is the key difference between hallucinations and illusions?

A

hallucinations have absence of external stimulus, whereas illusions are misperceptions

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8
Q

If a patient claims every time clothing touches her skin, it feels like it is “burning” what symptom would that be?

A

illusion

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9
Q

If a patient insists that the government is able to spy on him through his television, even when it is turned off, unless he leaves it unplugged and turns the screen to face the wall. What symptom is this?

A

delusion

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10
Q

a patient reports hearing people laughing at her and insulting her; others around her are unable to hear these voices/comments. What symptom is this?

A

hallucination

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11
Q

patient reports that he cannot eat because all food smells like raw sewage. He denies smelling this unless food is present in front of him. What symptom is this?

A

illusion

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12
Q

psychiatric disorder with chronic or recurrent psychosis that impairs functioning and can be severely diabling

A

schizophrenia

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13
Q

how is schizophrenia diagnosed?

A

characteristic symptoms + social and/or occupational dysfunction for at least 6 months in the absence of another diagnosis that would better account for the disease

Cannot be due to a substance

If autistic or developmental delay, must have hallucinations or delusions for at least a month

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14
Q

WHO ranks schizophrenia in top ____ of illnesses contributing to global disease burden

A

10

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15
Q

to be diagnosed with schizophrenia, how many of the characteristic symptoms have to be present? For how long?

A

two or more, significant portion of time during a one-month period for 6 months

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16
Q

There is no clinical sign or symptom that is _____ for Schizophrenia

A

pathognomonic (every sign and symptom can be seen in other psychiatric and neurologic disorders)

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17
Q

What are important patient factors to consider with a schizophrenia diagnosis?

A

intellectual ability, educational level, culture/subculture

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18
Q

what is the typical patient presentation of schizophrenia?

A

poorly groomed, failure to bathe, and dressed too warmly for the current weather

(important to take patient factors into account because may not have economic means/education)

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19
Q

What are positive symptoms of schizophrenia?

A

exaggeration of normal processes thought to be due to increased dopamine activity: hallucinations, delusions, disorganization (speech, thoughts, behaviors)

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20
Q

what are negative symptoms in schizophrenia?

A

diminution or absence of normal processes thought to be due to decreased dopamine activity

ex catatonia

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21
Q

what is the most common form of hallucinations?

A

auditory ie voices, music, body noises, machinery

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22
Q

this is often the most responsive symptom of schizophrenia to antipsychotic meds

A

auditory hallucinations

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23
Q

what are forms of hallucinations in schizophrenia?

A

auditory, visual, somatic, olfactory/gustatory

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24
Q

somatic hallucinations can include feelings of being _____

A

touched, pain, or sexual intercourse

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25
Q

what is the least studied of all hallucinations?

A

olfactory/gustatory

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26
Q

fixed, false belief present even in the face of evidence to the contrary?

A

delusions

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27
Q

what types of delusions can be present?

A

bizarre or non-bizarre, mood-congruent or mood-neutral, and many more

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28
Q

Patients often have ______ for their hallucinations

A

delusional explanations

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29
Q

what is the most common type of delusion and what does it mean?

A

delusions of persecution: someone/everyone is out to get me (or harrassing, following, poisoning, drugging, etc)

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30
Q

delusion of exaggerated perception of one’s own abilities or importance, may believe famous person or character

A

delusion of gradeur

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31
Q

delusion that one does not exist or has died

A

cotard delusion/nihilistic delusion

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32
Q

delusion that someone is in love with the patient

A

erotomania

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33
Q

delusion that insignificant remarks, events or objects in one’s environment have personal meaning or significance for ex receiving personal messages from TV

A

delusions of reference

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34
Q

delusion that another person, group of people, or other external force controls one’s general thoughts, feelings, or behavior

A

delusions of control

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35
Q

belief regarding one’s bodily functioning, sensations, or appearance usually involving the body being diseased or infested

A

somatic delusions

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36
Q

What is disorganized speech?

A

disruption in the organization of person’s thoughts during speech

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37
Q

what are the most commonly observed aspects of disorganized speech?

A

tangentiality, circumstantiality

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38
Q

what are the more severe types of disorganized speech?

A

derailment, neologisms, word salad

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39
Q

speech begins in a goal-directed manner, but deviates gradually and consistently off-topic such that answers to questions are not reached

A

tangentiality

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40
Q

circumstantiality

A

Speech is goal-directed but full of unneeded detail and gets to the answer in a “roundabout” way

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41
Q

derailment

A

Speech begins in a goal-directed manner, but topics shift rapidly between sentences with no logical connection to the topic previously discussed

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42
Q

creation of new, nonsensical words

A

neologisms

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43
Q

incomprehensible speech due to loss of logical connections between words, phrases and sentences

A

incoherence, severe form- word salad

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44
Q

words are used on how they sound rather than what they mean, may cause excessive rhyming or alliteration

A

clanging

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45
Q

inability to use abstract thinking

A

concrete speech

46
Q

consistently returning to one topic despite the conversation going in a different direction

A

preservation of ideas (stuck on one topic)

47
Q

what are the types of disorganized speech (8)?

A

tangentiality, circumstantiality, derailment, neologisms, incoherence, clanging, concrete speech, preservation of ideas

48
Q

what is disorganized behavior?

A

behavior that doesn’t correspond with situation

childlike, unprovoked outbursts of behavior or emotion; aimless, compulsive or bizarre behavior, inappropriate social behaviors (ex remarks about genitalia), severe neglect of hygiene, catatonic behaviors

49
Q

inability to move normally

not always present in schizophrenia and can be due to other disorders or a sign of drug toxicity

A

catatonic behavior

50
Q

Catatonia is a ____ symptom but can be ____ or ____

A

positive, negative, positive

51
Q

what is negative catatonia?

A

motiveless abnormally decreased movement

Ex: immobility, mutism, stupor, negativism, waxy flexibility, posturing/catalepsy, staring

52
Q

what is positive catatonia?

A

motiveless abnormally increased movement

ex: grimacing, teeth clicking, rocking, touching or tapping, speech mannerisms, echolalia, echopraxia

53
Q

What are negative symptoms of schizophrenia?

A

social withdrawal, anhedonia (loss of interest), flattened affect, loss of motication (not taking care of self), alogia (decreased verbal communication), loss of hygiene

54
Q

Negative symptoms means a _____

A

decrease or absence of normal psychosocial processes

55
Q

What cognitive impairment is present in schizophrenia?

A

deficits in processing speech, attention, working memory, speech, visual learning and memory, reasoning/executive functioning, social cognition

56
Q

What psychological disorders are commonly present with schizophrenia?

A

depressive disorder, anxiety disorders, suicide

10% of schizophrenic patients successfully commit suicide
20-50% of schizophrenic patients attempt suicide

57
Q

what social findings are often present with schizophrenia?

A

increased substance use and polysubstance use (50% or more of schizophrenic patient)

commonly nicotine (90%), cannabis, alcohol, or cocaine

58
Q

what neurological findings can be present with schizophrenia?

A

subtle sensory and motor impairment ie agraphesthesia (can’t understand number in hand), asterognesia (can’t determine identity of object)

59
Q

what metabolic findings are often present with schizophrenia?

A

HTN, diabetes, hyperlipidemia due to sedentary lifestyles, smoking, poor lifestyle choices

they have increased insulin resistance (not sure why) and increased medication side effects

60
Q

what is the epidemiology of schizophrenia?

A

1% globally
1.5 per 10000 people per year
billions of dollars in yearly cost ($11.5 billion)

Average age of onset: men- 10-25 years old; women- 25-35 years old

61
Q

What are risk factors of schizophrenia (7)?

A

1st degree relative with schizophrenia
Male gender
OB complications or maternal malnutrition
infections (birth during winter or summer months)
inflammation/autoimmune
cannabis use
immigrant status

62
Q

Over ____ of schizophrenia patients have no family history

A

1/2

63
Q

if both of your parents have schizophrenia, what is your risk?

A

40%

64
Q

What is the difference in diagnosis between women and men?

A

more common in men, women tend to be diagnosed later in life and typically have less severe symptoms with better response to therapy

65
Q

what are obstetrical complications that increase risk of schizophrenia?

A

hemorrhage or blood incompatibility, preterm labor, fetal hypoxia, maternal infection

66
Q

How do maternal factors impact pregnancy and schizophrenia?

A

maternal stress increases risk

67
Q

what particular infections can increase risk of schizophrenia?

A

influenza during pregnancy or early childhood
toxoplasma gondii during pregnancy (70% risk)
herpes simplex 2 (controversial)
measles antibodies

68
Q

what is the correlation of inflammation/autoimmune disorders with schizophrenia?

A

increased cytokines may increase schizophrenia: higher incidence of autoimmune diseases ie acquired hemolytic anemia, interstitial cystitis

69
Q

what drug is a risk factor for psychosis but depends on dose?

A

cannabis

70
Q

how is immigrant status related to schizophrenia?

A

higher risk possibly due to stress of immigration and social discrimination

71
Q

What are the theories of etiology of schizophrenia?

A

dopamine hypothesis
glutamate/NMDA hypothesis
GABA hypothesis
Acetylcholine hypothesis

Structural and functional brain abnormalities

72
Q

Increased dopamine in the dopamine hypothesis causes

A

positive symptoms

73
Q

negative symptoms are due to _____ in the dopamine hypothesis

A

decreased dopamine

74
Q

all antipsychotics block _______

A

dopaminergic D2 receptors

75
Q

dopamine receptor agonist drugs can cause ____ and dopamine receptor antagonist drugs can ____ psychosis

A

psychosis, reduce

76
Q

what is the serotonin hypothesis?

A

idea that excess serotonin in the brain causes psychosis

because partial serotonin agonists cause psychotic symptoms and 2nd gen antipsychotics block serotonin receptor and improve negative symptoms

**no longer accepted as likely/main theory

77
Q

What is the glutamate hypothesis?

A

glutamate is a major CNS excitatory neurotransmitter

Low function of NMDA glutamate receptor is believed to contribute to schizophrenia
NMDA antagonists can lead to psychosis, negative symptoms

78
Q

what is the gaba hypothesis?

A

GABA is major CNS inhibitor neurotransmitter
decreased functioning may be related to schizophrenia

79
Q

what is the acetylcholine hypothesis?

A

came from higher likelihood of smoking in schizophrenic patients

Theory that nicotine corrects because treating with nicotine improves eye-tracking and EEG

80
Q

What are structural brain abnormalities with schizophrenia?

A

decreased overall brain tissue, larger ventricle size, increased rate of brain tissue loss

81
Q

how are functional brain abnormalities related to schizophrenia?

A

cognitive defects present before positive symptoms appear

82
Q

positive symptoms generally respond well to _____

A

antipsychotics

83
Q

negative symptoms respond better to which medications?

A

less responsive to antipsychotics, atypicals work better than typical
Cariprazine (Vraylar) has supporting evidence

84
Q

What should you screen for prior to beginning antipsychotic drugs due to SE profile?

A

BMI, waist circumference, HR, BP, EKG
Screen for movement disorder using AIMS score
Labs: CBC (some can cause agranulocytosis), fasting CMP (electrolytes, liver function, renal function, protein), lipids, TFTs (some can change thyroid function)

85
Q

How are most antipsychotics administered?

A

oral tablet/capsule

Also available as IM injection, depot IM injection, ER tab, oral solution

86
Q

About ___ with delusions or hallucinations have a good response to antipsychotics

A

70% (30% still have moderate to severe positive symptoms)

87
Q

what is the therapeutic lag for antipsychotics?

A

4-6 weeks (may see response within 1 week)

minimum of 6 weeks trial per drug and recommended not to try high-dose therapy until 6 week trial done

88
Q

What are the benefits/cons of typical (1st gen) antipsychotics?

A

Good for positive symptoms, more side effects

MOA: dopamine receptor antagonists
equal efficacy to atypicals

89
Q

what are the lower potency/higher potency typical antipsychotics?

A

lower: thorazine, mellaril
higher: haldol, compazine

90
Q

what are the benefits, MOA of atypical antipsychotics?

A

MOA: dopamine/5HT antagonists
less side effects
good for both positive and negative symptoms
equal efficacy to typicals

91
Q

commonly used atypicals?

A

clozaril, zyprexa, seroquel, geodon, risperdal, abilify, rexulti, vraylar, latuda, caplyta–> new with less data

92
Q

what is neuroleptic malignant syndrome?

A

rigidity, fever, autonomic instability, altered mental status that can lead to fatal hypertensive crisis and can happen with any antipsychotic (often 1-3 days)

93
Q

how is neuroleptic malignant syndrome treated?

A

cooling measures, supportive treatment, dopaminergic meds

94
Q

side effects of antipsychotics?

A

neuroleptic malignant syndrome, hyperprolactinemia, anticholinergic, sedation, extrapyramidal symptoms, hypotension, agranulocytosis, seizures, cardiac arrhythmias, metabolic syndrome

95
Q

what medications is hyperprolactinemia common with?

A

typicals and risperidone, may also be seen with high dose olazapine or ziprasidone

96
Q

what is hyperprolactinemia?

A

Side effect that causes gynecomastia, galactorrhea, abnormal menses, sexual dysfunction, acne, hirsutism, infertility

97
Q

what are anticholinergic symptoms? What drugs are they more common with?

A

constipation, urinary retention, dry mouth, blurred vision, cognitive impairment (can’t see, spit, shit)

highly likely with low-potency typicals and clozapine, may also see with high dose olanzapine, quetiapine

98
Q

When is sedation more commonly seen?

A

low-potency typicals and clozapine, may also see with olanzapine, quetiapine

99
Q

What are extrapyramidal symptoms and what medications can cause it?

A

pseudoparkinsonism (rigidity, bradykinesia, masked facies, shuffling gait)
akathisia (inner restlessness leading to pacing or fidgeting)
dystonia (spastic, uncontrollable muscle contractions)
tardive dyskinesia (involuntary movements usually involving the orofacial region that disappear during sleep)

can happen with any antipsychotic but more common with high-potency typical antipsychotics

100
Q

What medications/populations is hypotension due to antipsychotics more common in?

A

any antipsychotics but more likely with low-potency typicals and clozapine, rapid titration of risperidone, quetiapine

more common in elderly, HTN, or cardiovasuclar disease

101
Q

Which medication can cause agranulocytosis? How would you monitor this?

A

clozapine: usually within first 3 months increased risk in elderly, female, asian ethnicity

must have CBC weekly x 6 mo, biweekly x 6 mo, then q 1 month going forward

102
Q

What medications can cause seizures?

A

all antipsychotics and those that are more sedating have more potential of lowering threshold, more common in low-potency typicals and clozapine

103
Q

What are cardiac arrhythmias that can occur with antipsychotics?

A

all can cause prolonged ventricular repolarization (long QT), can cause arrhythmia torsades de points and sudden cardiac death

avoid giving with medications that prolong QT interval

seen most often with thioridazine and ziprasidone but dose dependent

104
Q

What antipsychotics most commonly/least commonly cause weight gain?

A

clozapine/olanzapine, intermediate with most antipsychotics

minimal with ariprazole, brexpiprazole, cariprazine, lurasidone, ziprasidone

105
Q

What glycemic abnormalities can occur with antipsychotics? What medications is this worse with?

A

insulin resistance, DKA, increased glucose in patients with pre-existing DM

worse with clozapine and olanzapine

106
Q

What medications cause worse dyslipidemia, especially elevated triglycerides?

A

low-potency typicals, clozapine, olanzapine, quetiapine

107
Q

overall, metabolic problems are worse with ______; intermediate with ______ and least with _____

A

clozapine, olanzapine
low-potency typicals and quetiapine
aripiprazole, brexpiprazole, cariprazine, ziprasidone, high-potency typicals

108
Q

What should you keep in mind when treating the initial episode of schizophrenia?

A

usually better response to lower antipsychotic doses
Greater vulnerability to SE so recommended not to use clozapine or olanzapine
if agitated, may adjunct anxiolytic or sedative meds

109
Q

what should you keep in mind with maintenance therapy of schizophrenia?

A

continue antipsychotic indefinitely at lowest effective dose to reduce relapse
psychotherapy essential
social support services
close clinical follow-up

110
Q

what is schizophrenia prognosis?

A

10% eventually recover, 20% do not recover fully but have a good outcome, 30-35% have a stable but intermediate outcome
30-40% have a deteriorating course

significant proportion continue to have psychotic s/s

111
Q

what patients have a better prognosis of schizophrenia?

A

later onset, good social support, positive symptoms, acute onset, female sex, few relapses, good premorbid functioning, mood symptoms

112
Q

what patients have a poorer prognosis of schizophrenia?

A

early onset, poor social support, negative symptoms, gradual onset, male sex, multiple relapses, poor premorbid functioning, + family history

Behavioral Dynamics (6 decks)

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