Schizophrenia Flashcards
What are the positive symptoms of schizophrenia?
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic motor behavior
What are the negative symptoms of schizophrenia?
avolition
social deficits
flattened affect
cognitive deficits
What are the different types of schizophrenic and psychotic disorders?
schizotypal personality disorder
delusional disorder
brief psychotic disorder
schizophreniform disorder
schizophrenia
schizoaffective disorder
What are the common symptoms within the spectrum of schizophrenic disorders?
delusions
hallucinations
disorganized speech
disorganized motor behavior or catatonia
negative symptoms
What is the prevalence of schizophrenia?
lifetime prevalence of schizophrenia 1%
schizophrenic patients may account for up to 50% of repeat hospital admissions and 25% of inpatient beds
vastly overrepresented in prison and homeless populations
estimated 1/3 of homeless in US
estimated 20% of prison population
What is the morbidity of schizophrenia?
suicidality is estimated at up to 60%: 20% attempt suicide, 5-7% die by suicide
up to 50% co-morbid with substance abuse
psychiatric co-morbidities include mood and anxiety disorders
What is the mortality of schizophrenia?
decreased life expectancy of 10-25 years
What are delusions?
fixed beliefs that are not amenable to change despite conflicting evidence
What are the types of delusions?
persecutory: belief of pursuit, harassment, or harm from an individual or group
referential: belief that gestures, comments, or cues are directed at oneself
control: belief that one’s thoughts or actions are under external influence
grandiose: belief in special abilities or status
erotomanic: belief that another has fallen in love with oneself
nihilistic: belief in impending disaster or calamity
somatic: belief in an adverse health condition
What are common delusions in schizophrenia?
though broadcasting: belief in thoughts being cast to the outside world
though insertion: belief in thoughts implanted from an outside source
thought withdrawal: belief that thoughts have been removed from mind
What are bizarre delusions?
a delusion that is neither plausible not understandable and des not derive from normal life experiences
What are hallucinations?
sensory or perceptual disturbances that are difficult or impossible to distinguish from reality
What are types of hallucinations?
auditory: occur in up to 60% of cases
tactile: tingling, burning or electrical sensations
somatic: e.g., feeling snakes writhing in one’s belly
visual: much rarer
gustatory and olfactory: tasting or smelling things that are not present
What are “normal” hallucinations?
hallucinations can occur as a normal experience
normal when falling asleep or waking (hypnogogic or hypnopompic)
induced by sensory deprivation
religious experiences and normal grieving
considered symptomatic of mental illness only when experienced in a clear sensory state
“normal” hallucinations can typically be recognized as such by the experiencer
What are speech and thought disturbances in schizophrenia?
disturbances in coherent, meaningful speech
believed to represent a though disorder
loss of connections or associations between thoughts
leads to disorganized, illogical thought patterns
What are examples of altered speech patterns?
derailment: loss of connectivity, changes of topic
tangentiality: unrelated content to conversation
word salad: lack of connection between words within a single utterance
distractibility: loss of train of thought
What are rare and severe speech disturbances?
neologisms: words made up by the speaker
perseveration: persistent repetition of a word or phrase
clang associations: stringing together rhyming words
echolalia: verbatim repetitions of phrases directed at patient
blocking: inability to complete sentences due to internal distraction
What is the disorganized/abnormal motor behavior in schizophrenia?
widely ranging expression
severe motor agitation
unpredictable agitation
inappropriate behavior: childlike silliness, inappropriate facial expressions, giggling
purposeless activities
catatonia
What is catatonia in schizophrenia?
resistance to instruction (negativism)
lack of verbal or motor response (mutism, stupor)
excessive activity without cause (catatonic excitement)
maintaining rigid, bizarre posture
waxy flexibility (positionable catatonia)
What is diminished social expression in schizophrenia?
blunting of affect
reduced facial expression
lack of eye contact
reduced intonation, gesturing
How do schizophrenic patients retain emotional reactions?
different from anhedonia
patients are particularly deficient in non-verbal expression
What is avolition in schizophrenia?
lack of motivation to initiate or engage in activity
apathy or indifference to consequences
What are the attentional deficits in schizophrenia?
difficulty filtering irrelevant or distracting stimuli
What are the social deficits in schizophrenia?
social withdrawal
decreased pleasure from social interactions
What are the cognitive deficits in schizophrenia?
alogogia or poverty of speech
attention, long-term memory, working memory, abstraction and planning
What is the course and modifiers of schizophrenia?
early onset (75% of cases present before 25)
no gender differences (but earlier presentation in males)
4 phases to the course of schizophrenia
What is the premorbid phase of schizophrenia?
preclinical and usually only described retrospectively
lower performance at school: decline between 13-16
poor social adjustment: less socially responsive, less positive emotional valence
delayed or abnormal motor development
What is the prodromal phase of schizophrenia?
marks a period of observable functional decline
last months to few years
typically begins in adolescence: waning social interest, irritability, depression, antagonistic thoughts and behaviors, reduced care of appearance
non-specific psychiatric symptoms typically retrospectively identified as schizophrenic prodrome
subtle psychotic behaviors: suspiciousness or perceptual distortions
may represent the ideal therapeutic window
What is the florid phase of schizophrenia?
emergence of psychotic symptoms
high prevalence of substance abuse may act as a precipitant: associations between alcohol, cannabis, and amphetamine use and “first break”
early age of onset ad delayed treatment are associated with worse prognosis
leading cause of involuntary hospitalization
What is the residual phase of schizophrenia?
return to behavioral state of the prodromal phase after treatment: negative symptoms: social impairment, cognitive impairments remain, remission varies among individuals
residual phase typically marked by episodic psychotic illness with persistent “clinical deterioration” - failure to recover to pre-episodic level
positive symptoms are typically episodic while negative symptoms are progressive
20% show favorable outcomes, recovery is rare
