Schizophrenia Flashcards
What are the three main divisions of the frontal lobe?
1) prefrontal cortex
2) premotor area
3) motor area
Schizophrenia definition
Splitting of senses
1911 - Swiss Psychiatrist Eugene Bleuler German
Abnormalities of People with Scizophrenia
1) Alteration of the senses
2) Inability to sort and interpret incoming sensations, and an inability therefore to respond appropriately
3) delusions and hallucinations
4) altered sense of self
5) changes in emotions
6) changes in movements
7) changes in behavior
8) decreased awareness of illness
Alterations of Senses
Enhancement or Blunting of senses
Perceptual more common than auditory
Experiencing so many realities that it can be confusing and totally overwhelming
Pain can be blunted: fractured bones, perforated ulcers, or ruptured appendixes they might not know they have.
Temporal Lobe
1) auditory perception
2) memory
3) speech
4) emotional responses
5) visual perception
Kurt Schneider’s (German Psychiatrist)
First Rank Symptoms for Schizophrenia
- Auditory hallucinations: voices speak ones thoughts aloud
- Auditory hallucinations: 2 voices arguing
- Auditory hallucinations: voices commenting on ones actions
- Hallucinations of touch when the bodily sensation is imposed by so e external agency
- Withdrawal of thoughts from ones mind
- Insertion of thoughts into ones mind by others
- Believing ones thoughts are being broadcast to others, as by radio or television
- Insertion by others of feelings into ones mind
- Insertion by others of irresistible impulses into ones mind
- Feeling that all ones actions are under the control of others, like an automaton
- Delusions of perception, as when one is certain that a normal remark has a secret meaning for oneself
Definition of Crazy
Craziness has it’s roots in the disordered brain function that produces erroneous sensory data and disordered thinking.
Anosognosia
Decreased awareness of illness
Frontal Lobe
1) Motor functions
2) Higher order functions
3) Planning
4) Reasoning
5) Judgment
6) Impulse Control
7) Memory
Preliminary Criteria for the diagnosis of Schizophrenia under DSM-V
A. Two or more of the following symptoms must be present for a significant portion of time during a one-month period.
- Delusions
- Hallucinations
- Disorganized speech
- Catatonic or other grossly abnormal psychomotor behavior
- “Negative” symptoms, eg restricted affect, asociality
B. Significant decreased function at work, in interpersonal relations, or in self-care.
C. At least one month of active symptoms (criteria A) unless successfully treated and at least six months of all symptoms (pro formal, active, and residual).
D. Does not meet criteria for schizoaffective disorder, and symptoms of psychosis are not caused by substance abuse.
Main difference between Manic-Depressive Illness (Bi-Piloar) and Schizophrenia
The predominant clinical symptoms involving disorders of mood rather than disorders of thought
Why is it so common to see schizophrenia begin after a person has used mind altering drugs?
- Both drug abuse and the onset of schizophrenia occur in the same age range of the late teens and early 20s. The percentage of people in this age range who have at least smoked a few joints is very high.
- Second, and more important, is the common sequence of people developing the early symptoms of schizophrenia and then turning to mind altering drugs to provide a rationalization for what they are experiencing.
Hendricks Decision
1994 Kansas passed law allowing the indefinite incarceration of sexually violent predators in public psychiatric hospitals.
Law upheld by US Supreme Court in 1997
Bad Predictor Outcomes
Major problems in childhood Male Family history of schizophrenia Younger age of onset Slow onset Predominantly "negative" outcomes Flattening of emotions Poor awareness of illness Abnormal CT or MRI Poor initial response to medication
Good Predictor Outcomes
Relatively normal childhood Female No family history of schizophrenia Older age at onset Sudden onset Paranoid or catatonic symptoms Presence of normal emotions Good awareness of illness Normal CT or MRI Good initial response to medication
Average patient length of stay in 1993
Acute psychiatric care = 13 days
Average patient length of stay 2009
9 days
Are laws that govern the commitment of psychiatric patients state or federal laws?
State. Wherefore, they vary from state to state
“Parens Patriae”
The right of the state to act as parent and protect a disabled person
What are the Major differences in commitment procedures among states?
1) the Grounds that are used for commitment
2) the standard of proof.
What state was one of the the first to move in broadening the grounds for commuting a patient?
Washington. 1979
What are the different alternatives to hospitalizations?
- Use of drugs given by injection at an emergency room or clinic. (Temporary. Does not give rest to family.)
- Mobile treatment teams that go to the individuals home, assess the situation, and frequently begin treatment on the spot. (Effective only where there is also skilled and coordinated follow-up)
- Institutions other than hospitals: Semi-Hospitals, Institutions for mental disease (IMD’s), or crisis homes.
- Treatment of patient at home, using public health nurses or, rarely, physicians to make home visits.
- Partial Hospitalizations. Day Hospitals. (Less available tha. They should be because of restrictions on how federal Medicaid funds can be used.
What are the 3 important variables that determine the quality of outpatient psychiatric care?
- Competency of the Professionals
- Targeting the seriously Mentally Ill as first priority
- Continuity of Care
What are the 2 reasons we do not provide quality outpatient services for individuals with schizophrenia?
- We have structured the fiscal aspects of outpatient services in a way that guarantees failure. For outpatient psychiatric services, Medicaid and private insurance companies will reimburse for some kinds of specific services but not for others; there are no fiscal incentives to utilize continuous treatment teams or to keep patients from relapsing.
- Managed Care. Originally implemented in the 1990’s to help stem the tide of rapidly escalating medical costs, it has actually guaranteed poor care for chronic diseases, including schizophrenia.
How many different antipsychotic drugs exist in pill form?
18
How are antipsychotic drugs divided?
1st Generation - before 1990 (Typical)
2nd Generation - after 1990 (atypical)
How should the voice of drug be made?
Whenever possible, the choice should be made jointly by the patient and the patients family
After how long of a period should another antipsychotic be tried with a patient?
Two weeks
Which herbal medications help with schizophrenia?
Evening primrose oil
Ginkgo biloba
Which is the most effective antipsychotic drug used to treat schizophrenia?
Clozapine (Clorazil)
What are the major side effects for Clozapine (Clorazil)?
Rarely used in US Sedation Weight gain Constipation Salivation
- decreased white blood cells
- can be fatal
- if using, 1st 6 months need blood test once a week
- 2nd 6 months need blood test once every other week
