Schizophrenia

Question 0

What are the three main divisions of the frontal lobe?

Answer 0

1) prefrontal cortex
2) premotor area
3) motor area

Question 1

Schizophrenia definition

Answer 1

Splitting of senses

1911 - Swiss Psychiatrist Eugene Bleuler German

Question 2

Abnormalities of People with Scizophrenia

Answer 2

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

Question 3

Alterations of Senses

Answer 3

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.

Question 4

Temporal Lobe

Answer 4

1) auditory perception
2) memory
3) speech
4) emotional responses
5) visual perception

Question 5

Kurt Schneider’s (German Psychiatrist)

First Rank Symptoms for Schizophrenia

Answer 5

1. Auditory hallucinations: voices speak ones thoughts aloud
2. Auditory hallucinations: 2 voices arguing
3. Auditory hallucinations: voices commenting on ones actions
4. Hallucinations of touch when the bodily sensation is imposed by so e external agency
5. Withdrawal of thoughts from ones mind
6. Insertion of thoughts into ones mind by others
7. Believing ones thoughts are being broadcast to others, as by radio or television
8. Insertion by others of feelings into ones mind
9. Insertion by others of irresistible impulses into ones mind
10. Feeling that all ones actions are under the control of others, like an automaton
11. Delusions of perception, as when one is certain that a normal remark has a secret meaning for oneself

Question 6

Definition of Crazy

Answer 6

Craziness has it’s roots in the disordered brain function that produces erroneous sensory data and disordered thinking.

Question 7

Anosognosia

Answer 7

Decreased awareness of illness

Question 8

Frontal Lobe

Answer 8

1) Motor functions
2) Higher order functions
3) Planning
4) Reasoning
5) Judgment
6) Impulse Control
7) Memory

Question 9

Preliminary Criteria for the diagnosis of Schizophrenia under DSM-V

Answer 9

A. Two or more of the following symptoms must be present for a significant portion of time during a one-month period.

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Catatonic or other grossly abnormal psychomotor behavior
5. “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.

Question 10

Main difference between Manic-Depressive Illness (Bi-Piloar) and Schizophrenia

Answer 10

The predominant clinical symptoms involving disorders of mood rather than disorders of thought

Question 11

Why is it so common to see schizophrenia begin after a person has used mind altering drugs?

Answer 11

1. 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.
2. 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.

Question 12

Hendricks Decision

Answer 12

1994 Kansas passed law allowing the indefinite incarceration of sexually violent predators in public psychiatric hospitals.

Law upheld by US Supreme Court in 1997

Question 13

Bad Predictor Outcomes

Answer 13

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

Question 14

Good Predictor Outcomes

Answer 14

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

Question 15

Average patient length of stay in 1993

Answer 15

Acute psychiatric care = 13 days

Question 16

Average patient length of stay 2009

Answer 16

9 days

Question 17

Are laws that govern the commitment of psychiatric patients state or federal laws?

Answer 17

State. Wherefore, they vary from state to state

Question 18

“Parens Patriae”

Answer 18

The right of the state to act as parent and protect a disabled person

Question 19

What are the Major differences in commitment procedures among states?

Answer 19

1) the Grounds that are used for commitment

2) the standard of proof.

Question 20

What state was one of the the first to move in broadening the grounds for commuting a patient?

Answer 20

Washington. 1979

Question 21

What are the different alternatives to hospitalizations?

Answer 21

1. Use of drugs given by injection at an emergency room or clinic. (Temporary. Does not give rest to family.)
2. 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)
3. Institutions other than hospitals: Semi-Hospitals, Institutions for mental disease (IMD’s), or crisis homes.
4. Treatment of patient at home, using public health nurses or, rarely, physicians to make home visits.
5. Partial Hospitalizations. Day Hospitals. (Less available tha. They should be because of restrictions on how federal Medicaid funds can be used.

Question 22

What are the 3 important variables that determine the quality of outpatient psychiatric care?

Answer 22

1. Competency of the Professionals
2. Targeting the seriously Mentally Ill as first priority
3. Continuity of Care

Question 23

What are the 2 reasons we do not provide quality outpatient services for individuals with schizophrenia?

Answer 23

1. 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.
2. 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.

Question 24

How many different antipsychotic drugs exist in pill form?

Answer 24

18

Question 25

How are antipsychotic drugs divided?

Answer 25

1st Generation - before 1990 (Typical)

2nd Generation - after 1990 (atypical)

Question 26

How should the voice of drug be made?

Answer 26

Whenever possible, the choice should be made jointly by the patient and the patients family

Question 27

After how long of a period should another antipsychotic be tried with a patient?

Answer 27

Two weeks

Question 28

Which herbal medications help with schizophrenia?

Answer 28

Evening primrose oil

Ginkgo biloba

Question 29

Which is the most effective antipsychotic drug used to treat schizophrenia?

Answer 29

Clozapine (Clorazil)

Question 30

What are the major side effects for Clozapine (Clorazil)?

Answer 30

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