Schizophrenia

Question 1

What are the 4 A’s originally associated as the hallmarks of schizophrenia?

Answer 1

Autism - social withdrawal

Ambivalence - lack of motivation

Affect - inappropriate or flat

Association - loose and disorganized

Question 2

DSM5 Criteria for Schizophrenia?

Answer 2

Continuous signs of disturbance for at least 6 months and at least 2 or more symptoms for most of 1 month:

• delusions
• hallucinations
• disorganized speech
• grossly disorganized or catatonic behavior
• Negative symptoms (alogia, affective flattening, avolition)

+Social/Occupational Dysfunction

Question 3

Briefly describe the 5 Schizophrenia Spectrum Disorders?

Answer 3

1) Delusional Disorder: one or more delusions of 1 month or longer
2) Brief Psychotic Disorder: psychotic symptoms at least 1 day but less than 1 month; often in response to stressor
3) Schizophreniform Disorder: Criteria A symptoms >1 month but <6 months
4) Schizoaffective Disorder: psychotic symptoms (only for 2 weeks) + Mood disorder symptoms more of the time
5) Substance/Medication induced psychotic disorder

Question 4

Positive Symptoms of Schizophrenia

Answer 4

Delusions - firm, false, fied ideas including ideas of reference

Disorganization - tangentially, incoherent, loose association, word salad

Inappropriate affect

Grossly disorganized or catatonic behavior

Hallucinations - false perceptions

Question 5

NEgative symptoms of Schizophrenia

Answer 5

Blunted Affect

Alogia - poverty of speech or speech content

Avolition - lack of will and motivation to do things

Negative Symptoms can be primary or secondary (secondary to antipsychotic meds)

Question 6

Describe some of the other features of schizophrenia?

Answer 6

Relational problems - social interactions and intimacy

***Cognitive Dysfunction - attention/vigilance, processing speed, problem solving, learning and memory, social cognition

Question 7

What is the Modified Da Hypothesis of Schizophrenia?

Answer 7

POsitive symptoms may be mediated by Da excess in Limbic regions

Negative symptoms may be mediated by decreased Da in Prefrontal areas

Side effects are caused by Anti-Da effects of medications in the BG

Question 8

What are some factors predicting poor prognosis in schizophrenia?

Answer 8

Early onset

no precipitating factors and insidious onset

Poor premorbid functioning

Withdrawn, autistic behavior

Family history

Negative symptoms

Question 9

What are the first-line treatments to reduce positivy psychotic symptoms? What’s the difference between the 2 categories of drugs used?

Answer 9

Older - Typical - 1st Generation Antipsychotics: Chlorpromazine, Perphenazine, Haloperidol all work through D2 blockade and have EPS

Newer - Atypical - 2nd generation Antipsychotics: Olanzapine, Risperidone, Quetiapine all work with varying Da affinity and have more metabolic side effects

Question 10

When/who would you use Clozapine for?

Answer 10

Clozapine is a unique atypical that should be offered to people with persistent and clinically significant positve symptoms in spite of treatment with other antipsychotics aka non-responders

Question 11

What is the model for “recovery”?

Answer 11

also talked about in addiction

Want symptom remission and return to functioning

is a continual PROCESS rather than an end state

Strength-based vs symptom based

Hope, Respect, Empowerment