Schizophrenia Flashcards
4 phases of schizophrenia
Premorbid
Prodromal
Acute or Psychotic
Stable/residual phase
Premorbid Phase
Indications for early intervention include:
- delayed motor milestones
- Poor scholastic performance
- Reduced concentration
- Passivity
- Depression, anxiety, irritability and/or anger
- Sleep disturbance
- Bedwetting
- Social withdrawal
Prodromal Phase
Often ignored, may result in treatment delays:
- Marked peculiar behavior
- Inappropriate expression of feeling
- Speech difficult to follow
- Poverty of speech and thought
- Odd ideas and ideas of reference
- Feelings of unreality
- Suspiciousness
- Deterioration in role functioning
Acute or Psychotic Phase
Positive Symptoms
Full-blown psychosis
Stable/Residual Phase
Symptoms similar to schizophrenia prodromal phase
Genetics of Scz
- Seemingly multigenic vulnerability to schizophrenia that is no completely expressed
- Chromosomes 6 and 22 suggested as possible locations
- Monozygotic twins of schizophrenics have a 35 to 50% risk, fraternal twins and other siblings have a 15% risk, children of one parent also have a 15% risk, and children with 2 schizophrenic parents have a 35% risk.
Neurobiological Findings in Scz
Dec brain volume
Larger third ventricles
Atrophy of frontal lobe, cerebellum, hippocampus, and amygdala
PET scans in scz
Dec blood flow to frontal cortex and overactivity in basal ganglia
NT abnormalities in scz
Abnormal serotonin, glutamate, and GABA activity
Environmental/Situational Factors
Slim correlations:
Urban environments and/or high pollution
Maternal starvation and viral infections during fetal development
Children born after long labor or delivery complications
Following high fevers in childhood
Stress Vulnerability Model of Scz
Combination of:
- Genetic or neurodevelopmental vulnerability
- Triggered by high exposure to psychosocial stressors
Stressors in Scz
- Over-involved, critical, and hostile families with high levels of expressed emotion often have more difficulty assisting the schizophrenic member with maintaining stability.
- Even when compliant with meds stressed out people with scz become vulnerable to exacerbations
Protective Factors in Scz
High SES
Learned coping skills
Stable family
Higher education
Types of scz
Paranoid Disorganized Catatonic Undifferentiated Residual
Paranoid Type
Preoccupied with delusions and auditory hallucinations with little disorganized or affective flattening
Disorganized Type
Characterized by disorganized speech and behavior with flat or inappropriate affect
Catatonic Type
Clinical picture dominated by 2 or more behavioral patterns:
- Motor immobility cataplexy, waxy flexibility, stupor
- Seemingly purposeless excessive motor activity
- Extreme negativism
- Peculiar movement, posturing, stereotype movement, prominent mannerisms or grimacing
- Echolalia or echopraxia
Undifferentiated Type
Meets criteria for schizophrenia but not one of other types
Residual Type
- Absence of prominent delusions
- Hallucinations
- Disorganized speech or behavior
- Catatonic behavior but continuing evidence of negative symptoms or attenuated symptoms of scz
Schizophreniform DO
Scz sx last between 1 and 6 months
Brief Psychotic DO
Scz sx last between 1 day and 1 month
Shared Psychotic Disorder
A second person develops a similar delusion in a close relationship with an individual with an established delusion
Men and women in schizophrenia
Equal rates
PORT Study
Recommends psychotherapeutic interventions for Schizophrenia
PORT Study recommendations
- Assertive Community Treatment
- CBT for 4-9 months
- Alcohol and substance abuse interventions
- Skill training: Healthy lifestyle
- Trigger and relapse identification
- Family services: 6-9 months
- Group therapy: Clubhouse groups
- Self-help and support groups
First Choice pharma for scz
SGAs, but not Clozaril or Zyprexa because of metabolic problems
If antipsychotic naive…
use a lower dose than someone who is more chronic a relapsing
If pt responds initially to antipsychotic, but relapses…
try another SGA
Treatment resistant schz:
After 2 (8-12 week) failed trials of SGAs, considered treatment resistant. Consider clozapine
Therapeutic Clozapine (Clozaril) blood level
350 ng/mL
SGA most likely to widen QTc interval
Geodon (Ziprasodone)
Seroquel side effects
Cataracts in dogs
Abilify SEs
Orthostatic hypotension
Zyprexa primary SE
Weight Gain
Risperdal Primary SE
Sexual Dysfunction
Hyperprolactinemia
Treatment for Delusions
- Question facts presented and meaning to patient
- Assess duration, frequency, intensity, and triggers
- Identify emotional components and assist patient to connect with stress
- Discuss consequences when patient is ready and not actively delusional
- Focus on emotions, not content
- Promote distraction and healthy ways of meeting needs and spending time.
