Schizophrenia

Question 1

4 phases of schizophrenia

Answer 1

Premorbid
Prodromal
Acute or Psychotic
Stable/residual phase

Question 2

Premorbid Phase

Answer 2

Indications for early intervention include:

1. delayed motor milestones
2. Poor scholastic performance
3. Reduced concentration
4. Passivity
5. Depression, anxiety, irritability and/or anger
6. Sleep disturbance
7. Bedwetting
8. Social withdrawal

Question 3

Prodromal Phase

Answer 3

Often ignored, may result in treatment delays:

1. Marked peculiar behavior
2. Inappropriate expression of feeling
3. Speech difficult to follow
4. Poverty of speech and thought
5. Odd ideas and ideas of reference
6. Feelings of unreality
7. Suspiciousness
8. Deterioration in role functioning

Question 4

Acute or Psychotic Phase

Answer 4

Positive Symptoms

Full-blown psychosis

Question 5

Stable/Residual Phase

Answer 5

Symptoms similar to schizophrenia prodromal phase

Question 6

Genetics of Scz

Answer 6

1. Seemingly multigenic vulnerability to schizophrenia that is no completely expressed
2. Chromosomes 6 and 22 suggested as possible locations
3. 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.

Question 7

Neurobiological Findings in Scz

Answer 7

Dec brain volume
Larger third ventricles
Atrophy of frontal lobe, cerebellum, hippocampus, and amygdala

Question 8

PET scans in scz

Answer 8

Dec blood flow to frontal cortex and overactivity in basal ganglia

Question 9

NT abnormalities in scz

Answer 9

Abnormal serotonin, glutamate, and GABA activity

Question 10

Environmental/Situational Factors

Answer 10

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

Question 11

Stress Vulnerability Model of Scz

Answer 11

Combination of:

1. Genetic or neurodevelopmental vulnerability
2. Triggered by high exposure to psychosocial stressors

Question 12

Stressors in Scz

Answer 12

1. Over-involved, critical, and hostile families with high levels of expressed emotion often have more difficulty assisting the schizophrenic member with maintaining stability.
2. Even when compliant with meds stressed out people with scz become vulnerable to exacerbations

Question 13

Protective Factors in Scz

Answer 13

High SES
Learned coping skills
Stable family
Higher education

Question 14

Types of scz

Answer 14

Paranoid
Disorganized
Catatonic
Undifferentiated
Residual

Question 15

Paranoid Type

Answer 15

Preoccupied with delusions and auditory hallucinations with little disorganized or affective flattening

Question 16

Disorganized Type

Answer 16

Characterized by disorganized speech and behavior with flat or inappropriate affect

Question 17

Catatonic Type

Answer 17

Clinical picture dominated by 2 or more behavioral patterns:

1. Motor immobility cataplexy, waxy flexibility, stupor
2. Seemingly purposeless excessive motor activity
3. Extreme negativism
4. Peculiar movement, posturing, stereotype movement, prominent mannerisms or grimacing
5. Echolalia or echopraxia

Question 18

Undifferentiated Type

Answer 18

Meets criteria for schizophrenia but not one of other types

Question 19

Residual Type

Answer 19

1. Absence of prominent delusions
2. Hallucinations
3. Disorganized speech or behavior
4. Catatonic behavior but continuing evidence of negative symptoms or attenuated symptoms of scz

Question 20

Schizophreniform DO

Answer 20

Scz sx last between 1 and 6 months

Question 21

Brief Psychotic DO

Answer 21

Scz sx last between 1 day and 1 month

Question 22

Shared Psychotic Disorder

Answer 22

A second person develops a similar delusion in a close relationship with an individual with an established delusion

Question 23

Men and women in schizophrenia

Answer 23

Equal rates

Question 24

PORT Study

Answer 24

Recommends psychotherapeutic interventions for Schizophrenia

Question 25

PORT Study recommendations

Answer 25

• 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

Question 26

First Choice pharma for scz

Answer 26

SGAs, but not Clozaril or Zyprexa because of metabolic problems

Question 27

If antipsychotic naive…

Answer 27

use a lower dose than someone who is more chronic a relapsing

Question 28

If pt responds initially to antipsychotic, but relapses…

Answer 28

try another SGA

Question 29

Treatment resistant schz:

Answer 29

After 2 (8-12 week) failed trials of SGAs, considered treatment resistant. Consider clozapine

Question 30

Therapeutic Clozapine (Clozaril) blood level

Answer 30

350 ng/mL

Question 31

SGA most likely to widen QTc interval

Answer 31

Geodon (Ziprasodone)

Question 32

Seroquel side effects

Answer 32

Cataracts in dogs

Question 33

Abilify SEs

Answer 33

Orthostatic hypotension

Question 34

Zyprexa primary SE

Answer 34

Weight Gain

Question 35

Risperdal Primary SE

Answer 35

Sexual Dysfunction

Hyperprolactinemia

Question 36

Treatment for Delusions

Answer 36

1. Question facts presented and meaning to patient
2. Assess duration, frequency, intensity, and triggers
3. Identify emotional components and assist patient to connect with stress
4. Discuss consequences when patient is ready and not actively delusional
5. Focus on emotions, not content
6. Promote distraction and healthy ways of meeting needs and spending time.