Schizophrenia Flashcards
define delusions
fixed beliefs that are not amendable to change in light of conflicting evidence
most common type of delusion
persecutory
the belief that one is going to be harmed, harassed etc by an individual, organization or group
persecutory delusion
the belief that certain gestures, comments, environmental cues etc are directed at oneself
referential delusion
the belief that they have exceptional abilities, wealth or fame
gradiose
belief that another person is inlove with them (ps this delusion isn’t true)
ergotomanic delusion
the conviction that a major catastrophe will occur (every day in PA school)
nihilistic delusion
the preoccupation on health or organ function
somatic delusion
are acute psychoses more or less organized
LESS organized
bizarre, implausible, and not derived from ordinary life experiences
delusions of psychotic disorders
a disturbance in perception that occurs without external stimulus. vivid and clear with full force and impact on normal perceptions.
Hallucinations
are hallucinations voluntary or involuntary
involuntary
what are the 2 most common hallucinations?
sensory and auditory
thinking is frequently incomprehensible and illogical
disturbance of thought process
looseness of association, derailment, tangential thought midsentence and incoherent speech
disturbance of thought process
normal human thinking has 3 characteristics
content (any delusions or obsessions)
form: how thoughts are linked together
stream/flow: how it is being thought about, amount, and speed of thinking
content of the speech moves quickly and from one idea to another so that the one train of thought is not carried to completion befor another takes place.
flight of ideas
with flight of ideas is the normal logical sequence of ideas preserved?
yes, actually it is. There is a sense of direction and form. However, thoughts are linked by distracting cues.
three types of verbal distractions that prompt flight of ideas
clang associations, puns, and rhymes
does looseness of association demonstrate a sense of direction
NO!
overinclusiveness
continually disrupting flow of thought by including irrelevant information
coining new words which often have a symbolic meaning to them
neologism
blocking
speech halted midsentence then picked up moment/minutes later, usually in another place (can represent intrusive hallucinations)
clanging
chooses next words and themes based on the sound of the words he is using rather than the thought content (often rhymes a primary word in one sentence with a word in preceding sentence)
repeating words or phrases in a musical fashion
echolalia
concreteness
patient of normal or above normal IQ thinks in abstract terms poorly
speaking very little (poverty of speech) or speak normal amount, but say little (poverty of speach content)
alogia
what condition is alogia common in
schizophrenia
is alogia a positive or negative symptom
negative
what gives a psych patient a MUCH better prognosis?
insight into their illness
examples of abnormal motor behavior (4)
strange grimacing/posturing
excessive silliness (childlike)
aggressiveness or unprovoked agitation
sexual inappropriateness
most common abnormal motor behavior
grimacing/ abnormal posturing
marked decrease in reactivity to surrounding environment
catatonic behavior
the following are characteristics of what type of behavior?
resistance to instructions (negativism)
maintaining rigid of inappropropriate posture
a complete lack of verbal (mutism) or motor (stupor) response
catatonic behavior
purposeless and excessive motor activity without obvious cause
catatonic excitement
is catatonic behavior exclusive to schizophrenia?
no!
three positive symptoms
delusions
hallucinations
disorganized/bizarre behavior
4 negative symptoms
flat affect
alogia
avolition
anhedonia
prosody
intonation of speech
decrease in motivated self-initiated purposeful activities
avolition
is psychosis a degree of severity or a specific disorder
degree of severity
a person with grossly impaired sense of reality often coupled with emotional and cognitive disabilities that severely compromises their ability to function
psychotic patient
a patient who is likely to talk and act in a bizarre fashion, have hallucinations, or strongly hold ideas that are contrary to fact (delusions)
psychotic patient
are psychotic patients confused or disoriented?
yes, BOTH!
do psychotic patients have insight?
NO WAY JOSE!
what are major psychotic disorders?
conditions that MUST reach psychotic proportions AT SOME TIME during their course (although patients may be non-psychotic most of the time)
psychotic disorders include…
schizotypal personality disorder delusional disorder catatonia disorder brief psychotic disorder schizophreniform disorder schizophrenia schizoaffective disorder psychotic disorder due to general medical conditions substance-induced psychotic disorder
delusion disorder
the presence of one or more delusions with a duration of ONE MONTH OR LONGER
is functioning and behavior markedly impaired and bizarre?
nah
is it still delusional disorder if manic or major depressive episodes have occured?
yes, but they have to be brief relative to the duration of the delusional periods
if the disturbance is due to substance, medical, or other mental disorder is it still delusional disorder?
NOPE!
types of delusional disorder (7)
erotomanic type grandiose type jealous type persecutory type somatic type mixed type unspecified type
are delusional patients able to acknowledge that their delusion is irrational?
yes, but they can’t accept it themselves
gender predominance of delusional disorder
there is none!
is global functioning of delusional disorder better or worse than schizophrenia
BETTER :)
does delusional disorder have a stable disease course
yes, but few go on to develop schizophrenia
delusional disorder’s affect on mood or mood stability
there is none!
drug of choice to treat delusional disorder
anti-psychotics
what route should you administer anti-psychotics to an agitated patient
IM!
are delusional patients likely to accept drugs?
no!
what is the most common cause of drug failure in delusional patients
noncompliance
secondary treatment for delusional disorder
psychotherapy
4 clinical pearls to treating delusional patients with psychotherapy
don’t challenge or support delusion
ask for further elaboration of the story
acknowledge that the delusion causes them distress
they are sensitive to criticism so beware
criteria of brief psychotic disorder
at least one of the following (1-3)
- delusions
- hallucinations
- disorganized speech (frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
for more than one day but less than one month
must return to normal
three things to specify in brief psychotic disorder
marked stressors
without marked stressors
with postpartum onset
turbulent and dramatic with marked emotional labiality with bizarre behavior, confused and incoherent speech, transient disorientation and memory loss, and brief but striking hallucinations and delusion
brief psychotic disorder
what is the long term prognosis of brief psychotic disorder
good if the issue is resolved
what is a huge worry with brief psychotic patients
suicide
treatment for brief psychotic disorder
high potnency antipsychotics with anticholinergic medication to stop medication induced movement disorder
a disorder that is clinically indistinguishable from brief psychotic disorder and schizophrenia EXCEPT that the symptoms last more than a month but less than 6 months
schizophreniform disorder
symptom duration of schizophreniform disorder
more than 1 month but less than 6
what must you rule out before diagnosing schizophreniform disorder
organic psychosis
how to rule out organic psychosis
TSH
brain CT
drug test
is prognosis better or worse for schizophreniform disorder than an acute schizophrenic episode
BETTER
what three things must be ruled out before diagnosing someone with schizophreniform disorder
schizoaffective disorder and depressive or bipolar disorder with psychotic features
if major depressive or manic episodes occur concurrently with the active-phase symptoms of schizophreniform disorder is it still the diagnosis
no
if mood symptoms occur during active phase of schizophreniform disorder symptoms is it still the diagnosis?
they must be present for a minority of the total duration
what are active phase symptoms of schizophreniform disorder
delusions
hallucinations
disorganized speech
what makes a good prognosis for schizophreniform disorder
atleast two of the following
onset of prominent psychotic features within 4 weeks of noticable change in unusual behavior or functioning
confusion or perplexity
good premorbid social and occupational functioning
absence of blunted or flat affect
are the characterisitc symptoms of schizophreniform disorder like or unlike schizophrenia
they’re identical, in fact
how do you differentiate schizophreniform disorder from schizophrenia
difference in duration
when calculating the duration of schizophreniform disorder do you include prodromal, active, and residual phases?
yes
how many don’t progress from schizophreniform disorder to schizophrenia or schizoaffective disorder
1/3
provisional schizophreniform disorder
2 weeks short of the diagnosis
delusions of grandeur, paranoia, deterioration of cognitive function, and personality
schizophrenia
criteria for diagnosing schizophrenia
Two or more of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1), (2), or (3)
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior
5) Negative symptoms
duration of symptoms to diagnose schizophrenia
> 6 months of continuous signs of disturbance with 1 month of symptoms (less if successfully treated)
what aspects of one’s life must schizophrenia permeate?
atleast one or more of (work, interpersonal relations, and self care) is markedly below the level achieved prior to the onset
what must you rule out to diagnose schizophrenia
schizoaffective disorder and depressive or bipolar disorder
what two other medical conditions heightens the threshold for diagnosing schizophrenia
autism and communication disorder of childhood onset
what additional criteria must be met to diagnose an autistic patient or one with a communication disorder of childhood onset with schizophrenia
if prominent delusions or hallucinations, in addition to other required symptoms of schizophrenia are also present for at least 1 month
pathognomonic cognitive, behavioral, and emotional dysfunctions of schizophrenia
there are none
what kind of mood may schizophrenics have
dysphoric that can take the form of anxiety, anger, or depression
what sleep pattern may schizophrenics have?
sleep all day, up all night
what type of affect may schizophrenics have
inappropriate, laughing at nothing
how does schizophrenia affect memory and learning
deficits
do schizophrenics have insight?
nope, but if they do then they’ll have a good prognosis
how common is spontaneous or random assult in schizophrenics
uncommon even though they can be hostile or aggressive
gender predominance of schizophrenia
equal
peak onset age of schizophrenia in men
teens-25
peak onset of schizophrenia in women
25-30 and women have a second peak in middle age
late onset schizophrenia after what age
45
gender with better outcome of schizophrenia
women
risk of first degree relative to develop schizophrenia
10x
does nicotine help or harm schizophrenia functioning
help, seems to have less hallucinations
three neurotransmitters related in schizophrenia
too much DOPAMINE
too much SEROTONIN
NOREPI
schizophrenia’s affect on the brain
loss of brain volume, decreased axon density, dendrites, and synapses
residual phase of schizophrenia
Thinking and speech are vague and seen by other as odd
Become convinced that they are different from others
May believe they have special powers and sensitivities, have mystical or psychic experiences
Personal appearance and manners deteriorate
Affect often blunted, flat, or inappropriate
Although maintain close to normal intelligence, performance on cognitive tests is modest
Frequently anhedonic
is the disease still present if psychosis resolves in schizophrenia
yes!
suspect suicide in schizophrenic patients with…
Absolute emptiness Auditory commands to kill themselves Awareness of the illness Males College educated Young age Change in the course of the disease Living alone Improvement after a relapse Dependence on hospital because they have no where else to go
what substances do schizophrenics commonly abuse
nicotine
alcohol
cannabis
cocaine
when can the patients course of schizophrenia be determined
first 5 years
do positive symptoms in schizophrenia get better or worse with time
better
do negative symptoms in schizophrenia get better or worse with time
worse
DDx for schizophrenia
schizophreniform disorder (but 1mo-6mo) brief psychotic d/o (
differentiating MDD or bipolar with psychotic features from schizoid d/o
Distinction between schizophrenia VS major depressive or bipolar d/o with psychotic features depends on temporal relationship between mood disturbance and psychosis
If psychosis occurs exclusively during a major depressive or manic episode, the diagnosis is depressive or bipolar d/o with psychotic features
strikingly odd or strange, peculiarities of thinking, behavior or appearance but lack psychosis (symptoms are subthreshold and persistent)
schizotypal personality disorder
lifelong pattern of social withdrawal, not episodic, bland constricted affect, can seem cold/aloof. Lack positive symptoms
schizoid personality d.o
considerations of treatment for schizophrenia
Treatment shaped individually in light of individual, family, and social factors
How the patient is affected by the disorder
How the patient will be helped by therapy
No single therapeutic approach to deal with this multifaceted disorder
mainstay of tx for schizophrenia
antipsychotics
This phase usually lasts 4-8 weeks
Typically associated with severe agitation
Can be from a frightening delusion or hallucination, suspiciousness etc.
acute phase
goal of schizophrenia tx
prevent relapse and improve fxn
An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with symptoms of schizophrenia
schizoaffective d.o
Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness
schizoaffective d/o
Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
schizoaffective d/o
to differentiate schizoaffective vs bipolar/depression with psychotic features
The delusions or hallucinations must be present for at least 2 weeks in the absence of major mood episode
Need very good history, disease progress info to make accurate dx
common onset of schizoaffective disorder
adulthood
prognosis for schizoaffective d/o
Prognosis better than schizophrenia, but worse than for mood disorders
culture bound psychotic syndromes
Amok and koro
amok
Murderous frenzy
Seen in Papua New Guinea
Sudden, unprovoked outburst of wild rage wherein people attack and maim people and animals
Brooding and mild depression precede
After attack, person has no memory and often commits suicide
Tx by overpowering person; attack lasts a few hours
koro
feeling penis is shrinking and will disappear into abdomen
Southeast Asia and some areas of China
