Schizophrenia Flashcards
Schizophrenia
Signs and Symptoms
Delusions
Hallucinations
Disorganized thinking
Disorganized behavior
Negative symptoms (flat affect, alogia, avolution, anhedonia)
What are the negative symptoms of Schizophrenia?
Affective flattening (no discernable emotion)
Alogia (not speaking a lot)
Anhedonia (does not derive pleasure from anything)
Avolution (not much motivation)
How might you screen for delusions in a patient with Schizophrenia?
Get a collateral history from someone who came with pt
Ask “Are you having any conflicts in your life? Tell me about them.” (They will have had conflicts with those who don’t believe their delusions)
What are delusions?
Unusual thoughts, suspiciousness
Strange thoughts out of touch with reality
May be bizarre (aliens)
May be about marital affairs, neighbors watching them
What are the most and least common hallucinations in Schizophrenia?
Most common: Auditory
2nd most common: Visual
Least common: Gustatory and Olfactory
What is disorganized thinking?
Trouble thinking clearly and understanding others, which impairs good communication
Tangential thought process
Incoherence
Word salad
What is disorganized behavior?
Childlike silliness
Agitation
Inappropriate sex behavior
Shouting, swearing
Catatonic behavior (assuming many postures)
What are the criteria for Schizophrenia A?
2/5 symptoms (delusions, hallucinations, disorganized thinking/behavior, negative symptoms)
One must be a delusion, hallucination, or disorganized thinking
Describe the Downward Drift Hypothesis of Schizophrenia
Because of their sociooccupational dysfunction, Schizophrenia pts lose their other supports (jobs, friends, family, money).
They gradually shift down on the socioeconomic spectrum.
Schizophrenia
Time/Duration
Signs/symptoms for at least 6 months
For diagnosis, need to have met A criteria for at least 1 month
If you have symptoms of Schizophrenia for ____, what do you have?
Less than 1 month–
1-6 months–
Over 6 months–
Less than 1 month– Brief psychotic reaction
1-6 months– Schizophreniform disorder
Over 6 months– Schizophrenia
Schizoaffective Disorder
What are the criteria?
MDD or Bipolar + Schizophrenia A criteria met
Needs a period of time in which they had a psychotic episode with no mood symptoms for at least 2 weeks
Delusional Disorder
What are the criteria?
Delusions, bizarre or not, for 1 month
Schizophrenia A Criteria are NOT MET
(Outside of the delusion, they are doing fine!)
What is psychosis due to a substance?
Psychosis caused by intoxication or withdrawal from a substance
Should resolve fairly quickly
High doses of ___ can results in a clinical picture that looks like Schizophrenia, depression, or a manic episode
Steroids
In a child who comes in with poor communication skills or reciprocal social skills, what are they likely to have?
50x more likely to have Autism, Rhett’s, Asperger’s than Childhood Schizophrenia
Schizophrenia
Prevalence (Males v Females)
M = F
More prevalent than Alzheimers, T1DM, MS
Schizophrenia
Three Phases in the Course of Disease
Prodromal phase- months to years before active
Active Phase- meets criteria A
Residual phase- remission
Schizophrenia
Peak age of Onset for Males and Females
Males: late teens/early 20s
Females: late 20s (also have a small pear after 40)
Schizophrenia
Suicide Risk
20% attempt
Higher risk in those who are well functioning and have good insight about their disease
Schizophrenia
How can Cognitive Impairment be measured?
SMART- Speed, Memory, Attention, Reasoning, Tact
Wisconsin Card sort
Schizophrenia
What is Anosognosia?
Lack of partial awareness or insight, varying with phase of illness
Schizophrenia
Good Prognostic Predictors
- Responds well to first course of antipsychotics
- Older age
- Female
- No family history
- No negative symptoms
Schizophrenia
Outcome
Most don’t work or marry. Only 1/3 live independently. Most have limited social contact.
Low quality of life
Life expectancy is 48-53 years
Neurochemical Theory of Schizophrenia Cause
Too much dopamine leads to psychosis and Schizophrenia symptoms
Anti-psychotics are dopamine antagonists
Genetics Theory of Schizophrenia Cause
- 50% risk if identical twin has it
- 40% risk if both parents have it
- 10% risk if parent or sibling has it
What is the leading theory of what causes Schizophrenia?
Genetic predisposition with environmental exposures/stresses during pregnancy or early life
