Schizophrenia Flashcards
what is psychosis?
Psychosis is a pathological mental state characterized by the abnormal
interpretation,
organization of cognitive stimuli, those generated internally and encountered externally.
It includes an inability to distinguish between real and not real stimuli.
psychosis is a ______, and _____ can lead to psychosis
symptoms, multiple illnesses
Early schizophrenia characteristically was described as having:
loss of distinct cognitive processes and early onset of deteriorating disorder (including hallucination and delusion)
when Schneider described schizophrenia he:
began focusing on the positive aspects of the disease, i.e. auditory hallucinations, voices telling you how to move or controlling your actions, breathing, etc (also maybe the devil doing throught broadcasting, etc)
what is psychosis?
A break from reality involving
Delusions
Perceptual disturbances
Disordered thinking
epidemiology of schizophrenia:
Lifetime prevalence: 0.5-1% Average age of onset: 18 for men, up to 25 for women. ~50% of psychiatric beds ~15% of all treated mental illness Costs to society: ~$30 billion/yr 2.5% of total health care costs 9th leading cause of disability worldwide Suicide: 50% attempt, 10% complete
difference between men and women with schizophrenia:
men often are diagnosed at a young age, and they become homeless, drug users, etc. The females often get married, have kids, come to doctors appointments, tke medications, etc
having support and taking medication makes a huge difference!
TEST: if 21 yr old shows up in ed naked with aluminum foil hat talking about aliens reading his thoughts and hasn’t slept for 5 days:
can’t be diagnosed with schizophrenia because you have to have continous signs of disturbance that persist for at least 6 months
the characteristic symptoms of schizophrenia (must have 2 or more) include:
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized or catatonic behavior
Negative symptoms (flat affect, apathy, alogia, or avolition)
before you can diagnose someone with schizophrenia, you must first:
rule out schizoaffective and mod disorders, as well as substance abuse and general medical conditions
delusions refers to:
if the person coughs and thinks they have lung cancer, the doctor does tests, and shows that they don’t, they’ll still believe they do and that the md is lying to them
types of delusions:
Erotomanic: delusions resolve around love
Grandiose: inflated self-worth
Jealous: delusions of unfaithfulness
Somatic: physical delusions
Percusatory: delusions of being persecuted
Mixed: more than 1 delusion
people with schizophrenia are often unable to hold down a job bc:
Erotomanic: delusions resolve around love
Grandiose: inflated self-worth
Jealous: delusions of unfaithfulness
Somatic: physical delusions
Percusatory: delusions of being persecuted
Mixed: more than 1 delusion
positive vs negative symptoms:
positive is something more than what we need (hearing stuff, seeing stuff, thinking more than we should), negative is lacking what we need to have (lacking affect, emotion, etc)
negative symptoms of schizophrenia:
Anhedonia-asociality
Recreation, sex, intimacy, friendship
Attention
Social inattentiveness
Affective Flattening
Facial expression, eye contact, vocal inflection, inappropriate affect
Alogia
Poverty of speech/content of speech, blocking
Avolition-Apathy
Poor self care, loss of persistence in school/work
how do you measure schizophrenia?
Brief Psychiatric Rating Scale (BPRS) 18-24 symptoms
Scale for Assessment of Positive Symptoms (SAPS)
4 domains: auditory hallucinations, delusions, bizarre behaviors, formal thought disorder
0 (absent) to 5 (severe)
Scale for Assessment of Negative Symptoms (SANS)
5 domains: flat affect, alogia, avolition-apathy, anhedonia, inattention
Clinician rated from 0 (absent) to 5 (severe)
Positive And Negative Symptoms of Schizophrenia (PANSS)
45 minute clinician interview
30 different symptoms rated from 1-7
before you diagnose someone with psychosis:
you have to rule out other medical causes (i.e. huntingtons, parkinsons, vit B, etc)
how do we thinschizophrenia work?
The DA hypothesis of schizophrenia, as originally postulated, proposed that schizophrenia is due to an excess of DA activity in limbic brain areas,
the nucleus accumbens, stria terminalis,
lateral septum,
olfactory tubercle (e.g., mesolimbic dopamine hyperactivity).
This hypothesis was based on evidence that chronic administration of the stimulant d-amphetamine produced a psychosis that resembles paranoid schizophrenia.
what is the problem with dopaminergic pathway?
when the limbic system is effected, you have all the fibers criss crossing throughout the entire brain, and you cannot just cut out or burn one part without effecting the brain on all levels
starting medication early is VERY important bc:
it is shown that schizophrenia patients have a loss of brain tissue mass, and if they take medication early they can prevent loss of brain matter
diagnosing schizophrenia;
there is not 1 test, it must be tested in multiple ways, the entire brain, to diagnose someone with schizophrenia
TEST: physically, one of the main things we can see in regards to the brain deteriorating is:
ventriculomegaly;
the enlargement of the 3rd and 4th ventricles and decrease of the cortical regions, and we definitely have a 5-10% loss in brain mass the same way they postulated 150 years ago
etiology of schizophrenia:
The stress–diathesis model posits that a biological predisposition toward developing schizophrenia is inherited genetically, and that this vulnerability interacts with environmental challenges.
TEST brief psychotic disorder:
we will have delusions, hallucinations, and disorganized speech and behavior, and symptoms will only have been present for at least 1 day and less than 1 month with full return to baseline; characterised by delusions or hallucinations for a short period of time usually after exposure to some external stressor
TEST: if boy shows up naked with aluminum foil hat on and says his roomate is trying to poison him, and aliens are coming for him, and says he has been like this for 2 weeks, he will be diagnosed with:
brief psychotic disorder
TEST: if boy shows up naked with aluminum foil hat on and says his roomate is trying to poison him, and aliens are coming for him, and says he has been like this for 6 weeks, he will be diagnosed with:
schizophreniform: Present for at least 1 month but less than 6 months