Schizophrenia Flashcards
clinical psychosis components
- Disordered Thought Form
- Disordered Thought Content
- Hallucinations (stimulus ≠ perception)
- Bizarre behavior
- Other: time, “boundaries,” etc.
^all areas in which “reality” can slip away
Mood Disorders
- Bipolar d/o
- Major Depression with psychosis
Personality Disorders
Borderline
Schizotypal
Paranoid
Schizoid
sudden psychosis - what to consider?
Consider medical or toxic conditions
- not exclusively during delirium
OVERALL: psychosis often is not due to mental illness
Schizophrenia diagnostic criteria
1) Two or more for a month (Psychotic Sx)... Delusions Hallucinations Disordered Speech Disorganized or Catatonic Behavior Negative Symptoms
2) Social / Occupational Dysfunction
3) 6 Months (Time)
4) Not Schizoaffective or Mood d/o
5) Not substance related, not medical
6) Not Pervasive Development d/o
OVERALL: psychosis+loss of function+time
Schizophrenia is
chronic, degenerative, psychosis
Schizophrenia subtypes
Catatonic Disorganized Paranoid Undifferentiated Residual
OVERALL: HETEROGENEITY, little clinical utility and not in DSM-5
Schizophreniform d/o
Schizophrenia-like psychosis (criteria A)
Not enough time
Provisional; not a valid construct
Prevents over-dx of Schizophrenia
OVERAL: schizophrenia-like, maybe not chronic or degenerative
Schizoaffective d/o
Schizo/Mood psychosis w/ Schizophrenia criteria A
Psychotic when not moody
Loss of function (not criteria)
Time (not criteria)
OVERALL: chronic, degenerative moody psychosis
Delusional d/o
do NOT meet criteria A for schizophrenia
Delusional
Preserved functioning
Unknown cause
Rare
OVERALL: thought content psychosis only
Brief Psychotic d/o
Psychosis under stress (schizophrenia criteria A)
Brief
Self-resolving
OVERALL: Possible universal toxicity of stress
Other Schizophrenia / Psychotic Spectrum Disorders
- Persistent Auditory Hallucinations
- Delusions with overlapping mood episodes
- Attenuated psychosis syndrome
- Delusion in context of relationship w/ delusional person(once called “Folie á deux”)
VAGUE, NOT USEFUL
Positive vs. negative psychotic sx
All psychotic disorders include “positive” symptoms
“Negative” symptoms are a core feature of schizophrenia and S/A d/o - these represent degeneration and functional loss.
Hallucinations
perceptions w/o stimulus
Types:
Auditory
Visual
Olfactory, gustatory, tactile
Delusions
- Fixed, false beliefs
- Untrue and “contrary” to persons education/culture
- In any psychotic d/o
Exp.:
- Paranoid / persecutory
- Nihilistic
- Ideas of reference
- Thought delusions: Broadcasting, insertion or made thoughts, thought withdrawal
- Made feelings
- Delusions of Control
- Jealous
- Guilty
- Grandiose
- Sexual
- Religious
- Somatic (think body is rotting)
We measure quality of formal thought by
studying person’s SPEECH
Formal thought disorder types
- Speech poverty/content poverty (alogia - negative symptom)
- Perseveration (repeat similar phrase over and over)
- Distractibility
- Blocking
- Echolalia, clang/bang, neologisms (made up words)
- Tangentiality
- Circumstantiality
- Loose Associations / derailment
- Incoherence / illogical
Psychotic behavior
goal directed
odd
out of context
- Catatonia, echolalia, echopraxia
- Pacing, rocking, talking to self
- Wearing heavy coat in summer
- Collecting excrement
- Mannerisms
Catatonia requires 3 or more …
- Stupor (no psychomotor activity)
- Catalepsy (passive, inactive posture)
- Waxy Flexibility (Gumby effect)
- Mutism (little or no verbal response)
- Negativism (opposition to instructions/ stimuli)
- Stereotypy (repetitive, purposeless)
- Posturing, Mannerisms,
- Grimacing
- Echolalia, Echopraxia, Mitgehen
- Agitation
catatonia is a SPECIFIER for various psychotic and medical disorders
Negative Symptoms
Affective flattening or blunting Apathy Avolition (apathy) Alogia (poverty of speech) Anhedonia Asociality Attention Poor Self-monitoring
Schizophrenia Epidemiology
Prevalence: 1%
Lifetime incidence: 1-2%
2+ million people in US
25-50% attempt suicide, 10% complete suicide
personal/social burden, economic motive to find drugs
Schizophrenia course/prognosis
onset
course (prodromal/active/residual)
prognosis (variable)
*longitudinal features (neurodegenerative)
Schizophrenia heritability genetics
One affected parent: 4-9% schizophrenia risk
Two affected parents: 40-50% risk
One affected sibling: 15% in other sibs
Fraternal Twins: 28% concordant
Identical Twins: 60% concordant
Schizophrenia is __% heritable
70-85% heritable
